Infection Control Today

APRIL 2000

Covergown Policy and Postoperative Infection Rate by Kathy Donaldson, Debra Frederick, Ann Alameda and Margaret Hodge

  1.  Recommended practices for surgical attire. In: Standards, Recommended Practices & Guidelines. Denver: Association of Operating Room Nurse, Inc.; 1999:184.

  2. Mangram A, et. alGuideline for the Prevention of Surgical Site Infection, 1999.  On Line report http://www.cdc.gov/ncidod/hipSSI/SSI-guideline.htm
  3.  Copp G, et. al. Covergowns and the control of operating room contamination. Nurs Res. Sept/Oct 1986; 35:263-268.

  4. Birenbaum H, et. al. Gowning on a postpartum ward fails to decrease colonization in the newborn infant. AJDC. Sept 1990; 144:1031-1033.
  5. Rush J. A randomized controlled trial of a nursery ritual: wearing cover gowns to care for healthy newborns. BIRTH. March 1990;17:1.
  6. Garner J, et. al. Operating room practices for the control of infection in US hospitals. Surgery, Gynecology and Obstetrics. December 1982; 155:873-880.
  7. Patterson P. Is a cover gown policy worth the cost and effort? OR Manager. December 1989; 5:12-15.
  8. Standards for operating room apparel (I-5). In University of California Medical Center Davis Medical Center Operating Room Policy & Procedure Manual. November 1992.
  9. Fairchild S. Perioperative Nursing, Principles and Practice. 2nd ed. Boston: Little, Brown & Co; 1996:79-82.
  10. Shimkus J. Holy cow! Whats so sacred about cover gowns. Materials Mange. June 1999:19.

Handwashing Problems and Solutions: Part I by David Dyer

  1. United States Center for Disease Control.  1999.  Preventing Emerging Infectious Diseases:  A strategy for the 21st Century.
  2. United States Center for Disease Control.  1994.  Addressing emerging infectious disease threats:  A prevention strategy for the United States.
  3. Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med. 1975;83(5):683-90.
  4. Garner S, Favero MS. Guidelines for handwashing and hospital environmental control, 1985. Infection Control.1985;7:231-5.
  5. Cooper BS, Medley GF, Scott GM. Preliminary analysis of the transmission dynamics of nosocomial infections: stochastic and management effects. J Hosp Infect. 1999;43(2):131-47.
  6. Larson EL. Skin hygiene and infection prevention:  more of the same, or different approaches? Clin Infect Dis. 1999;29(5):1287-94.
  7. Tucker M. Handwashing tames E. coli outbreak. Family Practitioner.  December, 1999.
  8. Khan MU. Interruption of shigellosis by hand washing. Trans R Soc Trop Med Hyg. 1982;76(2):164-8.
  9. Isaacs D. Reducing hospital respiratory infections. Nurs Times. 1991;87(29):36
  10. Isaacs D, Dickson H, O'Callaghan C, Sheaves R, Winter A, Moxon ER. Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus. Arch Dis Child. 1991;66(2):227-31.
  11. Larson EL and 1992, 1993, and 1994 APIC Guidelines committee. APIC Guidelines for handwashing and hand antisepsis in healthcare settings. AJIC.  1995;23:251-69.
  12. Tentative final monograph for healthcare antiseptic drug products; proposed rule.  Federal Register. 1994;59:31402-31542.
  13. Jones RD. Bacterial resistance and topical antimicrobial wash products. AJIC. 1999;27(4):351-63.
  14. Roujeinikova A, Levy CW, Rowsell S, Sedelnikova S, Baker PJ, Minshull CA, Mistry A, Colls JG, Camble R, Stuitje AR, Slabas AR, Rafferty JB, Pauptit RA, Viner R, Rice DW. Crystallographic analysis of triclosan bound to enoyl reductase. J Mol Biol. 1999;294(2):527-35.
  15. Roujeinikova A, Sedelnikova S, de Boer GJ, Stuitje AR, Slabas AR, Rafferty JB, Rice DW. Inhibitor binding studies on enoyl reductase reveal conformational changes related to substrate recognition. J Biol Chem. 1999;274(43):30811-7.
  16. Levy CW, Roujeinikova A, Sedelnikova S, Baker PJ, Stuitje AR, Slabas AR, Rice DW, Rafferty JB. Molecular basis of triclosan activity. Nature. 1999;398(6726):383-4.
  17. Chodosh D. 1998. United States Patent 5661107.
  18. Dyer DL, Gerenraich KB, Wadhams PS. Testing a new alcohol-free hand sanitizer to combat infection.  AORN J. 1998;68(2):239-251.
  19. FDA. Tan Sheet. Antimicrobial Hand Sanitizers Position in Continuum Model Challenged.  July 27, 1998.
  20. Paulson DS, Fendler EJ, Dolan MJ, Williams MS. A close look at alcohol gel as an antimicrobial sanitizing agent. AJIC. 1999;27: 332-338.
  21. Standard test method for evaluation of health care professional handwash formulation.  Method E 1174-94. 1994. American Society for Testing and Materials.
  22. Paulson DS. Comparative evaluation of five surgical hand scrub preparations.  AORN J. 1994;246-256.
  23. Voss A, Widmer AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol. 1997;18(3):205-8.
  24. Moad-dab A, Rupley K, Wadhams P. Effectiveness of an alcohol free instant hand sanitizer. J Am Pod Med Assoc. Submitted 2000.
  25. Miller ML, James-Davis LA, Milanesi L. A field study evaluating the effectiveness of different hand soaps and sanitizers. Dairy, Food Env Sanitation. 1994;14(3):155-160.
  26. Meers PD, Yao GA. Shedding of bacteria and skin squames after handwashing. J Hygiene (Camb). 1978;81:99-105.
  27. Davies RR, Noble WC. Dispersal of bacteria on desquamated skin. Lancet. 1962;2:1295-7.
  28. Larson EL, McGinley KJ, et. al. 1986.  Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control. 1986;7:59-63.
  29. Lason EL, Norton-Hughes CA, Pyrek JD, Sparks SM, Cagatay EU, Bartkus JM.  Changes in bacterial flora associated with skin damage on hands of healthcare personnel. AJIC. 1998;26:513-521.
  30. Larson EL. Persistent carriage of gram-negative bacteria on hands. AJIC. 1981;9:112-119.
  31. Larson EL. Effects of handwashing frequency, agent used and clinical unit on bacterial colonization of the hands. AJIC. 1984;12:76-82.
  32. Nobel WE, Pitcher DG. Microbial ecology of the human skin. Advances in Microbiol Ecol. 1978;2:245-289.
  33. Sugibayashi K, Nakagama S, Seki T, Hosoya K. Mechanism of skin penetration-enhancing effect by laurocapram. Pharm Sci. 1992;81(1):58-64.
  34. Walters KA. Percutaneous absorption and transdermal therapy. Pharm Tech. 1986;10:30-42.
  35. Idson B. Percutaneous absorption enhancers. Durg Cosmet Ind. 1985;137:30.
  36. Idson B. Percutaneous absorption. J Pharm Sci. 1972;64:901-924.
  37. Ghosh TK, Banga AK. Methods of enhancement of transdermal drug delivery Part II B: Chemical permeation enhancers. Pharm Tech. 1993;17:68-76.
  38. Ghosh, T.K. and Banga, A.K.  1993.  Methods of enhancement of transdermal drug delivery Part II A:  Chemical permeation enhancers.  Pharm Tech.  17:  62-90
  39. Rolf D. Chemical methods of enhancing transdermal drug delivery. Pharm Tech. 1988;12:130-139.
  40. Watanakunakorn C, Wang C, Hazy J. An observational study of handwashing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol. 1998;19:858-860.
  41. Tibballs J. Teaching hospital medical staff to handwash. Med J Aust. 1996;164:395-398.
  42. Daniesl IR, Rees BI. Handwashing: simple but effective. Ann J R Coll Surg Engl. 1999;81:117-118.
  43. Larson EL, Talbot GH. An approach for selection of healthcare personnel handwashing agents. Infect Control. 1986;7: 419-424.
  44. Springthorpe S, Sattar S. Handwashing: what can we learn from research? Infect Control Today. 1998;2:20-26.
  45. Celest AJ. 1990. United States Patent 4967935.
  46. Wirt K, Foslein M.1999. United States Patent 5897031.
  47. Ophardt T. 1999. United States Patent 5960991.
  48. Gerenraich KB. 1999. Personal communication. Woodward Laboratories, Inc.
  49. Larson EL, Bryan JL, Adler LM, Blane C. A multifaceted approach to changing handwashing behavior. AJIC. 1997;25:3-10.
  50. Smit HA, Burdorf A, Coenrads PJ. Prevalence of hand dermatitis in different occupations. Int Arch Occup Environ Health. 1994;64:541-544.
  51. Larson EL, Friedman C, Cohran J, trestan-Aurand J, Green S. Prevalence and correlates of skin damage on the hands of nurses. Heart Lung. 1997;26:404-412.
  52. Dihoom M, Mahmoud GS, Sudami OH. An outbreak of hand dermatitis among workers using sodium lauryl sulfate for skin cleaning. Contact Dermatitis. 1996;34:366-367.
  53. Kawasaki Y, Kwan D, Sakamoto K, Maibach HI. Electron resonance for skin cleansing. Dermatology. 1997;194:238-242.
  54. Ramsing DW, Agner T. Effect of glove occlusion on human skin I: short term experimental exposure. Contact Dermatitis. 1996;34:1-5.
  55. Ramsing DW, Agner T. Effect of glove occlusion on human skin II:  long term experimental exposure. Contact Dermatitis.  34:  258-262.
  56. Loden M. Urea-containing moisturizers influence barrier properties of normal skin.  Arch Deratol Res. 1996;288:103-107.
  57. 21 CFR 333 and 369:  Topical antimicrobial drug products for over the counter human use; tentative final monograph for first aid antiseptic drug products; proposed rule:  Federal Register 56(140), July 22, 1991:  33644-33680.
  58. Bernstein IL. Is the use of benzalkonium chloride as a preservative for nasal formulations a safety concern?  A cautionary note based on compromised mucociliary transport. J Allergy Clin Imunol. 2000;105(1:1) 39:44.
  59. Brosin A, Wolf W, Matteus A, Neise H. Use of XXT assay to assess the cytotoxicity of different surfactants and metal salts in human keratinocytes. A feasible method for in vitro testing of kin irritants. Acta Derm Venereol.  1997;77(1):26-8. 
  60. Dyer DL. Effectiveness of an alcohol-free instant hand sanitizer at reducing illness absenteeism. J Nurse Pract. Publication pending.
  61. Dorsey ST, Cydulka RK, Emerman GL. Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department. Acad Emerg Med. 1996;3(4):360-365.
  62. Mayers JA, Dubbert PM, Miller M, Burkett PA, Chapman SW. Increasing handwashing in an intensive care unit. Infection Control. 1986;7(5):259-262.
  63. Conly JM, Hill S, Ross J, Lertzman J, Louie TJ. Handwashing practices in an intensive care unite: the effect of an educational program and its relationship to handwashing. AJIC. 1989;17(6):330-339.
  64. Dubbert PM, Dolce J, Richter W, Miller M, Chapman SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp. Epidemiol. 1990;11(4):191-3.
  65. Kimel, L.S. Handwashing education can decrease illness absenteeism. J Sch Nursing. 1996;12(2):14-16, 18.
  66. Guinan M, McGuckin-Guinan M, Sevareid A. Who washes their hands after using the bathroom? AJIC. 1997;25(5):424-425.
  67. McGuckin M, Waterman R, Porten L, Bello S, Caruso M, Juzartis B, Krug E, Mayer S, Ostrawski S. Patient education model for increasing handwashing compliance. AJIC. 1999;27(4):309-314.
  68. Quraishi ZA, McGuckin M, Blais FX. Duration of handwashing in intensive care units: a descriptive study. AJIC. 1984;12(2):83-87.
  69. Personal communication. (Ton D).

Instrument Processing: An Advancement in High-Level Disinfection by Martin S. Favero

  1. Spaulding EH. Chemical disinfection and antisepsis in the hospital. J Hosp Res. 1972;9:531. 
  2. Garner JS, Favero MS. Guidelines for Handwashing and Hospital Environmental Control.  Atlanta, Ga.: Centers for Disease Control and Prevention; 1985.  HHS publication No. 99-1117. 
  3. Favero MS, Bond WW. Chemical disinfection of medical and surgical materials.  In: Block SS, ed. Disinfection, Sterilization, and Preservation.  4th ed. Philadelphia, Pa.: Lea & Febiger; 1991:617641. 
  4. Rutala WA. APIC guideline for selection and use of disinfectants. AJIC. 1996;24:31342. 

Cost Effective Glove Selection by Curt Hamann, Therese Long, and Pamela Rodgers

  1. Center for Devices and Radiological Health, Medical Glove Guidance Manual. Food and Drug Administration, 1996, US Department of Health and Human Services, Rockville, MD.
  2. Guin JD, Hamann C, Sullivan KM. Natural and synthetic rubber. In: Occupational Skin Disease. 3rd ed. Philadelphia: WB Saunders Co.; 1998:501-551.
  3. Estlander T, Jolanki R, Kanerva L. Allergic contact dermatitis from rubber and plastic gloves. In: Protective Gloves for Occupational Use. Boca Raton, Fla: CRC Press; 1994:221-240.
  4. Center for Devices and Radiological Health, Medical Glove Guidance ManualDraft Guidance. Food and Drug Administration, 1999, U.S. Department of Health and Human Services, Rockville, MD.
  5. Rabussay D, Korniewicz DM. The risks and challenges of surgical glove failures. AORN J. 1997;66:867.
  6. Fay MF, Dooher DT.  Surgical gloves: measuring costs and barrier effectiveness. AORN J. 1992;55:1500.
  7. Albin MS, Bunegin L, Duke ES, Ritter RR, Page CP. Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment. Crit Care Med. 1992;20:170.
  8. Perkins JL, Pool B. Batch lot variability in permeation through nitrile gloves. Am Ind Hyg Assoc J. 1997;58:474.
  9. Munksgaard EC. Permeability of protective gloves to (di)methacrylates in resinous dental materials. Scand J Dental Res. 1992;100:189.
  10. Mellstrom M, Linberg M, Boman AS. Permeation and destructive effects of disinfectants on protective gloves. Contact Dermatits. 1992;26:163.
  11. Connor TH. Permeability of nitrile rubber, latex, polyurethane and neoprene gloves to 18 antineoplastic drugs. Am J Health-Syst Pharm. 1999;56:2450.
  12. Baur X, Chen Z, Allmers H. Can a threshold limit value for natural rubber latex airborne allergens be defined? J Allergy Clin Immunol. 1998;101:24.
  13. Williams PB, Halsey JF. Endotoxin as a factor in adverse reactions to latex gloves. Ann Allergy Asthma Immunol. 1997;79:303.
  14. Hamann CP, Turjanmaa K, Rietschel R, Siew C, Owensby D, Gruninger SE, Sullivan KM. Natural rubber latex hypersensitivity: incidence and prevalence of Type I allergy in the dental professional. JADA. 1998;129:43.
  15. Liss GM, Sussman GL, Deal K, Brown S, Cividino M, Siu S, Beezhold D, Smith G, Swanson MC, Yunginger J, Douglas A, Holness DL, Lebert P, Keith P, Wasserman S, Turjanmaa K. Latex allergy: epidemiological study of 1351 hospital workers. Occup Environ Med. 1997;54:335.
  16. De Groot H, De Jong NW, Duijster E, Van Wijk R, Vermeulen A, Van Toorenenbergen AW, Geursen L, Van Joost T. Prevalence of natural rubber latex allergy (type I and type IV) in laboratory workers in the Netherlands. Contact Dermatitis. 1998;38:159.
  17. Kujala VM, Reijul KE. Glove-induced dermal and respiratory symptoms among healthcare workers in one Finnish hospital. Am J Ind Med. 1995;28:89.
  18. Phillips VL, Goodrich MA, Sullivan TJ. Health care worker disability due to latex allergy and asthma: a cost analysis. Am J Public Health. 1999;89:1024.
  19. Kim KT, Grave PB, Safadi GS, Alhadeff G, Metcalfe J.  Implementation recommendations for making health care facilities latex safe. AORN J. 1998;67:615.
  20. Swanson MC, Bubak ME, Hunt LW, Ynginger JW, Warner MA, Reed CE. Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol. 1994;94: 445.
  21. Unpublished data, courtesy of C. Hamann.

Endoscope Cleaning & Disinfection by Marilyn Schaffner

  1. Ott BJ, Nelson B. The structure and function of endoscope channels: the inside story. Gastroenterol Nurs J. 1998;21:48-51.
  2. Axon ATR. Working party report to the world congresses of gastroenterology, Sydney, 1990. J Gastroenterol Hepatol. 1991;6:23-24.
  3. Society of Gastroenterology Nurses and Associates, Inc. 1997. Standards for infection control and reprocessing of flexible gastrointestinal endoscopes. SGNA Monograph Series.1-13. Chicago, IL: Author.
  4. Society of Gastroenterology Nurses and Associates, Inc. Guideline for the use of high-level disinfectants and sterilants for reprocessing of flexible gastrointestinal endoscopes. Gastroenterol Nurs J. 1999;22:127-134.

  5. Tsuji S, Kawano S, Oshita M, Ohmae A, Shinomura Y, Miyazaki Y, Hiraoka S, Matsuzawa Y, Kamada T, Hori M, Maeda T. Endoscope disinfection using acidic electrolytic water. Endoscopy. 1999;31:528-535.
  6. Ellett ML, Mikels CA, Fullhart JW. SGNA endoscopic disinfectant survey. Gastroenterol Nurs J. 1998;21:64-72.
  7. The Working Party of the British Society of Gastroenterology Endoscopy Committee. Cleaning and disinfection of equipment for gastrointestinal endoscopy. GUT. 1998;42:585-593.

  8. Cowen, A. Of microbes, men, and machines. Am J Gastroenterol. 1998;93:2011-2013.

  9. FDA and CDC Public Health Advisory. 1999, September. FDA and CDC Public Health Advisory: Infections from endoscopes inadequately reprocessed by an automated endoscopy reprocessing system.

CS Role in Perioperative Team by Julie Stoller

  1. Websters New Universal Unabridged Dictionary. 2nd ed.
  2. Central Service Technical Manual. 5th ed.

Using Glutaraldehyde Solutions by Martha Young

  1. Safe use and handling of glutaraldehyde-based products in health care facilities. Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST58, 1996.
  2. 01/11/1999-OSHA Chemical Sampling Information, Glutaraldehydes. www.osha-slc.gov/ChemSamp_data/CH_243400.html.
  3. Working Safely with Glutaraldehydes: American Conference of Governmental Industrial Hygienists Recommended Exposure Limit. www.ccohs.ca. Do a search using the term glutaraldehydes.
  4. Norarianni GL. Glutaraldehyde: A seven-step safety program. Infect Control Sterilization Technol. November 1996:19-26.

  5. Ventilation, Routine. Material Safety Data Sheets for Cidex Disinfecting Solutions. Advanced Sterilization Products.

  6. 10/03/1997-Use of latex surgical exam gloves for protection from glutaraldehyde. www.osha-slc.gov/OshDoc/Interp_data//I19971003.html.

  7. Norarianni GL. Controlling glutaraldehyde exposure: Part 1. Infect Control Sterilization Technol. March 1995:20-26.
  8. Norarianni GL. Controlling glutaraldehyde exposure: Part 2. Infect Control and Sterilization Technol. April 1995:16-26.
  9. Standards for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes. Society of Gastroenterology Nurses and Associates.  Inc., 1997.
  10. Indicators for use: Cidex disinfecting solutions. Advanced Sterilization Products.

  11. Occupational Safety and Health Administration.  Hazard communication standard. Code of Federal Regulations. Title 29, Part 1910.1200.

Using Germicides for Cleaning the OR by Lisa S. Higa

  1. Garner JS, Faver MS. Guideline for Handwashing and Hospital Environmental Control. Atlanta, Ga: Centers for Disease Control and Prevention, 1985.

  2.  Favero MS, Bond W. Chemical disinfection of medical and surgical materials. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, Pa: Lea & Febiger. 1991;617-641.

  3. Rutala WA. APIC Guideline for Selection and Use of Disinfectants. AJIC. 1996;23(4):251-259.

  4. Cokendolpher JC, Haukos JF. The Practical Application of Disinfection and Sterilization in Healthcare Facilities. Chicago, Ill: American Hospital Association. 1996.
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