Preoperative Hand Disinfection Research Articles

Scrub sink contamination and transmission to operating room personnel.

Multiple studies have established the contamination of hospital sinks and transmission to hospital personnel. Few studies have assessed the contamination and transmission of microorganisms from the faucets of operating bay scrub sinks to operating room (OR) personnel, a potential route of infection for patients. This study aimed to investigate if there was pathogenic contamination of scrub sinks and possible transmission of those pathogens to the hands of OR personnel after preoperative hand disinfection. Swabs were taken from the hands of 50 OR personnel and from the faucets of 24 scrubs sinks at two different hospital sites, and were cultured. Hands were swabbed after completing a surgical hand scrub. Results were reported in colony-forming units per millilitre. There was significant scrub sink contamination with primarily Gram-negative organisms, such as Delftia acidovorans and Sphingomonas paucimobilis. There was no overlap in bacterial species between the cultures from hands and scrub sinks. Cultures from the sinks and the hands of the OR personnel from one site had significantly higher bacterial growth compared with the other site (p < 0.0001 and p < 0.0118, respectively). The data showed significant contamination on the faucets of operating bay scrub sinks. However, there was no observed transmission of pathogens from the scrub sinks to OR personnel, shown by the lack of overlap in bacterial species. Routine hygienic maintenance of scrub sinks is recommended.

Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study

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.

Preoperative Hand Decontamination in Ophthalmic Surgery: A Comparison of the Removal of Bacteria from Surgeons’ Hands by Routine Antimicrobial Scrub versus an Alcoholic Hand Rub

ABSTRACTPurpose: The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons’ hands after application of each of these methods.Methods: Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone–iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands.Results: Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p < 0.0001). There was no statistically significant difference between log10 reductions for CHG and PVP-I (p = 0.97).Conclusions: This study provides evidence that an alcohol rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.

Alcohol Based Handrub versus Traditional Hand Scrub as Surgical Hand Disinfection in a Tertiary Eye Teaching Hospital in Iraq

Aim of the study: To compare alcohol-based handrub solutions and standard surgical scrub in preoperative hand disinfection.Methods: Single center, blinded, controlled study performed over a period of 4 weeks in the Ibn Al Haithem hospital. Surgeons, seniors and residents (with more than 2 years of experience) volunteered for inclusion in this study by taking their fingerprints on blood agar before and after hand disinfection.The two methods of disinfection were the following:A: Alcohol-based handrub with sterillium. The solution is applied to the hands for 1.5 min and then left to dry. The fingertips and thumb prints are then taken on blood agar plates.B: The hands are washed with soap and water using a gentle brush for 5 min and then left to dry.The fingertips and thumbprints are then taken on blood agar plates.Results: One hundred samples were collected twice. Fifty volunteers were in each group, and samples were collected before and after washing the hands.The mean reduction in colony counts was 104.6 (P 0.001) in the standard scrub group.Conclusion: In preoperative hand disinfection, alcohol-based handrub significantly reduces the bacterial colony counts compared with standard surgical scrub.

Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection

While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log₁₀. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative hand disinfection, provided that an appropriate product is used.

Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration

Background In most surgical theatres, a 1 min or even longer hand wash is routine as part of the pre-operative hand disinfection. But its benefit has recently been seen critically. Methods We have therefore investigated the effect of a 1 min hand wash on skin hydration and on the efficacy of consecutive surgical hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical hand disinfection, (ii) no pre-wash before surgical hand disinfection and (iii) no pre-wash but use of a brush for 1 min during disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the hand wash on skin hydration, 10 volunteers washed their hands with sapo kalinus for 1 min and dried hands with a paper towel. Skin hydration was measured with a corneometer before the hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of hands. We also tested the reduction of bacterial spores by a 15 s hand wash according to EN 1499 after artificial contamination of hands of 14 volunteers with spores of B. stearothermophilus. Results Propan-1-ol (60%) was most effective with a mean log 10 reduction of 2.11, followed by ethanol (80%) with a mean log 10 reduction of 1.76 and propan-2-ol (60%) with a mean log 10 reduction of 0.57 (all immediate effect without hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min hand wash, but there is a trend towards better efficacy on dry hands. Using a brush for 1 min during disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol ( p = 0.013 ) and propan-2-ol ( p = 0.001 ) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min hand wash for up to 10 min despite drying hands with a paper towel. A 15 s hand wash reduced the number of bacterial spores significantly from log 10 3.84 to log 10 1.99 ( p = 0.001 ). Conclusions There is no benefit of a hand wash as part of surgical hand disinfection except that a short hand wash of 15 s can effectively reduce spores. The best time for this short hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based hand rub to give the skin enough time to dry.

Glove punctures and postoperative skin flora of hands in cardiac surgery

Background. Surgical gloves are frequently perforated during operations, including heart operations. This infection risk factor is inadequately studied. Methods. After preoperative hand disinfection and at the end of 116 heart operations, bacterial samples from hands of surgeons, altogether 800 samples, were taken. Glove punctures were examined with water test. Results. Surgeons changed 70 gloves because of breakage during operations. Additionally, 154 of 400 (39%) gloves had holes in postoperative testing. The breakage rate of gloves increased from 30% in operations shorter than 3 hours to 65% when operations were longer than 5 hours. High bacterial counts of the hands were also more common after prolonged operations. Conclusions. Glove puncture rates and bacterial counts of hands increase with increasing operation time. We recommend changing of both gloves when a puncture is detected. Before donning new gloves, hands should be disinfected.

Comparison Study of Disinfection with Various Disinfectants Used for General Hand Washing

Although there have been a number of clinical reports on preoperative hand disinfection, a very few evaluation tests for efficacy of general hand washing in hospital have been made, hence resulting in few reports on this subject. Comparative test of sterilizing ability were carried out with Hibiscrub, a preoperative hand disinfectant, and Osvan and Phisohex, diluted disinfectants in basin. The method. used for these tests is Price's continuous basin method which is most reliable. in measuring the reappearing number of resident bacteria on hands. Efficacy duration test was also studied for Hibiscrub. Hence, it was shown that Hibiscrub, compared with the other two disinfectants, has satisfactory efficacy for general hand washing in wards or examination rooms in short time (30 sec) and in small amount (20 ml).

手指消毒に関する実験的研究 (第2報)

Meny methods have been described for the preoperative hand disinfection so far, but recently guaternary ammonium compounds and Hexachlorophene are widely used.First, the bacteriologial experiments were made on the scrubbing with lysol and the modified technic of Furbringer's method, which has been being adapted until recently in our clinic.Next, the comparative experiments were made on various technics of scrubbing with the Hyamine and the G-11 soap containing 2 per cent of Hexachlorophene.