Department of Cardiothoracic Surgery and Vascular Surgery, University Hospital in Örebro, Örebro, Sweden.
School of Health Sciences, Faculty of Medicine and Health, Örebro University, SE 701 82, Örebro, Sweden.
BMC Infect Dis. 2018 Sep 17;18(1):466. doi: 10.1186/s12879-018-3375-3.
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.
为了防止交叉感染，手术团队在穿手术服和手套之前进行术前手部消毒。术前手部消毒并不能使手部无菌，并且手术手套袖口末端已被视为薄弱环节，因为它不是防液体的接口。目的是调查手术室护士与非卫生保健工作者之间手部细菌生长和再定植是否存在差异，以及调查手术过程中手术手套袖口末端是否存在细菌生长。
本试点研究作为探索性临床对照试验进行。在术前手部消毒后，立即从 12 名手术室护士和 13 名非卫生保健工作者对照组的手套和手术服接口以及手部三个部位采集细菌培养物，并在戴手术手套和手术服后再次采集。使用 Mann-Whitney U 检验和 Wilcoxon 符号秩检验分析菌落形成单位，比较重复测量。使用卡方检验或 Fisher 确切检验评估分类变量。
与非卫生保健工作者相比，手术室护士在手术手部消毒后三个培养部位中的两个部位的细菌生长明显更高。两组在戴手术手套后，三个培养部位中的一个部位均有更高的再定植。两组在总菌落形成单位方面没有差异，即在所有采样部位。12 名手术室护士中有 5 名在手套袖口处有细菌生长，其中 4 名在手套袖口处的细菌与手部培养物中的细菌相同。从手套袖口处分离出的细菌为痤疮丙酸杆菌、华纳氏葡萄球菌、表皮葡萄球菌和微球菌，CFU/mL 范围为 10 到 40。
组间存在细菌生长和再定植的差异，但这并不明确。然而，在手套袖口和手术服接口处确实存在细菌生长，需要进一步在更大的研究中进行调查，以建立在这些有希望但初步的发现基础上。
试验于 2013 年 1 月 14 日在瑞典 FOU 的 Research web（注册号：117,971）进行前瞻性注册，于 2015 年 1 月 27 日在 ClinicalTrials.gov（注册号：NCT02359708）进行回顾性注册。
