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ContextSurgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce.ObjectiveTo compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice.DesignRandomized equivalence trial.SettingSix surgical services from teaching and nonteaching hospitals in France.PatientsA total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001.InterventionsSurgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic …