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The Use of UV Light to Compare Two Methods of Pre-Operative Sterilization For the Hand
Daniel Allan Seigerman, MD; Michael Rivlin, MD; Fred Liss, MD; Pedro Beredjiklian, MD
Rothman Institute/ Jefferson Medical College, Philadelphia, PA

Introduction: The purpose of our study was to determine the effectiveness of two popular pre-surgical preparatory application processes for surgical sterility. A commercially available “prep-stick” and the manual use of two 4x4 sponges were compared. Our group hypothesized that the use of two sterile 4x4 sponges would leave fewer missed spots when compared to a commercially available “prep-stick” for surgical sterilization of the hand and wrist.
Materials & Methods: Two orthopaedic surgeons simulated the standard pre-surgical prep protocol on forty upper extremities distal to the wrist crease of healthy volunteer subjects. Each surgeon prepared ten arms with a commercially available “prep-stick,” and ten arms with two sterile gauze pads. The prep-solution used in all cases was a commercially available solution that enhances under exposure to a UV-A light. Spots on the skin that did not illuminate under the UV-A light were identified as un-prepped sites. Prior to all simulated sterilizations, each hand was visualized under the UV-A light to ensure no illumination as an internal control. The location of all missed skin spots were identified and noted.
Results: The average number of missed spots when using the “prep-stick” applicator was 2.25 (0-5, std dev 1.37), and when using two sterile 4x4 gauze sponges was 0.5 (0-4, std. dev. 0.97). This difference was found to be statistically significant with a p-value <0.0001 when using a paired, two-tailed t-test. Among the hands prepped with the “prep-stick,” there were 45 missed spots. When using the two gauze sponges, only 10 missed spots were identified. The volar and dorsal aspects of the fingers, distal to the proximal interphalangeal (PIP) joint were the most common sites for un-prepped skin with both sterilization methods; 29/45 for the prep-stick, and 9/10 for the gauze sponges.
Conclusions: Our group advocates for the use of two sterile 4x4 gauze pads immersed in sterilization solution, instead of commercially available “prep-sticks.” With either sterilization method, the most common un-prepped area was the volar and dorsal finger distal to the PIP joint.

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