The aim of the present study was to observe surgical team members’ compliance with basic hand hygiene and intraoperative hygiene guidelines during the anaesthetic and surgical procedure. A secondary aim was to investigate the team members’ knowledge and attitudes toward these guidelines. A structured observation schedule was designed to capture observational data on compliance with hygiene guidelines. A questionnaire was also designed to elicit written responses on attitudes, beliefs and knowledge about hygiene routines.
The results showed that the clinical procedures for basic hand hygiene and intraoperative hygiene were flawed in three areas. Hand disinfection before and after direct patient contact was incomplete. Secondly, the team members used gloves in an incorrect way. Thirdly, the scrub nurse did not always change sterile gloves after intraoperative skin disinfection before handling sterile instruments. The quantity of 0.5% chlorhexidine with 70% ethanol used varied and the mechanical performance of skin disinfection varied. Knowledge of hand hygiene routines and intraoperative hygiene routines among surgical team members is incomplete and adherence needs to improve. Regular routine observations and continuous feedback to all staff may be necessary to improve compliance and avoid deterioration of practice.
CastellaACharrierLDi LegamiVPastorinoFFarinaECArgenteroPAZottiCA. (2006) Surgical site infection surveillance: analysis of adherence to recommendations for routine infection control practise. Infection Control and Hospital Epidemiology27: 835–40.
2.
CreedonSA. (2006) Health care worker’ hand decontamination practices, an Irish study. Clinical Nursing Research15: 6–26
3.
DarouicheROWallMJItaniKMFOttersonMFWebbALCarrickMMMillerHJAwadSSCrosbyCTMosierMCAlSharifABergerDH. (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. New England Journal of Medicine362: 18–26.
4.
EklundAMOjajärviJLaitinenKValtonenMWerkkalaKA. (2002) Glove punctures and postoperative skin flora of hands in cardiac surgery. Annals of Thoracic Surgery4: 149–53.
5.
EveillardMHitotoHRaymondFKouatchetADubéLGuilloteauVPradelleMTBrunelPMercatAJoly-GuillouML. (2009) Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes. Journal of Hospital Infection72: 211–17.
6.
FribergBFribergSBurmanLG. (1999) Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination. Journal of Hospital Infection42: 287–93.
7.
GaribaldiRASkolnickDLererTPoirotAGrahamJKrisuinasELyonsR. (1988) The impact of preoperative skin disinfection on preventing intraoperative wound contamination. Infection Control and Hospital Epidemiology9:109–13.
8.
HarnoβJCParteckeL-IHeideckeC-DHübnerN-OKramerAAssadianO. (2010) Concentration of bacteria passing through puncture holes in surgical gloves. American Journal of Infection Control38: 154–8.
9.
Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. (1999) Infection Control and Hospital Epidemiology20: 247–78.
10.
JangJ-HWuSKirznerDMooreCYoussefGTongALourencoJStewartRBMcCreightLJGreenKMcGeerA. (2010) Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada. Infection Control and Hospital Epidemiology31: 144–50.
11.
JennerEAFletcherBCWatsonPJonesFAMillerLScottGM. (2006) Discrepancy between self-reported and observed hygiene behaviour in healthcare professionals. Journal of Hospital Infection63: 418–22.
12.
KitsonAHarveyGMcCormackB. (1998) Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care7: 149–58.
13.
MagiorakosAPLeensEDrouvotVMay-MichelangeliLReichardtCGastmeierPWilsonKTannahillMMcFarlaneESimonA. (2010) Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe. Eurosurveillance15: 1–5.
14.
NaverLPSGottrupF. (2000) Incidence of glove perforations in gastrointestinal surgery and the protective effect of double gloves: a prospective, randomised controlled study. European Journal of Surgery166: 293–95.
15.
NobleWC. (1975) Disperal of skin microorganisms. British Journal of Dermatology93: 477–85.
16.
ParteckeLIGoerdtA-MLangnerIJaegerBAssadianOHeideckeC-DKramerAHuebnerN-O. (2009) Incidence of microperforation for surgical gloves depends on duration of wear. Infection Control and Hospital Epidemiology30: 409–14.
17.
PatarakulKTan-KhumAKanhaSPadungpeanDJaichaiyapunOO. (2005) Cross-sectional survey of hand-hygiene compliance and attitudes of health care workers and visitors in intensive care units at King Chalaongkorn Memorial Hospital. Journal of the Medical Association of Thailand88: 287–93.
18.
PittetD. (2001) Improving adherence to hand hygiene practice: a multidiscipline approach. Emerging Infectious Diseases7: 234–40.
19.
ReinmüllerBLjungqvistB. (2003) Modern clean room clothing systems: people as a contamination source. PDA Journal of Pharmaceutical Science and Technology57: 114–25.
20.
SwenneCLLindholmCBorowiecJCarlssonM. (2004) Surgical site infections within 60 days of coronary artery by-pass graft surgery. Journal of Hospital Infection57: 14–24.
21.
SwenneCLSkyttBLindholmCCarlssonM. (2007) Patients’ experiences of mediastinitis after coronary artery bypass graft procedure. Scandinavian Cardiovascular Journal A41: 255–64.
22.
TammelinAHambraeusAStåhleE. (2000) Routes and sources of Staphylococcus aureus transmitted to the surgical wound during cardiothoracic surgery: possibility of preventing wound contamination by use of special scrub suits. Infection Control and Hospital Epidemiology22: 338–46.
23.
TannerJNorriePMelenK. (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database of Systematic Reviews11: CD004122.
24.
TegnellAArénCÖhmanL. (2000) Coagulase-negative Staphylococci and sternal infection after cardiac operation. Annals of Thoracic Surgery69: 1104–9.
25.
ThomasSAgarwalMMehtaG. (2001) Intraoperative glove perforation – single versus double gloving in protection against skin contamination. Postgraduate Medical Journal77: 458–60.
26.
World Health Organization. (2005) World alliance for patient safety. WHO Guidelines on hand hygiene in health care (advanced draft): a summary. Available at: http://www.who.int/patientsafety/events/05/HH_en.pdf (accessed 14 March 2012).
27.
World Medical Association (WMA). (2008) World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Available at: http://www.wma.net/en/20activities/10ethics/10helsinki/ (accessed 14 March 2012)
