As noted in Table 2, the FDA TFM of 1994 classified both ethanol, 60 to 95%, and povidone iodine, 5-10%, as Category I agents, i.e., generally safe and effective for use in surgical hand antisepsis.27 The FDA, the CDC, and the WHO recommend surgical hand antisepsis (Table 4) using either an antimicrobial soap and water or two-stage surgical hand antisepsis, i.e., handwashing with plain soap and water followed by the application of an alcohol-based handrub with (preferably) persistent activity (alcohol-based preparations containing 0.5% to 1% chlorhexidine gluconate have persistent activity).1,25,27
Traditionally, surgical staff has been required to scrub hands for 10 minutes with an antiseptic agent. The CDC concluded that scrubbing with a brush for 10 minutes can damage skin and result in increased shedding of microorganisms from the hands; scrubbing for 5 minutes reduces microbial counts as effectively as a 10 minute scrub; and scrubbing for 2 to 3 minutes reduces microbial counts to acceptable level; and scrubbing with a disposable sponge reduces microbial counts on the hands as effectively as scrubbing with a brush.1 However, neither a brush nor a sponge is necessary to reduce microbial counts on the hands of surgical personnel to acceptable levels.1
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