ATP bioluminescence as an assessment tool for effectiveness of surgical hand scrubbing

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ATP bioluminescence as an assessment tool for effectiveness of surgical hand scrubbing


Author: Chan, Wing Sze
Title: ATP bioluminescence as an assessment tool for effectiveness of surgical hand scrubbing
Degree: M.Sc.
Year: 2012
Subject: Surgical scrub.
Hand washing.
Microbial contamination -- Prevention.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: 104 leaves : ill. (some col.) ; 30 cm.
Language: English
InnoPac Record:
Abstract: Background: The purpose of surgical hand scrubbing is to reduce the microbial counts on hands which may be transferred to wounds through tiny, unobserved punctures in surgical gloves. According to the World Health Organization (WHO) (2009), surgical hand scrubbing was one of the recommended hand hygiene practices among the five elements. There are many published studies on surgical hand scrubbing products. However, few of them address the issue of compliance with surgical hand scrubbing procedures. Objectives: The aims of this study are to evaluate the effectiveness of Adenosine triphosphate (ATP) swabbing for rapid assessment of microbial contamination before and after surgical hand scrubbing. The study also evaluates the knowledge, clinical practice, and compliance of nursing staff and theatre service assistants with surgical hand scrubbing procedures. Design: A quasi-experimental pretest posttest control design was used in this study. Methodology: The study was carried out at a regional hospital in Hong Kong in the operating theatre (OT) department from May 2011 to October 2011. The study consisted of two parts. The first part was a questionnaire of the knowledge and clinical practice of surgical hand scrubbing. The second part examined surgical hand scrubbing using either 4% chlorhexidine gluconate (CHG) or 7.5% povidone iodine (PVI). Thirty-nine nursing staff and 5 theatre service assistants were randomly selected and divided into junior and senior groups according to their date of joining the department. Their compliance with surgical hand antisepsis was assessed by the duration of surgical hand scrubbing, relative light units (RLU) of ATP bioluminescence swabbing and logarithm of bacterial count before and after surgical hand scrubbing. The correlation between RLUs generated from ATP swabs and bacterial counts was also examined.
Results: In the questionnaire on knowledge and practice of surgical hand scrubbing, 93 nursing staff and theatre service assistants were recruited with 70 questionnaires returned. The questionnaire found that 97% of the staff understood that surgical hand scrubbing should be performed for two to five minutes. However, 57% of the staff had not read the instructions provided by the surgical antisepsis manufacturers. Nevertheless, staff would sometimes adjust the surgical hand scrubbing time according to the prevailing situation. In the hand scrubbing study, cleanliness of hands before and after hand scrubbing was assessed using ATP swabbing and conventional bacterial count. The average mean log10RLU counts obtained from ATP swabbing before and after scrubbing were 3.415±0.475 and 2.299±0.492, respectively. The mean logarithms of colony-forming units per hand (log10 CFU/H) before and after surgical hand scrubbing were 5.75±0.50 and 4.06±1.63, respectively. The correlation between log10RLU and log10 CFU was analysed for various data sets using Spearman’s correlation test. No correlation was found in most of the data sets and a medium correlation was observed in the post-scrubbing group using 4% CHG (p-value = 0.015; rho = 0.487). Conclusion: Apart from a medium correlation observed in post-scrubbing group using 4% CHG, the RLUs generated by ATP swabbing did not correlate with the bacterial counts. Hence, ATP swabbing is not an appropriate assessment tool for hand hygiene. This study also showed that 4% CHG achieved a higher bacterial reduction than 7.5% PVI. This study observed that the junior group complied with the duration of hand scrubbing recommended by the Centre for Health Protection, Hong Kong. Recommendation: Further study on ATP bioluminescence swabbing and colony forming units during use of 4% CHG is suggested. The sensitivity and identification of micro-organisms using ATP swabbing should be improved.

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