Removal of nail polish and finger rings to prevent surgical infection

 

Abstract

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 25 January 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1); MEDLINE (2007 to January Week 2 2010); MEDLINE (In-Process & Other Non-Indexed Citations) (searched 25 January 2010); EMBASE (2007 to 2010 Week 02); and CINAHL (2007 to 26 January 2010). We wrote to manufacturers of surgical scrubbing agents for ongoing and unpublished research, and searched reference lists of articles. We applied no publication date, language or publication status restrictions.

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.

 

Plain language summary

No evidence to show whether removing nail polish and finger rings prevents wound infection after surgery

People having surgery can get a serious wound infection from bacteria (germs) on the hands of operating theatre staff (doctors, nurses, and assistants). Theatre staff scrub their hands intensively before operations to reduce the number of bacteria on them. It may be that nail polish (varnish) and rings (jewellery) hide bacteria and reduce the effectiveness of hand scrubbing. This review could not locate any trials that investigated the effect of theatre staff wearing rings, but did find one small trial that investigated the number of bacteria before and after scrubbing on the hands of theatre staff with varnished and unvarnished nails. This trial did not identify any clear differences between the number of bacteria on varnished and unvarnished nails, but evidence from more trials is required before we can be certain that this is a true result.

 

摘要

背景

清除指甲油和移除戒指以預防手術感染

手術傷口感染可能因手術中手術團隊人員手上的細菌而引起。術前刷手可減少皮膚上細菌數量，手指戴戒指和擦指甲油會降低刷手的功效，因為細菌可能存留於不平滑的指甲油和戒指下的皮膚。

目標

評估由手術刷手人員手上有無指甲油和戒指對術後傷口感染率的影響。

搜尋策略

此次更新我們搜尋The Cochrane Wounds Group Specialised Register (於 2010年元月25日搜尋) ，The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1); MEDLINE (2007 to January Week 2 2010); MEDLINE (InProcess & Other NonIndexed Citations) (searched 25 January 2010); EMBASE (2007 to 2010 Week 02); and CINAHL (2007 to 26 January 2010).。我們寫信給手術刷手器具製造商以取得進行中和未發表的研究以及搜尋的參考文獻。我們沒有發表日期，語文或發表狀態的限制。

選擇標準

隨機有對照組試驗，評估穿戴或除去指甲油和戒指對刷手和術後傷口感染率的影響。

資料收集與分析

所有摘要經確認清單檢查以確定是否符合納入條件。取得相關研究全文報告。所有作者檢視試驗報告以確認適當的排除。

主要結論

我們確定沒有新的試驗;沒有隨機對照試驗比較有否戴戒指;和清除指甲油量測手術感染率。我們發現一個小型隨機對照試驗評估指甲油對術前刷手後殘留手上細菌菌落形成單位數目。護士有的沒:有塗擦指甲油的、有的剛擦指甲油的(兩天內)，或舊有的指甲油(四天以上)。刷手前後兩組之間手上細菌數目沒有顯著差異。

作者結論

梅有試驗檢視是否塗擦穿戴指甲油獲戒指影響手術傷口感染率. 。沒有足夠證據決定是否塗擦指甲油影響皮膚刷手後的細菌數目。。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠證據顯示是否除去指甲油或戴戒指會預防術後傷口感染率:接受手術的病人會因手術人員(醫生，護士和助理)手上的細菌(病菌)，而有嚴重傷口感染。所以手術人員術前密集進行刷手以減少手上細菌數。指甲油(漆)和戒指(首飾)隱藏細菌且降低刷手效能。本回顧無法確定任一試驗探討人員穿戴戒指的影響，但一個小試驗探究人員的有無漆料的指甲於刷手前後的細菌數量。這一試驗未能確定任何清楚的細菌數目的差別，在能確定這項是真的結果之前需要更多的試驗證據。