Imagine how careful surgeons must be during operations. The room, their tools, and the personnel’s clothing must be sterile.
Surgeons will handle the patients’ internal organs and perform delicate techniques; there must be no chance of infection at all times.
But the hands can be exceedingly dirty: it is the home of up to ten million bacteria, not to mention disgusting particles and matter.
Because of this, you might be curious and asking this question: With what do surgeons wash their hands? What are the materials that sanitize their hands, and how do they use them?
In answering these, we will refer to the official guideline of the World Health Organization on state-of-the-art surgical hand preparation.
Medicated soap
Surgeons use formulated soaps and hand rub formulations with chlorhexidine and povidone-iodine.
At first applications, these can lower bacterial counts from 70 to 80%, but these can reach 99% efficacy through repetition.
Components of surgical medicated soaps
Chlorhexidine is a water-soluble antiseptic that can destroy the membranes of bacteria. It can also destroy viruses like influenza, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus.
This antiseptic is also more effective than povidone-iodine in lowering the counts of bacteria.
It has limitations, though: it is significantly less effective against certain fungi and non-enveloped viruses (like rotavirus and adenovirus, infamous for their stronger resistance).
Chemicals used before in surgical medicated soaps
In the medical industry’s effort to find the best possible soap for surgeons and operating room personnel, they gradually removed agents that were not effective and even harmful.
Also, chlorhexidine and povidone-iodine soaps are quicker and just as effective, but without the poisonous side effects that other chemicals bring.
Triclosan, a chlorinated and antimicrobial substance, was discouraged as a hand sanitizer because it can become toxic and a lake pollutant.
Similarly, the antibacterial cleanser hexachlorophene is banned because it has damaging side effects and a high skin absorption rate.
Warm water
Surgeons also regulate the temperature of the water they use to make handwashing effective.
The guidelines of the World Health Organization say that antiseptics and soap become more effective in warm water, but water in high temperatures can remove the skin’s protective fatty acids.
Sterile cloth towels
After meticulously washing their hands, surgeons use sterile cloth towels to dry them.
Hospitals apply different techniques and substances to clean these cloth towels, like steam, dry heat, chemicals, plasma gas, vaporized hydrogen peroxide, and sterilizing accessories.
However, the World Health Organization notes that these techniques have no significant differences.
Alcohol
Alcohol can stop bacteria regrowth immediately, as shown by studies conducted in laboratories in European countries allowed by the World Health Organization.
Because of this, surgeons also apply alcohol before wearing their gloves. In practice, operating room personnel do alcohol hand rubs for three to five minutes at first, but if the surgery is over two hours long, they apply another hand rub for a minute.
On applying alcohol after washing the hands
Should surgeons wash with both soap and alcohol?
The guideline shows that it is not required to hand wash with soap and hand rub with alcohol unless the personnel’s hands are visibly dirty.
Handwashing is critically required, for it eliminates most risks of contamination. But the effectiveness of applying alcohol after washing the hands lacks experimental data.
Also, the alcohol’s efficacy drops if the hands are not dry before application. So, when should hand rubbing be mostly done?
The guideline recommends cleaning the hands with alcohol before switching to the following surgical procedure.
Technique in rubbing the hands with alcohol
Although alcohol application is not standardized, surgeons follow the hand rub methods recommended by the World Health Organization.
At least 15 mL of alcohol must be rubbed to kill bacteria significantly; it is crucial to make the whole hands wet with alcohol.
In hand rubs, surgeons focus on their forearms, fingers, and hands. The hands must stay above the elbows too.
Should sponges or brushes be used during handwashing?
Thinking that making their hands sterile is a priority, some surgeons tried using sponges and brushes while cleaning their hands.
Research shows that disposable sponges can also reduce bacterial count, but most studies discourage surgeons from using brushes.
Operating room personnel may use brushes if their hands are visibly contaminated and dirty.
However, these do not decrease the number of microbes on the hands. Worse, it may cause irritation, dermatitis, and other side effects on the skin.
Why should surgeons do these if they all wear gloves?
You might be thinking that all of these careful hygiene standards are not worth it. After all, they wear surgical gloves!
But the guidelines prepared by the World Health Organization explain the rationale behind these.
First, the personnels’ gloves might be punctured, releasing dangerous bacteria to the patients’ wounds.
Proper handwashing and hand rubbing also eliminate microbes and their growth, whether the hands are gloved or not.
Which products should surgeons use in washing their hands?
By now, you already know that surgeons use medicated soap, warm water, sterile cloth towels, alcohol, and sponges (occasionally) when washing their hands.
But which handwash products should surgeons use to ensure that their hands are free of dirt and microbes?
The World Health Organization admits that there are no conclusive studies or criteria to answer this question.
However, they point to the recommendations of the United States Food and Drug Administration (FDA).
Their memorandum states that hand preparation products for surgeons must be assessed based on how much they lower down bacterial count on three occasions: right after scrubbing, after wearing gloves for six hours, and after multiple uses on five days.
Infection Control Today lists the required characteristics for each surgical scrub product: antimicrobial power, long-lasting protection, human safety, and wide acceptance.
What must surgeons remove before washing and operating?
The guidelines from the World Health Organization strictly prohibit surgeons and personnel from wearing watches, bracelets, jewelry, and artificial fingernails while scrubbing and operating.
These can pose risks of contamination and hinder the wearers from the standards of hand hygiene.
