Bharat Gurnani1, Kirandeep Kaur2. 1. Consultant Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. 2. Consultant Cataract, Pediatric and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Dear Editor,We read an interesting article by Dolma et al.[1] on improving surgical scrub time in an Ophthalmic theater by quality improvement methodology, and we congratulate the authors for touching on an important aspect of the surgical curriculum. However, we have a few important observations and suggestions to make to streamline surgical scrub time and reduce the surface microbial load.The surgical scrub time can be easily streamlined in every operation theater (OT) if we obey the regular OT protocols and follow the seven steps of handwashing as suggested by National Health Services (NHS), UK.[2] The minimum recommended time is 20 s; if we employ 20 s on each step, it accounts for 140 sA handwashing poster should be stuck on the wall facing the scrub area to remind the surgeon of the basic protocol for hand washingUsually most ophthalmic theaters have two water sources for scrubbing: a normal tap water source and a reverse osmosis (RO) water source. The guideline that can be followed is two cycles of tap water and two cycles of RO water. Some theaters also employ hot water flow to kill microorganismsThere can be two soaps for washing the hands. A normal hand soap/Dettol soap and another alcohol-based antiseptic skin disinfectant soap. In addition, there can be a single cycle of povidone-iodine scrub.Wheelock and Lookinland[3] in their clinical trial demonstrated that two-minute surgical hand scrub was clinically as effective as a three-minute surgical hand time to scrub. Some centers rarely also employ waterless hand scrub as compared to traditional hand scrub. Chen et al.[4] in their analysis showed that waterless hand scrub is as effective as traditional hand scrub to get rid of the microorganisms and efficiency is more in terms of scrub time, but this cannot be generalized.Hence, if we follow the regular OT protocols and suggestions listed above even when there is a time constraint, the surgical teams will not have to compromise on scrubbing technique and scrubbing time.