Surgical Hand

Antisepsis
Antiseptic preparations intended for use as
surgical hand scrubs are evaluated for their
ability to reduce the number of bacteria released
from hands at different times, including
1) immediately after scrubbing,
2) after wearing surgical gloves for 6 hours (i.e.,
persistent activity),
3) after multiple applications over 5 days (i.e.,
cumulative activity).
U.S. guidelines recommend that agents
used for surgical hand scrubs should
substantially reduce microorganisms on
intact skin,
contain a nonirritating antimicrobial
preparation,
have broad-spectrum activity, and
be fast-acting and persistent.
Self-reported factors for poor
adherence with hand hygiene
Handwashing agents cause irritation and
dryness
Sinks are inconveniently located/shortage of
sinks
Lack of soap and paper towels
Often too busy/insufficient time
Understaffing/overcrowding
Patient needs take priority
Hand hygiene interferes with health-care worker
relationships with patients
Low risk of acquiring infection from patients
 Wearing of gloves/beliefs that glove use
obviates the need for hand hygiene
Lack of knowledge of guidelines/protocols
Not thinking about it/forgetfulness
No role model from colleagues or superiors
Skepticism regarding the value of hand hygiene
Disagreement with the recommendations
Lack of scientific information of definitive impact
of improved hand hygiene on health-care
associated infection rates
 Gloving Policies
CDC has recommended that HCWs wear gloves to
1) reduce the risk of personnel acquiring
infections from patients,
2) prevent health-care worker flora from being
transmitted to patients, and
3) reduce transient contamination of the hands
of personnel by flora that can be transmitted
from one patient to another.
The Occupational Safety and Health
Administration (OSHA) mandates that
gloves be worn during all patient-care
activities that may involve exposure to
blood or body fluids that may be
contaminated with blood
Recommendations
Each recommendation is categorized on the basis
of existing scientific data, theoretical rationale,
applicability, and economic impact. The system
for categorizing recommendations is as follows:
Category IA. Strongly recommended for
implementation and strongly supported by well-
designed experimental, clinical, or epidemiologic
studies.
Category IB. Strongly recommended for
implementation and supported by certain
experimental, clinical, or epidemiologic studies
and a strong theoretical rationale.

 Category IC. Required for implementation, as

mandated by federal or state regulation or
standard.
Category II. Suggested for implementation and
supported by suggestive clinical or
epidemiologic studies or a theoretical rationale.
No recommendation. Unresolved issue.
Practices for which insufficient evidence or no
consensus regarding efficacy exist.
Indications for handwashing and
hand antisepsis
A. When hands are visibly dirty or contaminated
with proteinaceous material or are visibly soiled
with blood or other body fluids, wash hands with
either a non-antimicrobial soap and water or an
antimicrobial soap and water (IA).
B. If hands are not visibly soiled, use an alcohol-
based hand rub for routinely decontaminating
hands in all other clinical situations described in
items 1CJ (IA). Alternatively, wash hands with
an antimicrobial soap and water in all clinical
situations described in items 1CJ (IB).
 C. Decontaminate hands (reduce bacterial
counts on hands by performing antiseptic hand
rub or antiseptic handwash) before having direct
contact with patients (IB).
D. Decontaminate hands before donning sterile
gloves when inserting a central intravascular
catheter (IB).
E. Decontaminate hands before inserting
indwelling urinary catheters, peripheral vascular
catheters, or other invasive devices that do not
require a surgical procedure (IB).
F. Decontaminate hands after contact with a
patients intact skin (e.g., when taking a pulse or
blood pressure, and lifting a patient) (IB).
 G. Decontaminate hands after contact with body
fluids or excretions, mucous membranes, nonintact
skin, and wound dressings if hands are not visibly
soiled (IA
H. Decontaminate hands if moving from a
contaminated-body site to a clean-body site during
patient care (II).
I. Decontaminate hands after contact with
inanimate objects (including medical equipment) in
the immediate vicinity of the patient (II).
J. Decontaminate hands after removing gloves (IB).
K. Before eating and after using a restroom, wash
hands with a non-antimicrobial soap and water or
with an antimicrobial soap and water (IB).
 L. Antimicrobial-impregnated wipes (i.e., towelettes)
may be considered as an alternative to washing
hands with non-antimicrobial soap and water.
Because they are not as effective as alcohol-based
hand rubs or washing hands with an antimicrobial
soap and water for reducing bacterial counts on the
hands of HCWs, they are not a substitute for using
an alcohol-based hand rub or antimicrobial soap
(IB).
M. Wash hands with non-antimicrobial soap and
water or with antimicrobial soap and water if
exposure to Bacillus anthracis is suspected or
proven. The physical action of washing and rinsing
hands under such circumstances is recommended
because alcohols, chlorhexidine, iodophors, and
other antiseptic agents have poor activity against
spores (II).
Hand-hygiene technique
A. When decontaminating hands with an alcohol-
based hand rub, apply product to palm of one
hand and rub hands together, covering all
surfaces of hands and fingers, until hands are dry
(IB). Follow the manufacturers recommendations
regarding the volume of product to use.
B. When washing hands with soap and water,
wet hands first with water, apply an amount of
product recommended by the manufacturer to
hands, and rub hands together vigorously for at
least 15 seconds, covering all surfaces of the
hands and fingers.
 Rinse hands with water and dry thoroughly with
a disposable towel. Use towel to turn off the
faucet (IB). Avoid using hot water, because
repeated exposure to hot water may increase
the risk of dermatitis (IB).
C. Liquid, bar, leaflet or powdered forms of plain
soap are acceptable when washing hands with a
non-antimicrobial soap and water. When bar
soap is used, soap racks that facilitate drainage
and small bars of soap should be used (II) .
D. Multiple-use cloth towels of the hanging or roll
type are not recommended for use in health-
care settings (II).
Surgical hand antisepsis
A. Remove rings, watches, and bracelets before
beginning the surgical hand scrub (II).
B. Remove debris from underneath fingernails
using a nail cleaner under running water (II).
C. Surgical hand antisepsis using either an
antimicrobial soap or an alcohol-based hand rub
with persistent activity is recommended before
donning sterile gloves when performing surgical
procedures (IB).
 D. When performing surgical hand antisepsis
using an antimicrobial soap, scrub hands and
forearms for the length of time recommended by
the manufacturer, usually 26 minutes. Long
scrub times (e.g., 10 minutes) are not necessary
(IB).
E. When using an alcohol-based surgical hand-
scrub product with persistent activity, follow the
manufacturers instructions. Before applying the
alcohol solution, prewash hands and forearms
with a non-antimicrobial soap and dry hands and
forearms completely. After application of the
alcohol-based product as recommended, allow
hands and forearms to dry thoroughly before
donning sterile gloves (IB).
Other Aspects of Hand Hygiene
A. Do not wear artificial fingernails or extenders
when having direct contact with patients at high
risk (e.g., those in intensive-care units or
operating rooms) (IA).
B. Keep natural nails tips less than inch long
(II) (350).
C. Wear gloves when contact with blood or other
potentially infectious materials, mucous
membranes, and nonintact skin could occur (IC).
 D. Remove gloves after caring for a patient. Do
not wear the same pair of gloves for the care of
more than one patient, and do not wash gloves
between uses with different patients (IB).
E. Change gloves during patient care if moving
from a contaminated body site to a clean body
site (II) .
F. No recommendation can be made regarding
wearing rings in health-care settings