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Authors: Sidney G. Jones, Montri D. Wongworawat

Title: Influence of Hand Jewelry on Hand Sanitization Procedures and Residual Bacterial Contamination

Addresses: Department of Orthopaedic Surgery, Loma Linda University 11406 Loma Linda Drive, Suite 218, Loma Linda, CA 92354

Purpose: Previous studies have demonstrated the increased number of residual bacteria on the hand after hand sanitization in the presence of hand jewelry. In light of the new "scrubless" techniques, we re-examine the impact of wearing rings during the scrub process.

Methods: Sixty subjects were used for the study, made up of healthy perioperative staff volunteers. Paired hands were used in each subject, and one ring finger was randomly assigned for ring wear. Sanitization by one of three methods was randomly assigned: (1) Betadine, (2) water-aided alcohol wash (Triseptin), and (3) waterless alcohol chlorhexidine lotion (Avagard); n = 20 pairs for each group. The participants were gloved in a sterile fashion, and 30 cc of nutrient broth were added to the gloves. After culture for 24 hours on blood agar plates, colony counts were obtained. Comparisons between ring vs. no ring wear within each decontamination method were performed using the Wilcoxon Signed-Rank Test, and comparisons between the three methods were performed using Kruskal-Wallis ANOVA, with significance determined at p < 0.05.

Results: When using Betadine, ring wear resulted in a significantly elevated bacterial count. However, for both scrubless preparations (water-aided and waterless), ring wear did not result in any significant differences. When comparing between the three decontamination methods, the waterless preparation resulted in the smallest number of residual contamination.

Scrub Method Without Ring With Ring p
Betadine 16.4 ± 28.5 CFU 21.6 ± 37.4 CFU 0.0496
Water-aided 3.1 ± 5.5 CFU 5.1 ± 9.1 CFU 0.3054
Waterless* 0.1 ± 0.4 CFU 0.0 ± 0.0 CFU 0.8413
* Significantly superior to other methods when considered without ring
(p = 0.0076) and with ring (p = 0.0086).
CFU = Colony Forming Units

Discussion: Recent evidence has proven the efficacy of scrubless alcohol preparations that rely on exposure and contact. Scrub-based preparations seem to require removal of jewelry and mechanical action to remove bacteria (from under the ring), while scrubless formulae are shown to be efficacious through mere contact. Furthermore, the waterless preparation is superior, possibly because it does not rely on scrub action, and its effect is not diluted as in the water-aided technique.

Significance: The waterless surgical decontamination preparation yields the lowest residual bacterial count, and its efficacy is not reduced by the presence of hand jewelry.

Musculoskeletal Infecton Society
Musculoskeletal Infecton Society