A RANDOMIZED TRIAL OF SURGICAL SCRUBBING WITH A BRUSH COMPARED TO ANTISEPTIC SOAP ALONE

Background: The difference between use of a scrub brush versus soap al one in reducing hand bacterial counts has never been established by a prospective, comparative study. Methods: Fifteen volunteers were taugh t the 5-minute surgical scrub; Baseline specimens were obtained by the glove fluid sampling procedure. Subjects were randomized to (1) scrub with an inert scrub brush and 4% chlorhexidine soap with isopropyl al cohol or (2) wash with 4% chlorhexidine soap with isopropyl alcohol al one. Specimens were obtained immediately after the scrub was completed and 45 minutes later. The experiment was repeated by use of a cross-o ver design after a 1-week washout period. The data were analyzed by th ree methods that took into account the broad range of baseline hand co unts (5 x 10(1) to 11.2 X 10(4)): method 1, the discordance between pr esence/absence of hand bacterial counts within individuals at 45 minut es for soap versus soap and brush; method 2, the absolute reduction of bacteria (baseline vs 45 min.) for soap versus soap and brush; and me thod 3, the proportional change in bacterial counts at 45 minutes from baseline for soap versus soap and brush. Results: Although there was no statistically significant difference for any method, the point esti mates for the odds ratio (OR) showed that up to twice the number of su bjects had a greater reduction in bacterial counts when they washed wi th soap than when they scrubbed with a brush, as evidenced by the foll owing data: method 1, OR 2.3 (95% confidence interval [CI] 0.53, 13.99 ) for soap alone; method 2, OR 1.0 (CI 0.23, 4.35); and method 3, OR 2 .0 (CI 0.54, 9.10) for soap alone. Conclusions: The effect of use of s oap alone in reducing hand bacterial counts at 45 minutes was similar to use of soap and brush. Soap can be used alone and the surgical infe ction rate prospectively monitored.