Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost

• Published in: JAMA ophthalmology Vol. 138; no. 4; p. 382
• Main Authors: Javitt, Matthew J, Grossman, Adriana, Grajewski, Alana, Javitt, Jonathan C
• Format: Journal Article
• Language: English
• Published: United States 01.04.2020
• Subjects: Anti-Infective Agents, Local - administration & dosage; Anti-Infective Agents, Local - economics; Antisepsis - methods; Chlorhexidine - administration & dosage; Chlorhexidine - analogs & derivatives; Chlorhexidine - economics; Disinfectants; Ethanol - administration & dosage; Ethanol - economics; Female; Hand Disinfection - economics; Hand Disinfection - methods; Humans; Male; Operating Rooms; Ophthalmologic Surgical Procedures - economics; Preoperative Care; Water
• ISSN: 2168-6173
• DOI: 10.1001/jamaophthalmol.2020.0048

Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions. To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation. A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019. The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year. Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year. Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.