Surgical Hand Wash

Surgical hand wash includes all the procedures and practices that limit the transfer of microorganisms that could cause infections in an individual. It is most common method of hand hygiene since it aims at killing and retarding the pathogenic microorganisms and reduces chances of wound contamination in case surgical gloves get damaged in the process of clinical care (Crisp, J and Taylor, C 2005). Agents for surgical hand washing are similar as those for the hygienic hand wash however the scrub time in surgical hand wash is increased to and also includes both wrists and forearms.

Multiple community-based studies have demonstrated significant reductions in infections, usually gastrointestinal or respiratory, associated with hand hygiene interventions (E. Larson et al, 2003). There are four principles of in infection control as proposed by (Brown D and Edwards H, 2005) these are:

  • Duration and sequence of surgical hand washing.
  • The use of the brush.
  • Minimizing/removal of jewelry when hand washing and keeping the nails short
  • Position of the hands during hand washing.

Duration and sequence of surgical hand wash

The period of time during surgical hand washing is depended on: how soiled the care giver’s hands are, the amount of the jewelry worn by the caregiver, the length of the nails, the surgical procedure to be carried out as well as whether the nurse is to wear surgical gloves or not. However, the length of time needed for effective surgical hand wash is a minimum of two minutes and a maximum of six minutes (2-6minutes). To effectively remove the transient microorganisms, one has to use an anti-microbial cleanser that contains chlorohexidine or a detergent based providone-iodine (Brown D and Edwards H, 2005) these are used together with warm water to wash from the fingertips to the elbow. As Diane Murphy and Chikami put it, “people must learn to wash their hands and in general consider that the world around them is contaminated with many viruses and bacteria”, needless to say, more so those in constant contact with the sick. Much time may be required for soiled hands since they may be containing more micro organisms and also if not washed properly they may harbor microorganisms which may transferred to other healthy persons. Soiled hands should be washed under running water.an antiseptic should be applied onto the palm before and allowed to lather properly so as to dissolve all the dirt and attached microorganisms so that they can be easily removed on rinsing (Crisp, J and Taylor, C 2005). The hands are then rubbed together vigorously so as to lather properly while taking a lot of care in the area between the fingers, thumbs, and wrists and at the back of the hands since they are the parts that are often forgotten. The arms are then rinsed separately starting from the fingertips edging to the elbows under running water. This is done with the hands held higher than the elbows so as to avoid the contaminated lather from the soap or detergent from running back to the fingertips and to the hands. When rinsing, water is allowed to drip from the fingertips down to the forearms and off the elbows (http://www.biomedcentral.com/content/pdf). Rinsing of the hands in running water is very critical since it leads to complete removal of the detergent as well as the pathogenic microorganisms: drying of the hands is also a major step and this must be done using a good quality absorbent and disposable towel. This towel must not be reused. The rationale behind this is because microorganisms are known not to thrive well in dry surfaces and also the drying of hands helps removal residual microorganisms as well the dry skin, which might harbor microorganisms and all these helps to reduce recontamination of the hands.

Removal of Jewelry and Keeping the Nails Short

Jewels other than hindering proper hand washing they also harbor micro-organisms either inside the many decorations they posses or underneath the jewels where they find refuge and can not be removed during hand washing. Equally a health worker who does not remove his/her jewelry during hand washing may develop skin reactions with the cleaning reagents as well as with the gloves powder when they accumulate for longer periods underneath the jewelry which may lead to growth and development of more resident and transient micro-organisms which may later be transmitted to the patients or the other staff during nursing care as well as when greeting each other (http://www.engenderhealth.org/IP/surgical/sum3.html). In addition the jewelry such as rings, bracelets and watches may tear the surgical gloves increasing chances of transmissions of infections to and from patients and nursing staff during invasive surgical procedures.

Nails are known to harbor many disease causing microorganisms as well as food poisoning pathogens. These microorganisms attach loosely inside the long nails that are kept clean or whenever their nail polish chips off are not cleaned they attach there and multiply (Journal of Hospital Injection, 2001). Therefore avoid contamination health care workers mostly the nursing staff are asked to clean their hands aseptically so as to kill or eliminate this microorganisms and also they should put on sterilized gloves before performing any clinical care. They are further advised to wash their hands with disinfectants after the removal of the gloves and before greeting or attending other persons. Short nails also allow ease washing beneath the nails as well as reduced glove tears.

The use of Brush

Although the use of brushes in surgical hand wash is no longer recommended, there are incidences where they encouraged. The brush to be used should contain an anti-microbial soap or detergent, which is then used to scrub fingernails on one hand and then to another sequentially (http://www.biomedcentral.com/content/pdf). A brush can also be used to scrub to scrub the whole hand and then to the other using an anti-microbial detergent. If the fingernails are so much soiled, a brush is used to remove all the debris inside the fingernails. The use of a brush is not encouraged since frequent use may lead to damage of the skin this is because of its abrasive nature. However when used it is advisable that one uses gently as rupturing of the skin can be a route for infection as well as a reservoir for multiplication and transmission. Also due to the availability of many layers, they provide deeper breeding grounds for the pathogenic microorganisms. And this may be a potential danger for patients especially if surgical gloves get torn. Brushes should not be used on the skin that is damaged since it may worsen the condition. The brush should be used only in the first scrub of the day after which one should use alcohol-based formulation to enhance the destruction of microorganisms (http://www.biomedcentral.com/content/pdf). The brushes should be kept dry and clean since dampness and dirt can cause a good breeding ground for microorganisms. However they are reliable if one has long and much soiled fingernails.

Positioning of Hands While Doing Surgical Hand Washing

When performing surgical hand washing one’s hands should always remain above the elbow (http://www.sesahs.nsw.gov). This must be done throughout the procedure. When wetting hands one should incline the hands so as they slant towards the elbow, also when scrubbing with soap and water one should start with the fingertips edging towards the elbow. This is because surgical hand washing is done to remove microorganisms from the hands. The fingertips are mostly contaminated with fecal material which are major cause of ill health due to poor hand hygiene. The other parts of the arm contain microorganisms and the microbial flora found on the skin. Surgical hand washing removes numerous microorganisms from the skin and are trapped in the soap lather. This means that the lather is very contaminated with pathogens and one should make sure that he/she does not come into contact with the lather. It is advised that one cleans the arms up to two inches from the elbow. By placing the hands at a level higher than the elbow ensures that the contaminated water and lather does not come into contact with the fingertips and the palm (Crisp. J and Taylor C, 2005). This water is allowed to trip off the elbow and thus ensuring that at the end of the procedure few or no microorganism will be found on the hands. Positioning of hands is a preventive measure against recontamination and it is very critical in surgical hand washing procedure.

References

  1. Brown, D. and Edwards, H (2005). Lewis’ Medical Surgical Nursing. Assessment and Management of Clinical Problems. Sydney: Elselver.
  2. Crisp J and Taylor, C (2005) Potter and Perry’s Fundamentals of Nursing (2nd Ed Sydney Mesby.
  3. Larson, E., Aiello, A., Lee, L. V., Della-Latta, P., Gomez-Duarte, C., & Lin, S. (2003). Short- and Long-Term Effects of Handwashing with Antimicrobial or Plain Soap in the Community. Journal of Community Health, 28(2), 139+. Web.
  4. Murphy, D., & Chikami, G. K. (1998). Microbial Menace. Forum for Applied Research and Public Policy, 13(4), 11+. Web.
  5. Standard Principles of Preventing Hospital Acquired Infections, Journal of Hospital Injection 2001: 47 (Suppl): S 21 – S37