Eliminating water from presurgical hand preparation and instead adopting exclusive use of alcohol-based hand scrub may save modern health care facilities millions in costs and potentially conserve water resources.
You may also like: Robots Cut C.difficile Transmissions
A new study (Javitt et al. 2020) found thatat a large ophthalmic surgical hospital adopting waterless scrub technique could result in substantial savings in water usage, supply costs and scrub time.
Alcohol-based
surgical scrub is recommended for presurgical antisepsis by leading health
organisations, including the WHO. It is used in American hospitals alongside
traditional aqueous scrub solutions, which have changed little since the
introduction of the practice of preoperative hand antisepsis (scrubbing) in 1847.
In order
to calculate the potential financial impact of converting to waterless surgical
hand preparation, the authors reviewed accounting records and assessed costs in
relation to water consumption and scrub materials for both alcohol-based
surgical scrub and water-based presurgical scrub.
The
assessment used the standard definition of a preoperative aqueous scrub by the
WHO – two minutes of scrubbing with soap and one minute of running water per
hand, ie two minutes of continuous water use per scrub. Scrub sinks were found
to consume 15.9 l of water per scrub (47.7 l per procedure with an average of three
scrubbed personnel), which amounted to 61 631 l and €250 ($277) in water and
sewer cost per operating room per year.
Water savings and resulting environmental benefits associated
with the shift to alcohol-based surgical scrub are substantial. Still, the biggest
input to cost savings comes from the lower costs of supplies and the savings in
chargeable operating room time.
The supply
cost of alcohol-based surgical scrub was €976 ($1,083) less than that of aqueous
soap and €244 ($271) less than that of chlorhexidine gluconate-impregnated scrub
brushes per operating room per year. It may potentially save€4,085 ($4,534) annually per staff member.Adopting waterless scrub
technique could also result in decreased scrub time and potential annual
savings of between €252 000 and €314 000 ($280 000 and $348 000) per operating room depending on
the duration of scrubbing.
The
authors note that their model has limitations and that flow rates of sinks, cost
of water, surgical volumes and scrubbing procedures will vary between
institutions. However, adopting waterless scrub techniques has the potential
for cost saving in water as well as in supplies and facilities resources. The
effect may be more pronounced for surgical facilities performing more
personnel-intensive procedures.
References
Javitt MJ et al. (2020) Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost. JAMA Ophthalmol. Published online February 27, 2020. doi:10.1001/jamaophthalmol.2020.0048
Image credit: Wikimedia Commons, by Alfre95luna – Own work, CC BY-SA 4.0
