FAR EASTERN UNIVERSITY INSTITUTE OF NURSING Nicanor Reyes St.

Sampaloc, Manila

EVIDENCE-BASED NURSING
[hand rubbing with an aqueous alcohol solution as effective as hand scrubbing with antiseptic soap?]

Submitted by: THALLA, MARK LESTER O. Group 60B BSN215

Submitted to: Zenia Lim Clinical Instructor

January 2012

EVIDENCE-BASED NURSING BSN215 GROUP 60

I. CLINICAL QUESTION:

Does hand rubbing with an aqueous alcohol solution as effective as hand scrubbing with antiseptic soap? II. CITATION: Handrubbing with an aqueous alcohol solution was as effective as handscrubbing with antiseptic soap for preventing surgical site infections Parienti JJ, Thibon P, Heller R, et al.Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA 2002;288:722 7. III. STUDY CHARACTERISTICS a. Patients Included (population and sample) 4823 consecutive patients having surgery. Patients who had contaminated or dirty procedures and those having a second surgery < 15 days after a first surgery were excluded. 4387 patients (91%) were included in the as-treated analysis (mean age 50 years old). b. Intervention Compared  The main intervention compared were the (1) Hand rubbing using an aqueous solution (2) Hand scrubbing with an antiseptic soap in preventing surgical site infection. a. Outcome monitor  In the study, the principle outcome monitored is the nosocomial surgical site infections in patients.

.IV. METHODOLOGY/ DESIGNS a. Methodology  In this study there were 3 surgical services were allocated to begin with the handrubbing protocol (75% AAS containing propanol-1, propanol-2, and mecetronium etilsulfate [Strillium, Rivadis Laboratories, Thouard, France]), and 3 were allocated to begin with the handscrubbing protocol (4% povidone iodine [Betadine, Asta Medica, Merignac, France] or 4% chlorhexidine gluconate [Hibiscrub, AstraZeneca, Rueil-Malmaison, France]). At the end of 1 month, each service switched to the alternative antiseptic product. Services alternated protocols monthly for 16 months. Standard surgical scrubbing was done according to Centers for Disease Control Guidelines ( 5 min systematic hand scrubbing with a sterile sponge and brush). Surgical personnel in the hand rubbing group were instructed to do a 1 minute hand wash (including subungual space cleaning with a brush) with non-antiseptic soap before the first procedure of the day, or if the hands were visibly b. Design  Cluster randomized (unclear allocation concealment), unblinded, crossover controlled equivalence trial with follow up at 30 days. c. Setting  The setting was in 6 surgical services in France d. Data Sources  Parienti JJ, Thibon P, Heller R, et al.Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA 2002;288:722 7 e. Does the original study been replicated?  No, the study had not been replicated yet but several studies related to this have been published. Studies that talks about handrubbing alcohol based solution has been tested and studied. f. What was the risk/benefit of the nursing action/ interventions tested in the study?  There are no risks related to the intervention occurred.  The benefits are, this is cost wise, easily done, hand rubbing with aqueous alcohol solution will not much time, and will not dry your skin.

V. RESULT OF THE STUDY 99 in-hospital and 9 post-discharge SSIs were identified (global SSI rate at 30 d 2.46%, 95% CI 1.81 to 3.11). Patients in the handrubbing and handscrubbing groups did not differ for SSIs at 30 days (table). Surgical personnel in the handrubbing group spent more time on hand antisepsis in the first procedure of the day than personnel in the handscrubbing group (mean 313 v 287 s, p=0.01). VI. AUTHOR S CONCLUSION Routine surgical practice using a protocol of hand rubbing with an aqueous alcohol solution was as effective as a protocol of hand scrubbing with antiseptic soap for preventing surgical site infections at 30 days. VII. APPLICABILITY a. Does the study provide a direct enough answer to clinical question in terms of type of patients, intervention and outcome?  This study was able to answer the clinical question and provided enough information concerning the clinical question. b. Is it feasible to carry out the nursing action in the real world? The use of hand rubbing aqueous alcohol solution can be applied especially in the operating room, surgical procedures. This could lessen the time and effort of the surgeon, nurses VIII. REVIEWER S CONCLUSIONS AND RECOMMENDATIONS The study by Parienti et al did focus on a meaningful patient ,but examined the use of an alcohol based hand rub as a surgical scrub in a different context. Teaching and non-teaching hospitals were involved, and various surgical procedures were included. The main concern in interpreting this study s findings is that the study centres (cluster) were randomised, not the patients. Although randomising by cluster is legitimate, clusters may be quite different, and this can affect outcomes. For instance, teaching and non-teaching hospitals differ in the complexity of patients and the experience of members of the surgical team (many of whom may still be in training). These differences may cause differential rates of SSI among clusters, which typically inflate the numbers required in a cluster trial compared with a trial that randomises by individual patient. It is a common error, as in this study, to randomise by cluster, but to analyse by individual, and such an error leads to inaccurately smaller p values or narrower confidence intervals. Cluster

randomised trials should report baseline differences and treatment effects by cluster, allowing readers to interpret just how different clusters are. While the study by Parienti et al is an intriguing trial, whether hand rubs and handwashing are truly equivalent remains unclear. IX. EVALUATING HEALTH CARE PRACTICES A. Safety Findings from the study had provided sufficient evidence to warrant claims that the intervention is not damaging and that it can be employed as a protection for both health care providers and patients. B. Acceptability Since the result of the study shows that the use of alcohol solution is as effective as the use of antiseptic soap, it is therefore acceptable to apply the result of this study in a real setting. C. Appropriateness This study is appropriate since the use of aqueous alcohol solution has not been popularized yet, it is appropriate in a manner that the alcohol solution in hand rubbing is as effective as the use of antiseptic soap in hand scrubbing to prevent infection.