Infection Control Today




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

1.     MangramAJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infections ControlPractices Advisory Committee. Guideline for prevention of surgical siteinfection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-278.

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

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

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

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

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

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

8.     Associationof Operating Room Nurses. Recommended practices: Selection and use of packagingsystems. 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-GlovingDouble the Protection? By Carolyn Twomey, RN, BSN

1.     Hancock A, Wilson T. Impact of changes to OSHAs bloodborne pathogensdirective 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 amongemergency department personnel; implications for prevention programs. AJIC.October 1999;27(5).

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

5.     Korniewicz DM. Barrier protection of latex. Immunol Allergy Clin NorthAm. 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 PlastSurg. 1989;42:481-483.

8.     Giercksky KE. Non-antibiotic perioperative infection prophylaxis.Infection in Surgery: International Congress and Symposium Series 234. March1998.

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

10. Dodds RD, Gay PJ, Peacock AM, et. al. Surgical glove perforation. BrJ 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 glovingprotect surgical staff from skin contamination during plastic surgery? PlastReconstr Surg. April 1997;99(40):956-960.

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

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

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

16. Quebbeman EJ, Telford GL, et. al. Double gloving. Protectingsurgeons 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 gloveleak 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 bloodcontact in association with selected obstetric surgical procedures. Am JObstet Gynecol. May 1993;168(5):1354-1357.

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

20. Greco RJ, Garza JR. Use of double gloves to protect the surgeon fromblood contact during aesthetic procedures. Aesthetic Plast Surg. May-June1995;19(3):265-267.

21. Hollaus PH, Lax F, Janakiev D, Wurnig PN, Pridun NS. Glove perforationrate in open lung surgery. Eur J Cardiothoracic Surg. April1999;15(4):461-464.

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

23. Novak CB, Patterson JMM, Mackinnon SE. Evaluation of hand sensibilitywith single and double latex gloves. Plast Reconstr Surg. January1999;103:128-131.

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

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

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

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

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

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

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


Handwashing Problems andSolutions: Part II By David Dyer

1.     UnitedStates Center for Disease Control.  1999. Preventing Emerging Infectious Diseases: A strategy for the 21st Century.

2.     UnitedStates Center for Disease Control.  1994. Addressing emerging infectious disease threats: A prevention strategy for the United States.

3.     SteereAC, Mallison GF. Handwashing practices for the prevention of nosocomialinfections. Ann Intern Med. 1975;83(5):683-90.

4.     Garner S,Favero MS. Guidelines for handwashing and hospital environmental control, 1985. InfectionControl.1985;7:231-5.

5.     CooperBS, Medley GF, Scott GM. Preliminary analysis of the transmission dynamics ofnosocomial infections: stochastic and management effects. J Hosp Infect.1999;43(2):131-47.

6.     LarsonEL. 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 andcohorting in prevention of hospital acquired infections with respiratorysyncytial virus. Arch Dis Child. 1991;66(2):227-31.

11. Larson ELand 1992, 1993, and 1994 APIC Guidelines committee. APIC Guidelines forhandwashing and hand antisepsis in healthcare settings. AJIC. 1995;23:251-69.

12. Tentativefinal monograph for healthcare antiseptic drug products; proposed rule. Federal Register. 1994;59:31402-31542.

13. Jones RD. Bacterial resistance and topical antimicrobial washproducts. 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 toenoyl 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 conformationalchanges related to substrate recognition. J BiolChem. 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 combatinfection.  AORN J.1998;68(2):239-251.

19. FDA. TanSheet. Antimicrobial Hand Sanitizers Position in Continuum Model Challenged. July 27, 1998.

20. PaulsonDS, Fendler EJ, Dolan MJ, Williams MS. A close look at alcohol gel as anantimicrobial sanitizing agent. AJIC. 1999;27: 332-338.

21. Standardtest method for evaluation of health care professional handwash formulation. Method E 1174-94. 1994. American Society for Testing and Materials.

22. PaulsonDS. 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 weafford 100% compliance? Infect Control Hosp Epidemiol. 1997;18(3):205-8.

24. Moad-dabA, Rupley K, Wadhams P. Effectiveness of an alcohol free instant hand sanitizer.J Am Pod Med Assoc. Submitted 2000.

25. MillerML, James-Davis LA, Milanesi L. A field study evaluating the effectiveness ofdifferent 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. DaviesRR, Noble WC. Dispersal of bacteria on desquamated skin. Lancet.1962;2:1295-7.

28. LarsonEL, McGinley KJ, et. al. 1986.  Physiologicand microbiologic changes in skin related to frequent handwashing. InfectControl. 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 ofhealthcare personnel. AJIC. 1998;26:513-521.

30. LarsonEL. Persistent carriage of gram-negative bacteria on hands. AJIC.1981;9:112-119.

31. LarsonEL. Effects of handwashing frequency, agent used and clinical unit on bacterialcolonization 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. SugibayashiK, Nakagama S, Seki T, Hosoya K. Mechanism of skin penetration-enhancing effectby laurocapram. Pharm Sci. 1992;81(1):58-64.

34. WaltersKA. 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.  PharmTech.  17: 62-90

39. Rolf D.Chemical methods of enhancing transdermal drug delivery. Pharm Tech.1988;12:130-139.

40. WatanakunakornC, Wang C, Hazy J. An observational study of handwashing and infection controlpractices by healthcare workers. Infect Control Hosp Epidemiol.1998;19:858-860.

41. TibballsJ. Teaching hospital medical staff to handwash. Med J Aust.1996;164:395-398.

42. DanieslIR, Rees BI. Handwashing: simple but effective. Ann J R Coll Surg Engl.1999;81:117-118.

43. LarsonEL, Talbot GH. An approach for selection of healthcare personnel handwashingagents. Infect Control. 1986;7: 419-424.

44. SpringthorpeS, Sattar S. Handwashing: what can we learn from research? Infect ControlToday. 1998;2:20-26.

45. Celest AJ.1990. United States Patent 4967935.

46. Wirt K,Foslein M.1999. United States Patent 5897031.

47. OphardtT. 1999. United States Patent 5960991.

48. GerenraichKB. 1999. Personal communication. Woodward Laboratories, Inc.

49. LarsonEL, Bryan JL, Adler LM, Blane C. A multifaceted approach to changing handwashingbehavior. AJIC. 1997;25:3-10.

50. Smit HA,Burdorf A, Coenrads PJ. Prevalence of hand dermatitis in different occupations. IntArch Occup Environ Health. 1994;64:541-544.

51. LarsonEL, Friedman C, Cohran J, trestan-Aurand J, Green S. Prevalence and correlatesof 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 sodiumlauryl sulfate for skin cleaning. Contact Dermatitis. 1996;34:366-367.

53. KawasakiY, Kwan D, Sakamoto K, Maibach HI. Electron resonance for skin cleansing. Dermatology.1997;194:238-242.

54. RamsingDW, Agner T. Effect of glove occlusion on human skin I: short term experimentalexposure. Contact Dermatitis. 1996;34:1-5.

55. RamsingDW, 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 CFR333 and 369:  Topical antimicrobialdrug products for over the counter human use; tentative final monograph forfirst aid antiseptic drug products; proposed rule:  Federal Register 56(140), July 22, 1991: 33644-33680.

58. BernsteinIL. Is the use of benzalkonium chloride as a preservative for nasal formulationsa safety concern?  A cautionary notebased 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 ofdifferent surfactants and metal salts in human keratinocytes. A feasible methodfor 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 illnessabsenteeism. J Nurse Pract. Publication pending.

61. DorseyST, Cydulka RK, Emerman GL. Is handwashing teachable?: failure to improvehandwashing behavior in an urban emergency department. Acad Emerg Med.1996;3(4):360-365.

62. MayersJA, Dubbert PM, Miller M, Burkett PA, Chapman SW. Increasing handwashing in anintensive 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 careunite: the effect of an educational program and its relationship to handwashing.AJIC. 1989;17(6):330-339.

64. DubbertPM, 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. McGuckinM, 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. QuraishiZA, McGuckin M, Blais FX. Duration of handwashing in intensive care units: adescriptive study. AJIC. 1984;12(2):83-87.

69. Personalcommunication. (Ton D).



Water Quality andReprocessing 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 occludedin 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 Bacillussubtilis var. niger spores included within water-soluble crystals. ApplMicrobiol. 1968;16:1110-1113.

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


Hazardous Materials Emergencies inSurgery By Jack Donaldson, RN, CNOR, CSPDM

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

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

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

4.     SeibertP. Complying with the hazard communication standard. J Am Veterinary MedAssoc. 1994;204(4):531-534

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

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

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

8.     DonaldsonJ. Mad Cow Disease: An overview of the nursing concerns regarding the SpongiformEncephalopathies. 1998. Online Article


Surgical Site Infections ByVickie VanDeventer, RN, BSN, CIC

HICPAC,Centers for Disease Control & Prevention. Guideline for prevention ofsurgical site infection, 1999.  AJIC1999;27:97-134.

  • 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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