solution product should not be a factor that influences the decision making
process.
8
B. When evaluating a scrub solution, the following FDA standards should be
taken into consideration. The scrub solution should:
substantially reduce transient microorganisms
possess a broad-spectrum of antimicrobial properties
be fasting-acting
have persistent, cumulative activity
be a nonirritating antimicrobial preparation
Standard of Practice VI
Alcohol-based solutions are an effective scrubbing agent (CDC, 2000). The selection
of an alcohol-based solution should be based upon the solution being FDA-approved
that provides persistent, cumulative activity and is approved by the healthcare
facility.
1. The antimicrobial action of alcohols is the denaturing of proteins. Alcohol
solutions that contain 60%-95% alcohol are the most effective. Solutions higher in
alcohol concentration are less effective since the denaturing of proteins does not
easily occur in the absence of water.
8
2. Alcohols have a broad-spectrum of antimicrobial properties, including the ability
to destroy Gram-positive and Gram-negative bacteria, as well as multidrug-
resistant pathogens, including MRSA and VRE, Mycobacterium tuberculosis and
fungi.
9,30,50
3. Alcohols have rapid activity when applied to the skin, but alone do not have a
persistent, cumulative activity; however, when combined with another scrub
solution persistent, cumulative activity results.
8
Therefore, if a healthcare facility
adopts the use of alcohol, it is recommended that the agent be a combination of
alcohol and another scrubbing agent (alcohol-based solution).
A. Alcohol-based solutions have a greater antimicrobial activity as compared
to other scrub solutions. Studies have shown that alcohol-based solutions
immediately lower the microbial count on the skin postscrub more
effectively than other scrub solutions.
8
B. Alcohol-based solutions that contain 0.5% to 1% chlorhexidine gluconate
have been found to have a persistent antimicrobial activity that is equal to,
or greater than, that of chlorhexidine gluconate alone. The next most
effective scrubbing agents are chlorhexidine gluconate, iodophors, and
triclosan. Studies of parachlorometaxylenol (PCMX) have produced
contradictory results and therefore, further studies are required in order to
determine the efficacy of the agent with other scrubbing agents.
53
4. When using an alcohol-based solution, the healthcare facility procedure for
performing the surgical scrub should follow the manufacturer’s instructions since
the instructions can vary according to the solution that is being used.
5. The alcohol-based solution should not be used when the hands and/or forearms
are visibly dirty or contaminated with proteinaceous materials since that decreases
the antimicrobial action of the alcohol.
32
The hands and forearms should be
prewashed with a non-antimicrobial soap unless it is suspected that hands are