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Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel
OCTOBER 1989, VOL. 50. NO 4
AORN JOURNAL ~
Research Reviews
GLOVE COMPARISON Integrity of vinyl and latex procedure gloves D M Kotniewicz et a1 Nursing Research Vol38 (May/June 1989) 144-146 The acquired immune deficiency syndrome epidemic has alerted health care providers of the need for research on which to base recommended infection control practices. Gloving practices are a concern for all clinical personnel. Currently, both vinyl and latex gloves are being used in clinical practice settings as barriers against the human immunodeficiency virus (HIV). This article reports on a series of experiments testing the integrity of vinyl and latex gloves under clinical-use conditions. Gloves were tested for watertightness, bacterial penetrability, and dye exclusion. Researchers designed a series of hand manipulations to simulate approximately 15 minutes of clinical use. Participants in the study were 24 females and four males between 20 and 55 years of age. Participants did not wear rings or nail polish, and their fingernails were clipped short. Researchers tested a total of 646 gloves from five manufacturers. A visible examination showed 13 of 315 vinyl gloves and nine of 330 latex gloves had defects, including pinholes or tears. Of the five latex gloves purposefully punctured with a needle, four (80%) resealed (ie, no leaks were detected during the watertight test). All five vinyl gloves, which also had been purposefully punctured, leaked. In the dye test, researchers found that 53% of the vinyl gloves were permeable compared to 3.3% 898
of latex gloves. The tips of the thumb and the index fingers were the predominant areas for permeability. In the bacteria test, researchers found that 20% of the latex gloves and 34% of the vinyl gloves that had passed the watertight test allowed penetration of the test bacteria. Perioperative nursing implications. This study offers additional evidence that gloves that are supposed to provide a barrier may not be impermeable. In general, latex gloves provide a better barrier than vinyl gloves. Nurses, however, should practice good handwashing techniques after providing patient care even if gloves are worn. Handwashing should be done before and after glove removal. In addition, nurses should change gloves frequently during high-stress use in high-risk situations. Gloves should never be reused or washed between patients. As always, perioperative nurses must be particularly vigilant of gloving practices for the entire surgical team. SUSANB. CHRISTOPH,RN, DNSc, CCRN CHAIRMAN NURSINGRESEARCHCOMMITTEE
HANDWASHING Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel E Larson, K Mayur, B A Laughon American Journal of Infection Control Vol 17 (April 1989) 83-88 Health care professionals have the option of three
AORN JOURNAL
different types of handwashing products: plain soap, antiseptic soap, and surgical scrub preparations. In this study, researchers compared the antimicrobial effect of three commercially produced antiseptic handwashing products on normal resident flora after handwashing. Products containing chlorhexidine gluconate, parachlorometaxylenol, and tridosan were used. The 80 volunteers in the sample were randomly assigned to one of eight groups. Groups of 10 subjects were assigned to one of the three antiseptic soaps or to a control soap and to one of two handwashing schedules (six or 18 times a day). The test period lasted five days. A strict protocol was developed to minimize confounding variables. Three days before testing, all subjects were given a control soap for general bathing and handwashing. During the test period, the subjects had to wear gloves if their hands would come into contact with any other products, such as shampoo. No rings, nail polish, or hand lotions were permitted. Researchers supervised all handwashings. Cultures were taken from the subjects’ dominant hand three times: immediately before the study began, after the first wash on the first day, and after the last wash on the fifth day. Data were analyzed using an analysis of covariance controlling for baseline counts. The Tukey technique, a systematic procedure to compare all possible pairs, was used to make multiple comparisons between groups. The authors reported no statistically significant differences in mean bacterial counts after the initial wash with any of the test products. Similarly, there were no statistically significant reductions in bacterial counts at the end of five days when the handwashing was performed six times per day. After 18 washes per day, however, all three antiseptic products performed significantly better than the control group. One product, the chlorhexidine gluconate, produced the greatest reduction in colony counts at both frequencies. The authors concluded that antimicrobial soap is best when handwashing frequency is high and long-term reduction in colonizing flora is desirable. Perioperative nursing implications. The results of this study have immediate clinical
OCTOBER 1989, VOL. 50, NO 4
applications for perioperative practice. Because circulating nurses wash their hands frequently, the soap should be antimicrobial soap. Furthermore, this study provides a framework for methodology to research our recommended practices. Following a similar protocol, perioperative nurses could study the effects of various methods of scrubbing (time versus counted strokes) with several different antimicrobial soap products. AILEENR. KILLEN,RN, MS, CNOR NURSINGRESEARCHCOMMITTEE
POSTOPERATIVE PAIN Use of transcutaneous electrical nerve stimulation for postoperative pain A Hargreaves, J Lander Nursing Research Vol38 (May/June 1989) 159-161 Although narcotic therapy is the primary method of managing postoperative pain, it has been reported to offer poor pain control. Recently, research studies have shown that transcutaneous electrical nerve stimulation (TENS) can offer an alternative to reducing postoperative pain. Many postoperative nursing procedures cause intense, short-term pain for patients. One procedure, cleaning and repacking wounds, stimulates damaged nerve endings, which produces pain. Although the pain may be temporary, it can impede proper cleaning and repacking of incision wounds. It also increases anxiety, which can further increase the patient’s pain. The purpose of this study was to examine the effects of transcutaneous electrical nerve stimulation on postoperative pain caused by cleaning and packing an abdominal surgical wound. The hypothesis was that TENS would reduce the pain arising from the wound care procedure. Seventy-five patients requiring abdominal wound cleaning and repacking postoperatively participated in the study. None of the patients had previously experienced TENS. The patients consisted of 41 males and 34 females with a mean age of 56.9 years. Patients were randomly assigned to one of three
AORN JOURNAL ~
Research Reviews
GLOVE COMPARISON Integrity of vinyl and latex procedure gloves D M Kotniewicz et a1 Nursing Research Vol38 (May/June 1989) 144-146 The acquired immune deficiency syndrome epidemic has alerted health care providers of the need for research on which to base recommended infection control practices. Gloving practices are a concern for all clinical personnel. Currently, both vinyl and latex gloves are being used in clinical practice settings as barriers against the human immunodeficiency virus (HIV). This article reports on a series of experiments testing the integrity of vinyl and latex gloves under clinical-use conditions. Gloves were tested for watertightness, bacterial penetrability, and dye exclusion. Researchers designed a series of hand manipulations to simulate approximately 15 minutes of clinical use. Participants in the study were 24 females and four males between 20 and 55 years of age. Participants did not wear rings or nail polish, and their fingernails were clipped short. Researchers tested a total of 646 gloves from five manufacturers. A visible examination showed 13 of 315 vinyl gloves and nine of 330 latex gloves had defects, including pinholes or tears. Of the five latex gloves purposefully punctured with a needle, four (80%) resealed (ie, no leaks were detected during the watertight test). All five vinyl gloves, which also had been purposefully punctured, leaked. In the dye test, researchers found that 53% of the vinyl gloves were permeable compared to 3.3% 898
of latex gloves. The tips of the thumb and the index fingers were the predominant areas for permeability. In the bacteria test, researchers found that 20% of the latex gloves and 34% of the vinyl gloves that had passed the watertight test allowed penetration of the test bacteria. Perioperative nursing implications. This study offers additional evidence that gloves that are supposed to provide a barrier may not be impermeable. In general, latex gloves provide a better barrier than vinyl gloves. Nurses, however, should practice good handwashing techniques after providing patient care even if gloves are worn. Handwashing should be done before and after glove removal. In addition, nurses should change gloves frequently during high-stress use in high-risk situations. Gloves should never be reused or washed between patients. As always, perioperative nurses must be particularly vigilant of gloving practices for the entire surgical team. SUSANB. CHRISTOPH,RN, DNSc, CCRN CHAIRMAN NURSINGRESEARCHCOMMITTEE
HANDWASHING Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel E Larson, K Mayur, B A Laughon American Journal of Infection Control Vol 17 (April 1989) 83-88 Health care professionals have the option of three
AORN JOURNAL
different types of handwashing products: plain soap, antiseptic soap, and surgical scrub preparations. In this study, researchers compared the antimicrobial effect of three commercially produced antiseptic handwashing products on normal resident flora after handwashing. Products containing chlorhexidine gluconate, parachlorometaxylenol, and tridosan were used. The 80 volunteers in the sample were randomly assigned to one of eight groups. Groups of 10 subjects were assigned to one of the three antiseptic soaps or to a control soap and to one of two handwashing schedules (six or 18 times a day). The test period lasted five days. A strict protocol was developed to minimize confounding variables. Three days before testing, all subjects were given a control soap for general bathing and handwashing. During the test period, the subjects had to wear gloves if their hands would come into contact with any other products, such as shampoo. No rings, nail polish, or hand lotions were permitted. Researchers supervised all handwashings. Cultures were taken from the subjects’ dominant hand three times: immediately before the study began, after the first wash on the first day, and after the last wash on the fifth day. Data were analyzed using an analysis of covariance controlling for baseline counts. The Tukey technique, a systematic procedure to compare all possible pairs, was used to make multiple comparisons between groups. The authors reported no statistically significant differences in mean bacterial counts after the initial wash with any of the test products. Similarly, there were no statistically significant reductions in bacterial counts at the end of five days when the handwashing was performed six times per day. After 18 washes per day, however, all three antiseptic products performed significantly better than the control group. One product, the chlorhexidine gluconate, produced the greatest reduction in colony counts at both frequencies. The authors concluded that antimicrobial soap is best when handwashing frequency is high and long-term reduction in colonizing flora is desirable. Perioperative nursing implications. The results of this study have immediate clinical
OCTOBER 1989, VOL. 50, NO 4
applications for perioperative practice. Because circulating nurses wash their hands frequently, the soap should be antimicrobial soap. Furthermore, this study provides a framework for methodology to research our recommended practices. Following a similar protocol, perioperative nurses could study the effects of various methods of scrubbing (time versus counted strokes) with several different antimicrobial soap products. AILEENR. KILLEN,RN, MS, CNOR NURSINGRESEARCHCOMMITTEE
POSTOPERATIVE PAIN Use of transcutaneous electrical nerve stimulation for postoperative pain A Hargreaves, J Lander Nursing Research Vol38 (May/June 1989) 159-161 Although narcotic therapy is the primary method of managing postoperative pain, it has been reported to offer poor pain control. Recently, research studies have shown that transcutaneous electrical nerve stimulation (TENS) can offer an alternative to reducing postoperative pain. Many postoperative nursing procedures cause intense, short-term pain for patients. One procedure, cleaning and repacking wounds, stimulates damaged nerve endings, which produces pain. Although the pain may be temporary, it can impede proper cleaning and repacking of incision wounds. It also increases anxiety, which can further increase the patient’s pain. The purpose of this study was to examine the effects of transcutaneous electrical nerve stimulation on postoperative pain caused by cleaning and packing an abdominal surgical wound. The hypothesis was that TENS would reduce the pain arising from the wound care procedure. Seventy-five patients requiring abdominal wound cleaning and repacking postoperatively participated in the study. None of the patients had previously experienced TENS. The patients consisted of 41 males and 34 females with a mean age of 56.9 years. Patients were randomly assigned to one of three