Bacterial regrowth following various surgical scrubbing methods in prolonged surgeries

Abstract

Bacterial regrowth beneath surgical gloves during prolonged operations remains a critical challenge in infection prevention. While surgical scrubbing methods effectively reduce microbial load at the start of procedures, the persistence and reappearance of skin flora over time can compromise the sterile field, especially during glove changes or unnoticed micro-perforations. The type of antiseptic agent, its residual activity, and the duration of the procedure influence how rapidly bacteria recolonize the hands. Alcohol-based hand rubs offer rapid initial reduction but may lack prolonged antimicrobial activity, while chlorhexidine and povidone-iodine formulations exhibit longer-lasting effects due to their ability to bind to the skin. Environmental conditions under gloves such as moisture, heat, and friction further contribute to microbial resurgence. The skin's natural characteristics, including the presence of deep-seated resident flora and the integrity of the skin barrier, also shape the rate of regrowth. Studies indicate that even with strict adherence to antisepsis protocols, bacterial levels under gloves can approach pre-scrub levels after several hours of wear. This risk is heightened in long surgeries where intraoperative interventions are limited. Infection control strategies must evolve to include time-based glove changes, selection of antiseptics with sustained activity, and intraoperative hygiene protocols when necessary. Institutional policies often overlook regrowth dynamics, focusing solely on preoperative practices. A more dynamic model that accounts for intraoperative changes and incorporates evidence-based antiseptic selection can reduce the risk of surgical site contamination. Understanding the multifactorial nature of bacterial regrowth and addressing it through procedural, environmental, and product-based adjustments is essential for maintaining surgical sterility in extended operations.