Ati surgical asepsis trial#

aeruginosa, possibly facilitated by not routinely practising double gloving. 162 A cardiac surgeon with onychomycosis became the source of an outbreak of SSIs due to P. 522 A similar, more recent outbreak with CoNS and endocarditis was observed by Boyce and colleagues, strain identity being confirmed by molecular methods. Koiwai and colleagues detected the same strain of coagulase-negative staphylococci (CoNS) from the bare fingers of a cardiac surgeon and from a patient with postoperative endocarditis with a matching strain. 520 Several reported outbreaks have been traced to contaminated hands from the surgical team despite wearing sterile gloves. 518, 519 In addition, even unused gloves do not fully prevent bacterial contamination of hands. 517 Double gloving decreases the risk of puncture during surgery, but punctures are still observed in 4% of cases after the procedure.

Ati surgical asepsis trial#

A recent trial demonstrated that punctured gloves double the risk of SSIs. After two hours of surgery, 35% of all gloves demonstrate puncture, thus allowing water (hence also body fluids) to penetrate the gloves without using pressure 516 (see Part I, Section 23.1). 515 However, 18% (range: 5–82%) of gloves have tiny punctures after surgery, and more than 80% of cases go unnoticed by the surgeon. Sterile gloves contribute to preventing surgical site contamination 514 and reduce the risk of bloodborne pathogen transmission from patients to the surgical team. The introduction of sterile gloves does not render surgical hand preparation unnecessary. 197 A comparison of different countries showed almost as many protocols as listed countries. 509 – 512 Even today, 5-minute protocols are common. 63 In the second half of the 20th century, the recommended time for surgical hand preparation decreased from >10 minutes to 5 minutes. 508 In 1939, Price suggested a 7-minute handwash with soap, water, and a brush, followed by 70% ethanol for 3 minutes after drying the hands with a towel. 508 In 1894, three steps were suggested: 1) wash hands with hot water, medicated soap, and a brush for 5 minutes 2) apply 90% ethanol for 3–5 minutes with a brush and 3) rinse the hands with an “aseptic liquid”. 507 During the 19th century, surgical hand preparation consisted of washing the hands with antimicrobial soap and warm water, frequently with the use of a brush.

506 At that time, surgical gloves were not yet available, thereby making appropriate disinfection of the surgical site of the patient and hand antisepsis by the surgeon even more imperative. Historically, Joseph Lister (1827–1912) demonstrated the effect of disinfection on the reduction of surgical site infections (SSIs).