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Pre surgical hand preparation: moving from tradition

02 October 2016
10 mins read
Volume 7 · Issue 8


The theory of pre surgical hand preparation dates back centuries, and the same basic principles remain today. However, the historical methods of using a scrubbing brush with certain soap-based products has been proven to irritate the skin on hands making it somewhat counterproductive. An alternative, alcohol hand rub, has been found to be superior to traditional hand scrubs with studies showing that this is the case. This article takes the reader through the evidence that might enable for a change to the current practice of pre surgical hand preparation.

The notion of washing hands before carrying out surgical procedures was introduced by Lister in the late 18th century. He found that there were fewer infections when surgeons washed their hands with an antiseptic agent before carrying out a procedure (Boyce and Pittet, 2002). At the time the antiseptic used was carbolic acid and, although thankfully no longer accepted practice, the hand hygiene theory still remains strongly today.

Bacteria on the skin can be divided into two groups, residual and transient. Residual bacteria naturally occur in the deeper layers of skin on the hands and other areas of the body. Their numbers can be reduced by hand antisepsis, but they are never fully eradicated. Transient bacteria, however, can be removed from the surface of the skin by hand antisepsis. These bacteria are not naturally occurring and can colonise the skin on the hands following contact with patients and the environment (Boyce and Pittet, 2002). A common example of picking up transient bacteria includes contact with ‘high touch’ areas, such as telephones and computer keyboards.

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