Surgical Hand Antisepsis and Surgical Site Infections

Surgical Hand Antisepsis: Environmental and Cost Impact in Hand Surgery

Health care systems, including operating rooms, are a considerable contributor to environmental waste. Given ongoing concerns regarding water scarcity in the United States and worldwide, action to reduce water utilization should be taken. Traditional water-based hand scrubbing wastes an estimated 11 L of water per scrub. Waterless hand rubbing with an alcohol-based solution has been shown to be as effective as traditional water-based hand scrubbing in surgical hand antisepsis and in preventing surgical site infections. Furthermore, alcohol-based rubbing results in less waste and reduced costs when compared with water-based hand scrubbing. The hand surgery operating room, including minor procedure rooms, serves as an opportunity to decrease water use and reduce the environmental impact of our field. Waterless alcohol-based hand rubbing for antisepsis may also be an opportunity to save money and provide value-based care to our patients.

Protocol for a systematic review of good surgical practice guidelines for experimental rodent surgery

Objective

Surgery is an integral part of many experimental studies. Aseptic and minimal invasive surgical technique and optimal perioperative and post-operative care are prerequisites to achieve surgical success and best possible animal welfare outcomes. Good surgical practice cannot only improve the animal’s postoperative recovery, but also study outcome and validity. There seems to be a lack of implementation of good surgical practice during rodent surgery. The aim of this systematic review is to identify, critically evaluate and compare the currently recommended standards and underlying guidelines for rodent surgery—and finally to compile a comprehensive guideline of good surgical practice for rodent surgery.

Search strategy

PubMed, Embase and Web of Science were searched to identify guidelines published in peer-reviewed journals. To identify grey literature and unpublished guidelines, we will perform a Google search for published guidelines and search laboratory animal sciences books for relevant book chapters. Additionally, we will conduct a survey among animal researchers enquiring about the guidelines they use.

Screening and study selection

For publications retrieved by the systematic search, unique references are screened by two reviewers, first for eligibility based on title and abstract and subsequently for final inclusion based on full text. Eligibility of books is based on title and content, final inclusion based on chapter full text. Guidelines are either retrieved by Google searches or a survey. Google searches will be conducted by at least four of the authors. Thereafter, guidelines will be screened by two of the authors.

Data extraction and synthesis

We will extract data from publications, book chapters and guidelines. Based on the extracted data, we will perform a descriptive synthesis of the bibliographical details, guideline development and endorsement, and the prevalence of individual recommendations, including subgroup analysis of the guidance per continent or country and differences between peer-reviewed versus non-peer-reviewed guidance.

Comparison of Improved Surgical Eight-Step Handwashing Combined with ATP Fluorescence in Detecting the Infection Rate at the Site of Seven-Step Surgical Handwashing and 30-Day Orthopaedic Surgery: A Randomized Study

OBJECTIVES

To compare the effects of two hand cleaning schemes on the prevention of surgical site infection in routine orthopaedic surgery. Compared with the standard surgical seven-step washing technique and detected by ATP fluorescence method, the handwashing effects of the improved surgical eight-step washing technique and the standard surgical seven-step washing technique were compared, so as to provide a basis for eliminating the handwashing blind area of the surgical seven step washing technique and improving the surgical handwashing method.

METHODS

A total of 800 consecutive patients who underwent clean and clean-contaminated orthopaedic surgery between January 1, 2020 and December 31, 2020. Twenty orthopaedic doctors in the operating room of our research team were randomly divided into the improved eight-step washing technique group (improved group) and the traditional seven-step washing technique group (traditional group), with 10 people in each group. Each person was randomly sampled 40 times, 400 people in each group, a total of 800 people, and completed by stages in 12 months. Main Outcome Measures. The infection rate of surgical site 30 days after operation was the primary end point. The qualified rate of fingertip culture was combined with ATP fluorescence in the two groups and three new culture areas in the two groups: the lateral edge of the palm, the medial edge of the palm, and the nail groove of the middle finger and the nail root were secondary end points.

RESULTS

The 2 protocols were comparable in regard to surgical site infection risk factors. The infection rate of surgical site in the traditional group was 10 cases (2.50%) in 400 cases and 0 cases (0%) in the improved group. Three culture areas were added: the qualified rate of lateral edge of palm, medial edge of palm, and nail groove and nail root of middle finger, and the nosocomial infection rate of surgical incision between the two groups was statistically significant (P < 0.05). There was no significant difference in the qualified rate of fingertip culture (P > 0.05). The handwashing scheme in this study meets the recommended duration of hand disinfection and has good tolerance, and the skin dryness and skin irritation after using aqueous solution are similar.

CONCLUSIONS

The improved surgical eight-step washing technique combined with ATP fluorescence detection is helpful to eliminate the "blind area" of handwashing. It is also necessary to add three training areas. Handwashing and training are more scientific, rigorous, and effective. They are effective in reducing orthopaedic surgical infection and have application value. They can safely replace the traditional surgical seven-step washing technique, which is worthy of clinical promotion.

Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand

Background: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms. Methods: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation. Results: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci. Conclusions: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons.

Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice

BACKGROUND

The numbers of minimally invasive cosmetic procedures performed in the United States have steadily increased each year. Concurrently, the rates of filler complications have also increased. Delayed filler reactions and granulomas have recently been attributed to biofilm infections.

OBJECTIVE

The biology and pathogenesis of biofilms, and their diagnosis, treatment, and prevention will be discussed.

METHODS

The relevant and recent literature on delayed filler reactions and biofilms was reviewed.

RESULTS

Increasing evidence implicates biofilm infections in the pathogenesis of delayed filler reactions. Therapeutic and preventative measures can be taken to minimize the occurrence of these potentially devastating consequences of dermal fillers.

CONCLUSION

Awareness of biofilm infections is key in the assessment of filler reactions in order to ensure timely and accurate diagnosis and treatment.

The impact of surgical hand antisepsis technique on surgical site infection

BACKGROUND

Limited evidence exists regarding the effect on superficial and deep incisional surgical site infections (SDSSIs) of alcohol-based hand rubs (ABR) versus traditional aqueous surgical scrubs (TSS). User preferences and practice are unknown.

METHODS

A retrospective cohort study examining SDSSIs using VA Surgical Quality Improvement Program cases before ABR implementation (2007-2009, TSS group) and after (2013-2014, ABR group). A descriptive survey.

RESULTS

SDSSI rates were 1.8% and 1.5% for TSS (n=4051) and ABR (n=2293), respectively (p=0.31). The adjusted odds of SDSSI using ABR was not significant (OR 0.82; 95% CI, 0.51-1.32). Greatest SDSSI risk was from preoperative radiotherapy (OR, 2.78; 95% CI, 1.14-6.78), general surgery (OR, 2.39; 95% CI, 1.30-4.39) and preoperative smoking (OR, 1.58; 95% CI, 1.02-2.44). Of 95 surveys included, 52% favored ABR. Although 95% self-reported correct product application, improper duration was revealed in both groups (TSS 18% and ABR 10%).

CONCLUSIONS

Implementation of an ABR for use in surgical hand antisepsis did not alter SDSSI rates. Improving product knowledge and compliance may improve SSI rates.