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

Camilla Wistrand, Bo Söderquist, Karin Falk-Brynhildsen, Ulrica Nilsson, Camilla Wistrand, Bo Söderquist, Karin Falk-Brynhildsen, Ulrica Nilsson

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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: 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.

Keywords: Bacterial growth; Bacterial re-colonization; Cross infection; Hand disinfection; Intraoperative; Preoperative; Surgery; Surgical gloves; Surgical site infections.

Conflict of interest statement

Ethics approval and consent to participate

The study has been performed in accordance with Declaration of Helsinki and the study is registered prospectively at Researchweb (FOU in Sweden, 117,971) and registered retrospectively at ClinicalTrials.gov (NCT02359708). The study was approved by the Regional Ethical Review Board of Uppsala (reference number 2013/283), by the chairman Erik Lempert. The study was voluntary, oral and written informed consent was obtained from all participants before data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Photo illustrating a dark visible indication of fluid at the glove cuff end
Fig. 2
Fig. 2
Flow chart of participant inclusion in the study

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