Concentric Circles Painting Versus Back-and-Forth Scrubbing: A Comparison Between Two Skin Disinfection Techniques

Abstract

Traditionally, skin disinfection is performed in concentric circles. In recent years, there are studies which suggest that back-and-forth scrubbing could be a better technique. However, there is insufficient evidence to demonstrate which disinfection technique is better in reducing microbial load prior to invasive procedures. This study aims to compare the effectiveness of concentric circles painting and back-and-forth scrubbing skin disinfection techniques in reducing microorganisms’ Adenosine Triphosphate (ATP) measured in Reactive Light Units (RLU). 293 participants were recruited in the quasi-experimental study. Before disinfection, the participants’ bilateral antecubital fossa was swabbed using the 3M clean-trace surface ATP test swab (3M Clean-Trace) to detect microorganisms’ ATP measured in RLU. Subsequently, on one antecubital fossa, using an assigned cleansing agent (0.9% normal saline or 70% isopropyl alcohol), it was disinfected by concentric circles painting. On the opposing antecubital fossa, using the same cleansing agent, it was disinfected by back-and-forth scrubbing. Thereafter, the participants’ bilateral antecubital fossa was swabbed using the 3M Clean-Trace to determine the amount of ATP present post-disinfection. The pre and post disinfection median RLU and median difference in RLU between the disinfection techniques were compared. Based on 146 participants after removal of outlying data, both concentric circles painting and back-and-forth scrubbing disinfection techniques significantly reduced microorganisms’ ATP measured in RLU (p<0.05). However, between the two disinfection techniques, no significant median difference in RLU was observed (p>0.05). Both concentric circles painting and back-and-forth scrubbing disinfection techniques reduced microorganisms’ ATP on skin surfaces. However, no significant difference was observed between the two disinfection techniques, which could suggest that both are equally effective for skin disinfection.