Adesão às etapas da técnica de degermação das mãos pelas equipes cirúrgicas: revisão integrativa

Fernanda Dolores Pinto; Rosilene Alves Ferreira; Fernanda Marilac Costa dos Santos de Siqueira; Julia de Oliveira Lima Silva; Danielle de Mendonça Henrique; Flavia Giron Camerini; Cintia Silva Fassarella

doi:10.36517/2175-6783.20252695533

Authors

Fernanda Dolores Pinto Universidade do Estado do Rio de Janeiro https://orcid.org/0009-0007-5463-9626
Rosilene Alves Ferreira Universidade do Estado do Rio de Janeiro https://orcid.org/0000-0001-7274-8753
Fernanda Marilac Costa dos Santos de Siqueira Universidade do Estado do Rio de Janeiro https://orcid.org/0009-0002-1268-1184
Julia de Oliveira Lima Silva Universidade do Estado do Rio de Janeiro https://orcid.org/0009-0008-9957-8350
Danielle de Mendonça Henrique Universidade do Estado do Rio de Janeiro https://orcid.org/0000-0002-0656-1680
Flavia Giron Camerini Universidade do Estado do Rio de Janeiro https://orcid.org/0000-0002-4330-953X
Cintia Silva Fassarella Universidade do Estado do Rio de Janeiro https://orcid.org/0009-0006-6089-9670

DOI:

https://doi.org/10.36517/2175-6783.20252695533

Keywords:

Health Personnel; Hand Disinfection; Surgicenters.

Abstract

Objective: to synthesize evidence on adherence to surgical hand antisepsis technique steps by surgical teams. Methods: an integrative review conducted in six stages across MEDLINE, Embase, LILACS, BDENF, CINAHL, Web of Science, SCOPUS, Redalyc, and SciELO databases, covering the period 2009-2024. Studies were classified according to their level of evidence. Results: initially, 647 studies were identified. After applying eligibility criteria and thorough reading, 11 were selected. Most publications originated from SCOPUS (36.4%) and MEDLINE (36.4%) databases, predominantly from Brazil, evaluating multiprofessional teams (90.9%), with a predominance of observational studies (63.6%) at evidence level IV (81.8%). Main gaps identified: low adherence to the complete technique, inadequate hand drying, low adherence to nail cleaning, low adherence to the recommended duration, low adherence to the removal of adornments, and inadequate rinsing. Conclusion: the findings reveal gaps that compromise technique effectiveness (friction time, nail cleaning, and complete technique execution), while reinforcing its importance for patient safety. Contributions to practice: this study is expected to guide educational interventions, audits, and standardized protocols.

References

1. Araújo BSD, Oliveira ACD. Compliance with surgical site infection prevention measures in hospitals. Acta Paul Enferm. 2023;36:eAPE01714. doi:https://dx.doi.org/10.37689/acta-ape/2023AO017134

2. Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, Kay K, Hoffmann KK, et al. SHEA/IDSA/APIC practice recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(3):355-76. doi: https://dx.doi.org/10.1017/ice.2022.304

3. Baier C, Tinne M, von Lengerke T, Gossé F, Ebadi E. Compliance with hand disinfection in the surgical area of an orthopedic university clinic: results of an observational study. Antimicrob Resist Infect Control. 2022;11(1):22. doi: https://doi.org/10.1186/s13756-022-01058-2

4. Fassarella CS, Ferreira RA, Bueno AAB, Romero LB, Ribeiro OMPL, Cardoso RB, et al. Reflection on safety culture and the novice to expert theory in the surgical setting. Rev Min Enferm. 2024;28:e-1554. doi: https://dx.doi.org/10.35699/2316-9389.2024.46436

5. World Health Organization. Global report on infection prevention and control [Internet]. 2022 [cited Jun 10, 2025]. Available from: https://www.who.int/publications/i/item/9789240051164

6. Pinto TC, Henrique DM, Fassarella CS, Camerini FG, Leão RS, Saldanha-Gama RFG, et al. Surgical hand scrubbing in cardiac surgery teams: a microbiological analysis. Rev SOBECC. 2024; 29:E2429988. doi: https://dx.doi.org/10.5327/Z1414-4425202429988

7. Agency for Healthcare Research and Quality. Making healthcare safer IV: final report on prioritization of patient safety practices for a new rapid review or rapid response [Internet]. 2023 [cited Jun 10, 2025]. Available from: https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/prioritization-report.pdf

8. Nações Unidas Brasil. Os Objetivos de Desenvolvimento Sustentável no Brasil [Internet]. 2015 [cited Jul 20, 2025]. Available from: https://brasil.un.org/pt-br/sdgs/3

9. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced Recovery After Surgery (ERAS) protocols: time to change practice? Can Urol Assoc J [Internet]. 2011 [cited Jul 20, 2025];5(5):342-8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3202008/

10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: https://dx.doi.org/10.1136/bmj.n71

11. Organização Mundial de Saúde. Cirurgias seguras salvam vidas - Manual [Internet]. 2009 [cited Jun 10, 2025]. Available from: https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/pnsp/materiais-de-apoio/arquivos/cirurgias-seguras-salvam-vidas-manual/view

12. Johnson N, Phillips M. Rayyan for systematic reviews. J Electron Resour Librariansh. 2018;30(1):46-8. doi: https://doi.org/10.1080/1941126X.2018.1444339

13. Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein. 2010;8(1 Pt 1):102-6. doi: https://dx.doi.org/10.1590/S1679-45082010RW1134

14. Umit UM, Sina M, Ferhat Y, Yasemin P, Meltem K, Ozdemir AA. Surgeon behavior and knowledge on hand scrub and skin antisepsis in the operating room. J Surg Educ. 2014;71(2):241-5. doi: https://doi.org/10.1016/j.jsurg.2013.08.00316

15. Schwartz X, Schmitz M, Safdar N, Pop-Vicas A. Adherence to surgical hand antisepsis: Barriers and facilitators in a tertiary care hospital. Am J Infect Control. 2018;46(6):714-6. doi: https://doi.org/10.1016/j.ajic.2017.12.011

16. Laurikainen E, Rintala E, Kaarto A-M, Routamaa M. Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland. Infect Dis. 2015;48(2):116-21. doi: http://dx.doi.org/10.3109/23744235.2015.1089591

17. Shoaei MN, Arbabisarjou A, Zare S, Shafiee S, Ghoreishinia G, Amin MR. Evaluation of operating room staff hand scrub and its compliance with hand scrub standards. Der Pharm Lett [Internet]. 2015 [cited Jun 10, 2025];7(12):242-5. Available from: https://www.scholarsresearchlibrary.com/articles/evaluation-of-operating-room-staff-hand-scrub-and-its-compliance-with-hand-scrub-standards-2015.pdf

18. Ezzat A, Safdar MM, Ahmed I. Are we following the WHO recommendations for surgical scrubbing? Scott Med J. 2014;59(4):214-9. doi: https://dx.doi-org.ez83.periodicos.capes.gov.br/10.1177/0036933014554885

19. Abdollahi L, Tabrizi JS, Jodati A, Safaie N, Moradi-Joo M, Daemi A. Quality of surgical scrub in a heart hospital: do not take it for granted. J Cardiovasc Thorac Res. 2017;9(3):164-9. doi: https://dx.doi.org/10.15171/jcvtr.2017.28

20. Gaspar T, Campos M, Antunes C, Pereira R, Calado J. Alcohol-based surgical hand preparation: translating scientific evidence into clinical practice. J Hosp Infect. 2018;98(4):379-84. doi: https://doi.org/10.1186/s13756-018-0372-7

21. Francois M, Girard R, Mauranne CC, Ruffion A, Terrier JE. Intégrer la désinfection chirurgicale des mains comme indicateur de qualidade dans un bloc opératoire d’urologie. Prog Urol. 2017;27(16):1015-9. doi: https://doi.org/10.1016/j.purol.2017.08.009

22. Oliveira AC, Gama CS. Surgical antisepsis practices and use of surgical gloves as a potential risk factors to intraoperative contamination. Esc Anna Nery. 2016;20(2):370-7. doi: https://doi.org/10.5935%2F1414-8145.20160051

23. Gülşen M, Aydıngülü N, Arslan S, Doğan SD, Alptekin D, Evsen N. Surgical handwashing practices of operating room staff: an observational study. Scand J Caring Sci. 2022;36(4):926-34. doi: https://doi.org/10.1111%2Fscs.12988

24. Peixoto JGP, Branco A, Dias CAG, Millão LF, Caregnato RCA. Surgical hand antisepsis with alcohol solution: microbial reduction at different application times in the surgical center. Rev SOBECC. 2020;25(2):83-9. doi: https://doi.org/10.5327/Z1414-4425202000020004

25. Hussain F, Rahman MKU, Qadri HM, Rabbani RA. Surgical hand washing – a clinical audit of young surgeons at a tertiary care hospital. Pak J Med Health Sci. 2022;16(6):205-7. doi: https://doi.org/10.53350/pjmhs22166205

26. Nieves V, Gundersen T, Mykkeltveit I. The surgical team’s adherence to recommended guidelines for surgical hand preparation: a quantitative observation study. Sykepleien Forsk. 2024;(95142):e-95142. doi: https://dx.doi.org/10.4220/Sykepleienf.2024.95142en

27. Pérez-Guerrero EE, Guillén-Medina MR, Márquez-Sandoval F, Vera-Cruz JM, Gallegos-Arreola MP, Rico-Méndez MA, et al. Methodological and statistical considerations for cross-sectional, case–control, and cohort studies. J Clin Med. 2024;13(14):4005. doi: http://doi.org/10.3390/jcm13144005

28. Association of periOperative Registered Nurses (AORN). Guideline Quick View: Hand Hygiene. AORN J. 2022;116(3):287-90. doi: https://dx.doi.org/10.1002/aorn.13783

29. Khan HA, Baig FK, Mehboob R. Nosocomial infections: epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed. 2017; 7(5):478-82. doi: https://doi.org/10.1016/j.apjtb.2017.01.019

30. Kramer A, Seifert J, Abele-Horn M, Arvand M, Biever P, Blacky C, et al. S2k-Guideline hand antisepsis and hand hygiene. GMS Hyg Infect Control Sci. 2024;19:Doc42. doi: https://dx.doi.org/10.3205/dgkh000497