Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost | Ophthalmology | JAMA Ophthalmology | JAMA Network
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    Original Investigation
    February 27, 2020

    Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost

    Author Affiliations
    • 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
    • 2Medical Student, University of Miami Miller School of Medicine, Miami, Florida
    • 3Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Baltimore, Maryland
    JAMA Ophthalmol. 2020;138(4):382-386. doi:10.1001/jamaophthalmol.2020.0048
    Key Points

    Question  Are potential financial savings achievable by exclusive use of alcohol-based hand scrub for surgical preparation at a large ophthalmic surgical hospital?

    Findings  In this economic evaluation conducted at a surgical eye hospital, water savings amounted to 61 631 L per operating room per year after sole use of alcohol-based hand scrub was initiated. The savings from adopting waterless scrub technique could be between $280 000 and $348 000 per operating room per year.

    Meaning  These data suggest that eliminating water from presurgical hand preparation could save modern health care facilities millions of dollars per year and potentially conserve valuable water resources, although potential savings regarding the water used to prepare and distribute alcohol-based hand scrubs for surgical preparation were not calculated.


    Importance  Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions.

    Objective  To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation.

    Design, Setting, and Participants  A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019.

    Main Outcomes and Measures  The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year.

    Results  Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year.

    Conclusions and Relevance  Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.