Abstract
BackgroundTo prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.MethodsThis pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher’s exact test.ResultsOperating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.ConclusionsThere were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.Trial registrationTrial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov (NCT02359708). 01/27/2015.
Highlights
To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves
There were no significant differences between the groups except for the duration of time wearing the surgical gloves (Table 1)
After preoperative hand disinfection the operating room (OR) nurses had higher bacterial growth at the palm and the finger sites compared to the non-HCWs, p = 0.044 and p = 0.019, but no difference regarding the nail sites p = 0.434
Summary
To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery. Prevention of surgical site infections (SSIs) is important to avoid patient suffering and death and to lower the cost of health care providers [1]. There are different strategies to reduce SSIs in an operating room (OR), such as the use of basic hygiene procedures, controlled OR ventilation, normothermia, surgical techniques, sterile materials, prophylactic antibiotics, and preoperative skin disinfection [10]. A preventive method is to perform preoperative hand disinfection prior to wearing surgical gloves and to double glove for easy detection of puncture in the outer glove [11]
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