Surgical hand preparation in an equine hospital: Comparison of general practice with a standardised protocol and characterisation of the methicillin-resistant Staphylococcus aureus recovered.
Authors: Rocktäschel Tina, Renner-Martin Katharina, Cuny Christiane, Brehm Walter, Truyen Uwe, Speck Stephanie
Journal: PloS one
Summary
# Surgical Hand Preparation in Equine Hospitals: Moving Beyond Individual Variation Despite hand asepsis being fundamental to surgical practice, considerable variation exists in how veterinary personnel prepare their hands preoperatively, with little evidence supporting current individual protocols. Researchers compared bacterial recovery from hands during routine practice amongst 42 equine hospital staff (surgeons, clinic members and students) against a standardised protocol of 1-minute hand washing without brushing followed by 3-minute disinfection with Sterillium®, measuring total bacterial counts before washing, after washing, after disinfection, and intraoperatively. Whilst hand-washing duration made no significant difference to bacterial reduction, the standardised protocol achieved markedly superior disinfection efficacy (98.85–98.92% reduction versus 89.97–90.72% in routine practice; p<0.001), and crucially eliminated individual variability in outcomes. An additional concern emerged: 19% of participants carried methicillin-resistant *Staphylococcus aureus* (MRSA), specifically a gentamicin-resistant subpopulation (spa type t011, ST398) known to establish in equine facilities, with glove perforation occurring in 54% of surgeon-used gloves during longer procedures—correlating with increased hand bacterial counts, particularly on the non-dominant hand. These findings suggest that standardised hand-preparation protocols are essential for reliable infection control in equine surgical settings, warranting their implementation as institutional prerequisite rather than relying on individual technique and awareness.
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Practical Takeaways
- •Implement standardized surgical hand preparation protocols in your facility: 1 minute hand wash with neutral soap (no brush needed) followed by 3 minutes of approved disinfectant—this nearly doubles bacterial reduction compared to inconsistent individual practices
- •Screen personnel for MRSA carriage regularly and establish infection control procedures, as nearly 1 in 5 staff members may harbor equine-associated resistant strains that pose nosocomial infection risk
- •Inspect surgical gloves frequently during procedures exceeding 60 minutes, as perforation rates are high and contamination increases dramatically—particularly critical for left-handed surgeons and invasive procedures
Key Findings
- •Standardised hand disinfection protocol (1 min wash, 3 min disinfection) achieved 98.85-98.92% bacterial reduction versus 89.97-90.72% with routine practices (p<0.001)
- •Wide variation in current practice habits ranged from 1-8 minutes for disinfection and 0-48 ml disinfectant volume between individuals
- •19% of personnel (8/42) carried MRSA spa type t011/CC398, a nosocomial pathogen established in equine clinics and gentamicin-resistant
- •Glove perforation occurred in 54% of surgeon gloves and 17% of assistant gloves, with bacterial numbers increasing significantly during procedures >60 minutes