Cummings, Elizabeth I, BSN, RN

Grim, Kelly A, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingSURGICAL HAND ANTISEPSISElizabeth I. Cummings BSN, RNLehigh Valley Health Network, elizabeth_i.cummings@lvhn.orgKelly A. Grim BSN, RNLehigh Valley Health Network, kelly_a.grim@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtCummings, E., & Grim, K. (2016, July 20). SURGICAL HAND ANTISEPSIS. Poster presented at LVHN Vizient/AACN NurseResidency Program Graduation, Lehigh Valley Health Network, Allentown, PA.© 2014 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaSURGICAL HAND ANTISEPSIS• A systematic review by de Jesus Gonçalves, Graziano, and Kawagoe (2012) found that 90.5% of the studies reported that the alcohol preparations generated higher or equal microbial reductions compared to traditional scrub products. 17 studies reported higher microbial reductions through use of alcohol hand rubs verses traditional scrub products. • 4 recent studies demonstrated that alcohol-based hand rubs are significantly more effective at reducing microbial counts as traditional hand scrub practices. (reference articles: 2, 8, 9 10)• 6 research studies demonstrated that alcohol-based hand rubs are equally as effective at reducing microbial counts as traditional scrub practices. (reference articles: 1,3,4,5,7,11)LVHN’s current policy details the procedures for both methods of surgical hand antisepsis -- the traditional scrub and the rub with Avagard – but the policy doesn’t dictate which method staff must use. The decision is left to the scrubbed personnel.By determining the best current evidence based practice for surgical hand antisepsis and educating OR staff members, there is a potential for: improved staff well-being and patient outcomes, a standardized policy on surgical hand antisepsis, and reduced OR operational costs if fewer varieties of hand scrub can be purchased and consumedSurgical Scrub Method Performed by OR Staff LVH-M and LVH-CCThe use of Avagard increased from 30% to 37% 17% indicated a change in scrubbing practice following education, but 80% of those changed to a mix of Avagard and traditional scrubbingPercentage of Staff Who Believe Avagard is the More Effective Scrub:• Conduct research on the best methods of surgical hand antisepsis• Create and disseminate a pre-education survey to OR surgical nurses and surgical technicians (LVHN-M and LVHN-CC) on their hand scrubbing beliefs and practices• Creation and disseminate a TLC education module presenting best evidence for surgical hand antisepsis• Create and disseminate post-education survey to OR nurses and surgical technicians  to evaluate if changes were made to their hand scrubbing beliefs and practices• Present findings to management with recommendations based on findings• TLC education indicating that Avagard was the more effective surgical scrub did not affect significant change in practice. – 17% indicated a change in scrubbing practice following education, but 80%   of those reported using a combination of Avagard and traditional scrub. – 63% of staff still use the traditional scrub or a combination of the traditional scrub and Avagard. • The percentage of staff who indicated that they believe Avagard is the superior scrub method rose from 12% to 36% post education while the percentage of staff using only Avagard increased from 30% to 37%• Survey responses indicate that several staff performing a mix of Avagard and traditional scrub believe that they are already in line with the evidence presented, and did not change their practice. • Response rate for the post-education survey was poor. An on-line version and/or email reminders  may have helped with response rate. Further, additional education and reinforcement (i.e. handouts or fliers placed at scrub sinks) may have proven more effective than TLC alone. • The majority of staff (53%) still do not want a standard scrub policy.   On-site studies, further research, and additional staff education may    be warranted before  creation of a standard surgical scrub policy.  Elizabeth Cummings BSN, RN and Kelly Grim BSN, RNBACKGROUND/EVIDENCE IMPLEMENTATION RESULTSDISCUSSION1. Al-Naami, M. Y., Anjum, M. N., Afzal, M. F., Al-Dohayan, A. D., El-Tinai, O. F., Al-Abdullkarim, A. A., & Al-Qahtani, S. M. (2009). Alcohol based hand rub versus traditional surgical scrub and the risk of surgical site infection: a randomized controlled trial. EWMA Journal, 9(3), 59.2. Barbadoro, P., Martini, E., Savini, S., Marigliano, A., Ponzio, E., Prospero, E., & D'Errico, M. M. (2014). In vivo comparative efficacy of three surgical hand preparation agents in reducing bacterial count. Journal of Hospital Infection,86(1), 64-67.3. Chen, S. H., Chou, C. Y., Huang, J. C., Tang, Y. F., Kuo, Y. R., & Chien, L. Y. (2014). Antibacterial effects on dry‐fast and traditional water‐based surgical scrubbing methods: A two‐time points experimental study. Nursing & health sciences, 16(2), 179-185.4. Chen, C. F., Han, C. L., Kan, C. P., Chen, S. G., & Hung, P. W. (2012). Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth. American journal of infection control, 40(4), e15-e17.5. Ghorbani, A., Shahrokhi, A., Soltani, Z., Molapour, A., & Shafikhani, M. (2012). Comparison of surgical hand scrub and alcohol surgical hand rub on reducing hand microbial burden. Journal of perioperative practice, 22(2), 67-70.6. Gonçalves, K. D. J., Graziano, K. U., & Kawagoe, J. Y. (2012). A systematic review of surgical hand antisepsis utilizing an alcohol preparation compared to traditional products. Revista da Escola de Enfermagem da USP, 46(6), 1484-1493.7. Howard, J. D., Jowett, C., Faoagali, J., & McKenzie, B. (2014). New method for assessing hand disinfection shows that pre-operative alcohol/chlorhexidine rub is as effective as a traditional surgical scrub. Journal of Hospital Infection,88(2), 78-83.8. Lai, K.W., Foo, T. L., Low, W., & Naidu, G. (2012). Surgical Hand Antisepsis–A Pilot Study comparing Povidone Iodine Hand Scrub and Alcohol-based Chlorhexidine Gluconate Hand Rub. Ann Acad Med Singapore, 41, 12-16.9. Mahmoud, M. H., Asaad, A. M., & Qureshi, M. A. (2013). Hand rubbing and scrubbing in relation to microbial count among surgical team members in a Saudi Hospital. Journal of American Science, 7, 9.10. Shen, N. J., Pan, S. C., Sheng, W. H., Tien, K. L., Chen, M. L., Chang, S. C., & Chen, Y. C. (2013). Comparative antimicrobial efficacy of alcohol-based hand rub and conventional surgical scrub in a medical center. Journal of Microbiology, Immunology and Infection.11. Weight, C. J., Lee, M. C., & Palmer, J. S. (2010). Avagard hand antisepsis vs. traditional scrub in 3600 pediatric urologic procedures. Urology, 76(1), 15-17.PICO QUESTIONAmong surgical nurses and technicians, does providing education on the best practice for surgical hand antisepsis lead to a change in practice within the clinical setting? P: Surgical nurses and surgical techniciansI: Educational intervention on best surgical hand antisepsis practiceC: Compared to no education (personal practice choice in accordance with hospital policy)O:  Is there improved compliance with the best evidence based practice?Avagard Only30%Traditional Scrub Only15%Mix of Avagard & Scrub55%Pre‐Education Avagard Only37%Traditional Scrub Only13%Mix of Avagard & Scrub50%Post‐Education 12%36%0%5%10%15%20%25%30%35%40%Pre‐education Post‐education

SURGICAL HAND ANTISEPSIS

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SURGICAL HAND ANTISEPSIS

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