Surgical hand hygiene is a rigorous process for medical professionals before performing invasive procedures. This meticulous cleansing of hands and forearms is a foundational healthcare practice, designed to minimize infection risk during operations. It is a stringent approach to hand antisepsis, aiming to eliminate transient microorganisms and significantly reduce resident skin flora. Its goal is to uphold patient safety within the surgical setting.
Why Surgical Hand Hygiene Matters
Surgical hand hygiene plays an important role in preventing healthcare-associated infections (HAIs), especially surgical site infections (SSIs). These infections can arise when microorganisms, such as Staphylococcus aureus or various viruses, enter a patient’s body during a surgical procedure, often leading to increased patient suffering and sometimes even death.
Inadequate hand hygiene by healthcare personnel is a main pathway for pathogen spread. Contaminated hands can inadvertently transfer microorganisms to a patient’s surgical site, making proper hand hygiene a key defense. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) emphasize hand hygiene as an essential practice for infection prevention. By reducing the microbial load on the surgical team’s hands, the risk of bacteria entering the surgical field—even through unnoticed glove punctures—is significantly lowered.
Preventing SSIs improves patient outcomes and reduces the financial burden on healthcare systems. HAIs, including SSIs, are among the most expensive hospital-acquired infections, contributing to billions of dollars in costs annually and increasing hospital stays. Diligent adherence to surgical hand hygiene protocols is an important measure in providing safe, cost-efficient, and effective patient care.
Techniques for Surgical Hand Hygiene
Two primary methods are employed for surgical hand hygiene: the traditional surgical scrub using antimicrobial soap and water, and the alcohol-based hand rub. Both methods aim to significantly reduce microorganisms on the hands and forearms before donning sterile gloves for surgical procedures. The choice often depends on facility protocols and procedure-specific needs.
Traditional Surgical Scrub
The traditional surgical scrub involves a detailed, timed process. Before beginning, all jewelry, including rings, watches, and bracelets, must be removed as these items can harbor bacteria. The initial step involves cleaning under fingernails with a nail cleaner under running water. Following this, an antimicrobial soap, such as chlorhexidine or povidone-iodine, is applied to the hands and forearms.
The scrubbing process typically lasts two to six minutes. Some protocols may extend to five minutes for the first scrub of the day. During the scrub, hands and forearms, extending approximately two inches above the elbows, are thoroughly lathered and scrubbed. While brushes were historically common, modern practice advises against their routine use on skin to prevent damage, reserving them for cleaning nails or visibly soiled areas.
After the scrub, hands and forearms are rinsed thoroughly, always keeping the hands elevated above the elbows to prevent water from flowing back over cleaned areas. Hands and forearms are then dried with sterile disposable towels, moving from fingertips towards the elbows. Immediately following this drying process, sterile surgical gowns and gloves are donned to maintain the prepared sterile field.
Alcohol-Based Hand Rub
The alcohol-based hand rub offers an alternative to the traditional scrub, often preferred for its efficiency and skin-friendly properties. This method is performed on clean, dry hands. A sufficient volume of an alcohol-based hand rub is dispensed into the palm of one hand.
The product is then applied to all surfaces of the hands and forearms, extending up to the elbows. This involves rubbing the fingertips of one hand into the palm containing the rub to decontaminate under the nails, then spreading the rub over the hand and forearm using circular movements. The process is repeated for the other hand and forearm, ensuring complete coverage.
The rubbing continues until the solution has fully evaporated and the hands are completely dry, which takes about one and a half to three minutes. Once the hands and forearms are dry, sterile gloves can be donned.
How Surgical Hand Hygiene Differs
Surgical hand hygiene stands apart from routine social or medical handwashing due to its intensity, products used, and objective. Routine handwashing, performed with plain or antibacterial soap and water for about 15 to 20 seconds, focuses on removing visible dirt and transient microorganisms from the hands. Its goal is general cleanliness and reducing everyday germ spread.
In contrast, surgical hand hygiene involves a longer duration, often ranging from two to six minutes, and extends cleansing beyond the hands to include the forearms up to the elbows. It employs broad-spectrum antimicrobial agents, such as chlorhexidine gluconate or povidone-iodine, specifically formulated to eliminate transient flora and significantly reduce resident skin flora. The objective is not just cleanliness, but achieving a significant reduction in microbial counts to minimize infection risk during invasive procedures.
The higher level of microbial reduction required for surgical procedures means that even after meticulous washing, sterile gloves are immediately worn to maintain the aseptic state. Surgical hand hygiene aims to create a near-sterile environment on the skin, a higher standard than the microbial reduction achieved through routine handwashing.