To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

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The intention of preoperative skin antisepsis is to reduce the risk of postoperative surgical wound infections through the prevention of contamination of the wound site from the patient's skin flora, and to provide a sterile work area. This pilot study aimed to compare warm versus cold skin disinfection with a chlorhexidine solution on bacterial growth, skin temperatures and the experiences of the disinfection. Ten healthy volunteers without any association to Sweden's healthcare services were included in an experimental study with crossover design. The results showed that warm (38°C) disinfection seems to be comparable with cold (20°C) disinfection in reducing bacterial growth. Experiences differ, but warm disinfection is generally considered more pleasant than cold as a result of heat-loss to the skin. However, further research with larger sample sizes and on patients undergoing surgery is needed.

Skin disinfection with preheated skin disinfectant is an easy and inexpensive nursing intervention that has a positive impact on heat loss and on patients' experience of the disinfection process.

BackgroundIn clinical practice, patients who are awake often comment that cold surgical skin disinfectant is unpleasant. This is not only a problem of patients’ experience; heat loss during the disinfection process is a problem that can result in hypothermia. Evidence for the efficacy of preheated disinfection is scarce.We tested whether preheated skin disinfectant was non-inferior to room-temperature skin disinfectant on reducing bacterial colonization during pacemaker implantation.MethodsThis randomized, controlled, non-inferiority trial included 220 patients allocated to skin disinfection with preheated (36 °C) or room-temperature (20 °C) chlorhexidine solution in 70 % ethanol. Cultures were obtained by swabbing at 4 time-points; 1) before skin disinfection (skin surface), 2) after skin disinfection (skin surface), 3) after the incision (subcutaneously in the wound), and 4) before suturing (subcutaneously in the wound).ResultsThe absolute difference in growth between patients treated with preheated versus room-temperature skin disinfectant was zero (90 % CI −0.101 to 0.101; preheated: 30 of 105 [28.6 %] vs. room-temperature: 32 of 112 [28.6 %]). The pre-specified margin for statistical non-inferiority in the protocol was set at 10 % for the preheated disinfectant. There were no significant differences between groups regarding SSIs three month postoperatively, which occurred in 0.9 % (1 of 108) treated with preheated and 1.8 % (2 of 112) treated with room-temperature skin disinfectant.ConclusionPreheated skin disinfection is non-inferior to room-temperature disinfection in bacterial reduction. We therefore suggest that preheated skin disinfection become routine in clean surgery.Trial registrationThe study is registered at ClinicalTrials.gov (NCTO2260479).

Background: Surgical site infections are a global patient safety concern. Due to lack of evidence on contamination, pre-set surgical goods are sometimes disposed of or resterilized, thus increasing costs, resource use, and environmental effects. Aim: To investigate time-dependent bacterial air contamination of covered and uncovered sterile goods in the operating room. Methods: Blood agar plates (N ¼ 1584) were used to detect bacterial air contamination of sterile fields on 48 occasions. Each time, three aerobe and three anaerobe plates were used as baseline to model the preparation time, and 60 (30 aerobe, 30 anaerobe) were used to model the time pending before operation; half of these were covered with sterile drapes and half remained uncovered. Plates were collected after 4, 8, 12, 16, and 24 h. Findings: Mean time before contamination was 2.8 h (95% confidence interval: 2.1e3.4) in the uncovered group and 3.8 h (3.2e4.4) in the covered group (P ¼ 0.005). The uncovered group had 98 colony-forming units (cfu) versus 20 in the covered group (P ¼ 0.0001). Sixteen different micro-organisms were isolated, the most common being Cutibacterium acnes followed by Micrococcus luteus. Of 32 Staphylococcus cfu, 14 were antibiotic resistant, including one multidrug-resistant Staphylococcus epidermidis. Conclusion: Protecting sterile fields from bacterial air contamination with sterile covers enhances the durability of sterile goods up to 24 h. Prolonged durability of sterile goods might benefit patient safety, since surgical sterile material could be prepared in advance for acute surgery, thereby enhancing quality of care and reducing both climate impact and costs.

BackgroundTo prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.MethodsThis pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher’s exact test.ResultsOperating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.ConclusionsThere were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.Trial registrationTrial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov (NCT02359708). 01/27/2015.

Background: Clinically, patients often comment on the coolness of the skin disinfectant. However, scarce evidence is available regarding patients’ experience during intraoperative skin disinfection. Aims: The aim of this study was to describe and compare intraoperative patient experiences with preheated and room temperature skin disinfectant. Method: This randomised controlled trial included 220 patients undergoing cardiac device implantation. Patients allocated to preheated (36°C) or room temperature (20°C) chlorhexidine in 70% ethanol verbally answered an open-ended question regarding their experience with the skin disinfection. Results were assessed using a qualitative approach with comparative quantification. Results: The analysis resulted in nine categories describing the patients’ experiences with preheated and room temperature skin disinfection. Most of the patients described the skin disinfection process as a negative experience, which consisted of six categories: cold, smell, change in temperature, unpleasant, wet and painful. In addition, two neutral categories of response (nothing in particular and neither pleasant nor unpleasant) and one positive response (pleasant) emerged through the analysis. Preheated skin disinfection yielded significantly fewer negative experiences in the category cold (85% vs. 15%, P<0.0001) and significantly more positive experiences (66% vs. 34%, P<0.002). Neutral categories (neither pleasant nor unpleasant 65% vs. 35%, P=0.01, nothing in particular 74% vs. 26%, P<0.001) dominated after preheated skin disinfection. Conclusion: The use of preheated skin disinfection promotes a positive patient experience with skin disinfection. Trial registration: ClinicalTrials.gov registration number NCT02260479 ( https://clinicaltrials.gov/ct2/results?cond=preheated+skin+disinfection ).