Surgical hand scrubbing in cardiac surgery teams: a microbiological analysis

Authors

DOI:

https://doi.org/10.5327/Z1414-4425202429988

Keywords:

Hand disinfection, Surgical wound infection, Infection control, Patient safety

Abstract

Objective: To describe the microbiota of the hands of the cardiac surgery team after surgical hand scrubbing and glove removal at the end of the surgical procedure, and to compare this with adherence to the recommended surgical scrubbing time. Method: An observational study was carried out at two points: after the surgical scrubbing of the cardiac surgery team’s hands and after glove removal at the end of the surgical procedure. The variables analyzed included professional identification and aspects of surgical hand scrubbing. Data were collected using an observation script based on the literature. Results: Twenty professionals were observed, resulting in 40 samples. At both collection times, microorganisms from the skin’s resident microbiota were identified, including coagulase-negative Staphylococcus, methicillin-sensitive Staphylococcus aureus, and Bacillus sp. in 35% (7) of the surgical team. Microorganisms potentially related to surgical site infections, such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were isolated in 25% (5) of the population studied. The risk of pathogenic microorganisms being present when surgical hand scrubbing was not carried out in the recommended time was 14.2%. Conclusion: Strategies for ensuring adherence to proper hand scrubbing technique and periodic training should be implemented to mitigate the occurrence of surgical site infections and enhance patient safety.

References

Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton DG, Abdali Z, Roberts TE. Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PloS One. 2020;15(6):e0232960. https://doi.org/10.1371/journal.pone.0232960 DOI: https://doi.org/10.1371/journal.pone.0232960

Berhe DF, Beyene GT, Seyoum B, Gebre M, Haile K, Tsegaye M, et al. Prevalence of antimicrobial resistance and its clinical implications in Ethiopia: a systematic review. Antimicrobial Resistance & Infection Control. 2021;10(1):168. https://doi.org/10.1186/s13756-021-00965-0 DOI: https://doi.org/10.1186/s13756-021-00965-0

Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Critérios Diagnósticos das infecções relacionadas à assistência à saúde de notificação nacional obrigatória. Brasília: Ministério da Saúde; 2024.

National Healthcare Safety Network (NHSN). Patient Safety Component Manual [Internet]. NHSN; 2024 [accessed on Apr 10, 2024]. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf

Araújo BS, Oliveira AC. Compliance with surgical site infection prevention measures in hospitals. Acta Paul Enferm. 2023;36:eAPE01714. https://doi.org/10.37689/acta-ape/2023AO017134 DOI: https://doi.org/10.37689/acta-ape/2023AO0171344

Oliveira MC, Dalcól C, Carvalho REFL, Poveda VB. Patient participation in surgical site infection prevention: perceptions of nurses, physicians and patients. Rev Esc Enferm USP. 2023;57:e20220459. https://doi.org/10.1590/1980-220X-REEUSP-2022-0459en DOI: https://doi.org/10.1590/1980-220x-reeusp-2022-0459pt

Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, DeKay K, Hoffmann KK, et al. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(3):355-76. https://doi.org/10.1017/ice.2022.304 DOI: https://doi.org/10.1017/ice.2022.304

Association of periOperative Registered Nurses. Guideline Quick View: Hand Hygiene. AORN J. 2022;116(3):287-90. https://doi.org/10.1002/aorn.13783 DOI: https://doi.org/10.1002/aorn.13783

Zhang Z, Gao X, Ruan X, Zheng B. Effectiveness of double‐gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta‐analysis. J Adv Nurs. 2021;77(9):3630-43. https://doi.org/10.1111/jan.14824 DOI: https://doi.org/10.1111/jan.14824

Sandström N, Söderquist B, Wistrand C, Friberg Ö. The presence of skin bacteria in the sternal wound and contamination of implantation materials during cardiac surgery. J Hosp Infect. 2023;135:145-51. https://doi.org/10.1016/j.jhin.2023.03.018 DOI: https://doi.org/10.1016/j.jhin.2023.03.018

Beloborodova N, Pautova A, Grekova M, Yadgarov M, Grin O, Eremenko A, et al. Microbiota Metabolism Failure as a Risk Factor for Postoperative Complications after Aortic Prosthetics. Biomedicines. 2023;11(5):1335. https://doi.org/10.3390/biomedicines11051335 DOI: https://doi.org/10.3390/biomedicines11051335

Baier C, Tinne M, von Lengerke T, Gossé F, Ebadi E. Compliance with hand disinfection in the surgical area of an orthopedic university clinic: results of an observational study. Antimicrob Resist Infect Control. 2022;11(1):22. https://doi.org/10.1186/s13756-022-01058-2 DOI: https://doi.org/10.1186/s13756-022-01058-2

Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. STROBE initiative: guidelines on reporting observational studies. Rev Saúde Publ. 2010;44(3):559-65. https://doi.org/10.1590/S0034-89102010000300021 DOI: https://doi.org/10.1590/S0034-89102010000300021

Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Orientações gerais para higiene das mãos em serviços de saúde. Brasília: Ministério da Saúde; 2018.

Renuka S, Er Jun C, Patrick G, Jia Quan O, Kyaw Thu A. Microbiological Profiles of Disposable Gloves Used for Handling Ready-to-Eat Foods. J Food Prot. 2023;86(11):100146. https://doi.org/10.1016/j.jfp.2023.100146 DOI: https://doi.org/10.1016/j.jfp.2023.100146

Ponath FS, Valiatti TB, Sobral FOS, Romão NF, Alves GMC, Passoni GP. Avaliação da higienização das mãos de manipuladores de alimentos do Município de Ji-Paraná, Estado de Rondônia, Brasil. Rev Pan-Amaz Saúde. 2016;7(1):63-9. https://doi.org/10.5123/s2176-62232016000100008 DOI: https://doi.org/10.5123/S2176-62232016000100008

American Public Health (APHA). Compendium of Methods for the Microbiological Examination of Association Foods (5ª Ed.). Estados Unidos: APHA; 2015.

Hussain F, Rahman MK, Qadri HM, Rabbani, RA. Surgical Hand Washing–A Clinical Audit of Young Surgeons at a Tertiary Care Hospital. Pak J Med Health Sci. 2022;16(6):205. https://doi.org/10.53350/pjmhs22166205 DOI: https://doi.org/10.53350/pjmhs22166205

Feng W, Lin S, Huang D, Huang J, Chen L, Wu W, et al. Surgical hand rubbing versus surgical hand scrubbing: Systematic review and meta-analysis of efficacy. Injury. 2020;51(6):1250-7. https://doi.org/10.1016/j.injury.2020.03.007 DOI: https://doi.org/10.1016/j.injury.2020.03.007

Pegu KD, Perrie H, Scribante J, Fourtounas M. Microbial contamination of the hands of healthcare providers in the operating theatre of a central hospital. S Afr J Infect Dis. 2021;36(1):221. https://doi.org/10.4102/sajid.v36i1.221 DOI: https://doi.org/10.4102/sajid.v36i1.221

Nieves V, Gundersen T, Mykkeltveit I. A adesão da equipe cirúrgica às diretrizes recomendadas para o preparo cirúrgico da mão: um estudo de observação quantitativa. Sykepleien Forskning. 2024;19(95142):e-95142. https://doi.org/10.4220/Sykepleienf.2024.95142en DOI: https://doi.org/10.4220/Sykepleienf.2024.95142

Neto AS, Marques SG, Bomfim MR, Monteiro SG, Souza RC, Nunes RA. Microbiological Analysis of Surgeons’ Hands in a Public Hospital in São Luis, Maranhão State, Brazil: A Cross-Sectional Study. Microorganisms. 2023;11(8):1895. https://doi.org/10.3390/microorganisms11081895 DOI: https://doi.org/10.3390/microorganisms11081895

Parlak EA, Iyigun E, Albay A, Bedir O. Impact of methods and duration of surgical hand scrub on bacterial count: a randomized controlled trial. Am J Inf Control. 2021;49(11):1376-83. https://doi.org/10.1016/j.ajic.2021.05.006 DOI: https://doi.org/10.1016/j.ajic.2021.05.006

Avestan Z, Jami M, Mirzaei M, Amini Y, Ghazvini K, Safdari H, et al. Investigation of the Microbial Contamination of the Hands of Healthcare Workers in Different Wards of Sheikh Hospital in Mashhad. Int J Infect. 2022;9(3):e130579. https://doi.org/10.5812/iji-130579 DOI: https://doi.org/10.5812/iji-130579

Bae SJ, Kim I, Song J, Chung ES. O efeito dos antibióticos profiláticos de primeira e terceira geração na hospitalização e despesas médicas para cirurgia cardíaca. J Cardiotóraco Surg. 2022;17:15. DOI: https://doi.org/10.1186/s13019-022-01763-4

Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. J Clin Med. 2022;11(23):6991. https://doi.org/10.3390/jcm11236991 DOI: https://doi.org/10.3390/jcm11236991

Andrade ABS, Brun LSO, Brandão P, Goulart MCL, Carvalho CA, Ávila FMVP. Bacterial growth on the hands of health care workers: implications for preventing nosocomial infections. Rev Rene. 2021;22:e70938. https://doi.org/10.15253/2175-6783.20212270938 DOI: https://doi.org/10.15253/2175-6783.20212270938

Conoscenti E, Enea G, Deschepper M, Huis D, Campanella M, Raffa G, et al. Risk factors for surgical site infection following cardiac surgery in a region endemic for multidrug resistant organisms. Intens Crit Care Nurs. 2024;81:103612. https://doi.org/10.1016/j.iccn.2023.103612 DOI: https://doi.org/10.1016/j.iccn.2023.103612

Leis JA, Powis JE, McGeer A, Ricciuto DR, Agnihotri T, Coyle N, Muller M. Introduction of group electronic monitoring of hand hygiene on inpatient units: a multicenter cluster randomized quality improvement study. Clin Inf Dis. 2020;71(10):e680-5. https://doi.org/10.1093/cid/ciaa412 DOI: https://doi.org/10.1093/cid/ciaa412

Polit DF, Beck CT. Pesquisa em enfermagem: gerando e avaliando evidências para a prática de enfermagem (11ª ed.). Filadélfia: Lippincott Williams & Wilkins; 2020.

Published

2024-08-21

How to Cite

Pinto, T. C., Henrique, D. M., Fassarella, C. S., Camerini, F. G., Leão, R. S., Saldanha-Gama, R. F. G., & Luna, A. A. (2024). Surgical hand scrubbing in cardiac surgery teams: a microbiological analysis. Revista SOBECC, 29. https://doi.org/10.5327/Z1414-4425202429988

Issue

Section

ORIGINAL ARTICLES