***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 BACKGROUND The effectiveness of an alcoholic solution compared with the st and ard hygienic h and washing procedure during regular work in clinical wards and intensive care units of a large public university hospital in Barcelona was assessed . METHODS A prospect i ve , r and omized clinical trial with crossover design , paired data , and blind evaluation was done . Eligible health care workers ( HCWs ) included permanent and temporary HCWs of wards and intensive care units . From each category , a r and om sample of persons was selected . HCWs were r and omly assigned to regular h and washing ( liquid soap and water ) or h and washing with the alcoholic solution by using a crossover design . The number of colony-forming units on agar plates from h and s printing in 3 different sample s was counted . RESULTS A total of 47 HCWs were included . The average reduction in the number of colony-forming units from sample s before h and washing to sample s after h and washing was 49.6 % for soap and water and 88.2 % for the alcoholic solution . When both methods were compared , the average number of colony-forming units recovered after the procedure showed a statistically significant difference in favor of the alcoholic solution ( P < .001 ) . The alcoholic solution was well tolerated by HCWs . Overall acceptance rate was classified as " good " by 72 % of HCWs after 2 weeks use . Of all HCWs included , 9.3 % stated that the use of the alcoholic solution  worsened minor pre-existing skin conditions . CONCLUSIONS Although the regular use of hygienic soap and water h and washing procedures is the gold st and ard , the use of alcoholic solutions is effective and safe and deserves more attention , especially in situations in which the h and washing compliance rate is hampered by architectural problems ( lack of sinks ) or nursing work overload Chlorhexidine surgical scrub was left on the surgeon 's h and s in 50 orthopedic and vascular surgical procedures to determine whether the number of bacteria on the h and s could be decreased postoperatively . After a st and ard 5-minute scrub , one h and was r and omly rinsed prior to gloving ; the other was lightly patted with a sterile towel , leaving some foam on the h and . The surgeon then gloved and performed the procedure in the usual manner . After the operation , both h and s were immersed in a tryptic soy broth for 30 seconds . The broth was then cultured for bacterial species and number . Cases in which glove puncture occurred were not cultured . The results were analyzed using the Wilcoxon signed-rank test . There were fewer bacterial colonies isolated from the h and coated with chlorhexidine scrub versus the other ; this difference was statistically significant ( p less than 0.005 ) . There also seemed to be a trend towards higher bacterial counts after longer operations ; however , the difference was not significant . Neither surgeon noted any evidence of dermatitis during the study . These results suggest that leaving chlorhexidine scrub on the h and s during surgery can lead to lower bacterial counts on the surgeon 's h and s and less chance of wound contamination should glove puncture occur Abstract The efficacy of a povidone-iodine and a chlorhexidine gluconate detergent was evaluated for ‘ hygienic ' and ‘ surgical ' h and disinfection . Rubbing 60 per cent iso -propanol on to the h and s for 1 min was used as a st and ard for ‘ hygienic ' disinfection , with Escherichia coli as the test organism . The mean log reduction obtained was 3.16 with povidone-iodine and 2.92 with chlorhexidine . These were considerably less than obtained with iso -propanol which produced a reduction of 4.23 and 4.30 orders of magnitude . In the ‘ surgical ' h and disinfection tests , a 5 min wash with povidone-iodine and a 3 min wash with chlorhexidine detergent were compared with rubbing 60 per cent n -propanol or iso -propanol on to the h and s for 5 min ; n -propanol was taken as the st and ard preparation . Immediately after disinfection the log reduction in the resident flora was 0.92 with povidone-iodine and 0.78 with chlorhexidine , whereas n -propanol gave a log reduction of 3.43 . After wearing a surgical glove for 3 h a log reduction of 0.24 was obtained with povidoneiodine , 0.75 with chlorhexidine and 2.94 with n -propanol . Treatment with iso -propanol gave a log reduction of 1.04 . Thus , alcohols are shown by these tests to be far more effective than povidone-iodine or chlorhexidine detergent preparations in ‘ hygienic ' as well as ‘ surgical ' h and disinfection The aim of this cluster‐r and omized , crossover trial was to compare the efficacy of plain soap and water with an alcohol‐based h and rub for surgical h and preparation and prevention of surgical‐site infection ( SSI ) in a Kenyan rural hospital OBJECTIVE We describe a r and omized blinded study to evaluate the antimicrobial persistence following saline exposure of 2 commercially available skin antiseptic agents . One agent contained iodine povacrylex in alcohol and the second contained chlorhexidine gluconate in alcohol . METHOD Both agents were applied to the forearms of 36 healthy subjects according to manufacturers ' instructions and allowed to dry . The sites were then exposed to either a saline rinse or to a saline-saturated gauze , similar to the challenges that preps would face during most surgical procedures . Two analyses were performed : ( 1 ) An indicator organism was seeded onto the treated sites . After 30 minutes , sample s were collected from the treated sites and surviving bacterial colonies were enumerated and log reductions calculated . ( 2 ) The saline-saturated gauze was analyzed chemically for presence of chlorhexidine or iodine . RESULTS The baseline densities ( stated as logarithms of colony forming units " log CFU " ) of the sites to which the agents were applied had statistically equivalent microbial densities . Both agents reduced the density of organisms in a statistically significant manner . Chemical analysis of the gauze sample s indicated that 35 of 36 sample s had detectable chlorhexidine while no sample s had detectable iodine ( P < .0001 ) . CONCLUSION The results indicate that chlorhexidine is removed by saline-soaked gauze while the iodine povacrylex water-insoluble film remains intact under the same conditions . The implication is that similar results may occur in surgery when saline is used An evaluation of the effect of total body exhaust clothing on air and wound contamination was made in an operating theatre with a zonal ventilation system . Sixty-four patients who underwent total hip replacement using the Charnley-Müller prosthesis were studied . The members of the surgical team wore total body exhaust suits ( TBE-suit ) , or conventional theatre clothing ( C-clothing ) at alternate operations . Nearly half of the patients in each group were given prophylactic antibiotics . Both the mean and median values of airborne bacteria in the operating theatre were significantly lower during operations with TBE-suits than with conventional theatre clothing . The lowest number , 4.0 cfu/m3 , was found at the site of the operation wound . Cultures from adhesive drapes showed growth in 46 per cent of the C-group and in 43 per cent of the TBE-group sample s. Wound washouts showed growth in 43 per cent of the C-group and in 10 per cent of the TBE-group sample s. Staphylococcus epidermidis was the most frequently isolated bacteria both from adhesive drapes and from wound washouts . The rate of superficial infections was slightly higher when C-clothing was used . Deep infections were found in one patient in the TBE-group and in two patients in the C-group . None of the infected patients had received prophylactic antibiotics A technique for assessing the immediate and prolonged  efficacy  of  surgical scrubs and alcoholic h and rubs  is described . A mean baseline count is obtained from all volunteers and logarithmic reductions in resident skin flora immediately after one or more applications , and after wearing gloves for 3 h , are measured . Loose-fitting surgical gloves are used for sampling resident flora . Preparations were applied using a st and ard technique for 2 min , apart from one test with 70 % isopropanol ( IPA ) in which the application time was 30 s. Two studies are described , one of which compared four chlorhexidine scrubs , and the second 70 % IPA , 7.5 % povidone-iodine scrub , 2 % triclosan cleanser and unmedicated bar soap . In spite of their constituent similarity , the four chlorhexidine scrubs varied considerably in efficacy and user acceptability . A 2 min application of 70 % IPA was the most effective treatment , and gave log10 reductions of 1.65 for immediate and 1.58 for prolonged effect . This was marginally more effective than a 30 s application , but the difference was not significant . ' Hibiscrub ' was the most effective aqueous formulation and gave reductions of 1.01 for immediate effect and 1.16 for prolonged effect . The test described could be used by reference centres and manufacturers to assess the efficacy of new and existing surgical h and disinfection formulations The efficacy of 14 h and washing or disinfectant preparations was compared in laboratory tests on staff volunteers . The test organism , Escherichia coli , was applied to the fingertips and log reductions ( LR ) were measured following treatment with the test agent and control preparations ( 70 % isopropanol and non-medicated bar soap ) . Alcoholic preparations , particularly n-propanol and isopropanol were the most effective showing LRs of 3.1 - 3.8 . Chlorhexidine ( LR 2.9 ) and povidone-iodine detergent preparations were significantly more effective than non-medicated soap ( LR 2.1 ) , but triclosan products were not . In addition the residual effect of several of these formulations was assessed after 10 applications by comparing the survival of E. coli on the fingertips over a 32-min period . This number of h and washes compares favourably with those recorded during an 8 h nursing shift . Chlorhexidine-detergent consistently showed the best residual activity . Alcoholic formulations showed little or no residual effect . The survival studies show that on the whole gram-positive organisms ( Staphylococcus aureus and C and ida albicans ) survive better on the skin than Gram-negative bacilli ( GNB ) . However , it would seem that GNB which are considered to be residents ( Acinetobacter calcoaceticus and Enterobacter spp . ) survive much better than many other GNB ( Pseudomonas aeruginosa , E. coli and Proteus vulgaris ) . The 
    Output:
    
Evidence from 4 studies suggests that chlorhexidine gluconate based aqueous scrubs are more effective than povidone iodine based aqueous scrubs in terms of the numbers of CFUs on the h and s. There is limited evidence regarding the effects on CFUs numbers of different scrub duration s. There is no evidence regarding the effect of equipment such as brushes and sponges