Should finger rings be removed prior to scrubbing for theatre?

Kelsall, Nicola Kim Richmond; Griggs, R; Bowker, Karen E.; Bannister, G.C.

doi:10.1016/j.jhin.2005.09.002

Cited by 23 publications

(19 citation statements)

References 12 publications

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“…8 Jacobson et al 9 concluded that, following thorough hand washing, the microbial load on the hands of ring wearers was similar to that of non-ring wearers despite the initial load being higher in the former group. However, in this study, a formal surgical scrub using anti-microbial agents was not performed.…”

Section: Discussionmentioning

confidence: 99%

Wedding Rings are not a Significant Source of Bacterial Contamination Following Surgical Scrubbing

Al‐Allak

Sarasin

Morris‐Stiff

2008

annals

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INTRODUCTION Despite some evidence that the wearing of rings may increase the microbial load, there is currently nothing to suggest that viable bacteria remain following a standard surgical scrub. The aim of the study was to examine the distribution and type of microbial flora seen on the hands of doctors following a standard surgical scrub.MATERIALS AND METHODS Ten surgeons and 10 anaesthetists, all of whom wore wedding rings on the fourth finger of their left hand, participated in the study. Each individual was asked to 'scrub-up' as for their normal first scrub of the day. Following completion of washing, the wedding ring was removed, its internal circumference swabbed and the swab placed in a culture medium. Volunteers placed each hand palm-down on separate agar plates. The plates were incubated and the number of colonies counted and classified. RESULTS The culture plates of one of the anaesthetists were damaged in transit leaving a total of 19 subjects for analysis. In all the palm imprint plates, coagulase-negative staphylococci were grown. One surgeon grew coagulase-negative staphylococci from the ring swab. A Candida spp. from the right hand of one surgeon was grown. There was no statistically significant difference between the number of colony-forming units (CFUs) cultured from the right and left (ring-wearing) hands of the surgeons (P = 0.260) and anaesthetists (P = 0.345). There was no statistical difference in CFUs when surgeons were compared with anaesthetists (P = 0.383 for right hand and P = 0.234 for left).CONCLUSIONS This preliminary study would suggest that a traditional band wedding ring is not a source of a bacterial load following a standard surgical scrub procedure and, as such, there is no requirement for their removal pre-operatively.

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Section: Discussionmentioning

confidence: 99%

Wedding Rings are not a Significant Source of Bacterial Contamination Following Surgical Scrubbing

Al‐Allak

Sarasin

Morris‐Stiff

2008

annals

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“…[12][13][14][15][16][17][18] Nurse B removes and secures her rings and watch and covers her earrings in accordance with the facility's policy.…”

Section: Jewelrymentioning

confidence: 99%

Guideline Implementation: Surgical Attire

Cowperthwaite¹,

Holm²

2015

AORN Journal

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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.

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“…Alp et al (2006) found pathogenic organisms exclusively on the hands of laboratory personnel who wore jewelry (36.7% rings, 46.9% watch, and 6.1% bracelet). Kelsall et al (2006) found that scrubbing reduces microbes under finger rings, compared to adjacent skin or the opposite hand. By removing rings before scrubbing, the number of bacteria is reduced, but is still higher than adjacent skin or the opposite hand.…”

Section: Introductionmentioning

confidence: 99%

Simulated Microbe Removal around Finger Rings Using Different Hand Sanitation Methods

Alur¹,

Rane

Lorenz

et al. 2009

Int J Oral Sci

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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°C and 40°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.

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Should finger rings be removed prior to scrubbing for theatre?

Cited by 23 publications

References 12 publications

Wedding Rings are not a Significant Source of Bacterial Contamination Following Surgical Scrubbing

Wedding Rings are not a Significant Source of Bacterial Contamination Following Surgical Scrubbing

Guideline Implementation: Surgical Attire

Simulated Microbe Removal around Finger Rings Using Different Hand Sanitation Methods

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