IF THEY LIKE, THEY'LL USE There is a correlation between hand hygiene compliance and the surgical scrub products that you use.

The perfect waterless surgical scrub? Yet to be invented, says Chantell Bartell, RN, BSN, the OR coordinator at the Tallahassee (Fla.) Outpatient Surgery Center. For if it existed, it would be odorless, it would dry in seconds, it wouldn't irritate the skin, and every surgeon and staff member would happily use it throughout the day without complaint or cracked cuticles.

"No, that doesn't exist," says Ms. Bartell. "Some of our doctors can use one scrub and some have to use an alternative scrub." That means the center is forced to stock 2 alcohol-based hand rubs — one that dries faster but has a higher alcohol content and is harsher on the skin than the one that's softer on the skin but takes longer to dry. "It takes a while to rub that one in," she says. "Some doctors don't like to have to wait for their hands to dry."

If they like it, they'll use it
Let's see — wait a few seconds for your hands to dry, or suffer dry, chapped, itchy skin? There's no clear-cut answer because convenience and hand-hygiene compliance go hand in hand. If your surgeons' hands are red and burning from dermatitis, compliance with hand-washing regulations will plummet as they avoid exposure to the irritants causing the problem.

"Yes, they're directly related," says Rene Bates, RN, BSN, clinical improvement manager at the Knoxville (Tenn.) Orthopaedic Surgery Center. "If they like the product and don't mind using it, they seem to be more apt to do hand hygiene when it's most appropriate."

Ms. Bates trialed 3 alcohol-based hand rubs before settling on the one that her team liked most and disliked least. Since the center opened in 2009, they'd been using a foam rub that "nobody was really a big fan of and several people hated," she says. "It caused some hands to crack and people didn't like the smell. It wasn't a fresh, clean smell. You can imagine our compliance rate."

They switched to a store-bought gel, but folks quickly complained of dry, cracked hands. The only positive review was that the gel didn't leave a slimy feeling — "probably because it didn't have any emollients," jokes Ms. Bates. There were more complaints when they switched to another foaming hand rub that left hands feeling slimy and smelling musty. They brought in another gel for a trial that wasn't perfect, but was certainly passable. "I couldn't find anybody to say anything bad about it, except that it smelled like alcohol and the emollients left your hands slimy after you washed your hands with soap and water," says Ms. Bates. "It wasn't pleasant for everybody, but these things weren't deal breakers."

To increase compliance with the gel, you'll find convenient wall-mounted dispensers outside every patient care area (6 ORs plus a procedure room), as well as around the 8 pre-op beds and 14 PACU bays. Dispensers also sit at each nurses station. To combat dryness, Ms. Bates also stocks a hand lotion that she encourages her team to apply in the morning, during their lunch break and at day's end. She discourages people from bringing in lotions from home.

Don't expect to please everybody. Ms. Bates held onto the trial products for the few staffers who "adored" the musty-smelling foam. "I knew we'd do better with hand hygiene if they had that available to them," she says.

TROUBLE WITH WATERLESS PRODUCTS
Watch Out for These Hand-Washing Shortcuts

SKIN KINDNESS You're unlikely to achieve the desired level of antimicrobial antisepsis if you don't use waterless hand rubs properly.

You may go through gallons of waterless alcohol-based hand rub agents each month, but there's no guarantee that your OR team is using them properly. Here are 4 shortcuts that could short circuit your hand hygiene compliance:

1. Not routinely performing a pre-wash.
2. Using less than the specified amount of product.
3. Not rubbing the product into the skin until dry.
4. Using a towel to aid drying.

— Dan O'Connor

The quest for the perfect rub
The hand rub is considered one of the single most important acts in preventing the spread of infections in the surgical setting. But some argue that alcohol-based hand rubs could be causing more harm than good.

"Before we switched rubs, there were too many complaints and not enough hand hygiene," says Patricia Walat, RN, BS, nurse manager and compliance officer at Sound Eye and Laser in Seattle, Wash. "We switched and now everyone is happy."

Is it too much to ask for a rub that dries quickly but doesn't dry out your skin as well? That got us wondering: What would the perfect waterless, brushless surgical scrub be like? We surveyed 50 facility leaders to find out. Here are the 10 attributes they cited the most:

• high, sustained bacteria kill
• disperses over the skin easily
• no sticky or slimy feeling
• fast-drying
• moisturizing
• calibrated dispensing for exact amount
• a timer to assure you achieve full, appropriate rub time
• gloves won't stick to hands after application
• does not damage or irritate the skin
• very little scent during and after the rub (a few respondents wouldn't mind a mild, pleasant smell)

Speaking of smell, keep in mind that hand rubs are like fragrances. Just as not all perfume smells the same on every individual who wears that scent, the hand rub that feels and smells great on you will make another nurse's skin crack and smell like gasoline. The perfect rub for you might literally rub someone else the wrong way.

A much larger reader survey of 171 facility leaders we conducted a few years back drilled down deeper into the biggest challenges to hand hygiene compliance. The No. 1 challenge? Rubs dry out hands (38.2%), followed by the time it takes to use the rub (13.3%), location of dispensers (13.3%) and the feel of the rub on the skin (10.3%). "Our challenge is getting surgeons to actually do the complete process with the waterless scrub," says Patricia Huber, MA, RN, nurse manager of perioperative services at the Jack C. Montgomery VA Medical Center in Muskogee, Okla.

Yes, it's true that "if they like it, they will use it" — but only if you make it convenient for your OR team to use the rub. Have as many gel or foam dispensers available in as many strategic locations as possible, especially in the hallways by the doorways outside each patient-care area (pre-op bay, OR, PACU bay), and by such high-traffic areas as the time clocks and the light switches. And remember to replace the dispensers when they're empty. You'll also boost your efforts if you place friendly visual reminders to wash your hands by the dispensers, several of you told us.