Monitoring the effectiveness of surgical handwashing in healthcare workers of a fourth level operating room using bioluminescence assays

Juan Jairo Vaca González; Claudia Marcela  Ramírez Espinosa; Ingrid Carolina  Guayan Ardila; Julieth Yadira  Serrano Riaño; Diana Paola  Torres Gil

doi:10.16925/2357-6014.2022.03.08

Monitoring the effectiveness of surgical handwashing in healthcare workers of a fourth level operating room using bioluminescence assays

Research Articles

https://doi.org/10.16925/2357-6014.2022.03.08

Juan Jairo Vaca González Ver Biografía

Universidad Nacional de Colombia

Claudia Marcela Ramírez Espinosa Ver Biografía

Fundación Universitaria del Área Andina

Ingrid Carolina Guayan Ardila Ver Biografía

Fundación Universitaria del Área Andina

Julieth Yadira Serrano Riaño Ver Biografía

Universidad Colegio Mayor de Cundinamarca

Diana Paola Torres Gil Ver Biografía

Hospital Universitario Clínica San Rafael

Aims: To assesses the effectiveness of surgical handwashing (S-HW) in healthcare workers (HCWs) in terms of organic material and bacteria elimination by means of bioluminescence assays.

Methods: 62-HCWs were subjected to bioluminescence analyses to determine adenosine triphosphate (ATP) and colony forming units (CFU) of Enterobacteriaceae (EB) and E. coli before and after S-HW. A checklist to evaluate adherence to hand hygiene (HH) protocol was implemented.

Results: ATP before HH (510.9/RLU) was reduced after S-HW (54.6/RLU), evidencing a significant decrease (p=0.001). Regarding the bacteria, 26.6/CFU and 4/CFU for EB and E. coli were reported before S-HW, respectively. After S-HW, CFU decreased for EB (21.8/CFU) and E. coli (3.5/CFU) without showing a significant reduction (p=0.679). Low ATP did not evidence a direct relation with EB (p=0.082) and E. coli (p=0.680) reduction. Surgical instrument professionals (p=0.001), general surgeons (p=0.001), residents (p=0.017), orthopedists (p=0.029) and otolaryngologists (p=0.029) evidenced a reduction in ATP after S-HW. Factors such as S-HW direction, surgical soap, moments and time of S-HW implemented showed a statistically significant difference in reduction of ATP, but not in CFU.

Conclusion: Although there was a reduction in elimination of ATP, there was no evidence of a decrease in bacteria. This finding not only allowed to identify potential errors in S-HW processes, but also permitted to generate strategies to improve HH to prevent healthcare-associated infections.

Keywords: handwashing, operation room, healthcare worker, adenosine triphosphate, bacteria, bioluminescence

T. Acter, N. Uddin, J. Das, A. Akhter, T. Choudhury, and S. Kim, “Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency,” Sci. Total Environ., vol. 730, pp. 1–19, 2020, doi: https://doi.org/10.1016/j.scitotenv.2020.138996.

W. Zingg et al., “Technology for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva IPC-Think Tank (Part 2),” Antimicrob. Resist. Infect. Control, vol. 8, no. 83, pp. 1–5, 2019, doi: 10.1186/s13756-019-0538-y.

M. Loftus et al., “Hand hygiene in low- and middle-income countries,” Int. J. Infect. Dis., vol. 86, pp. 25–30, 2019.

A. Alotaibi, A. Alsuraimi, A. Bawazir, S. Almutairi, and M. Kofi, “To What Extent the Hand Hygiene among Health Care Workers Become the Core of Best Practice in the COVID-19 Era?,” Int. Arch. Nurs. Heal. Care, vol. 6, pp. 966–977, Jun. 2020, doi: 10.23937/2469-5823/1510144.

D. Santosaningsih et al., “Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study,” Antimicrob. Resist. Infect. Control, vol. 6, no. 23, pp. 1–10, 2017, doi: 10.1186/s13756-017-0179-y.

K. Onyedibe et al., “Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study,” Antimicrob. Resist. Infect. Control, vol. 9, no. 30, pp. 1–9, 2020, doi: 10.1186/s13756-020-0693-1.

O. Genc and I. Arikan, “The relationship between hand hygiene practices and nasal Staphylococcus aureus carriage in healthcare workers,” Med. Lav., vol. 111, no. 1, pp. 54–62, Feb. 2020, doi: 10.23749/mdl.v111i1.8918.

H. Phan, W. Zingg, H. Tran, A. Dinh, and D. Pittet, “Sustained effects of a multimodal campaign aiming at hand hygiene improvement on compliance and healthcare-associated infections in a large gynaecology/obstetrics tertiary-care centre in Vietnam,” Antimicrob. Resist. Infect. Control, vol. 9, no. 51, pp. 1–9, 2020, doi: 10.1186/s13756-020-00712-x.

N. Nante, E. Ceriale, G. Messina, D. Lenzi, and P. Manzi, “Effectiveness of ATP bioluminescence to assess hospital cleaning: a review,” J. Prev. Med. Hyg., vol. 58, no. 2, pp. 177–183, Jun. 2017, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/28900359.

B. Casini, B. Tuvo, M. Totaro, F. Aquino, A. Baggiani, and G. Privitera, “Evaluation of the Cleaning Procedure Efficacy in Prevention of Nosocomial Infections in Healthcare Facilities Using Cultural Method Associated with High Sensitivity Luminometer for ATP Detection,” Pathogens, vol. 7, no. 3. pp. 1–9, 2018, doi: 10.3390/pathogens7030071.

J. Boyce, N. Havill, D. Dumigan, M. Golebiewski, O. Balogun, and R. Rizvani, “Monitoring the Effectiveness of Hospital Cleaning Practices by Use of an Adenosine Triphosphate Bioluminescence Assay,” Infect. Control Hosp. Epidemiol., vol. 30, no. 7, pp. 678–684, 2009, doi: DOI: 10.1086/598243.

R. Bassyouni, A. Wegdan, and N. El-Sherbiny, “The fundamental role of educational intervention on improving health care workers’ knowledge, attitude and practice towards infection control precautions,” Int. J. Infect. Control, vol. 12, no. 3, pp. 1–11, Sep. 2016, doi: 10.3396/ijic.v12i3.16002.

R. Castillo, “A case study: Utilization of ATP bioluminescence assay in monitoring medical device cleaning process, environment and hand hygiene in CSSD,” in Infection, Disease & Health, Nov. 2017, vol. 22, p. S2, doi: 10.1016/j.idh.2017.09.006.

S. Contreras, G. Caro, J. Cuevas, C. Barrientos, and A. Opazo, “La bioluminiscencia como herramienta para evaluar el lavado de manos durante la formación de profesionales relacionadas con la Salud Pública,” Rev. Investig. Vet. del Perú, vol. 31, no. 3, pp. 1–12, 2020.

Y. Ma, “Evaluation of Adenosine triphosphate Measurement to Monitor Hand Hygiene in ICU,” in American Journal of Infection Control, Jun. 2013, vol. 41, no. 6, p. S68, doi: 10.1016/j.ajic.2013.03.143.

C. Marena et al., “Assessment of handwashing practices with chemical and microbiologic methods: Preliminary results from a prospective crossover study,” Am. J. Infect. Control, vol. 30, no. 6, pp. 334–340, 2002, doi: https://doi.org/10.1067/mic.2002.125809.

L. Storti et al., “Candida spp. isolated from inpatients, the environment, and health practitioners in the pediatric unit at the Universitary Hospital of the Jundiaí Medical College, state of São Paulo, Brazil,” Revista da Sociedade Brasileira de Medicina Tropical, vol. 45. scielo, pp. 225–231, 2012.

K. Sakita et al., “Healthcare workers’ hands as a vehicle for the transmission of virulent strains of Candida spp.: A virulence factor approach,” Microb. Pathog., vol. 113, pp. 225–232, Oct. 2017, doi: 10.1016/j.micpath.2017.10.044.

World Health Organization, “WHO Guidelines on Hand Hygiene in Health Care: a Summary,” Geneva - Switzerland, 2009. [Online]. Available: https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf.

B. Andersen, “Surgical Hand Disinfection,” in Prevention and Control of Infections in Hospitals, Springer International Publishing, 2019, pp. 439–452.

M. Gülşen, N. Aydıngülü, S. Arslan, S. Doğan, D. Alptekin, and E. Nazik, “Surgical handwashing practices of operating room staff: An observational study,” Scand. J. Caring Sci., pp. 1–9, Apr. 2021, doi: https://doi.org/10.1111/scs.12988.

V. Hingst, I. Juditzki, P. Heeg, and H. Sonntag, “Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min,” J. Hosp. Infect., vol. 20, no. 2, pp. 79–86, Feb. 1992, doi: 10.1016/0195-6701(92)90109-Y.

D. O’Farrell, G. Kenny, M. O’Sullivan, P. Nicholson, M. Stephens, and R. Hone, “Evaluation of the optimal hand-scrub duration prior to total hip arthroplasty,” J. Hosp. Infect., vol. 26, no. 2, pp. 93–98, Feb. 1994, doi: 10.1016/0195-6701(94)90050-7.

M. O’Shaughnessy, V. O’Malley, G. Corbett, and H. Given, “Optimum duration of surgical scrub-time,” Br. J. Surg., vol. 78, no. 6, pp. 685–686, Jun. 1991, doi: 10.1002/bjs.1800780617.

A. Khan and S. Nausheen, “Compliance of surgical hand washing before surgery: Role of remote video surveillance,” JPak Med Assoc, vol. 67, no. 1, pp. 92–96, 2017.

J. Tanner, J. Dumville, G. Norman, and M. Fortnam, “Surgical hand antisepsis to reduce surgical site infection,” Cochrane Database Syst. Rev., no. 1, 2016, doi: 10.1002/14651858.CD004288.pub3.

A. Okgün-Alcan and F. Demir-Korkmaz, “Comparison of the efficiency of nail pick and brush used for nail cleaning during surgical scrub on reducing bacterial counts,” Am. J. Infect. Control, vol. 40, no. 9, pp. 826–829, Nov. 2012, doi: 10.1016/j.ajic.2011.10.021.

K. Lai, T. Foo, W. Low, and G. Naidu, “Surgical hand antisepsis-a pilot study comparing povidone iodine hand scrub and alcohol-based chlorhexidine gluconate hand rub,” Ann Acad Med Singap, vol. 41, no. 1, pp. 12–6, 2012.

J. Tsai et al., “Antiseptic Effect of Conventional Povidone–Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial,” Infect. Control Hosp. Epidemiol., vol. 38, no. 4, pp. 417–422, 2017, doi: DOI: 10.1017/ice.2016.296.

A. Trott, “Wound Cleansing and Irrigation,” in Wounds and Lacerations, A. T. B. T.-W. and L. (Fourth E. Trott, Ed. Philadelphia: W.B. Saunders, 2012, pp. 73–81.

L. Reilly, “Prosthetic Vascular Graft Infection,” in Comprehensive Vascular and Endovascular Surgery, J. W. Hallett, J. L. Mills, J. J. Earnshaw, J. A. Reekers, and T. W. B. T.-C. V. and E. S. (Second E. Rooke, Eds. Philadelphia: Mosby, 2009, pp. 688–713.

J. Macias, V. Arreguin, J. Munoz, J. Alvarez, J. Mosqueda, and A. Macias, “Chlorhexidine is a better antiseptic than povidone iodine and sodium hypochlorite because of its substantive effect,” Am. J. Infect. Control, vol. 41, no. 7, pp. 634–637, Jul. 2013, doi: 10.1016/j.ajic.2012.10.002.

R. Paul, N. Das, R. Dutta, R. Bandyopadhyay, and A. Banerjee, “Bacterial contamination of the hands of doctors: A study in the medicine and dermatology wards,” Indian J Dermatol Venereol Leprol, vol. 77, pp. 307–313, 2011, doi: 10.4103/0378-6323.79700.

V. La Fauci, G. Costa, C. Genovese, M. Palamara, V. Alessi, and R. Squeri, “Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy’s hospital,” Rev. Esp. Quimioter., vol. 32, no. 4, pp. 303–310, Aug. 2019, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/31257821.

H. Chrinius, E. Jatau, and C. Whong, “Prevalence and Antibiogram Pattern of Some Nosocomial Pathogens Isolated from Hospital Environment in Zaria, Nigeria,” Aceh Int. J. Sci. Technol., vol. 3, no. 3, pp. 131–139, Sep. 2014, doi: 10.13170/aijst.3.3.1593.

S. Visalachy, K. Palraj, S. Kopula, and U. Sekar, “Carriage of Multidrug Resistant Bacteria on Frequently Contacted Surfaces and Hands of Health Care Workers,” J. Clin. Diagn. Res., vol. 10, no. 5, pp. 18–20, May 2016, doi: 10.7860/JCDR/2016/19692.7772.

L. Ssemogerere et al., “Hand Colonization with Gram-Negative Organisms of Healthcare Workers Accessing the Cardiac Intensive Care Unit: A Cross-Sectional Study at the Uganda Heart Institute,” Crit. Care Res. Pract., pp. 1–8, Oct. 2019, doi: 10.1155/2019/6081954.

F. Eksi, A. Bayram, M. Mehli, S. Akgun, and I. Balci, “Microbial flora on the hands of healthcare workers,” African J. Microbiol. Res., vol. 4, no. 22, pp. 2343–2349, Dec. 2010.

Y. Sun, L. Yu, M. Sun, and Y. Tong, “Microorganisms from hands of traditional Chinese medical doctors in a central hospital environment,” African J. Tradit. Complement. Altern. Med., vol. 13, no. 1, pp. 95–98, 2016, doi: 10.4314/ajtcam.v13i1.13.

N. Joseph, S. Sistla, T. Dutta, A. Badhe, D. Rasitha, and S. Parija, “Role of intensive care unit environment and health-care workers in transmission of ventilator-associated pneumonia,” J. Infect. Dev. Ctries., vol. 4, no. 05 SE-Original Articles, May 2010, doi: 10.3855/jidc.800.

A. Sharma, J. Kalita, and V. Nag, “Screening for Methicillin-resistant Staphylococcus aureus Carriage on the Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices,” Indian J. Crit. Care Med., vol. 23, no. 12, pp. 590–592, Dec. 2019, doi: 10.5005/jp-journals-10071-23296.

I. Onwuezobe and E. Ochang, “Antibiogram of Bacterial Isolates from the Anterior Nares and Hands of Health Care Workers in University of Uyo Teaching Hospital (UUTH) Uyo, AkwaIbom State, Nigeria,” J. Bacteriol. Parasitol., vol. 4, no. 2, pp. 1–5, Jan. 2013, doi: 10.4172/2155-9597.1000168.

I. Méndez Rodríguez, O. Calixto, W. Becerra Cuervo, J. Vásquez, J. Bravo Ojeda, and D. Pachón Barinas, “Microorganismos presentes en fonendoscopios, manos, cavidad oral y nasal de estudiantes de una facultad de medicina,” Revista Med, vol. 20. scieloco, pp. 90–100, 2012.

H. Bankolé et al., “Bacteriological Investigation of the Infectious Risks in a Semi-Public Biomedical Laboratory in Benin (West Africa),” Int. J. Biol., vol. 8, no. 3, pp. 45–57, May 2016, doi: 10.5539/ijb.v8n3p45.

A. Haeidari, D. Keshavarzi, P. Owlia, H. Vatandoost, A. Rafinejad, and J. Rafinejad, “Isolation and enumeration of bacteria responsible for nosocomial infections from houseflies and determining their susceptibility to poison bait,” Nusant. Biosci., vol. 13, no. 1, pp. 26–28, Dec. 2020, doi: 10.13057/nusbiosci/n130104.

D. Matthew, A. Dadah, and S. Mohammed, “Bacterial contamination of operating theatres: a case study of a hospital in Northern Nigeria,” Sci. World J., vol. 15, no. 2, pp. 84–90, 2020.

T. Tan, J. Tan, H. Tay, G. Chua, L. Ng, and N. Syahidah, “Multidrug-resistant organisms in a routine ward environment: differential propensity for environmental dissemination and implications for infection control,” J. Med. Microbiol., vol. 62, no. 5, pp. 766–772, 2013, doi: https://doi.org/10.1099/jmm.0.052860-0.

A. Rodloff, T. Bauer, S. Ewig, P. Kujath, and E. Müller, “Susceptible, intermediate, and resistant - the intensity of antibiotic action,” Dtsch. Arztebl. Int., vol. 105, no. 39, pp. 657–662, Sep. 2008, doi: 10.3238/arztebl.2008.0657.

[1]

J. J. Vaca González, C. M. . Ramírez Espinosa, I. C. . Guayan Ardila, J. Y. . Serrano Riaño, and D. P. . Torres Gil, “Monitoring the effectiveness of surgical handwashing in healthcare workers of a fourth level operating room using bioluminescence assays”, ing. Solidar, vol. 18, no. 3, pp. 1–24, Sep. 2022, doi: 10.16925/2357-6014.2022.03.08.

Download Citation

This work is licensed under a Creative Commons Attribution 4.0 International License.

Cession of rights and ethical commitment

As the author of the article, I declare that is an original unpublished work exclusively created by me, that it has not been submitted for simultaneous evaluation by another publication and that there is no impediment of any kind for concession of the rights provided for in this contract.

In this sense, I am committed to await the result of the evaluation by the journal Ingeniería Solidaría before considering its submission to another medium; in case the response by that publication is positive, additionally, I am committed to respond for any action involving claims, plagiarism or any other kind of claim that could be made by third parties.

At the same time, as the author or co-author, I declare that I am completely in agreement with the conditions presented in this work and that I cede all patrimonial rights, in other words, regarding reproduction, public communication, distribution, dissemination, transformation, making it available and all forms of exploitation of the work using any medium or procedure, during the term of the legal protection of the work and in every country in the world, to the Universidad Cooperativa de Colombia Press.

Issue

Vol. 18 No. 3 (2022)

Published

2022-09-12

Downloads

PDF

Metrics

Metrics Loading ...

https://plu.mx/plum/a/?doi=10.16925/2357-6014.2022.03.08