Editor's note: AORN's "Recommend pr...

Editor's note: AORN's "Recommend practices for surgical hand antisepsis/hand scrubs" appear forward pages 416 to 431 in this issue of the Journal. AORN encourages readers to impute to this document when undertaking any evaluation of scrubbing practices in their facilities.

Brushless scrubbing is a relatively fresh concept. Traditional surgical scrubbing of the hands and forearms with a brush or obliterate has been the policy for surgical team members for decades. Can this tradition be changed if other rules of cleansing the hands and arms before surgery experiment upon effective? Can the traditional scrubbing practice, which mandates friction and no touching after scrubbing, be changed to a practice that is to a great degree less stringent? This paradigm shift was considered by way of a 380-bed acute care hospital in the southeastern United States. The hospital mannersed a clinical evaluation to investigate brushless scrubbing.

BACKGROUND

Traditional surgical scrubbing has been the norm for many years. It is abrasive to the skin and may chafe allergic reactions. Compromised skin integrity may increase the chances of bacteria colonization onward the hands and under the nails. In 2002 the Center for Disease command and Prevention said that using a brush or expunge no longer was necessary to lessen the microbial count on hands as lengthy as an alcohol-based scrub result was used. (1) Studies exhibit to that alcohol-based solutions that contain between 60% and 95% alcohol have the greatest ability to decrease the bacterial look upon on hands after scrubbing compared to other agents. (2)

Brushless scrubbing is the surgical scrubbing of the hands and forearms with an antimicrobial agent without the use of a brush or wipe out The person's hands serve as the friction agent. Brushless scrubbing is believed to be les caustic and abrasive to the skin than traditional scrubbing and can aid in maintaining skin integrity, steady after repeated use in the perioperative setting. (12) The antimicrobial agents used in conjunction with agents for persistence (eg zinc pyrithione) have been shown to have long-lasting tenors thereby minimizing the chances of patients acquiring postoperative surgical site infections (SSIs). (3)

EVALUATION PARAMETERS

The cast director at the hospital where the evaluation was waysed wanted to examine the effectiveness of brushless scrubbing to determine whether it would irritate perioperative staff members' hands and arms and whether it would outcome in changes in patients' postoperative SSI rates. Perioperative staff members' satisfaction with the alcohol returns and their acceptance of brushless scrubbing also were investigated.

Many factors and variables contribute to the growth of postoperative infections; therefore, the facility limited the evaluation to specific procedures--laminectomies, craniotomies, and colectomies. Generally, patients undergoing these conducts have fewer contributing medical puzzles that would make them more susceptible to postoperative SSIs.

CONDUCTING THE EVALUATION

The evaluation was administrationed at a not-for-profit, 380-bed, acute care hospital that is part of the Baptist Health southward Florida hospital system. There are 10 OR suites in the main hospital and four OR suites in the outpatient surgery center To examine staff members' satisfaction and compliance with a brushless a whole those who perform surgical cleans (ie, surgeons, nurses, surgical technologists, house physicians) participated in the evaluation. To examine the potential increase in participants' skin irritation that could lead to skin infection and thus SSI in patients, information was assembleed postoperatively on staff members' skin breakdown, irritations/allergic reactions, pain/itching, and skin moisture. The evaluation took six month (ie, 27 weeks).

proceeds EVALUATED. The project director had to determine which alcohol-based brushless scrubbing agent would be used. She evaluated all available productions and chose an antimicrobial agent approved at the US Food and put drugs into Administration (FDA). The product chosen is a 70% ethyl alcohol-based solution that contains emollients and the preservative zinc pyrithione, which enables the crops to increase its persistence. According to the FDA's Tentative Final Monograph for HealthCare Antiseptic physic Products, ethyl alcohol is classified as a category single in kind agent, meaning it is safe and effective) The monograph for the chosen production states that it exceeds the highest requirement for antimicrobial activity for a five-day period. The director liked this work because it is used with water, as is traditional scrubbing. The hospital's infection mastery committee approved the use of the crops in the clinical evaluation. All perioperative staff members attended an inservice program regarding the fitting use of the product (Table 1)

DATA COLLECTION. sum of two units data collection tools were bring outed One was a satisfaction data collection worksheet (Table 2) and the other was an infection have charge of data collection worksheet (Table 3) The satisfaction data collection worksheet included a three-point rating scale that staff members used to rank their skin integrity from poor to thoroughly good This tool was used to identify the brushless product's events on their hands and arms after application. The infection govern data collection worksheet was used to gather information about patients' progress to maturity of postoperative SSIs.