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    Surgical Hand Scrub Protocol Updates

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    Rex Lagunzad Flores
    This document summarizes updates to surgical hand scrub protocols and guidelines. It reviews recommendations from the AORN and CDC to use shorter scrub times of 3-5 minutes, which are as effective as longer scrubs. The new Vanderbilt protocol allows using either a 3-minute water-based scrub or an alcohol-based hand rub. It outlines the steps for each method and references supporting guidelines regarding eliminating brush use and emphasizing skin integrity.

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    Surgical Hand Scrub Protocol Updates

    Uploaded by

    Rex Lagunzad Flores
    400 views22 pages
    This document summarizes updates to surgical hand scrub protocols and guidelines. It reviews recommendations from the AORN and CDC to use shorter scrub times of 3-5 minutes, which are as effective as longer scrubs. The new Vanderbilt protocol allows using either a 3-minute water-based scrub or an alcohol-based hand rub. It outlines the steps for each method and references supporting guidelines regarding eliminating brush use and emphasizing skin integrity.

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    operating technique guide

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    This document summarizes updates to surgical hand scrub protocols and guidelines. It reviews recommendations from the AORN and CDC to use shorter scrub times of 3-5 minutes, which are as effective as longer scrubs. The new Vanderbilt protocol allows using either a 3-minute water-based scrub or an alcohol-based hand rub. It outlines the steps for each method and references supporting guidelines regarding eliminating brush use and emphasizing skin integrity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    400 views22 pages

    Surgical Hand Scrub Protocol Updates

    Uploaded by

    Rex Lagunzad Flores
    This document summarizes updates to surgical hand scrub protocols and guidelines. It reviews recommendations from the AORN and CDC to use shorter scrub times of 3-5 minutes, which are as effective as longer scrubs. The new Vanderbilt protocol allows using either a 3-minute water-based scrub or an alcohol-based hand rub. It outlines the steps for each method and references supporting guidelines regarding eliminating brush use and emphasizing skin integrity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 22

    Surgical Hand Scrub Updates

    Surgical Hand Scrub


    Updates

    February 2009

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    Objectives
    Review facts on Pathogens
    Review AORN and CDC guidelines for
    hand scrubs
    Review updates in Vanderbilt protocol for
    hand scrubs
    Review steps to Water-based hand scrub
    application
    Review steps to Avagard application
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    Facts on Pathogens
    The contribution of the surgical scrub is critical in
    reducing the incidence of operative wound
    infections.
    It is known that the individual person is the
    primary source of nosocomial bacteria in the
    operative setting.
    Handwashing results in a significant reduction in
    pathogen carriage[i].
    [i] Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med
    1975;83:683-90.

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    Products
    Ideally the surgical hand scrub product
    should have the following properties
    Broad spectrum of action
    Fast acting
    Persistent
    Non-irritating to the skin

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    Categories of antiseptics for scrubs


    Alcohols
    Alcohols are effective against most gram positive and negative
    bacteria, as well as most fungi and viruses.[i]
    [i] Larsen EL, Morton HE. Alcohols. In: Block SS, ed. Disinfection, sterilization and preservation. 4th ed.
    Philadelphia: Lea and Febiger, 1991; 191-203.

    Cholorhexidine Gluconate (CHG)


    CHG is more effective against gram-positive than gram-negative
    bacteria and also provides action against enveloped viruses [i],[ii].
    CHG is not as effective as other agents at immediately reducing
    bacterial counts, but its action is more persistent than others, lasting
    at least 6 hours.
    Denton GW. Chlorhexidine. In: SS Block. Disinfection, sterilization, and preservation. 4 th ed. Philadelphia: Lea
    and Febiger, 1991:274-89.
    [ii]
    Bernstein D, Schiff G, Echler G et al. In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate
    mouthrinse. J Dent Res 1990;69:874-6.
    [i]

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    Categories of antiseptics for scrubs


    Iodophors
    Exhibit a rapid onset of antimicrobial activity, due to the action of
    free iodine.
    They are effective against a broad range of microbes including
    gram-positive and negative bacteria, some bacterial spores, fungi
    and viruses[i].
    They have a limited duration of action due to neutralizing properties
    of organic matter[ii], and are also commonly associated with skin
    irritation and damage.

    [i] Gottardi W. Iodine and iodine compounds. In: Block SS, ed. Disinfection, sterilization and preservation. 4th ed. Philadelphia: Lea and Febiger, 1991:152-66.
    [ii] Zamora JL, Price MF, Chuang P, Gentry LO. Inhibition of povidone-iodine's bactericidal activity by common organic substances: an experimental study. Surgery. 1985
    Jul;98(1):25-9.

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    Current Products
    Cardinal Health Scrub Care
    (Chlorhexidine Gluconate Solution, 4%) brush &
    sponge
    (15% Povidone-Iodine) brush & sponge.

    3M
    Avagard Waterless Hand Antiseptic (Chlorhexidine
    Gluconate 1% Solution and Ethyl Alcohol 61%)

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    PREVIOUS PROTOCOL
    FOR SURGICAL HAND SCRUB at VANDERBILT

    Surgical Hand Scrub:


    30 second pre-wash before all scrubs.
    First scrub of the day:
    10 minutes for Ortho
    5 minutes all others
    Subsequent scrubs:
    5 minutes Ortho
    3 minutes all others
    Avagard use:
    Had to be preceded by a traditional first scrub of the day
    and a pre-wash in between cases.
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    AORN and CDC


    Recommendations
    AORN recommends for facilities to standardize scrub
    times and has presented studies to show that scrub
    times of three to four minutes are as effective as fiveminutes scrubs.[1]
    The CDC has stated that former traditional 10 minute
    scrubs are not necessary and frequently leads to skin
    damage, and sites studies that scrubbing for 2 or 3
    minutes reduced bacterial counts to acceptable levels.[2]
    [1] AORN, Perioperative Standards and Recommended Practices, 2008
    Edition, Denver: AORN Publications, 401.
    [2] Center for Disease Control Hand Hygiene Guidelines,
    http://www.ced.gov/handhygiene/ (Retrieved on 10/16/08).

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    New Protocol
    Choose one of these hand scrub methods and apply
    following new guidelines:
    Water Based Hand Scrub
    Three Minute Scrub
    Either-Or

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    Alcohol Based (Avagard)


    Apply to clean, dry hands
    and nails. For the first use
    of each day, wash hands
    and clean under nails with
    a nail stick. Note:
    Whenever debris is present,
    wash & dry hands before
    application.
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    AORN- Surgical Scrub Brush


    AORN outlines that the use of a brush for surgical
    hand scrubs is not necessary and scrubbing with a
    brush is associated with an increase in skin cell
    shedding.[1]
    AORN published an article that states that brushless
    scrubbing is believed to be less caustic and abrasive
    to the skin than traditional scrubbing and can aid in
    maintaining skin integrity, even after repeated use in the
    preoperative setting.[2]
    [1] AORN, Perioperative Standards, 402.
    [2] Berman, Mara One Hospitals Clinical Evaluation of Brushless Scrubbing. AORN
    Journal, (Volume 79, No. 2), 2004 retrieved at www.nursingconsult.com on 11/4/08.
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    CDC- Surgical Scrub Brush


    The CDC states that use of a brush results in
    increased shedding of bacteria from the
    hands.[1]
    Neither a brush nor a sponge is necessary to
    reduce bacterial counts on the hands of
    surgical personnel to acceptable levels,
    especially when alcohol-based products are
    used.[2]
    [1] CDC, Hand Hygiene Guidelines http://www.ced.gov/handhygiene/
    [2] Ibid.
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    Step One: Water based hand scrub

    Step One
    Wet hands and arms up to the elbows.
    Use nail pick to clean nails under
    running water.
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    Step Two: Water based hand scrub

    Wet sponge and squeeze to work up lather.


    Wash each finger, hand, and arm to two inches above
    the elbows using the non abrasive sponge for a total
    scrub time of three minutes.
    Note: Use brush side only on nails and cuticles or
    on areas of visible soil.
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    Step Three: Water based hand


    scrub

    Rinse hands and arms from finger tips to


    elbows. Dry hands and arms with a sterile
    towel.
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    Avagard: Pump 1
    Dispense one pump (2ml) into
    the palm of one hand. Dip
    fingertips of the opposite hand
    into the hand prep and work
    under fingernails. Spread
    remaining hand prep from wrist
    to 2 above the elbow.

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    Avagard: Pump 2
    Dispense one
    pump (2ml) and
    repeat procedure
    with opposite
    hand/arm.

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    Avagard: Pump 3
    Dispense final pump
    (2ml) of hand prep into
    either hand and
    reapply to all aspects
    of both hands up to the
    wrists. Allow to dryDo not use towels!

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    Reference sheets for scrub sinks

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    Summary of Hand Scrub Updates


    Choice of Water based hand scrub or
    Avagard
    Water based:
    3 minute scrub time
    Use brush only on nails and cuticles- or
    visible soil

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    Summary of Updates, continued:


    Avagard:
    Wash hands and pick nails before first
    application.
    Wash and dry hands if soiled before any
    subsequent applications.
    Apply product following manufacturers
    recommendations.

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    Instructions for Completing the


    Training
    1. Close this window and you should see
    My Personal Page in WebInservice.
    2. Click on the word TEST that is to the
    right of the completed lesson name.
    3. Then click on

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