Session VI - Reconstruction

The Use of Bandage Scissors in a Trauma Center: The Presence of Bacterial Pathogens and Blood, and Cleaning Habits of Health Care Workers

Carol E. Copeland, MD; Manjari G. Joshi, MD; Mark Scarboro, BA, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD

Objective: To evaluate the use of privately owned bandage scissors, document the presence of bacterial pathogens and blood on these scissors, and to explore the scissors care and cleaning habits of health care workers. To consider bandage scissors as a potential source for nosocomial soft-tissue infections.

Participants: Physicians, medical students, nurses, and nurse extenders of inpatient units at a level I trauma center of a university teaching hospital.

Intervention: Bandage scissors belonging to health care workers were cultured, then tested with hydrogen peroxide for the presence of blood. Employees answered a questionnaire regarding frequency and type of care and cleaning of their bandage scissors. Nosocomial soft-tissue infections were prospectively identified during the month before and after the culturing procedure.

Outcome measurements: Cultures were considered negative if no growth was present in broth subculture after 48 hours. Foaming on application of hydrogen peroxide to the scissors was considered positive for blood. Nosocomial soft-tissue and postoperative wound infection was identified by prospective collection, using the CDC guidelines.

Results: Of the 102 scissors cultured, only 10 scissors grew no organisms (9.8%). Nine scissors (8.8%) grew pathogens (2 Acinetobacter sp., 2 Strep. viridans, 2 methicillin sensitive S. aureus, 1 methicillin resistant S. aureus, 1 Pseudomonas sp., and 1 Group D enterococcus sp.) in addition to skin organisms. The remaining 83 scissors (81%) grew one or more skin organisms, most frequently coagulase negative Staphylococcus sp. (71) or Bacillus sp. (9). Twelve scissors tested positive for the presence of blood (12%), 2 of which were also positive for bacterial pathogens. A wide variety of reported care patterns existed, from never cleaning to autoclaving after each use. Neither frequency of cleaning or type of agent used to clean the scissors was associated with negative cultures (p>0.05). Level of training, years of experience, surgical service, or unit assignment did not affect the presence of positive cultures or blood (p>0.05). Twenty-five concurrent nosocomial soft-tissue infections were identified, of which 6 had identical organisms and interactions with scissors positive for pathogens.

Conclusions: 1. Pathogenic bacteria were found on 8.8% of bandage scissors in use. 2. The same organisms were identified in 6 of the 25 nosocomial soft tissue infections occurring in the same time period. Although a causal relationship has not been documented, the use of bandage scissors represents a potential risk for the transmission of pathogens. 3. Blood found on 12% of scissors warrants further investigation. 4. In the absence of an institutional policy for cleaning bandage scissors, the reported practices ranged widely. Because of contact with open soft tissues during use, bandage scissors should be handled under stricter guidelines than currently exist.