Infection Control Today

MAY 2000


Choosing a Sterilization Wrap for Surgical Packs By William A. Rutala PhD, MPH and David J. Weber, MD, MPH

1.      Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infections Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-278.

2.      Spalding M. Breakthrough still needed for sterilization wraps. Infect Control Today. January 1999.

3.      Standard PG, Mackel DC, Mallison GF. Microbial penetration of muslin- and paper-wrapped sterile packs stored on open shelves and in closed cabinets. Appl Microbiol. 1971;22:432-437.

4.      Mayworm D. Sterile shelf life and expiration dating. J Hosp Supply. November/December 1984.

5.      Klapes NA, Greene VW, Langholz AC, Hunstiger C. Effect of long-term storage on sterile status of devices in surgical packs. Infect Control. 1987;8:289-293.

6.      Widmer AF, Houston A, Bollinger E, Wenzel RP. A new standard for sterility testing for autoclaved surgical trays. J Hosp Infect. 1992;21:253-260.

7.      Rutala WA, Weber DJ. Use of gowns and drapes (single use and reusable) in healthcare: Review and meta-analysis. Submitted for publication.

8.      Association of Operating Room Nurses. Recommended practices: Selection and use of packaging systems. AORN J. 1992;56:1096-1100.


Training New Employees By Julie Stoller, CRCST

1.      Central Service Management Manual. IAHCSM.

2.      Supervision Principles: Leadership Strategies for Healthcare Facilities.


Does Double-Gloving Double the Protection? By Carolyn Twomey, RN, BSN

1.      Hancock A, Wilson T. Impact of changes to OSHAs bloodborne pathogens directive outlined by attorney. OSHA Guide for Health Care Facilities. January 2000;6(6).

2.      Blood safety survey shows room for improvement. OR Manager. 15;(11):9-11.

3.      Kim LE, Compliance with Universal Precautions among emergency department personnel; implications for prevention programs. AJIC. October 1999;27(5).

4.      OSHA seeks plan to curb needle sticks. The American College of Orthopaedic Surgeons Bulletin. October 1998;46(5).

5.      Korniewicz DM. Barrier protection of latex. Immunol Allergy Clin North Am. February 1995;15(1).

6.      Church J, Sanderson P. Surgical glove puncture. J Hosp Infect. 1980;1(84).

7.      Cole R, Gault DT. Glove perforation during plastic surgery. Br J Plast Surg. 1989;42:481-483.

8.      Giercksky KE. Non-antibiotic perioperative infection prophylaxis. Infection in Surgery: International Congress and Symposium Series 234. March 1998.

9.      Koch F. Whats new in personal protective devices. Infect Control Today. July 1999:22-28.

10.  Dodds RD, Gay PJ, Peacock AM, et. al. Surgical glove perforation. Br J Surg. 1988;75:966-968.

11.  Dodds RD, Barker SG, Morgan NH, Self protection in surgery: the use of double gloves. Br J Surg. 1990;77:219-220.

12.  Main-Bertolin S, Gonzalez-Martinez R, et. al. Does double gloving protect surgical staff from skin contamination during plastic surgery? Plast Reconstr Surg. April 1997;99(40):956-960.

13.  Munksgaard EC. Permeability of protective gloves to (di)methacrylates in resinous dental materials. Scand J Dent Res. 1992;100:189-192.

14.  Preventing disease in the operating room. Panel discussion, American College of Surgeons Spring Meeting. April 29, 1998.

15.  AORN. Recommended practices for maintaining a sterile field. Standards, Recommended Practices and Guidelines. Association of peri-Operative Registered Nurses, 1999.

16.  Quebbeman EJ, Telford GL, et. al. Double gloving. Protecting surgeons from blood contamination in the operating room. Arch Surg. 1992;127(2):213-216.

17.  Albin A, et. al. Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment. Crit Care Med. 1992;20:170-183.

18.  Chapman S, Duff P. Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures. Am J Obstet Gynecol. May 1993;168(5):1354-1357.

19.  Tokars JI, Culver DH, et. al. Skin and mucous membrane contacts with blood during surgical procedures: risk and prevention. Infect Control Hosp Epidemiol. December 1995;16(112):703-711.

20.  Greco RJ, Garza JR. Use of double gloves to protect the surgeon from blood contact during aesthetic procedures. Aesthetic Plast Surg. May-June 1995;19(3):265-267.

21.  Hollaus PH, Lax F, Janakiev D, Wurnig PN, Pridun NS. Glove perforation rate in open lung surgery. Eur J Cardiothoracic Surg. April 1999;15(4):461-464.

22.  Internal study conducted by SSL International, plc Research and Development Division, Cambridge, UK. September 1999.

23.  Novak CB, Patterson JMM, Mackinnon SE. Evaluation of hand sensibility with single and double latex gloves. Plast Reconstr Surg. January 1999;103:128-131.

24.  Webb JM, Pentlow BD. Double gloving and surgical technique. Ann Royal Coll Surg. July 1993;75(4):291-292.

25.  Jackson EM, Neal JG, et. al.. Biochemical performance of orthopaedic gloves. J Biochem Material. 1999;48(2):193-198.

26.  Beck WC. Barrier breach of surgical gloves. J Long Term Effects Med Implants. 1994;4(2-3):127-132.

27.  Rabussay DP, Korniewicz DM. Improving glove barrier effectiveness. AORN J. December 1997;66(6):1043-1046, 1049-1054, 1057-1060.

28.  Duron JJ, Keilani K, Wilan NG. Efficacy of double gloving with a coloured inner pair for immediate detection of operative glove perforations. Eur J Surg.1996;162:941-944.

29.  Nicoali P, Aldam CH, Allen PW. Increased awareness of glove perforation in major joint replacement. J Bone Joint Surg.1997;79-B:371-373.

30.  Avery CME, Taylor J, Johnson PA. Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery. Br J Oral Maxillofac Surg. 1999;37:316-319.


Handwashing Problems and Solutions: Part II 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).



Water Quality and Reprocessing Instruments By Herber Kaiser, PhD; Gerald E. McDonnell, PhD; Jason F. Tirey, MA; and Daniel Klein, BS

1.      Doyle JE, Ernst RE. Resistance of B. subtilis var. niger spores occluded in water-insoluble crystals to three sterilization agents. Appl Microbiol. 1967;15:726-730.

2.      Mullican CC, Hoffman RK. Dry heat or gaseous chemical resistance of Bacillus subtilis var. niger spores included within water-soluble crystals. Appl Microbiol. 1968;16:1110-1113.

3.      Muller HE. The effect of different water-insoluble anorganic salts on the resistance and storage time of B. stearothermophilus Spores used for biological indicators. Zentralblatt fur Hygiene and Umweltmedizin. 1994;196:360-366.


Hazardous Materials Emergencies in Surgery By Jack Donaldson, RN, CNOR, CSPDM

1.      Nightingale F. Notes On Nursing: What It Is, And What It Is Not, (Commemorative Edition). Philadelphia: J.B. Lippincott Company; 1859.

2.      Levitin H, Siegelson H. Hazardous materials: disaster medical planning and response. Emerg Med Clin North Am. 1996;14(2):327-348

3.      National Institute for Occupational Safety and Health, (1998) Guidelines for Protecting the Safety and health of Health Care Workers, "Chemicals Encountered in Selected Hospital Occupations, (Appendix 4)" Online Article, and Guidelines for Protecting the Safety and health of Health Care Workers, "Occupational Hazards by Location in the Hospital (Appendix 3)," Online Article,

4.      Seibert P. Complying with the hazard communication standard. J Am Veterinary Med Assoc. 1994;204(4):531-534

5.      Cox R. Decontamination and management of hazardous materials exposure victims in the emergency department. Ann Em Med. 1994;23(4):761-770.

6.      Agency for Toxic Substances and Disease Registry ATSDR (undated). Managing Hazardous Materials Incidents Volume II: Hospital Emergency Departments: A planning Guide for the Management of Contaminated Patients. US Department of Health and Human Services. Managing Hazardous Materials Incidents Volume III: Medical Management Guidelines for Acute Chemical Exposures. US Department of Health and Human Services.

7.      O'Neil K. Emergency department planning for hazardous materials victims: getting started. J Em Nurs. 1994;20(1):41-44.

8.      Donaldson J. Mad Cow Disease: An overview of the nursing concerns regarding the Spongiform Encephalopathies. 1998. Online Article


Surgical Site Infections By Vickie VanDeventer, RN, BSN, CIC

  1. HICPAC, Centers for Disease Control & Prevention. Guideline for prevention of surgical site infection, 1999.  AJIC 1999;27:97-134.

  2. Kluytmans J. Surgical infections including burns. In: Wenzel R, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Baltimore: Williams & Wilkins; 1998:841-865.
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