[Hygiene and care, when the wedding ring becomes nosocomial!] / Hygiène et soins, quand l'alliance devient nosocomiale !

In the care setting, hand washing constitutes an essential measure for preventing hand-transmitted infections. Best practices also recommend the principle of zero jewellery. Not so easy to implement, especially when it comes to the removal of wedding rings. A nurse shares her thoughts on this sensitive issue regarding the safety of care.

Amber necklaces: reasons for use and awareness of risk associated with bacterial colonisation.

Parents are increasingly placing amber necklaces on their infants or toddlers to prevent teething pain. The use of the necklaces can pose a risk of death by strangulation, however, there are no data on the potential infectious risk linked to bacterial colonisation associated with the necklaces. We aimed to analyse bacterial colonisation of amber necklaces worn by children during hospital consultations. This prospective observational study included all children wearing a teething necklace at consultation in the Paediatric Dermatology and the Paediatric Emergency Department of our hospital from April to December 2014. The study included 27 children (median age: 10.7 months; 70.4% female). The surface of necklaces underwent bacteriological analyses using three different agar cultures. Parents completed a brief questionnaire to provide reasons for using necklaces and express awareness of risks. One child had a history of impetigo. All necklaces were colonised by bacteria (median: four species per necklace [range: 1-9]); 32 different species were found, the most frequent being coagulase-negative staphylococci (Staphylococcus epidermidis in 88.9% of cases). In three cases, methicillin-sensitive Staphylococcus aureus was found. The most frequent reason for wearing a necklace was to prevent teething pain (n = 17; 63.0%); the necklace was judged effective (moderately/highly effective) in 74.1% of cases, however, 70.4% of parents considered the use of the necklace to be risky. Amber necklaces may be highly colonised by commensal germs of the skin, mainly coagulase-negative staphylococci. Although these bacteria are saprophytes, they may become pathogenic in particular conditions.

[Uniform and ornaments of hands of Healthcare workers: a point prevalence survey in Ausl of Rimini]. / La divisa e gli ornamenti delle mani del personale:un'indagine nell'Ausl di Rimini.

INTRODUCTION: The debate about uniform and hand ornament of nurses, technical and supporting staff is focused on two main topics: the risk of infections and the effect on the professional image perceived by patient. PRIMARY OBJECTIVE: to describe how nurses, technical and supporting staff dress their uniform. SECONDARY OBJECTIVE: to verify the use of ornaments of the hands during routine care. METHODS: The survey was conducted in a sample of 503 operators on 67 working contexts in hospital during 14 days. Study questionnaire was composed by 5 items that described behaviors regarding uniform (item 1-2) and the presence of hand ornaments (item 3-4-5). RESULTS: The 17.3% of observed subjects did not wear the uniform and identification badge appropriately; 16.1% had hand ornaments. DISCUSSION: Despite patient delegates, through advisory committee, pointed out the need to identify the workers through the uniform and badge, our results showed inadequate behaviours. The presence of ornaments that interfere with hands hygiene and increase infection risk is a critical issue that has to be periodically monitored. Future interventions are needed to improve behaviours of healthcare personnel.

Sporotrichosis in an unusual location--Case report.

Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.

Sporotrichosis in an unusual location - Case report

Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.

Guideline implementation: Surgical attire.

Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Removal of nail polish and finger rings to prevent surgical infection.

BACKGROUND: Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings. OBJECTIVES: To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates. SEARCH METHODS: For this fifth update, we searched The Cochrane Wounds Group Specialised Register (searched 23 July 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate. DATA COLLECTION AND ANALYSIS: All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all review authors to ensure appropriate exclusion. MAIN RESULTS: We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing. AUTHORS' CONCLUSIONS: No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

Removal of nail polish and finger rings to prevent surgical infection.

BACKGROUND: Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings. OBJECTIVES: To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates. SEARCH METHODS: For this update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012). SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate. DATA COLLECTION AND ANALYSIS: All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all authors to ensure appropriate exclusion. MAIN RESULTS: We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing. AUTHORS' CONCLUSIONS: No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital?

Our objective was to assess the presence of pathogenic organisms on the rings (worn on fingers) and cell phones carried by health-care workers (HCWs) and the public. Forty-two percent of mobile phones carried by HCWs and 18% carried by the general public were found to carry one or more organisms; 82% of the rings worn by HCWs and 36% of those worn by the general public were found to be positive for the presence of at least one type of microbe.

Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers.

AIMS: This paper is a report of a study of the impact of finger rings, wrist watches, nail polish, length of fingernails, hand lotion, gender and occupation on hand microbiology of healthcare workers. BACKGROUND: The impact of the above mentioned variables on hand microbiology of healthcare workers is not well defined. Large scale studies suitable for multivariate analysis are needed to elucidate their role. METHODS: Both hands of 465 Norwegian healthcare workers were sampled by the glove juice method during two study periods (2004 and 2007), and examined for total number of bacteria and presence of Staphylococcus aureus, Enterobacteriacea and non-fermentative Gram-negative rods. Multiple regression analysis was performed. RESULTS: The use of a wrist watch was associated with an enhanced total bacterial count on hands compared to hands without a watch [(B) 3·25 (95% CI: 1·73-6·07), P <0·001], while the use of one plain finger ring increased the carriage rate of Enterobacteriaceae [odds ratio 2·71 (95% CI: 1·42-5·20), P = 0·003]. The carriage rate of Staphylococcus aureus was enhanced with fingernails longer than 2 mm [odds ratio 2·17 (95% CI: 1·29-3·66), P = 0·004] and after recent use of hand lotion [odds ratio 22·52 (95% CI: 4·05-125·30), P < 0·001]. No effect of nail polish was observed. We found an association between occupation and carriage rate of S. aureus and Enterobacteriaceae. CONCLUSIONS: Health care workers should remove finger rings and watches at work. Fingernails should be shorter than 2 mm, nail polish may be used.

Evaluation of bacterial and fungal contamination in the health care workers' hands and rings in the intensive care unit.

INTRODUCTION: Nosocomial infections remain a major challenge to the health care system and result in significant mortality, morbidity, and economic burden. Intensive care unit (ICU) patients are at great risk of acquiring nosocomial infections. The objective of this study was to determine the contamination rate (bacterial and fungal) of the health care workers' (HCWs') hands and ring in ICU. METHODS: All health care workers were screened during the day shift in Emam hospital ICU. After obtaining informed consent, convenience samples of HCWs' hands and rings were cultured on specific media during their routine work hours, always after a patient care episode. The fungal and bacterial isolates were identified using standard microbiological procedures. RESULTS: A total of 40 subjects were selected in this study (28 females, 12 males). The rate of contamination of hands and rings was observed in 73.1%. Most of isolates are known to cause nosocomial infections which included: 23% staphylococci, 7.9% Klebsiella spp., 4.7% Enterobacter spp., 3.9% Escherichia coli, 3.1% Acinetobacter spp., 2.3% Pseudomonas spp., and 27.7% were colonized with fungi. The fungal isolates were 16.6% Candida spp., 3.9% Rhodotorula spp., 3.1% Aspergillus niger, and 3.9% Aspergillus flavus. CONCLUSION: According to these results HCWs' hands and their rings were contaminated with various types of microorganisms. Medical and hospital personals must follow careful hand-washing techniques to minimize transmission of disease and should remove rings, watches, and bracelets before washing their hands and entering the ICU.

Microbiological findings at tongue piercing sites: implications to oral health.

BACKGROUND: Body piercing enjoys a widespread popularity among juveniles and young people. The tongue is the most commonly pierced oral site. Tongue jewellery, however, can damage the teeth and periodontium and may provide an ideal environment for microorganisms. The aim of this report was to investigate if and in case in which amount periodontopathogenic organisms can be found at tongue piercing sites. METHODS: Patients with tongue piercings visiting the authors' dental office for a dental check-up volunteered. A questionnaire was used to collect data on the type of material used in the piercing, the time the device was in place, oral and piercing hygiene practices and smoking habits. The dental examination included an oral hygiene index and the periodontal screening index. From the surface of the piercing jewellery adjacent to the tongue perforation, microbiological samples were collected and analysed for the presence of 11 periodontopathogenic bacteria. RESULTS: A total of 12 patients with tongue piercing were asked and examined. Their tongue piercings had been in place between 2 and 8 years. The microbiological analysis showed an increased or substantially increased concentration of periodontopathogenic bacteria in all cases. It became obvious that the longer a piercing had been in place, the more pronounced was the shift from bacteria with a moderate periodontopathogenic potential to bacteria with a high periodontopathogenic potential. CONCLUSION: Tongue piercing provides a potential reservoir for periodontopathogenic bacteria.

Impact of finger rings on transmission of bacteria during hand contact.

OBJECTIVE: To investigate the impact of finger rings on the transmission of bacteria from the hands of healthcare workers and the impact on the microflora on the hands of healthcare workers in clinical practice. DESIGN: Our study had a nonequivalent control group posttest-only design (pre-experimental). Healthcare workers who wore finger ring(s) on 1 hand and no ring on the other hand (n = 100) and a control group of healthcare workers who did not wear any rings (n = 100) exchanged standardized hand shakes with an investigator wearing sterile gloves. Samples from the gloved hands of the investigators and the bare hands of the healthcare workers were thereafter obtained by the glove juice technique. SETTING: Two Norwegian acute care hospitals. PARTICIPANTS: Healthcare workers (n = 200) during ordinary clinical work. RESULTS: A significantly higher bacterial load (odds ratio, 2.63 [95% confidence interval, 1.28-5.43]; P = .009) and a significantly higher number of bacteria transmitted (parameter estimates, [corrected] 2.43 [95% confidence interval, 1.44-4.13]; P = .001) were associated with ringed hands, compared with control hands. However, a multiple analysis of covariance revealed no statistically significant effect of rings alone. The prevalence of nonfermentative gram-negative bacteria (42% vs 26%) and Enterobacteriaceae (26% vs 13%) was also significantly higher among persons who wore rings than among persons who did not wear rings. However, no statistically significant differences in the incidence of transmission of these pathogens were detected after hand contact. The prevalence of Staphylococcus aureus and incidence of transmission of S. aureus were the same in both groups. CONCLUSIONS: Wearing finger rings increases the carriage rate of nonfermentative gram-negative bacteria and Enterobacteriaceae on the hands of healthcare workers. However, no statistically significant differences in the incidence of transmission of nonfermentative gram-negative bacteria or Enterobacteriaceae were detected between the healthcare workers who wore rings and those who did not.

Simulated microbe removal around finger rings using different hand sanitation methods.

AIM: It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only "recommend" removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. METHODOLOGY: A gloved rubber hand manikin was made and fitted with a fresh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20 degrees C and 40 degrees C water alone, or with liquid hand soap. Light levels (in lux) of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance (ANOVA) was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey's post hoc honestly significant difference (HSD) test was applied to significant factors to examine pair-wise differences between factor levels. RESULTS: It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. CONCLUSION: The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses.

OBJECTIVES: The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings. METHODS: Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests. RESULTS: The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p=0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p>0.05). CONCLUSIONS: Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.