Mainil, Jacques[Université de Liège - ULg > Département des maladies infectieuses et parasitaires > Bactériologie et pathologie des maladies bactériennes >]
Serteyn, Didier[Université de Liège - ULg > Département clinique des animaux de compagnie et des équidés > Anesthésiologie gén. et pathologie chirurg. des grds animaux >]
Grulke, Sigrid[Université de Liège - ULg > Département clinique des animaux de compagnie et des équidés > Département clinique des animaux de compagnie et des équidés >]
19th Annual Scientific Meeting of the ECVS
1-07-2010 to 3-07-2010
European College of Veterinary Surgeons
[en] handasepsis ; veterinary ; surgery
[en] Introduction: Despite the fact that presurgical antiseptic hand treatment of surgical staff has since become a worldwide accepted procedure, surgical site infection is still one of the most frequent types of nosocomial infections. Many products have been used for hand antisepsis, but the popularity of alcoholic rubs amongst human surgeons is increasing as they have shown to provide a rapid and immediate action, are considerably faster than disinfecting soap scrubs and cause less skin damage after repeated use. The purpose of this study was 1) to identify surgical hand antisepsis habits amongst veterinary surgery specialists in Europe (ECVS) and the United States (ACVS), 2) to compare povidone iodine and chlorhexidine gluconate scrubs with a hydro-alcoholic rub hand antisepsis protocol and 3) to evaluate the usefulness of a hydro-alcoholic rub solution in a veterinary surgical setting. Materials and Methods: Emails were sent to 1300 Diplomates to invite them to participate to an online survey in order to obtain an idea about pre-surgical hand disinfection techniques. In a preliminary trial the efficiency of 4% chlorhexidine gluconate, 7.5 % PVP-iodine and an alcoholic solution containing 45% 2-propanol, 30% 1-propanol, 0.2% mecetronium ethylsulphate (Sterillium®) in bacterial reduction on hands was compared. In a clinical trial, the suitability of Sterillium® was assessed in an equine and small animal set up during surgery procedures. Fingertips were pressed on blood agar plates and Gassner plates prior to hand antisepsis (PHA), after handantisepsis (AHA) and three hours after wearing sterile gloves (AG) in the preliminary trial or at the end of surgery (AS) in the clinical trial. Bacterial counts (colony forming units : CFU’s) were obtained after 24 h of incubation of the plates. The obtained values of CFU from PHA, AHA, AG and AS were expressed as log10 values. For each sample, a reduction factor (RF) was obtained from the difference of log10 pre-value and log10 post-value. An ANOVA comparison between the effects of the different antisepsis protocols on the mean log10 CFU values and RF’s in function of the different steps was established. Results: A 42.6% response rate was obtained for the survey. Most surgeons’ still use a disinfecting soap only (79.9%) for hand antisepsis prior to surgery, the majority based on chlorhexidine gluconate (81.4%). Significant differences were found between immediate and sustained activities of the different products tested. Sterillium® was shown to have significantly lower LSM log10 CFU at AG compared to both other products. At AHA, povidone iodine revealed to have significantly higher LSM log10 CFU than Sterillium® and chlorhexidine gluconate, with the last two products having comparable activities. Reduction factors for the Sterillium® were significantly greater than for the other products. Only RF1 was comparable between Sterillium® and chlorhexidine gluconate. In the clinical trial, no significant differences were found between surgeons regarding LSM log10 CFU after hand antisepsis, neither between RF from samples taken at the small animal versus the equine surgery theatre. Discussion: This study confirms that Sterillium® is more effective in reducing bacterial counts on hands prior to surgery in a veterinary setting as are chlorhexidine gluconate (CHX) and povidone iodine soap. Moreover, they provide better tolerance and compliance to surgical hygiene protocols. Despite this, veterinary surgeons from all over the world still prefer the use of CHX soap, which has far more disadvantages than commonly accepted. Apart from the better skin tolerance and the absence of known resitance to the product, the use of Sterillium® offers the advantage of a fast (1.5 minute) surgical handantisepsis. This study shows that, as previously reported for human medicine, Sterillium® can safely be used in a veterinary surgical setting.