Glove Change Research Articles

Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review.

Microbiological contamination of surgical gloves occurs during surgery, which may warrant glove change during orthopaedic surgeries. However, no systematic review of this topic has previously been published. Therefore, this review evaluated whether changing gloves during arthroplasty surgeries reduces the risk of surgical site infection/prosthetic joint infection (SSI/PJI) and the optimal frequency of glove change. Search terms such as surgical gloves, surgical site infections, prosthesis-related infections, arthroplasty were used, including Medical Subject Headings terms. Of the 89 articles screened, 12 articles were included for qualitative synthesis. No studies measured the direct effect of glove change on PJI rate. Therefore, microbiological contamination and perforation rate of gloves were used as surrogate outcomes. Eight studies evaluated microbiological contamination of surgical gloves, with rates ranging from 3.4 to 30%. Five contamination studies recommended changing gloves after draping and before handling implants. One randomized controlled trial also recommended changing gloves at least once an hour regardless of surgical stages. Five studies recommended changing gloves to prevent perforation, with recommendations ranging from 20 to 90 min. Furthermore, one study advised change of gloves after resection of bone and before implantation. As microbiological contamination rates of gloves increase with duration of surgery, glove changes are recommended at least once per hour. Furthermore, gloves should be changed after draping, before handling implants and if visible perforation is seen to reduce contamination. Due to the lack of studies with SSI/PJI as primary outcomes, we cannot draw a definitive conclusion regarding the effectiveness of changing gloves in reducing the risk of SSI/PJI in arthroplasty.

Analysis of a ten step protocol to decrease postoperative spinal wound infections.

AIMTo define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODSIn response to unexplained increased infection rates at our institution following spine surgery, a ten-step protocol was implemented: (1) preoperative glycemic management based on hemoglobin A1c (HbA1c); (2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths; (3) limit operating room traffic; (4) cut the number of personnel in the room to the minimum required; (5) absolutely no flash sterilization of equipment; (6) double-gloving with frequent changing of outer gloves; (7) local application of vancomycin powder; (8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients; (9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and (10) use of DuraPrep skin preparation at the end of a case before skin closure. Through an extensive literature review, the current data available for each of the ten steps was evaluated.RESULTSUse of vancomycin powder in surgical wounds, routine irrigation of surgical site, and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported, but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperatively is not supported by the literature. Intraoperative use of DuraPrep prior to skin closure is not yet explored.CONCLUSIONThe ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection, instituting a standard protocol for all the described steps appears beneficial.

Revision surgery in acute periprosthetic knee joint infections

Reduction of pathogens in the knee joint by removal of infected periprosthetic soft tissue, irrigation and modular implant exchange of the total knee arthroplasty (TKA) to eliminate the infection and long-term preservation of the TKA. Early infection of TKA (<4weeks postoperatively); acute hematogenous TKA infection (symptom duration <3weeks). Delayed (>4weeks postoperatively) or chronic TKA infection; TKA loosening; difficult-to-treat pathogens; critical soft tissue with draining sinus tract. Excision of the wound or old surgical scar (=primary approach to the knee joint). Preparation of subcutaneous tissue. Opening the joint capsule. Removal of the old suture in tissue layers. Five tissue samples taken for microbiological and 1tissue sample for histopathological examination using an unused instrument from the knee joint. Debridement of the upper recesses with complete synovectomy. Partial resection of Hoffa's fat body. Eversion of the patella. Resection of peripatellar soft tissue and infection membranes from the medial and lateral part of the capsule. Removal of the polyethylene inlay. Débridement of the posterior joint capsule with protection of vessels and nerve. Systematic removal of avital and infected periprosthetic tissue. Checking for correct fit of the femoral and tibial part of TKA. Antiseptic rinsing of the joint cavity with mechanical cleaning of the TKA. Extensive irrigation of the joint cavity by jet lavage (3-5l saline solution). Glove change of the surgical team and new operation coverage. Inserting new polyethylene. Layerwise wound closure. Removal of redon drain on postoperative day2. Physiotherapy and CPM. Removal of cutaneous suture about 2weeks postoperatively. Antibiotic treatment for 12weeks postoperatively (2weeks intravenous, 10weeks per oral). Checking of inflammatory markers. Using correct indications and therapy, up to 90% of patients with acute periprosthetic TKA infection can be successfully treated with infection elimination and TKA preservation.

An Analysis of Skin Prick Tests to Latex and Patch Tests to Rubber Additives and other Causative Factors among Dental Professionals and Students with Contact Dermatoses

Background: Dental workers often experience unwanted allergic and nonallergic skin reactions resulting in different contact dermatoses (e.g., contact urticaria, irritant and allergic contact dermatitis) that are often attributed to rubber gloves. Objective: To examine allergic and nonallergic contact dermatoses by different methods amongst dental professionals and dental students, more specifically, reactions to natural rubber latex (NRL), rubber additives, and other causative factors. Methods: In this cross-sectional study we surveyed a total of 444 subjects (dentists, assistants, technicians, and students); 200 agreed to be tested to latex by the standard skin prick test (SPT) and prick-by-prick test, of whom 107 were patch tested to rubber additives (mercapto mix, thiuram mix, carba mix, and N-isopropyl-N-phenyl-4-phenylenediamine [IPPD]). Results: Skin lesions appeared significantly more frequently with longer work experience (p = 0.002; V = 0.181), frequent glove changes (p < 0.001; V = 0.310), and hand washing (p < 0.001; V = 0.263), and in subjects with a history of allergies (atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and others) (p < 0.001; V = 0.183). Positive SPTs to latex occurred in 14/200 subjects (7%), of whom 5/14 subjects (35.7%) were also positive in prick-by-prick tests. Patch tests were positive in 5/104 subjects (4.8%) (mercapto mix 1%, thiuram mix 1.9%, and carba mix 1.9%). Conclusion: Only a small number of our subjects were allergic to latex (7%) or rubber additives (4.8%). Thus, self-reported contact dermatoses (during NRL product use) in dental professionals and students are not commonly caused by allergies to latex and rubber additives, as is often assumed, but by other factors.

An Incision Closure Bundle for Colorectal Surgery: 2.0 www.aornjournal.org/content/cme.

Surgical site infections (SSIs) are among the most common and expensive of all health care–associated infections, and as many as 50% are considered preventable. Surgical care bundles, which involve a small set of reliably performed evidence-based practices, may effectively reduce SSI rates. However, closure of the surgical incision is one aspect of surgical care that is not well described in current SSI prevention bundles; this presents an opportunity for perioperative professionals to improve care by identifying and implementing evidence-based incision closure practices for high-risk procedures (eg, colorectal surgery). We propose and review the evidence supporting a colorectal incision closure bundle composed of a glove and sterile instrument set change, irrigation with 0.05% chlorhexidine solution, use of triclosan-coated sutures, removal of surgical drapes after applying postoperative dressings, use of topical skin adhesive or an antiseptic dressing, and distribution of comprehensive postoperative patient instructions.

National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections.

Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines. A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers. In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes. To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

Potential transmission routes of Dichelobacter nodosus

Footrot caused by Dichelobacter nodosus is a highly contagious bacterial disease affecting the claw of sheep and the main cause of lameness in these animals. It is not only an economic burden but also a serious animal welfare issue. More information about the transmission of D. nodosus is needed for effective footrot control programs. We therefore determined the prevalence of D. nodosus in sheep presented at shows and markets where commingling of animals occurs. Furthermore, possible transmission vectors during foot trimming were investigated and trimming knife decontamination protocols evaluated. Sheep at six markets and four shows were sampled and tested for the presence of D. nodosus by real-time PCR. Different vectors, such as trimming knives were tested by real-time PCR and for viable D. nodosus by culture. The prevalence of virulent D. nodosus in sheep presented at shows and markets ranged from 1.7% to 100%. Regions with an ongoing control program showed significantly lower prevalence. After trimming, positive real-time PCR and culture results were obtained from the knives, the hands of the claw trimmers as well as removed claw horn material whereas boots were only positive by real-time PCR. In conclusion, markets and shows pose a risk for transmission of D. nodosus. The risk of transmission is particularly high during claw trimming and recommended measures to limit this risk include wiping the knife with a disinfection towel, wearing and changing gloves after every sheep, as well as proper disposal of trimmed and infectious horn.

Efficacy of chlorine as a disinfecting agent on produce-harvesting gloves contaminated with Escherichia coli O157:H7 or Salmonella

To minimize pathogen transfer from field worker's hands during hand harvest of ready-to-eat produce, gloves are often worn. However, fields are not sterile environments and transfer of pathogens to the gloves could occur throughout the day if the gloves come into contact with contaminated materials such as soil and produce. Given that changing gloves repeatedly is a costly solution, the merits to disinfecting gloves with chlorine solutions in the field were explored with efficacy (percent prevalence of gloves that were negative or positive for the pathogen) evaluated by subjecting the treated gloves to enrichment culture. Both the glove's level of pathogen contamination and chlorine exposure concentration affected the efficacy (P = 0.0000 and 0.0025, respectively). For example, complete elimination of Salmonella inoculated at ca. 3 log CFU/nitrile glove piece occurred at 50 ppm chlorine. However, when glove pieces had initial levels of ca. 6 log CFU E. coli O157:H7, exposure to 175 ppm did not completely eliminate the pathogen. Moreover, the likelihood of E. coli O157:H7 and Salmonella surviving were 32.0 and 4.4 times greater when the pathogen had been cultured on solid agar versus in liquid broth (95% CIs: 10.9 to 94.3 [P = 0.0000] and 2.1 to 8.9 [P = 0.0000], respectively). Another observation of this study was that dirty gloves exposed to both soil and lettuce sap were 11.6 times more likely than clean gloves to have the pathogen present after chlorine treatment (95% CI: 3.4 to 39.2, P = 0.0000). Monitoring these wash solutions for active chlorine revealed that no more than a 50% drop occurred suggesting that sufficient active chlorine remained for inactivating suspended pathogens and preventing cross-contamination. This data together with the observation that washing gloves in a second fresh batch of chlorine had little effect on the number of gloves absent of contamination would suggest that soil and sap is likely serving to protect the pathogen from exposure to the chlorine disinfectant. In an attempt to remove these materials, scrubbing during the chlorine immersion did not affect the efficacy of contaminated nitrile gloves (P = 0.1054) and actually led to a decreased efficacy of the chlorine treatment on contaminated Canners gloves (P = 0.0308). Although Salmonella and E. coli O157:H7 residing on nitrile and Canners gloves that survived exposure to 200 ppm chlorine could be transferred to produce handled by the treated gloves, frequent washing of gloves with chlorine could be an effective risk reduction strategy as they would reduce the numbers of gloves that may be contaminated with low levels of pathogens.

Simple Operating Room Bundle Reduces Superficial Surgical Site Infections After Major Urologic Surgery

To reduce our superficial surgical site infection rate following major urologic surgery by implementing a simple operating room bundle. A simple operating room bundle was applied to all major urologic cases (cystectomy, nephrectomy, and prostatectomy) at a single tertiary referral center. The bundle included allowing skin prep to dry appropriately, changing gloves before skin closure, irrigating the wound before skin closure, and using a new separate sterile closing instrument set for skin closure. Alcohol-based preps were also introduced hospital-wide 3 months into the study period. The SSI rate was obtained from the National Surgical Quality Improvement Program (NSQIP) database. The surgical site infection (SSI) rate was assessed after a 14-month study period for a total of 510 cases. Before instituting the alcohol-based prep, but after the bundle was implemented, 138 cases were analyzed over a 3-month period with an SSI rate of 0%. For the remaining 11 months with both the alcohol-based prep and the infection prevention bundle in place, the infection rate was 1.37% (7/510) as compared with 3.57% (22/615) for the 12-month period before bundle introduction, a statistically significant reduction (P = .023). The SSI rate after major urologic surgery at 1 center was reduced after the introduction of a simple, fast, low-cost, and easily reproducible bundle into the operating room. The use of this bundle reduces SSI, which is critical for the patient and the physician in this era of public reporting and reimbursement based on outcomes.

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

Comparison of Two Glove-Sampling Methods to Discriminate Between Study Arms of a Hand Hygiene and Glove-Use Study.

BackgroundOur group will be assessing in a randomized trial whether the use of alcohol-based hand rub (ABHR) to clean non-sterile gloved hands (instead of performing hand hygiene (HH) and changing gloves) for the WHO 5 Moments of HH during a single patient encounter is an efficient and effective practice. In preparation for this future study and in the absence of a well-established gold standard, this pilot study aimed to identify an effective glove-sampling method with the ability to detect a difference between our two study arms.MethodsHealthcare workers (HCWs) entering Contact Precaution rooms were recruited and randomized into the intervention arm (HCWs directed to clean gloves with ABHR at each opportunity) or the usual care arm (HCWs behavior is silently recorded at each opportunity). In both arms, HCWs individual gloved hands were randomized then sampled, using both sponge stick and direct imprint methodology (Fig 1–2). The outcome of interest was total bacterial colony forming units (CFUs). A Wilcoxon rank-sum test was performed to compare the median distribution of CFUs recovered by each sampling method between study arms. Sampled gloved hands were also categorized by level of bacterial detection (0 CFUs vs. more than 0 CFUs). For each sampling method, the proportional difference between categories was analyzed using a Fisher exact test.Results42 unique HCWs participated in the study (25 intervention, 17 usual care). For each HCW interaction an average of 3 HH moments were recorded. Using the direct imprint technique, the median CFUs in the intervention arm compared with the usual care arm were 2 vs. 31, P < 0.01. Using the sponge stick technique, the median CFUs were 1 vs. 6, P = 0.25. (Fig 3). Using the agar method, bacteria was detected on 16/25 (64%) of gloved hands in the intervention arm compared with 17/17 (100%) in the usual care arm (P < 0.05). Using the sponge-stick method, bacteria was detected 16/25 (64%) of gloved hands in the intervention arm and on 15/17 (88%) in the usual care arm (P = 0.15).ConclusionThe direct imprint method is an effective method to discriminate between our intervention arms. In addition, this method is more affordable and less work-intensive in the lab and as a sampling method than the sponge-stick method.Figure 1.Figure 2.Figure 3.Disclosures A. D. Harris, CDC Epicenter Program: Grant Investigator, Grant recipient; K. A. Thom, AHRQ: Grant Investigator, Grant recipient

Evaluation of surgical glove integrity and factors associated with glove defect

Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ2 test was used with a significance threshold of 5%. A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015). This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.

Exploring inappropriate certified nursing assistant glove use in long-term care

Certified Nursing Assistants (CNAs) frequently wear gloves when they care for patients in standard precautions. If CNAs use gloves inappropriately, they may spread pathogens to patients and the environment, potentially leading to health care-associated infections (HAIs). Using a descriptive structured observational design, we examined the degree of inappropriate health care personnel glove use in a random sample of 74 CNAs performing toileting and perineal care at 1 long-term care facility. During the 74 patient care events, CNAs wore gloves for 80.2% (1,774/2,213) of the touch points, failing to change gloves at 66.4% (225/339) of glove change points. CNAs changed gloves a median of 2.0 times per patient care event. A median of 1.0 change occurred at a change point. CNAs failed to change their gloves at a glove change point a median of 2.5 times per patient care event. Most (61/74; 82.4%) patient care events had >1 contaminated touch point. Over 44% (782/1,774) of the gloved touch points were defined as contaminated for a median of 8.0 contaminated glove touch points per patient care event. All contaminated touches were with gloved hands (P <.001). Inappropriate glove use was frequently observed in this study. Contaminated gloves may be a significant cause of cross-contamination of pathogens in health care environments. Future research studies should evaluate strategies to improve glove use to reduce HAIs.

Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods

BackgroundNon-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred.MethodsMixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes.ResultsHand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay.ConclusionsThe adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines.

Dead mouse hopping: Tyzzer’s disease in spinifex hopping-mice (Notomys alexis)

Tyzzer’s disease is caused by Clostridium piliformes and affects a wide range of domestic and wildlife species. Non-descript signs, if any, and a short incubation period make Tyzzer’s disease difficult to diagnose and treat before death occurs. Here we describe an unexpected outbreak of Tyzzer’s disease in a colony of native Australian spinifex hopping-mice (Notomys alexis).In this study captive hopping-mice were used in a nutrition trial (n=11), and others were housed in close proximity (n=4). During the nutrition trial, two hopping-mice exhibited signs of lethargy and diarrhoea, and were removed from the trial but died soon after. Other hopping-mice exhibited limited clinical signs of ill-health, prior to their death. In total four animals were found dead, and another seven were euthanised, to prevent a potential disease outbreak. Tyzzer’s disease was confirmed post-mortem using histopathology silver stain to detect the bacilli-shaped bacteria (C. piliformes) in liver tissue of two hopping-mice. After Tyzzer’s disease was confirmed enhanced infection control measures were implemented. Enhanced control measures included the use of metal containers for food and water, sick animals were fed and cleaned last, 5% sodium hypochlorite was used as the cleaning agent, stricter hand washing protocols and a change of gloves between feeding animals, and strict limits on persons entering the facility.Control measures for this disease should include euthanasia of any animals suspected to be infected, complete disinfection of all enclosures and associated equipment using sodium hypochlorite. Molecular methods could be employed to ensure complete removal of bacterial spores prior to new animals being moved into enclosures where affected animals were housed. Tyzzer’s disease is a fast spreading disease which can cause detrimental effects to captive colonies and their environment. Captive colonies subjected to stress are at risk of Tyzzer’s disease. Appropriate quarantine procedures, close montoring and quick action in response to signs of illness will ensure Tyzzer’s disease outbreaks do not occur.

Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

Qual o intervalo de tempo sugerido para a troca de luvas cirúrgicas? Uma revisão integrativa

A troca das luvas cirúrgicas durante o procedimento constitui uma importante medida para a manutenção da sua integridade e prevenção da infecção do sítio cirúrgico, entretanto existe pouco consenso quanto ao tempo para essas trocas. Objetivou-se identificar, analisar e sintetizar os achados disponíveis na literatura sobre o intervalo de tempo sugerido para a troca das luvas cirúrgicas durante as cirurgias com intuito de manter a sua integridade. Tratou-se de uma revisão integrativa de estudos publicados entre 2003 e 2016. Foram selecionados 19 artigos que abordaram a relação integridade da luva cirúrgica e seu tempo de uso. Os estudos apontaram a relação direta entre tempo da cirurgia e aumento do percentual de perfuração das luvas. Com base na análise realizada, sugere-se a troca em menos de 120 minutos para cirurgias do aparelho digestivo, ginecológicas e torácicas. A elaboração de protocolos relativos às diferentes especialidades cirúrgicas deve ser considerada.

Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone.

A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD.

Effects of Changing Gloves, Forceps and Normal Saline during Colon Cancer Surgery in Korea

Objectives: This study was conducted to investigate the effects of exchanging surgical gloves, forceps and the normal saline during surgeries in lowering the level of the contamination. Methods/Statistical Analysis: 92 colon cancer surgeries were randomly allotted into one of four groups. Three different methods were tried: changing gloves in the experimental Group 1, changing forceps in the Experimental Group 2, changing normal saline used for operation in the Experimental Group 3 and no changing any materials with the standard operation method in the control group. After each operation finished, samples were taken and cultured for obtaining the contamination rate. Findings: Study results were as follow: the level of contamination in the experimental group 1 with exchanging gloves after extraction of the lesions of colon was significantly lower than that of the Control Group-Gloves. The method of exchanging the normal saline also demonstrated the effectiveness in lowering the level of contamination of the normal saline. The effectiveness of exchanging forceps was proved as the level of contamination in the experimental group 3 used the method of exchanging the forceps was significantly lower than the control group. Applications: These findings can be utilized as the evidenced foundation to establish the theoretical guidelines or the standards of practice for the surgical instruments to control the surgical site infection effectively.

Prospective study of avian influenza H9 infection in commercial poultry farms of Punjab Province and Islamabad Capital Territory, Pakistan.

A prospective study was conducted from November 2013 to February 2014 to estimate the spatial clustering; cumulative incidence and risk factors associated with avian influenza (AI) subtype H9 infection on commercial poultry farms of Pakistan. A total of 400 farms were enrolled and followed during the study period. Among these, 109 farms submitted samples suspected for AI to the laboratory, and only 47 farms were confirmed positive by hemagglutinin inhibition (HI) test. Data was collected from these 109 farms about their demography, management, and biosecurity practices. The cumulative incidence of H9N2 was 11.75 % (95 % confidence interval (CI) 8.76–15.23). The highest number of cases (40.42 %) was reported in January. One most likely cluster (p = 0.009, radius = 4.61 km) occurred in the Kasur district. Multivariable logistic regression analyses showed that the presence of wild birds on the farms (odds ratio (OR) = 16.18; 95 % CI 3.94–66.45) was independently associated with H9N2 infection. Cleaning of cages before delivery on farm (OR = 0.16; 95 % CI = 0.06–0.47), presence of a footbath at the entrance of farm (OR = 0.24; 95 % CI 0.08–0.79), and changing of gloves (OR = 0.33; 95 % CI 0.11–0.99) were protective factors against H9N2 infection. Reducing the exposure to risk factors and adapting biosecurity measures may reduce the risk of AI H9N2 infection on commercial poultry farms in Pakistan.