Study: Clean paper towels match or exceed sterile options in surgical hand antisepsis

Editor's Note

A study published July 9 in the American Journal of Infection Control found that clean paper towels are as effective—and in some cases more efficient—than sterile alternatives for surgical hand antisepsis. The results support their use as a cost-saving and safe alternative to sterile hand-drying products in surgical settings, provided contamination is minimized through proper dispenser design, handling, and staff training.

The controlled study was conducted in March 2024 at the Second Affiliated Hospital of Chongqing Medical University and included 50 trained medical volunteers. Participants performed surgical hand antisepsis using three different hand-drying products—clean paper towels, sterile cloth towels, and sterile paper towels—over three days. Bacterial counts on the hand surface were measured both after drying and again after application of a rinse-free disinfectant. The study also calculated the cost of each drying method per surgery.

After hand drying, median bacterial colony counts were:

• Clean paper towels: 0.01 (0.00, 0.18) CFU/cm²
• Sterile cloth towels: 0.30 (0.05, 0.77) CFU/cm²
• Sterile paper towels: 0.01 (0.00, 0.08) CFU/cm²

The differences in colony counts between sterile cloth towels and the two paper towel groups were statistically significant (p < 0.001), while the difference between the clean and sterile paper towels was not significant, researchers wrote. After application of rinse-free disinfectant, all three methods yielded 0.00 CFU/cm², with no statistically significant differences between them, and all met the ≤5 CFU/cm² standard for surgical hand antisepsis. Bacterial strain detection after hand drying was highest for sterile cloth towels (78%), followed by sterile paper towels (60%) and clean paper towels (56%). The difference between clean paper towels and sterile cloth towels was statistically significant (p = 0.043).

The bacteria identified were primarily Staphylococcus epidermidis and Staphylococcus warneri, species considered part of normal skin flora. No pathogens commonly associated with surgical site infections—such as Staphylococcus aureus or Pseudomonas aeruginosa—were detected.

As for the economics of the different options, costs were 0.2 RMB per surgery for clean paper towels, 5.7 RMB for sterile cloth towels, and 8.2 RMB for sterile paper towels. Clean paper towels: 0.20 RMB per surgery. Authors noted that the fiber properties of cloth towels may deteriorate with repeated cleaning and sterilization, leading to higher bacterial retention. Clean paper towels, in contrast, were found to be easy to manage, hygienically stable within 24 hours of dispenser opening, and economically advantageous.