Hand hygiene plays a central role in preventing infections within surgical environments. Before any procedure, medical professionals follow specialized protocols and use specific products to prepare their hands. This meticulous preparation is a fundamental measure to reduce the presence of microorganisms on the skin, thereby safeguarding patients from potential infections during surgery.
Active Ingredients in Surgical Soaps
Surgical hand hygiene products feature potent antimicrobial agents that reduce microbial populations on the skin. Chlorhexidine gluconate (CHG) is a widely used antiseptic, often found in concentrations like 4% in surgical scrubs. It exhibits a broad spectrum of activity against various bacteria, viruses, and fungi. CHG is known for its persistent effect, meaning it continues to work for a period after application by binding to the outer layer of the skin.
Another common active ingredient is povidone-iodine (PVP-I), typically available in a 7.5% concentration for surgical scrubs. PVP-I is a complex of iodine with povidone, providing broad-spectrum antimicrobial action. Alcohol-based hand rubs (ABHRs), often containing 60-95% alcohol, are also widely employed for surgical hand preparation, sometimes in conjunction with these agents. Alcohol demonstrates rapid antimicrobial activity against a wide range of microorganisms, offering a quick and effective reduction in bacterial counts.
Why Specific Soaps are Used
The selection of specific antimicrobial agents for surgical hand preparation is rooted in their ability to significantly reduce skin flora and maintain this reduction over time. These specialized solutions rapidly decrease the number of microorganisms on the hands and forearms. The goal is to minimize the risk of transferring bacteria from the surgical team’s hands to the patient, particularly to the surgical site.
Their persistent antimicrobial effect prevents the rapid regrowth of microorganisms under surgical gloves. Even with sterile gloves, tiny punctures can occur during procedures, allowing bacteria to potentially reach the surgical field. By maintaining a low microbial count on the skin beneath the gloves, the risk of surgical site infections (SSIs) is reduced. This sustained activity enhances patient safety throughout the duration of a surgical procedure.
The Surgical Hand Scrub Process
The surgical hand scrub is a standardized procedure that healthcare professionals follow before entering the operating room. This process begins with wetting the hands and forearms under running water. An approved surgical scrub agent is then applied to the wet hands and forearms.
The scrubbing technique involves paying close attention to all surfaces, including fingers, between the fingers, the back and front of the hands, and forearms. Cleaning under the fingernails with a disposable nail pick is also a standard step. While traditional methods often included brushes, many current guidelines recommend limiting their use to nails and subungual areas to prevent skin abrasion.
The duration of the scrub can vary, with many protocols recommending a minimum of two to five minutes. After thorough scrubbing, hands and forearms are rinsed by passing them through running water, keeping hands elevated above the elbows to ensure water flows from the cleanest to less clean areas. Finally, hands are dried thoroughly with a sterile towel before donning sterile gowns and gloves.