Sterillium, should we be using it?

RE: Sterillium, should we be using it?

Elliot Kneba — Tue, 31 May 2016 17:10:12 GMT

[quote user="Evelyn Barbour-Hill"]Why not just clean your whole hand with..... any suitable soap or detergent, then don your gloves in aseptic manner?[/quote]

Repeated scrubbing can damage your skin barrier, disrupt your normal flora, and generally dries your hands out. I am a delicate creature so I like that Sterillium not only disinfects, but helps maintain my skin barrier and doesn't dry me out.

[quote user="Evelyn Barbour-Hill"]By the way, is Sterilium effective against Clostridium difficile? What duration of exposure is required?[/quote]

I don't think any safe for skin products (chlorhexidine, soap, sanitisers, etc) are super effective against faecal organisms. You can wash your hands with soap or chlorhex and then follow up with a sanitiser to maximise your luck at decontamination, but only barrier nursing is really effective.

https://www.cdc.gov/media/releases/2012/p0306_cdiff.html

RE: Sterillium, should we be using it?

Evelyn Barbour-Hill — Tue, 24 May 2016 18:26:48 GMT

[quote user="Elliot Kneba"]

[quote user="Evelyn Barbour-Hill"]Why not just clean your whole hand with the Baktolin then don your gloves in aseptic manner?[/quote]

Baktolin is not an anti-septic soap, it's just a detergent.

[/quote]

Yes, I know it's not antiseptic. Is it a soap or a detergent?

Why not just clean your whole hand with..... any suitable soap or detergent, then don your gloves in aseptic manner?

Seeing as all you've done for under the fingernails is scrub with the detergent (or soap).

[quote user="Elliot Kneba"]I use sterilium between all patient exams, and wash my hands when they become grossly contaminated or every 10 uses.[/quote]

Sure, but the debate was about hand preparation for aseptic surgery.

By the way, is Sterilium effective against Clostridium difficile? What duration of exposure is required?

RE: Sterillium, should we be using it?

Elliot Kneba — Tue, 24 May 2016 17:55:02 GMT

[quote user="Evelyn Barbour-Hill"]Why not just clean your whole hand with the Baktolin then don your gloves in aseptic manner?[/quote]

Baktolin is not an anti-septic soap, it's just a detergent. If you are using chlorhexidine prior to using Sterilium then you may have chlorhex residue on your skin thus reducing the efficacy of Sterilium, hence their recommendation for that. I imagine you can use any plain hand soap to remove gross debris then carry on with using Sterilium for the day. Less damage to your skin barrier and flora, and it leaves a glorious feeling.

I use sterilium between all patient exams, and wash my hands when they become grossly contaminated or every 10 uses.

RE: Sterillium, should we be using it?

Rob Loxley — Mon, 16 May 2016 23:45:18 GMT

From the Cochrane review (link above):
There is no firm evidence that one type of hand antisepsis is better than another in reducing SSIs. Chlorhexidine gluconate scrubs may reduce the number of CFUs on hands compared with povidone iodine scrubs; however, the clinical relevance of this surrogate outcome is unclear. Alcohol rubs with additional antiseptic ingredients may reduce CFUs compared with aqueous scrubs. With regard to duration of hand antisepsis, a 3 minute initial scrub reduced CFUs on the hand compared with a 2 minute scrub, but this was very low quality evidence, and findings about a longer initial scrub and subsequent scrub durations are not consistent. It is unclear whether nail picks and brushes have a differential impact on the number of CFUs remaining on the hand. Generally, almost all evidence available to inform decisions about hand antisepsis approaches that were explored here were informed by low or very low quality evidence.

RE: Sterillium, should we be using it?

Evelyn Barbour-Hill — Mon, 16 May 2016 23:36:35 GMT

I've really no axe to grind but I find I'm getting drawn into this.

Cheaper? What does 5-10ml of Hibiscrub, a little bit of water, and the use of a nailbrush (lasts for ages) cost?

"Greener" – no water waste? How much water does it take to wash your hands with a scrubbing brush? (You surely don't keep the tap running, do you?). What's that in relation to all the water a practice uses? It's minute compared with, say, flushing the bog every time you take a slash.

Faster? Maybe, fractionally. What use do you actually make of that tiny time saving?

More effective? Maybe. How would you know? It depends what you mean by effective.

Easier to glove? Sorry, I just don't understand that one.

"Hibi hands": ah, that I can understand and sympathise with, but not everybody has that problem.

[quote user="Tim Charlesworth"]Interestingly the benefits of actual "scrubbing" (with hibi, as opposed to just washing with hibi) are thought to be mainly pyschological![/quote]

Yes, we've had a thread about this before. It all depends what you mean by "scrubbing". Soaps and detergents both require agitation to work properly. Even the usual rubbing together of hands when washing counts as a mild scrubbing.

And, you know, there is always superficial crud unless you have just washed your hands, whether it's visible to the naked eye or not.

I'm not bothered either way, I will continue to Hibiscrub, but if Sterillium works for you that's fine.

RE: Sterillium, should we be using it?

Tim Charlesworth — Mon, 16 May 2016 16:48:21 GMT

We've been using it for 2-3 years now and haven't had any probs. I'm sure you know the benefits (cheaper (no water/brushes), "greener" (no water waste), faster, more effective, easier to glove etc) but the seller for us was that several of us had "hibi hands" that has since resolved.

We use a neutral soap to remove gross contamination (if any) and then just sterilium for 90s. It's good. Interestingly the benefits of actual "scrubbing" (with hibi, as opposed to just washing with hibi) are thought to be mainly pyschological!

RE: Sterillium, should we be using it?

Evelyn Barbour-Hill — Mon, 16 May 2016 16:43:48 GMT

[quote user="Anthony Dennison"]

[quote user="Evelyn Barbour-Hill"]How does Sterilium get under the fingernails, can anybody say?[/quote]

You're supposed to clean your fingernails with their soap solution (Baktolin) and remove debris from under your nails, then make a pool of sterilium in a cupped palm and rub the ends of your fingers in it.

[/quote]

Why not just clean your whole hand with the Baktolin then don your gloves in aseptic manner?

RE: Sterillium, should we be using it?

Anthony Dennison — Mon, 16 May 2016 16:14:48 GMT

[quote user="Evelyn Barbour-Hill"]How does Sterilium get under the fingernails, can anybody say?[/quote]

RE: Sterillium, should we be using it?

Evelyn Barbour-Hill — Mon, 16 May 2016 12:39:32 GMT

[quote user="Neil Wheadon"]A practice I locummed in took swabs from their hands and cultured after scrubbing with hibiscrub or sterilium.[/quote]

Immediately after? That would obviously give an appearance – a false one – of superiority for Sterilium, because it's not rinsed so there would be some of the active ingredients transferred to the culture plate. And which bits of the hands I wonder? And were swabs taken from deep under the fingernails?

I'm not getting at you, Neil, just pointing out that amateur microbiology is fraught with errors and pitfalls.

How does Sterilium get under the fingernails, can anybody say?

RE: Sterillium, should we be using it?

Anthony Dennison — Mon, 16 May 2016 09:01:07 GMT

We've been using it for over 2 years now I think. Find it so much easier to use, the skin on my hands doesn't react (though it is a good way to find a cut you didn't know you had)

Re: cat castrates: I was told when we 1st got it hibiscrub inactivated sterilium/made it less effective or something like that (probably not true), so I will often just use hibi for these. Then use the bactolan wash, dry my handfs and use sterilium for everything else.

My practice is very hot on our clinical governance and it was inspected very closely for the 1st 6 months of using sterilium. If anything post-op infections went down.

RE: Sterillium, should we be using it?

Stephen Courtney — Sun, 15 May 2016 23:09:25 GMT

We use it - on the whole i like not having to scrub as my skin tends to react badly to such excesses. the only issue I have with sterilium is that it makes my fingers slippery for cat castrates, also it is very pungent if used in an enclosed space.

RE: Sterillium, should we be using it?

Glenn Hodgson — Sun, 15 May 2016 21:35:57 GMT

The "betters" that floated my boat were faster to scrub and prolonged duration action so kills off the hand slime which grows under gloves in a prolonged op.

RE: Sterillium, should we be using it?

Rob Loxley — Sun, 15 May 2016 21:25:15 GMT

http://www.ncbi.nlm.nih.gov/pubmed/26799160

[quote user="Joyce Whitehead"]My skin is much less dry and sore as a result of less scrubbing[/quote]

Not all chlorhexidine scrubs are the same with regards to looking after your skin, and most opinion seems to have moved away from scrubbing with a brush when using chlorhixidine

RE: Sterillium, should we be using it?

Neil Wheadon — Sun, 15 May 2016 20:16:19 GMT

A practice I locummed in took swabs from their hands and cultured after scrubbing with hibiscrub or sterilium. They switched to Sterilium

I like it, it's an 'act of faith' and I've seen no issues

Neil

RE: Sterillium, should we be using it?

Laura Kidd — Sun, 15 May 2016 20:08:23 GMT

https://www.ncbi.nlm.nih.gov/pubmed/?term=sterilium

this is useful

RE: Sterillium, should we be using it?

Evelyn Barbour-Hill — Sun, 15 May 2016 19:38:46 GMT

[quote user="Glenn Hodgson"]Anyone here got views? [/quote]

Better? How better?

RE: Sterillium, should we be using it?

Emily Rainbow — Sun, 15 May 2016 19:24:38 GMT

Yep all the Uni's are now using it and we've been using it for about 18m now. No problems apart from the occasional sting!

RE: Sterillium, should we be using it?

Joyce Whitehead — Sun, 15 May 2016 18:42:00 GMT

I've been using it for some time. I still scrub for the first op. Then dry hands and use sterillium for the required 2 minute rub in. Subsequent ops I wash and dry hands before sterillium. Our younger assistants say that their university orthopods use it so I reckon if it's good enough for them....

My skin is much less dry and sore as a result of less scrubbing.