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Background: During functionality testing and packaging of reusable surgical instruments (RSI) for sterilization, instruments are frequently touched. There is a lack of standards relating to hand hygiene frequency and use of gloves in the sterilizing service unit packing area., Aim: To determine the effect of hand hygiene and glove use on maintenance of RSI cleanliness., Methods: Following manual and automated cleaning, Halsted-mosquito forceps were assessed for adenosine triphosphate (ATP), protein and microbial contamination after handling with gloved and ungloved but washed hands using an ATP surface swab test, bicinchoninic acid assay, and standard culture plate/broth, respectively. Gram's stain was used to classify the isolates. RSI contamination was assessed immediately following and 1, 2, and 4 h after washing hands., Findings: Packing instruments with hands that had been unwashed for 2 or 4 h resulted in a significant increase in contaminating ATP when compared with all other treatment groups (P < 0.05). There was a significant correlation between the time since washing hands, the amount of ATP (r = 0.93; P ≤ 0.001), and the microbial load (r = 0.83; P ≤ 0.001) contaminating the forceps, where the longer the time the hands remained unwashed the higher the contamination. Significantly more contaminating protein was found on forceps handled with ungloved hands that had not been washed for 2 or 4 h (P < 0.001)., Conclusion: Critical RSI inspection, assembling, lubricating and packing should be performed using either gloves or within 1 h of washing hands., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

This study investigated both the impact of glove usage on bacterial hand contamination of laboratory technicians and extent of environmental contamination of a microbiology laboratory with potential bacterial pathogens. Two groups of laboratory technologists participated in the study - one group who always used gloves when handling bacterial cultures and another group who did not. Semiquantitative bacterial sampling from technicians' hands was performed before and after a defined work period. Frequently touched areas of the laboratory were sampled over a four-week period and selective or chromogenic media utilised for the identification of meticillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Salmonella spp. and Enterobacteriaceae. Laboratory technicians who did not use gloves were at significantly greater risk of acquiring MRSA following their work periods but no protective effect was demonstrated for glove usage against acquisition of Enterobacteriaceae. Hand washing was equally effective at removing acquired bacterial pathogens in both groups of workers. Environmental sampling documented the presence of MRSA in one-fifth of sampled sites, with the most frequent recovery from computer keyboards. Enterobacteriaceae and P. aeruginosa were less commonly recovered from the environment. This study demonstrates that glove usage is protective against the acquisition of MRSA and that MRSA is the most frequently recovered bacterial pathogen from our microbiology laboratory environment., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Hand hygiene is considered to be the single most effective measure to prevent healthcare-associated infection. Although there have been several reports on hand hygiene compliance, data on patients with multidrug-resistant (MDR) organisms in special isolation conditions are lacking. Therefore, we conducted a prospective observational study of indications for, and compliance with, hand hygiene in patients colonised or infected with meticillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing enterobacteria in surgical intensive and intermediate care units. Hand disinfectant used during care of patients with MRSA was measured. Observed daily hand hygiene indications were higher in MRSA isolation conditions than in ESBL isolation conditions. Observed compliance rates were 47% and 43% for the MRSA group and 54% and 51% for the ESBL group in the surgical intensive care unit and the intermediate care unit, respectively. Compliance rates before patient contact or aseptic tasks were significantly lower (17-47%) than after contact with patient, body fluid or patient's surroundings (31-78%). Glove usage instead of disinfection was employed in up to 100% before patient contact. However, compliance rates calculated from disinfectant usage were two-fold lower (intensive care: 24% vs 47%; intermediate care: 21% vs 43%). This study is the first to provide data on hand hygiene in patients with MDR bacteria and includes a comparison of observed and calculated compliance. Compliance is low in patients under special isolation conditions, even for the indications of greatest impact in preventing healthcare-associated infections. These data may help to focus measures to reduce transmission of MDR bacteria and improve patient safety., (Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves., (Copyright 2001 The Hospital Infection Society.)

In implant surgery air and surface contamination have become important factors in post-operative wound infection. We established the rate of contamination of surgical gown packs and found that dropping gloves onto the open gown pack prior to scrubbing had no effect on it. Ninety-six contact plates were used for this study, which was carried out during clean orthopaedic operations in one operating room. The overall rate of contamination was 65%. Most of the contaminants were skin commensals. The rate of contamination was 67% when gloves were dropped onto the gown pack compared with 63% when opened and presented to the scrubbed and gowned theatre staff. However this difference was statistically not significant. The high rate of contamination was probably due to the gown packs having been left opened for too long. This delay arose because each gown pack had three gowns and would have been avoided if single gown packs had been used.

Glove use and handwashing frequencies (HW) were observed in intensive care units (ICU) in two university hospitals in Denmark and two in Norway. The study included a total of 1632 patient procedures performed by 325 persons. Handwashing (HW) has become an important part of general barrier precautions. Earlier studies have shown that health care workers (HCW) far too often neglect to wash their hands after patient procedures when handwashing is strongly recommended. Despite earlier claims that increased glove use in hospitals would discourage handwashing, our results showed that HCW washed their hands more often after glove use (57%) than when gloves had not been used (40%). This significant difference in HW frequency was also noted when similar procedures were carried out by HCW with or without gloves. This might be a matter of personal discomfort after wearing gloves, but could also be due to differences in awareness of hygienic aspects of patient care. In the two countries gloves were used on average at 17% of the procedures, but were not used appropriately for dirty procedures. The results of this study indicate that more effective methods for the implementation of appropriate glove use and HW should be emphasized.

In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min.

Barrier precautions are a fundamental component of any infection control strategy and a critical aspect of all isolation systems. Because many infections are transmitted from patient-to-patient via the hands of personnel, gloves and gowns are widely recommended to provide an extra measure of protection against cross-infection. It is not clear whether gloves are superior to handwashing (if performed obsessionally) in this respect, and there is little evidence that gowns confer additional benefit. These concerns notwithstanding, barrier precautions can substantially reduce the risk of some infections, such as respiratory syncytial virus disease. On the other hand, the modes of transmission of many infections are complex (e.g. with rotavirus) or controversial (e.g. with rhinovirus), and, even though hands are involved in transmission, barrier precautions alone may not suffice to prevent spread. Moreover, neither gloves nor gowns can prevent nosocomial infections caused by endogenous microbial flora; perhaps this explains the limited efficacy of barrier precautions in reducing the endemic rate of infection due to bacteria such as Pseudomonas aeruginosa in intensive care units. Barrier precautions may also fail if colonized patients are not identified promptly. One potential solution to this problem is 'body substance isolation' (BSI), in which all patients are considered to be potential carriers of nosocomial pathogens whether or not they have been cultured or have developed a clinical infection. In BSI barrier techniques are used when any potentially contaminated patient material is handled. BSI also provides barrier protection from bloodborne pathogens for personnel.(ABSTRACT TRUNCATED AT 250 WORDS)