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Antiseptic efficacies of waterless hand rub, chlorhexidine scrub, and povidone-iodine scrub in surgical settings: a meta-analysis of randomized controlled trials

  • Author Footnotes
    1 Authors contributed equally to this work.
    Y-H. Ho
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Author Footnotes
    1 Authors contributed equally to this work.
    Y-C. Wang
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • E-W. Loh
    Affiliations
    Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • K-W. Tam
    Correspondence
    Corresponding author. Address: Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. Tel.: +886 2 22490088x8860; fax: 886 2 22490088x2507.
    Affiliations
    Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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  • Author Footnotes
    1 Authors contributed equally to this work.
Published:November 27, 2018DOI:https://doi.org/10.1016/j.jhin.2018.11.012

      Summary

      Background

      Presurgical hand washing is crucial for preventing surgical site infections (SSIs). Chlorhexidine gluconate (CHG) and povidone-iodine (PI) products have been conventionally used as hand scrubs for presurgical hand preparation. However, waterless hand rub (WHR) products have been developed for operating room staff.

      Aim

      The aim of this study was to conduct a systematic review and meta-analysis to compare the antiseptic efficacies of WHR, CHG, and PI in surgical settings.

      Methods

      PubMed, Embase, and Cochrane Library databases as well as the ClinicalTrials.gov registry were searched for studies published before October 2018. Randomized controlled trials (RCTs) comparing the clinical outcomes of the use of WHRs, CHG, or PI for presurgical hand washing were included. A random effects model was used for meta-analysis. Colony-forming unit (cfu) counts, SSI rates, and preference and compliance were determined to measure efficacies.

      Findings

      Eleven RCTs involving 5135 participants were included. Residual cfu counts were significantly lower in the WHR and CHG groups than in the PI group. The differences in cfu counts between the WHR and CHG groups were non-significant. No significant differences were observed in the SSI rates between the WHR and traditional hand scrub groups. Moreover, WHRs were considered most favourable and were associated with higher compliance rates than the other products.

      Conclusion

      WHRs and CHG exhibited higher antiseptic efficacies than PI. However, additional studies with consistent outcome measurements and accurate grouping are required to obtain comprehensive results. Moreover, preference, compliance, and the cost determine the selection of hand wash products.

      Keywords

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