A new checklist surgical hand scrub to replace time-based methods - A pixel intensity analysis.

BACKGROUND: Hand scrubbing is an absolute precaution to avoid surgical site infections. World Health Organization (WHO) recommends 4-min overall scrubbing (4MS) for surgical hand hygiene. However, we hypothesize that the more methodical 10-stroke counting technique (10SS) via locational partitioning of the arm is superior to WHO's superficial guideline dictating only the duration.

PURPOSE: The mechanical efficiency of 4MS and 10SS techniques are compared.

METHODS: 24 healthcare professionals were recruited for the study. A novel methodology was devised to quantify the average brightness change of skin-applied UV ink before and after scrubbing via pixel intensity analysis. A black-box setup is constructed with an integrated high-resolution camera to photograph the UV-stained dorsal arm. Each stain was then digitally isolated for brightness comparison.

RESULTS: It was observed that the 10SS technique was overall more successful in removing the UV ink in comparison to the 4MS method (p = 0.014). In addition, a bias was observed in removing more percentage of the proximal stains when compared to middle and distal stains with the 4MS technique (p = 0.0027), while location-based brightness change averages were statistically equal with the 10SS technique (p = 0.423).

CONCLUSIONS AND CLINICAL RELEVANCE: 10SS provided not only a more mechanically efficient scrubbing but also a more homogenous cleaning than 4MS. We recommend the use of the 10SS technique to achieve more effective pre-surgical hand hygiene.