Effect on the reduction of bacterial load after surgical hand antisepsis with triclosan 0.5% compared to triclosan 0.5% followed by 70% alcoholic solution

Abstract

Triclosan 0.5% by scrubbing does not meet the UNE-EN12791 criteria to be used in the surgical hand preparation (SHP). Triclosan 0.5% by scrubbing followed by ethanol 70% hand rubbing is suitable without the additional characteristic of sustained effect. This limited effectiveness implies that triclosan should be avoided in SHP given the restrictions on its use in consumer antiseptic products. The trial was registered at ClinicalTrials.gov (ID: NCT04538365).

Alcohol-Based Chlorhexidine and Potassium Sorbate Rub Strengthens the Effectiveness of Traditional Hand Scrubbing and Improves Long-Lasting Effectiveness—Evaluation of Hand Preparation Protocols According to EN 12791

“…However, the priority of surgical hand preparation should be based on the effectiveness of the process rather than on any personal preference and, in this sense, the efficacy of hand scrubbing is uncertain when assessed against EN 12791 [20][21][22][23]. Reapplication of the scrub or a combination of the scrub with an alcohol-based rub to improve the effectiveness of surgical hand scrubbing, prolonging the inhibition of bacterial growth on the skin for hours, is supported by multiple efficacy studies not guided by EN 12791 [9,17,19].…”

“…Based on the results of in vitro tests and non-standardized clinical trials, health professionals consider medicated soaps to be effective [9,[17][18][19], but the antimicrobial activity of these antiseptics differs significantly under practical conditions, such as those proposed by EN 12791 [20][21][22][23]. Medicated soaps containing PVP 10%, TC 0.5-1% or PCMX 3% do not meet the non-inferiority criteria of EN 12791 and should not be used in surgical hand scrubbing [20][21][22][23]. In this context, CHG 4% soaps have resulted in an inferior immediate effect compared to n-propanol, or non-inferiority without the sustained effect expected for this long-lasting agent when applied for 3 to 5 min [18,[20][21][22]24].…”

“…For these reasons, several studies have suggested the use of multi-stage disinfection protocols to ensure that traditional hand scrubbing meets the requirements of EN 12791 [21][22][23]. Protocols that supplemented traditional hand scrubbing with a rub using CHG or PVP aqueous solutions or alcohol-based solutions met the non-inferiority requirement [21][22][23], but only traditional hand scrubbing with CHG 4% followed by rubbing with aqueous CHG 5% showed sustained effects at the cost of a marked increase in the duration of the process [21].…”

“…For these reasons, several studies have suggested the use of multi-stage disinfection protocols to ensure that traditional hand scrubbing meets the requirements of EN 12791 [21][22][23]. Protocols that supplemented traditional hand scrubbing with a rub using CHG or PVP aqueous solutions or alcohol-based solutions met the non-inferiority requirement [21][22][23], but only traditional hand scrubbing with CHG 4% followed by rubbing with aqueous CHG 5% showed sustained effects at the cost of a marked increase in the duration of the process [21]. Despite the improved effectiveness, a balance between the effectiveness and duration of the disinfection process is needed to promote adherence to the disinfection procedure [22,23].…”

“…The alcohol-based CHG and potassium sorbate (PS) solution, Et70% (v/v), CHG3% (v/v) and PS 0.3% (v/v) (Et/CHG/PS), named Sorbectol ® [27], is a novel antiseptic product formulated to provide the sustained inhibition of hand microbiota beyond that achieved by alcohols. Although several alcohol-based hand sanitizers with CHG have been licensed, there is strong controversy over the need to include this long-lasting ingredient in hydroalcoholic formulations, because the immediate and profound reduction in bacterial load produced by alcohols in clinical practice already extends the inhibition of bacterial regrowth on the hands for several hours [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. In these circumstances, it is recommended not to include non-volatile agents such as CHG in alcohol-based formulations in order to reduce the risk of skin irritation [29].…”