Hand Washing Rituals in Trauma Theatre: Clean or Dirty?

Abstract

INTRODUCTION The aim of this study was to investigate the degree of contamination of a surgeon's hand following use of chlorhexidine gluconate or alcohol gel as disinfectants. MATERIALS AND METHODS In this prospective, randomised trial, orthopaedic surgeons were allocated to one of two different hand-washing protocols using a randomisation table. The hand-washing protocol dictated that all surgeons should wash for 5 min with chlorhexidine for their first case. Thereafter, the surgeon was randomised to wash for 3 min with either alcohol gel or chlorhexidine. At the end of each procedure, the gloves of each surgeon were carefully removed and the fingertips from each hand were placed on an agar plate. The number of bacterial colonies present after 24 h and 48 h of incubation were recorded for each agar plate by a microbiologist blinded to the washing protocol used. RESULTS Overall, 41 procedures and 82 episodes of hand washings were included in the study. Two episodes were discarded due to contamination at the time of glove removal. Four hands (8%) were contaminated in the chlorhexidine group compared to 19 (34%) in the alcohol group. Fisher's exact test confirmed a significantly higher risk of contamination using alcohol gel compared to chlorhexidine (P = 0.002). In addition, the average bacterial colony count was substantially higher in the alcohol group (20 colony forming units) compared to the chlorhexidine group (5 colony forming units). There was no relationship between the duration of surgery and the degree of contamination (P = 1.12). CONCLUSIONS Alcohol gel disinfectant is not a suitable alternative to chlorhexidine when hand washing before surgery. This study has identified a higher risk of bacterial contamination of surgeons' hands washed with alcohol. This may lead to higher levels of postoperative infection in the event of glove perforation.

Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

“…The ability to detect holes quickly enables the surgeon to change their outer pair of gloves, which should hopefully reduce any potential contamination of the surgical site in the event that both pairs of gloves are perforated. Although hands are aseptically prepared before gloving, it is accepted that this will not completely eliminate commensal bacterial burden . For example, regular changing of the outer pair of gloves during human total hip arthroplasty surgery was required to result in a “sterile state” in 80% of cases .…”

Presencia de Staphylococcus aureus después del lavado de manos quirúrgico en estudiantes de odontología

“…Analizando los resultados obtenidos, podemos observar una coincidencia con los estudios de Hajipour L, et al (5) y Jarral OA, et al (6) , quienes determinaron que la clorhexidina era la más efectiva y de mayor duración en comparación con el alcohol y la yodopovidona. En este estudio se determina de igual manera que el antiséptico de primera elección debe ser la clorhexidina.…”

“…Por eso en cada procedimiento quirúrgico, antes de la colocación de la vestimenta estéril, es importante realizar un lavado de manos quirúrgico, con el cual se reduce o elimina en algunos casos las bacterias que estén presentes en la piel de nuestras manos (5) .…”

Surgical hand antisepsis: experimental study

“…Hajipour et al [ 22 ] described in a randomized clinical trial the comparison between chlorhexidine gluconate and an alcohol gel as disinfectants. In the first part, all surgeons followed the traditional antisepsis protocol by using chlorhexidine under running water with a brush for 5 minutes in the first case.…”