Mattress disinfection; hand hygiene; latex safety; abdominal-perineal preps; hand rub characteristics; radiopaque packing - Clinical Issues

AORN Journal, March, 2004 by Dorothy Fogg

QUESTION: I work in an ophthalmological surgery center. Most of our patients remain on the transport stretcher during the surgical procedure and initial recovery period. Very few procedures result in appreciable Mood toss, and there is never any blood remaining on the bed or on the sheets. Is it necessary to wipe down the stretcher after each use? Some of the mattress pads on the stretchers are not in very good condition and are difficult to clean. Additionally, cleaning is time consuming, and if the inside mattress becomes wet where the cover is damaged, the moisture can seep through the sheet placed for the next patient.

ANSWER: Surfaces that patients come in contact with should be cleaned between patients. This includes the side rails and any portion of the stretcher touched by patients, including mattresses and mattress pads. Not all contamination is visible, and the amount of contamination or soil remaining on the stretcher is unknown. According to the Centers for Disease Control and Prevention, mattress covers should be replaced if they are torn or damaged. Mattresses should be kept dry and should be discarded if they become wet. (1) Between patients, moisture-resistant mattress pads and covers should be cleaned and disinfected with a hospital disinfectant registered with the Environmental Protection Agency. If a mattress pad cover is made of fabric, it should be removed and replaced with a clean one before each patient use. Portions of the stretcher that patients do not come in contact with (eg, wheels, base, frame) need not be cleaned and disinfected between patients.

QUESTION: We are having a big hand hygiene campaign in our hospital about which the infection control staff members are very excited. They are touting this as something new and different that is going to affect our infection control rate significantly. Is not hand hygiene the same as hand washing, and have not we been doing that for years? Is the surgical scrub performed before each procedure included in hand hygiene or is it considered something different?

ANSWER: Hand hygiene is an all-encompassing term that refers to degerming or decontaminating the hands. Hand hygiene can be accomplished by several methods, including hand washing with plain soap and water, hand washing with an antimicrobial soap, or using an antiseptic hand rub product. (2,3) According to AORN's "Recommended practices for surgical hand antisepsis/hand scrubs," (2) hand hygiene in the perioperative arena is divided into general hand hygiene and surgical hand antisepsis. The term general hand hygiene refers to routine hand decontamination using either plain or antimicrobial soap and water or an antiseptic hand rub product General use antiseptic hand rub products have been available over the counter for several years and have gained favor for situations in which soap and water are not available. Most antiseptic hand rub products are alcohol based, with or without emollients or other additives, because alcohol is known to be an effective skin disinfectant.

Compliance with general hand hygiene may improve when alcohol-based products are used. Dispensers can be placed strategically where no running water is available for hand washing. Health care providers seem more likely to use the conveniently located alcohol product than to locate a sink with running water between patient contacts or after contact with potentially infectious materials. Use of alcohol-based products is less time consuming than hand washing, and products with emollient additives may be less irritating to the hands. If your infection control practitioners are planning to introduce an alcohol-based hand rub product, they most likely are expecting a decrease in infection rates based on an expected increase in hand hygiene compliance throughout the facility.

The term surgical hand antisepsis refers to preoperatively preparing the hands and arms of surgical team members to eliminate transient bacteria and reduce resident hand flora. (2,3) The term refers to either traditional surgical scrubs with an antimicrobial soap and water or hand and arm preparation with a pre-selected, infection control-approved, antiseptic hand rub product. Products selected for surgical hand antisepsis should meet specific criteria and be labeled specifically for surgical hand antisepsis. Such products must be

* fast acting,

* nonirritating to the skin,

* effective against a broad spectrum of microorganisms, and

* compliant with US Food and Drug Administration (FDA) approval processes and protocols.

The antimicrobial ingredient should be capable of significantly reducing the number of microorganisms on the skin on contact and also demonstrate persistence and cumulative activity. Use of either an antimicrobial surgical scrub agent or an alcohol-based, antiseptic hand rub product with documented persistence and cumulative activity is acceptable for preparing the hands and arms of surgical team members preoperatively. If an alcohol-based, hand rub product is chosen for surgical hand antisepsis, the hands and arms should be prewashed and dried before application of the hand rub product because alcohol-based hand rub products do not remove soil.