Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-04T18:15:43.777Z Has data issue: false hasContentIssue false
  • English
  • Français

An Outbreak of Handscrubbing-Related Surgical Site Infections in Vascular Surgical Procedures

Published online by Cambridge University Press:  02 January 2015

Renato S. Grinbaum ,
Joao Silva de Mendonça  and
Denise M. Cardo
Renato S. Grinbaum*
Affiliation:
Hospital do Servidor Público Estadual, São Paulo, Brazil
Joao Silva de Mendonça
Affiliation:
Hospital do Servidor Público Estadual, São Paulo, Brazil
Denise M. Cardo
Affiliation:
Escola Paulista de Medicina, São Paulo, Brazil
*
Rua Pedro de Toledo 1800, 15 andar, 04039, São Paulo, SP, Brazil
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate an outbreak of surgical site infections (SSI) in a vascular surgery unit.

Setting:

A 60-bed unit of vascular surgery, where surgeons performed an average of 30 operations per month at the Hospital do Servidor Público Estadual, a 1,000-bed tertiary care hospital in São Paulo, Brazil.

Design:

We included in the case group nine patients who had limb amputations or arterial reconstructions, October 16 through 23, 1992. We included in the control group patients whose operations were performed within 30 days of the outbreak period. Control patients were matched for sex and type of operation.

Results:

Six of 9 case patients experienced SSI, as compared with 3 of 18 control patients (P= .026) and 28 of 244 patients in the pre-epidemic period (P= .0002). Risk factors were identical for case and control groups. Factors assessed were American Society of Anesthesiology (ASA) status, duration of surgery, wound class, emergency status, remote site infections, preoperative length of stay, use of prophylactic antibiotics, and underlying diseases. Possible common sources also were analyzed. No differences were observed concerning hair removal, preoperative shower, wound dressing, and surgical team present in the operating room. During the outbreak period, the operating room was not provided with povidone-iodine, used in our hospital for skin cleansing and handscrubbing. Surgeons from all departments, including vascular surgery, used 2% iodine with 70% alcohol for skin cleansing. Surgeons from other departments used this iodine solution for handscrubbing, but the vascular surgeons used plain soap for handscrubbing. No increases in SSI rates were reported in other services. Comparison of case and control groups for handscrubbing was statistically significant (P<.00001). After reinstitution of povidone-iodine, only one SSI was diagnosed in 13 vascular procedures.

Conclusions:

Although we could not demonstrate definitely that scrubbing with plain soap was related to SSI, we found a strong suggestion of this association

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 4 , April 1995 , pp. 198 - 202
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Haley, RW, Gaynes, RP, Aber, RC, Bennett, JV. Surveillance of nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown & Co; 1992:101.Google Scholar
2. Kaiser, AB. Postoperative infections and antimicrobial prophylaxis. In: Mandell-GL, , Douglas, RG, Bennett, JE, eds. Principles and Practice of Infectious Diseases. 3rd ed. New York. NY: Churchill Livingstone Inc; 1990:2245.Google Scholar
3. Gellert, GA, Gordon, SM, Gordon, RS, Strassburg, M, Brenner, WI, Fannin, SL. A cluster of sternal wound infections requiring muscle flap repair: problems in epidemiological investigation. Am J Infect Control 1991;19:283.10.1016/0196-6553(91)90174-BCrossRefGoogle Scholar
4. Everett, WD, Kipp, H. Epidemiologic observations of operating room resulting from variations in ventilation and temperature. Am J Infect Control 1991;19:277.CrossRefGoogle ScholarPubMed
5. Fynn, DM, Weinstein, RA, Nathan, C, Gaston, MA, Kabins, SA. Patients' endogenous flora as the source of ‘nosocomial’ Enterobacter in cardiac surgery. J Infect Dis 1987;156:363.Google Scholar
6. Richet, HM, Craven, PC, Brown, JM, et al. A cluster of Rhodococcus (Gordona) bronchialis sternal-wound infections after coronaryartery bypass surgery. N Engl J Med 1991;324:104.10.1056/NEJM199101103240206Google Scholar
7. Schaffner, W, Lefkowitz, LB, Goodman, JS. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224.10.1056/NEJM196905292802209Google Scholar
8. Stamm, WE, Feeley, JC, Facklam, RR. Wound infection due to group A Streptococcus traced to a vaginal carrier. J Infect Dis 1978;138:287.Google Scholar
9. Larson, E. Guideline for use of topical antimicrobial agents. Am J Infect Control 1988;16:253.CrossRefGoogle ScholarPubMed
10. Groschel, DHM, Pruett, TL. Surgical antisepsis. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA Lea & Febiger; 1991.Google Scholar
11. Culver, DH, Horan, TC, Gaynes, RP et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index . Am J Med 1991;91(suppl 3B):152S.CrossRefGoogle ScholarPubMed
12. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609.Google Scholar
13. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271.10.1016/S0196-6553(05)80201-9CrossRefGoogle ScholarPubMed
14. Webster, J, Faoagali, JL. An in-use comparison of chlorhexidine gluconate 4% w/v, glycol-poly-siloxane plus methylcellulose and a liquid soap in a special care baby unit. J Hosp Infect 1989;14:141.10.1016/0195-6701(89)90117-5Google Scholar
15. Sanderson, PJ, Weissler, S. A comparison of the effect of chlorhexidine antisepsis, soap and antibiotics on bacteriuria, perineal colonization an environmental contamination in spinally injured patients. J Hosp Infect 1990;15:235.CrossRefGoogle ScholarPubMed
16. Nicoletti, G, Boghossian, V, Borland, R. Hygienic hand disinfection: a comparative study with chlorhexidine detergents and soap. J Hosp Infect 1990;15:323.Google Scholar
17. Ayliffe, GAF, Babb, JR, Davies, JG, Lill, HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Infect 1988;11:226.10.1016/0195-6701(88)90101-6Google Scholar
18. Hayek, LJ, Emerson, JM. Preoperative whole body disinfection—a controlled clinical study. J Hosp Infect 1988;11 (suppl B): 15.Google Scholar
19. Aly, R, Maibach, HI. Comparative efficacy of a 2-minute surgical scrub with chlorhexidine gluconate, povidone-iodine and chloroxlenol sponge-brushes. Am J Infect Control 1988;16:173.Google Scholar
20. Blech, ME Hartemann, P, Paquin, JL. Activity of nonantiseptic soaps and ethanol for hand disinfection. Zbl Bakt Hyg I Abt Orig B 1985;181:496.Google Scholar
21. Larson, EL, Butz, AM, Gullette, DL, Laughon, BA. Alcohol for surgical scrubbing? infect Control Hosp Epidemiol 1990;11:139.Google Scholar
22. Bendig, JWA Surgical hand disinfection: comparison of 4% chlorhexidine detergent solution and 2% triclosan detergent solution. J Hosp Infect 1990;15:143.10.1016/0195-6701(90)90123-6Google Scholar
23. Babb, JR, Davies, JG, Ayliffe, GAJ. A test procedure for evaluating surgical hand disinfection. J Hosp Infect 1991;18(suppl B):41.Google Scholar
24. Rotter, ML, Keller, W, Wewalka, G. Evaluation of procedures for hygienic hand-disinfection: controlled parallel experiments on the Vienna test model. J Hyg Camb 1986;96:27.Google Scholar
25. Kobayashi, H. Evaluation of surgical scrubbing. J Hosp Infect 1991;11(suppl B):29.10.1016/0195-6701(91)90260-FGoogle Scholar
26. Holloway, PM, Platt, JH, Reybrouk, G, Lilly, HA, Mehtar, S, Drabu, Y. A multicentre evaluation of two chlorhexidine-containing formulations for surgical hand disinfection. J Hosp Infect 1990;16:151.CrossRefGoogle ScholarPubMed