To 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.
This 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.
Operating 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.
There 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 registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov (NCT02359708). 01/27/2015.
Friberg O, Dahlin LG, Levin LA, Magnusson A, Granfeldt H, Kallman J, et al. Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups. Scand Cardiovasc J. 2006;40(2):117–25. CrossRef
Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010;37(4):893–6. CrossRef
Broex EC, van Asselt AD, Bruggeman CA, van Tiel FH. Surgical site infections: how high are the costs? J Hosp Infect. 2009;72(3):193–201. CrossRef
Weber WP, Zwahlen M, Reck S, Feder-Mengus C, Misteli H, Rosenthal R, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol. 2008;29(7):623–9. CrossRef
Bitkover CY, Marcusson E, Ransjo U. Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room. Ann Thorac Surg. 2000;69(4):1110–5. CrossRef
Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg. 2002;21(5):825–30. CrossRef
Tegnell A, Aren C, Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg. 2000;69(4):1104–9. CrossRef
Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001;20(6):1168–75. CrossRef
Graf K, Sohr D, Haverich A, Kuhn C, Gastmeier P, Chaberny IF. Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program. Interact Cardiovasc Thorac Surg. 2009;9(2):282–6. CrossRef
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78 quiz 79-80. CrossRef
Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev. 2006;3:Cd003087.
Berg GA, Kirk AJ, Bain WH. Punctured surgical gloves and bacterial re-colonisation of hands during open heart surgery: implications for prosthetic valve replacement. Br J Clin Pract. 1987;41(9):903–6. PubMed
Edlich RF, Wind TC, Hill LG, Thacker JG. Creating another barrier to the transmission of bloodborne operative infections with a new glove gauntlet. J Long-Term Eff Med Implants. 2003;13(2):97–101. CrossRef
Meyer KK, Beck WC. Gown-glove interface: a possible solution to the danger zone. Infect Control Hosp Epidemiol. 1995;16(8):488–90. CrossRef
Larson EL, Hughes CA, Pyrek JD, Sparks SM, Cagatay EU, Bartkus JM. Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control. 1998;26(5):513–21. CrossRef
de Almeida e Borges LF, Silva BL, Gontijo Filho PP. Hand washing: changes in the skin flora. Am J Infect Control. 2007;35(6):417–20. CrossRef
Larson E, Girard R, Pessoa-Silva CL, Boyce J, Donaldson L, Pittet D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006;34(10):627–35. CrossRef
Kownatzki E. Hand hygiene and skin health. J Hosp Infect. 2003;55(4):239–45. CrossRef
Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH. Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control. 1986;7(2):59–63. CrossRef
World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. CrossRef
Falk-Brynhildsen K, Friberg O, Soderquist B, Nilsson UG. Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes. Biol Res Nurs. 2013;15(2):242–8. CrossRef
World Health Organization. WHO Guidelines on Hand Hygien in Health Care 2009. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf. Accessed 2 Sept 2015.
Eklund AM, Ojajarvi J, Laitinen K, Valtonen M, Werkkala KA. Glove punctures and postoperative skin flora of hands in cardiac surgery. Ann Thorac Surg. 2002;74(1):149–53. CrossRef
Tanner J, Swarbrook S, Stuart J. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2008;1:Cd004288.
Newman JB, Bullock M, Goyal R. Comparison of glove donning techniques for the likelihood of gown contamination. An infection control study. Acta Orthop Belg. 2007;73(6):765–71. PubMed
Rawson BV, Cocker J, Evans PG, Wheeler JP, Akrill PM. Internal contamination of gloves: routes and consequences. Ann Occup Hyg. 2005;49(6):535–41. PubMed
Rocha LA, Ferreira de Almeida EBL, Gontijo Filho PP. Changes in hands microbiota associated with skin damage because of hand hygiene procedures on the health care workers. Am J Infect Control. 2009;37(2):155–9. CrossRef
Fernandez M, Del Castillo JL, Nieto MJ. Surgical Gown’s cuff modification to prevent surgical contamination. J Maxillofac Oral Surg. 2015;14(2):474–5. CrossRef
Guo YP, Wong PM, Li Y, Or PP. Is double-gloving really protective? A comparison between the glove perforation rate among perioperative nurses with single and double gloves during surgery. Am J Surg. 2012;204(2):210–5. CrossRef
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