***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Surgical site  infections prolong hospital stays , are among the leading nosocomial causes of morbidity , and a source of excess medical costs . Clinical studies comparing the risk of nosocomial infection after different h and antisepsis protocol s are scarce . OBJECTIVE To compare the effectiveness of h and -cleansing protocol s in preventing surgical site infections during routine surgical practice . DESIGN R and omized equivalence trial . SETTING Six surgical services from teaching and nonteaching hospitals in France . PATIENTS A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1 , 2000 , and May 1 , 2001 . INTERVENTIONS Surgical services used 2 h and -cleansing methods alternately every other month : a h and -rubbing protocol with 75 % aqueous alcoholic solution containing propanol-1 , propanol-2 , and mecetronium etilsulfate ; and a h and -scrubbing protocol with antiseptic preparation containing 4 % povidone iodine or 4 % chlorhexidine gluconate . MAIN OUTCOME MEASURES Thirty-day surgical site infection rates were the primary end point ; operating department teams ' tolerance of and compliance with h and antisepsis were secondary end points . RESULTS The 2 protocol s were comparable in regard to surgical site infection risk factors . Surgical site infection rates were 55 of 2252 ( 2.44 % ) in the h and -rubbing protocol and 53 of 2135 ( 2.48 % ) in the h and -scrubbing protocol , for a difference of 0.04 % ( 95 % confidence interval , -0.88 % to 0.96 % ) . Based on subsets of personnel , compliance with the recommended duration of h and antisepsis was better in the h and -rubbing protocol of the study compared with the h and -scrubbing protocol ( 44 % vs 28 % , respectively ; P = .008 ) , as was tolerance , with less skin dryness and less skin irritation after aqueous solution use . CONCLUSIONS H and -rubbing with aqueous alcoholic solution , preceded by a 1-minute nonantiseptic h and wash before each surgeon 's first procedure of the day and before any other procedure if the h and s were soiled , was as effective as traditional h and -scrubbing with antiseptic soap in preventing surgical site infections . The h and -rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines . H and -rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical h and -scrubbing Five protocol s for surgical h and washing ( scrubbing ) were evaluated for their efficiency of removal of micro-organisms and their drying effect on the skin . The scrubbing protocol s tested were : ( 1 ) an initial scrub of 5 min and consecutive scrubs of 3.5 min with chlorhexidine gluconate 4 % ( CHG-5 ) ; ( 2 ) an initial scrub of 3 min and consecutive scrubs of 2.5 min with chlorhexidine gluconate 4 % ( CHG-3 ) ; ( 3 ) an initial scrub of 3 min and consecutive scrubs of 2.5 min with povidone iodine 5 % and triclosan 1 % ( PI-3 ) ; ( 4 ) an initial scrub of 2 min with chlorhexidine gluconate 4 % followed by a 30 s application of isopropanol 70 % and chlorhexidine gluconate 0.5 % , and a 30 s application of isopropanol 70 % and chlorhexidine gluconate 0.5 % for consecutive scrubs ( IPA ) ; and ( 5 ) an initial scrub of 2 min with chlorhexidine gluconate 4 % followed by a 30 s application of ethanol 70 % and chlorhexidine gluconate 0.5 % , and a 30 s application of ethanol 70 % and chlorhexidine gluconate 0.5 % for consecutive scrubs ( EA ) . A convenience sample of 23 operating theatre nurses completed each scrub protocol for one week in a r and omized order . A week of normal work activities intervened between each protocol . Subjects were assessed before commencing and after completing the week of each protocol to determine changes in the microbial counts and skin condition of the h and s. Specimens for microbial analysis were collected before , immediately after and 2 h after an initial scrub , and 2 h after a consecutive scrub . The CHG-5 , CHG-3 and PI-3 protocol s , which used detergent-based antiseptics only , were compared with protocol s incorporating an alcohol-based antiseptic ( IPA and EA ) . The protocol s incorporating alcohol-based antiseptics and the CHG-5 protocol were generally associated with the lowest post-scrub numbers of colony forming units ( cfu ) . No difference between the CHG-5 protocol and the alcohol-based antiseptics was found at the beginning of the test week , but after exclusive use of the respective protocol s for a week , the alcohol-based antiseptics were associated with significantly lower cfu numbers in two out of the three post-scrub sample s ( P = 0.003 , P = 0.035 ) . Although virtually no statistically significant differences in skin condition were found , many subjects reported the alcohol-based antiseptic protocol s to be less drying on the skin . The findings of this study support the proposition that a scrub protocol using alcohol-based antiseptics is as effective and no more damaging to skin than more time-consuming , conventional methods using detergent-based antiseptics H and washing is an indispensable procedure for surgical nurses . Although scrubbing up with a brush is preferable to prevent infections , it is not clear how irritating to the skin scrubbing with a brush is compared with h and washing without a brush .  TEWL , high frequency conductance and pH were measured on the h and skin of the same group of nurses before and after daily h and washing for 11 days in different seasons , which were chosen as favourable and unfavourable periods for the condition of h and skin , namely the early summer and autumn . Additionally , we compared the antimicrobial effects on the skin of scrubbing up , using a palm stamp method . TEWL showed significantly higher values with brush washing than with simple h and washing only in the autumn . There was no significant difference in the measurement of high frequency conductance , pH or in the antimicrobial effects between the two washing techniques . Results showed the deleterious effects on the skin of h and washing , particularly that of using a brush in the cold season OBJECTIVE To compare the frequency of skin irritation and dryness associated with using an alcoholic-h and -gel regimen for h and antisepsis versus using soap and water for h and washing . DESIGN Prospect i ve r and omized trial with crossover design . Irritation and dryness of nurses ' h and s were evaluated by self- assessment and by visual assessment by a study nurse . Epidermal water content of the dorsal surface of nurses ' h and s was estimated by measuring electrical capacitance of the skin . SETTING Miriam Hospital , a 200-bed university-affiliated teaching hospital . PARTICIPANTS Thirty-two nurses working on three hospital wards participated in the trial , which lasted 6 weeks . RESULTS Self- assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic-h and -gel regimen ( mean baseline score , 2.72 ; mean final score , 2.0 ; P=.08 ) but increased substantially during the 2 weeks when nurses used soap and water ( mean baseline score , 2.0 ; mean final score , 4.8 ; P<.0001 ) . Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic-h and -gel regimen was used ( mean baseline and final scores were both 0.55 ) , but scores increased substantially when nurses used soap and water ( baseline score , 0.59 ; mean final score , 1.21 ; P=.05 ) . Epidermal water content of the dorsal surface of nurses ' h and s changed little when the alcoholic-h and -gel regimen was used ( mean+/-st and ard deviation baseline electrical capacitance reading , 24.8+/-6.8 ; mean final reading , 25.7+/-7.3 ) , but decreased significantly ( skin became dryer ) with soap- and -water h and washing ( mean baseline , 25.9+/-7.5 ; mean final reading , 20.5+/-5.4 ; P=.0003 ) . CONCLUSIONS H and antisepsis with an alcoholic-h and -gel regimen was well tolerated and did not result in skin irritation and dryness of nurses ' h and s. In contrast , skin irritation and dryness increased significantly when nurses washed their h and s with the unmedicated soap product available in the hospital . Newer alcoholic h and gels that are tolerated better than soap may be more acceptable to staff and may lead to improved h and -hygiene practice Surgical  site infection after heart surgery increases morbidity and mortality . The method of presurgical h and disinfection could influence the infection risk . From February to April 2003 , we compared the microbiological efficacy of h and -rubbing ( R ) and h and -scrubbing ( S ) procedures . The surgical team alternately used h and -scrubbing or h and -rubbing techniques every two weeks . Fingertip impressions were taken before and immediately after h and disinfection , every 2h and at the end of the operation . Acceptability of  h and rubbing  was assessed by a question naire . Mean duration s of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively ( P=0.43 ) . Bacterial counts immediately after h and disinfection were comparable with the two techniques , but significantly lower in group R at the end of surgery . No differences were observed between the percentages of negative sample s taken after 2h , 4h and at the end of surgery between the two groups . Bacterial skin flora reduction immediately after h and disinfection , after 2h and 4h of operating time and at the end of surgery was better in group R , but the difference was not statistically significant . Before surgery , the h and -rubbing method with alcohol solution preceded by h and washing with mild neutral soap is as effective as h and scrubbing to reduce bacterial counts on h and s. It decreased the bacterial counts both immediately after h and disinfection and at the end of long cardiothoracic surgical procedures . The acceptability of h and rubbing was excellent and it can be considered to be a valid alternative to the conventional h and -scrubbing protocol Twenty surgical staff members participated in a clinical trial to compare the microbiology and skin condition of h and s when using a traditional surgical scrub ( TSS ) with a detergent-based antiseptic containing 4 % chlorhexidine gluconate ( CHG ) and a short application without scrub of a waterless h and preparation ( HP ) containing 61 % ethyl alcohol , 1 % CHG , and emollients . The HP was associated with less skin damage ( P = .002 ) and lower microbial counts postscrub at days five ( P = .002 ) and 19 ( P = .02 ) . The HP protocol had shorter contact time ( HP mean [ M ] = 80.7 seconds ; TSS M = 144.9 seconds ; P < .0001 ) , and more subjects preferred the HP regimen ( P = .001 ) . The HP performed better than the TSS , was less costly , and should be evaluated in larger trials and considered for widespread implementation OBJECTIVE To determine whether alcohol h and disinfection is an effective alternative to traditional agents for the pre-surgical scrub . DESIGN A prospect i ve clinical trial of a 70 % isopropanol pre-surgical h and disinfectant . SETTING The operating room suites at two hospital sites in British Columbia . METHODS Cases were selected to evaluate both short and longer procedures . The h and disinfectant was compared to agents in current use as surgical scrubs ( 4 % chlorhexidine and 7.5 % povidone-iodine ) . Surgical technique and glove use were not modified . Pre- and postoperative fingertip impression and " glove-juice " cultures were used to determine microbial burden , and h and s were evaluated for skin integrity . RESULTS There was no statistical difference between the microbial h and counts following use of the alcohol-based product or the current agents , for cases less than 2 hours ' duration . Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol h and rinse , but analysis of matched pairs showed no significant difference in microbial counts . The alcohol h and rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability . CONCLUSION An alcohol h and rinse was equivalently effective in reducing microbial h and counts as the traditional pre-surgical scrub , both immediately after h and disinfection and at the end of the surgical procedure BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in 
    Output:
    
Evidence showed that h and rubbing techniques are as effective as traditional scrubbing and seem to be better tolerated .
H and rubbing appears to cause less skin damage than traditional scrub protocol s , and scrub personnel tolerated brushless techniques better than scrubbing using a brush