Preparation of the hands for operation

Scrubbing of the hands is a very important way of preventing infection. Surgeons, operating theatre and dressing nurses should always see to it that their hands are clean, take care of their skin and nails. Taking care of the hands prevents from their cracking and callosity of the skin are prevented. The nails should always be trimmed and short. Whenever very dirty work is to be done manually, gloves should be it is better to worn. Taking good care of the hands should be regarded as a step in the preparation for operation. Whatever method of scrubbing the hands is used, this should start with mechanical cleansing.

Fuerbringer's and Alfred's methods are only of historic value and involve using sterile brush and sterile soap to scrub the hands. Soap is applied to the brush, which is kept in the right hand. After soaping the soap is placed on top of the brush and held at the hand which holds the brush. The brush or napkin should always be moved from outside the fingers to the elbow, fingers should be kept higher than the elbow and the stream of running water from the fingers to the elbows. Scrubbing with the brush is started and ended so that dirty water does not flow back from the elbow to the fingers. Scrubbing starts from the palmar aspect of each finger, then the dorsal aspects are scrubbed, the nail lodges, in between the fingers of the left hand, then the right, the palms and dorsal of the left, further the right hand, and lastly the hands up till the upper third of the forearm towards the elbow joint. The soapy foam is constantly washed away under the running water; the brush is soaped when necessary. Throughout the process of scrubbing it is forbidden to touch the tap, the water flowing; the temperature having been regulated before scrubbing is starts. At the end of scrubbing, the brush and soap are put on a table, the hands rinsed and with the fingers at the level of the chest they are dried with sterile a gauze or napkins, without touching the parts that were not scrubbed. Later on, depending on the method used, the fingers, hands, palms and the lower parts of the forearm are wiped with gauze soaked with alcohol solution and other antiseptics.

• Spasokukotski-Kochergin's method (also uncommon nowadays)

This method involves mechanical cleansing of the hands with 0, 5% ammonium. The hands are washed for 3 minutes in each of the two bowls, using a gauze or napkin, and following the steps similar to those in which the brush is used, starting from the fingers of the left hand. In the first bowl, the hands are washed up to the elbow, and in the second one they are washed up as high as the upper third and the middle of the forearm. At the end of scrubbing, the hands are rinsed with ammonium solution and the fingers raised so that the water drains towards the elbow. Since this moment the fingers should constantly kept above the level of the forearm. It is preferable to dry the hands with a sterile gauze or towel: first dry both hands and discard those napkins, then dry the lower parts of the forearm and then the middle parts.

The hands are disinfected with 96% ethyl alcohol, twice for 2 minutes each, the fingers and hands up till the lower third of the forearm, then the finger tips nail folds; skin creases and folds of the fingers and hands are smeared with 5% alcohol solution of iodine.

Current ways of hand scrubbing involve washing them with running water with soap or liquid washing compounds and subsequent disinfection with chemical antiseptics.

• Pervomur (C-4)

Pervomur is a solution that contains formic acid and hydrogen peroxide. The main solution is prepared initially in the ratio of 81 ml of 85% formic acid and 171 ml of 33% hydrogen peroxide which are mixed in a glass container with a plug and kept in the refrigerator for 2 hours, with periodical shaking. The two compounds react to form a type of the acid with a stronger bactericidal effect. From this amount of the main solution ten litres of 'working solution' of pervomur can be prepared via diluting it with distilled water. The working solution can be used within a day. Preparing the solution, one has to wear gloves to prevent the concentrated solution from burning the hands. Washing with running water and soap for a minute first precedes disinfection of the hands. The hands and forearms up to the middle third are then washed in the bowl with pervomur for another minute and dried with a sterile napkin. As many as five people can use the same bowl of solution.

• Chlorhexidine (0, 5% alcohol solution)

The hands (the finger up to the midforearm) are smeared with gauze swabs soaked in the solution of chlorhexidine for about three minutes; prior to this the hands are washed with soap for a minute.

• AHD solution and Eurosept

These solutions contain the antiseptics such as ethanol, chlorhexidine, and polyiolic fatty acid ether. The hands are first washed with soap and running water for a minute. A few millilitres of the solution are then poured onto the hands twice and rubbed for 2-3 minutes each.

Faster ways of washing the hands are used in the outpatient clinics and under extreme conditions (e.g. wartime). Special agents of membrane forming (e.g. «cerigel») with very strong bactericidal effect are used. This compound contains polyvinyl-buterol and 96% ethyl alcohol. Washed with soap, the hands are well dried. 3-4 ml of cerygel are poured into the palm and rubbed on the fingers, hands, up till the lower third of the forearm for 10 seconds. The fingers are half-stretched and spread for 2-3 min, until a membrane of cerygel is formed around the hands. This membrane has bactericidal function, and can easily (with gauze swabs soaked with alcohol) be cleaned off after the operation.

The hands can also be cleansed by rubbing the hands with 96% ethyl alcohol for 10 minutes (Brun's method) or with 2% alcohol solution of iodine for 3 minutes.

⇐ Предыдущая12345678910Следующая ⇒

Поделиться: