Anesthesiologist's hand hygiene and disinfection of reusable rubber tourniquet with alcohol swabs before intravascular cannulation
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Abstract:
Patients undergoing surgery have an increased risk for hospital-acquired infections. Various causes such as the catabolic response to surgery, old age, and co-existing diseases such as diabetes mellitus, make these patients more susceptible to nosocomial infections.
One of the major efforts to prevent hospital-acquired infections is personal hygiene of the health care provider, which reportedly reduces the incidence of hospital-acquired infections [1]. Another effort is the sterilization of instruments used in the operating rooms. Previous studies identified the anesthesiologists' hands and anesthetic equipment as possible contributing factors to the transmission of pathogenic organisms, as they are frequently in contact with upper airway secretions and the blood of patients [2].
We conducted this study with the infection control team of our hospital to assess the hygiene status of re-usable rubber tourniquets and to determine their proper care in the operating room. Reusable tourniquets are in direct contact with multiple surgical patients and the anesthesiologist's hands. We tried to determine whether simple alcohol swabbings could disinfect re-usable tourniquets.
This study took place in 30 operating rooms of 2 hospital buildings. The operating rooms were used for a wide range of surgical specialties. Collection and inoculation was performed in each operating room with aseptic technique. First, we analysed the gross appearance of the tourniquet to determine whether it was visibly soiled with dirt or blood. Second, the author who wore sterile gloves cut the tourniquet into 2 equal sizes using sterile scissors. Third, one half was rolled and pressed onto blood agar plates (BAP) and the other half was twice swabbed with 83% ethyl-alcohol, dried, and then rolled and pressed onto BAP. Subsequently, each part of the divided tourniquet was immediately immersed in a conical tube containing 40 ml of distilled water.
We used 2 methods to determine the hygiene of tourniquets, i.e. rolling and pressing onto BAP and inoculation of tourniquet derived solution into TSA.
BAP, which were inoculated with each divided tourniquet, were incubated at 35℃ for 48 hours. Organisms were identified from colony morphology, coagulase test, catalase test, and pyruvate reaction test by an experienced biomedical scientist. Colonies presumptively identified as Staphylococcus aureus or Enterococcus were subjected to further tests for antibiotic susceptibility to identify methicillin-resistant S. aureus (MRSA) or vancomycin-resistant Enterococcus (VRE).
The TSA media was incubated at 35℃ for 48 hours and the colonies were counted after one week. The total colony count was determined in colony-forming units (CFUs)/ml.
The questionnaire was distributed to anesthesiologists including professors, residents, and nursing staff involved with the peripheral intravascular catheter insertion in the operating room, to determine personal hygiene, hand washing or use of antimicrobial hand rubs, when the tourniquet was applied to the surgical patients in the operating room.
Paired t-test was used to compare the count of CFUs before and after alcohol swabbings. SAS software version 9.3 (SAS Institute Inc., Cary, NC, USA) was used for these analyses.
The expiration dates of the tourniquets were unknown. The most common reason for replacing a tourniquet was loss of the old one. Fifteen of the 30 (50%) tourniquets in the study were visibly soiled in appearance. Tourniquets from orthopedic operations showed the highest bacterial contamination (44.75 CFUs/ml).
We evaluated bacterial contamination of the re-usable tourniquets both before and after alcohol swabbing. No colonies were grown on blood agar plate culture in the alcohol swab - intervention group (100%). However various colonies were grown in the non-intervention group (100%) and they were identified by a microbiologist. Most colonies were S. aureus or enterococcus, however, none were positive for MRSA or VRE. All tourniquets before alcohol swabbings showed positive bacterial growth in the TSA culture. The amount of organisms found on the tourniquets (CFUs/ml) decreased significantly after alcohol swabbings (mean ± SD: 24.5 ± 6.3 vs. 3.5 ± 0.89, before and after swabbings respectively, P = 0.001). Alcohol swabbing (83% ethyl-alcohol) twice before the use of tourniquet decreased bacterial contamination considerably (mean reduction: 90.2 ± 11.5%).
Among the anesthesia staff who answered the questionnaire, 37% always washed their hands with soap or alcohol gel before intravascular catheter insertion, and 44% of the staff occasionally did. However, 19% of the staff made no attempts to clean their hands before cannulation (Table 1).
Table 1
Hand Hygiene Habits Regarding Tourniquet Use (n = 62)
The aim of this study was to confirm bacterial contamination of re-usable tourniquets in the operating room and to determine whether twice alcohol swabbings could eliminate bacterial organisms on the tourniquet.
All collected tourniquets in our study were negative for MRSA and VRE. However, previous studies reported differently. One study reported that 36% of tourniquets were positive for S. aureus and 12% were MRSA-positive [3]. Another study revealed that MRSA was isolated from 24.4% of collected tourniquets [4]. Results from our study differed from previous studies likely since the prior studies were conducted in general wards rather than in the operating rooms, which have relatively aseptic conditions.
Single use tourniquet is ideal, however as long as non-disposable tourniquets are used for various reasons, proper infection control is required. Kerstein and Fellowes [5] recommended disposable tourniquets because reducing transmission to patients by single-use tourniquets is more cost-effective, considering the cost of hospital-acquired infections.
In conclusion, tourniquet contamination is dependent on the hospital personnel's hygiene and that of the entire hospital. Poor hygiene combined with the careless use of tourniquets make reusable tourniquets a vehicle of hospital-acquired infections.Keywords:
Asepsis
Venipuncture
Operating theatres
Surgical team
Cryoprecipitate
Operating theatres
Asepsis
Operating room nursing
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In 4 operating theatres with 4 different air-conditioning equipments, the number of bacteria per m3 circulating air in the neighbourhood of the open wound has been investigated. The testing has been performed on comparable aseptic operations. The worst results were obtained in 2 conventional theatres, equipped with a modern-up-to-date air-conditioning. The number of bacteria was ranging between 230 and 270 per m3. A much better results was obtained in a theatre, equipped with a so-called germ-stop-wall, dividing the theatre into 2 sections, separating the surgical team and the open wound completely from the anaesthesist and other staff. With this arrangement, 45 germs per m3 were found. The best result with no bacteria at all is present in a vertical flow-enclosure with an exchange rate of 32 per hour. According to our 10-year experience, for aseptic surgery sterile air techniques should be adopted to improve asepsis and to decrease the risk of postoperative infection.
Operating theatres
Asepsis
Enclosure
Aseptic processing
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Background: Ventilation in the operating theatre is not only supposed to provide a comfortable and safe indoor air quality for the patient and the operating team, it plays, moreover, a key role when it comes to the prevention of surgical site infections. Surgical site infections continue to be a chief concern in Swedish hospital care, being the third most frequent hospital-acquired infection. Operating theatre nurses are responsible for ensuring the hygienic standards of the operating theatre before and during the on-going operation. Aseptic principles must be adhered to at all times in the operating theatre. Exhaust grilles are occasionally blocked by equipment, members of the operating team or other apparel. Avoiding disturbances of the air-flow of the ventilation system may help to avoid the spread of colony forming units and reduce the risks of surgical site infections. Aim of the study: The aim of the study is to describe the frequency of occurrence of blocked exhaust grilles in operating theatres during surgery. Method: Being an observation study, the design was of a quantitative descriptive character. The 24 surgical interventions included in the study were the result of accidental sampling. Findings: The findings show that the exhaust grilles of the operating theatres on more than half of the observed occasions were blocked by a number of various objects. There is a statistical significance when it comes to blocked exhaust grilles in operating theatres used for general surgery versus orthopedic surgery. When exhaust grilles were blocked, they were usually blocked during the entire duration of operation. Conclusion: Blocking of exhaust grilles in the operation theatre is a frequent occurrence. This study could, therefore, be an interesting starting point for further studies measuring the actual impact of blocked exhaust grilles on ventilation systems.
Operating theatres
Surgical team
Operating table
Surgical equipment
Accidental
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The assignment is focused on problems of following barrier nursing procedures in perioperating care. In the theoretical part there is a brief overview of the history of asepsis and sepsis, then hygienic and epidemilogic regime at operating theatres are described, individual nursing procedures, which enable them to be observed. My own research in the research section analyses the observance of asepsis and antisepsis principles at a surgical department focused on nurses specialized in surgical care and in intensive care.
Asepsis
Operating theatres
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Operating theatres
Surgical team
Perioperative nursing
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Operating theatres
Surgical team
Elective surgery
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Operating theatres
Asepsis
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Asepsis
Aseptic processing
Operating theatres
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The author contends one can not plan an operatief theatre and its organization, if it is dissociated from its immediate dependencies, entrances and exists. a) The necessity of the following dependencies is discussed: 1. an anesthetic room forming a sas between the entrance hall for the patient and the operating room that makes possible the preop. preparation; 2. an area where the surgeons may prepare, corectly ventilated and reserved to the entrance of the surgical team; 3. a reserve of sterile equipment in immediate contact with the operating threater; 4. a disposal area for the linen and soiled material and that may serve to the transfer of the patient after the operation, given the wastes be evacuated in thermosealed bags. b) The circuits of the personel is then considered with a study of the one way cloak-rooms, and an example is given. Then comes the introduction in these circuits of the so-called septic operating room and of room for decontamination of instruments that can be superimposed with the place of evacuation of the equipment. In conclusion, the author mentions the evacuation of atmospheric particles released in the operating theatre and the methods of improving asepsis. He suggests the surgeon be very critic concerning the techniques proposed by the advertising.
Asepsis
Operating theatres
Operating theater
Surgical equipment
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This final paper describes the organization of work in ophthalmic operating room, who makes the surgical team, and what kind of surgical procedures are being performed. Definitions like antisepsis, asepsis, desinfection and sterilization will be described, and what methods are used to implement it in the ophthalmic operating room. Particular importance is attached to the maintenance and sterilization of instruments, phaco machines preparing and what is equally important, but often underestimated is hand hygiene. Duties of operating nurses-technicians will be divided through the tasks of perioperative nurse and circulating nurse, and jobs which affect every one of them. Through an example of cataract surgery and small operations, will be given description of everything mentioned in this final paper. Also, it will be written about patient care, before and after surgical procedure, which is also one of the nursing tasks in operating room. It will be described which tasks are represented of working in daily and night shifts. In the end it will be spoken about documentation importance and how it's being implemented.
Asepsis
Sterilization
Operating room nursing
Operating theatres
Perioperative nursing
Operating theater
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