Authors: Nelson CL, McLaren SG, DeClerk R.
Title: The Effect of Monitoring on Recommended Hand Scrub Practices
Addresses: University of Arkansas for Medical Sciences, Little Rock, AR
Purpose: Although pre-operative hand scrubbing is a mandatory procedure in operating rooms, there is not currently a standard for scrub time that is universal among hospital facilities. Studies suggest that scrubbing for at least 2 minutes with a proven antiseptic is as effective as a ten-minute scrub in reducing bacterial counts. The optimum duration of scrubbing, however, has not been determined. There are no data that show a significant relationship between the duration of hand scrub and postoperative surgical site infections. Previously, 84 scrub times for 28 individuals were discreetly monitored in a study approved by the Institutional Review Board. Each subject was assigned a code number for the purpose of monitoring the data anonymously. All individuals scrubbed for a mean time of 2.24 minutes with a range from 0.1 minute to 4.5 minutes. Sixty-nine percent scrubbed greater than two minutes and thirty-one percent scrubbed less than two minutes; all were less than the 5-minute institutional policy.
Methods: The hypothesis of this study was that by informing OR personnel that scrub times would be monitored, providing clocks, and with knowledge of institutional guidelines, compliance would be improved. All operating personnel were informed that scrub time would be monitored and discreetly recorded without their knowledge. The institutional guidelines were provided. Clocks were provided at the scrub area.
Results: One hundred and six hand scrub times were recorded from a total of 18 individuals. The average length of scrub time was 3.12 minutes. 18/106 (17%) were less than 2 minutes; 85/106 (80%) were 2-5 minutes; and 3/106 (3%) were 5 minutes or greater.
Discussion: Informing OR personnel that scrub times would be recorded, providing policy guidelines, and providing clocks improved compliance.
Significance: If one believes that hand scrub standards should be followed, monitoring is effective in modifying behavior.