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Decrease Your Operating Room Costs by Switching to Alcohol-Based Scrubbing

By Christopher Cheney  
   February 27, 2020

At Bascom Palmer Eye Institute, the annual cost savings from switching to alcohol-based scrubbing is estimated at $281,000 per operating room.

Switching from water-based surgical scrubbing to an alcohol-based method generates substantial cost savings and environmental benefits, new research shows.

Preoperative hand scrubbing has been an established practice since the 1800s. The safety and efficacy of alcohol-based scrubbing is well-established, including an endorsement published in 2014 by the American Hospital Association, the Infectious Diseases Society of America, The Joint Commission, and the Society for Health and Epidemiology of America.

The new research, which was published today by JAMA Ophthalmology, examines the potential for cost savings from alcohol-based scrubbing at the University of Miami Miller School of Medicine's Bascom Palmer Eye Institute (BPEI).

"Waterless hand antisepsis is now well established as equal to or superior to traditional running-water scrubs in safety and efficacy. Our study suggests that the actual cost saving in water alone is eclipsed by savings in supplies as well as staff and facilities resources," the research co-authors wrote.

Research data

The JAMA Ophthalmology study, which was conducted in 2019, developed several key data points.

  • Eliminating water-based scrubbing would result in saving $277 in water and sewer cost per operating room per year.
  • For supply costs, savings from switching to alcohol-based surgical scrubbing range from $548 to $1,360 per operating room per year.
  • When calculating personnel costs associated with standard 5-minute and 6-minute scrubbing with soap and water, alcohol-based scrubbing would save between $280,000 and $348,000 per operating room per year. The World Health Organization's recommendation for waterless scrubbing is 40-70 seconds.
  • At BPEI, which has 10 ORs, the annual savings from lower personnel costs associated with alcohol-based scrubbing would be $2.8 million to $3.4 million.
  • If every surgical procedure at BPEI was performed with water-based scrubbing, about 163,000 gallons of water would be consumed annually.

From 2014 to 2018, BPEI performed an average of nearly 13,000 surgical procedures annually, with an average of three scrubbed staff members in the OR per procedure.

"A conversion from traditional water-based preoperative hand antisepsis to waterless, alcohol-based techniques has the potential to save a modern U.S. healthcare institution $281,323 per OR per year with a surgical volume similar to that of BPEI. Although there are environmental imperatives for saving water, by far the largest component of actual cost savings is attributable to the lower costs of supplies and the savings in chargeable OR time associated with waterless scrub techniques," the study co-authors wrote.

Environmental impact

Alcohol-based scrubbing contributes to water conservation, the co-authors wrote. "Access to clean water is a large obstacle to improving health outcomes in impoverished regions. Conserving water in the OR will help to alleviate the burden of healthcare on public water stores."

Waterless scrubbing also helps protect the environment, they wrote.

"Antibacterial agents used in hand soaps immediately enter the sewer system and pass through a sewage treatment plant to enter rivers and coastal waters. In doing so, they create a toxic environment for aquatic life, which is of growing concern worldwide. Alcohol-based scrubs, on the other hand, do not enter the ecosystem, except to the extent that residues are later washed off the skin during casual handwashing, bathing, or swimming."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


A body of research has established the safety and efficacy of alcohol-based scrubbing.

Alcohol-based scrubbing takes less time than water-based scrubbing, which is the biggest cost-saving driver because of the impact on personnel costs.

If every surgical procedure at Bascom Palmer Eye Institute was performed with water-based scrubbing, about 163,000 gallons of water would be consumed annually.

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