Surgeon's hand antisepsis

General preparation guidelines

Hand preparation is the primary means of preventing contact infection. Medical personnel (surgeons, operating and dressing nurses) must carefully monitor the condition of the skin on their hands: prevent cracks and calluses, keep nails short, and remove hangnails in a timely manner. All work associated with the risk of infection or severe skin contamination is performed exclusively in gloves.

The main areas where microorganisms accumulate are subungual spaces, nail folds, and skin cracks. Regardless of the chosen antiseptic, preparation always begins with mechanical cleaning.

Modern methods

The modern standard involves washing hands with running water and a liquid detergent (soap) followed by the application of chemical antiseptics.

• Chlorhexidine (0.5% alcoholic solution): Prepared by mixing 500 ml of 70% alcohol and 12.5 ml of 20% aqueous chlorhexidine solution. After washing and drying with sterile wipes, hands are wiped with a gauze swab soaked in the solution for 2–3 minutes.
• AHD and Eurosept preparations: Contain ethanol, chlorhexidine, and polyol fatty acid ester. After a one-minute preliminary wash, a few milliliters of the solution are applied to the skin and rubbed in twice up to the middle third of the forearms for 2–3 minutes.
• Accelerated methods (Cerigel): Used in outpatient practice or field conditions. Cerigel (polyvinyl butyrol and 96% ethanol) forms a bactericidal film. 3–4 ml of the preparation is applied to washed and dry hands, rubbed for 10 seconds, and fingers are kept apart for 2–3 minutes until dry. The film is removed after surgery using alcohol wipes.

Spasokukotsky-Kochergin method

An emergency method used in the absence of modern preparations. Based on mechanical cleaning with a 0.5% ammonia solution.

1. Washing: Performed with a sterile wipe in two basins for 3 minutes each. In the first basin, hands are washed up to the elbows; in the second, up to the border of the upper and middle thirds of the forearm.
2. Rinsing: With ammonia solution. Hands are held pointing upward so that drops flow toward the elbows.
3. Drying: With sterile wipes in a strict sequence (hands first, then forearms).
4. Disinfection: The skin is wiped twice with 96% alcohol wipes for 2.5 minutes each.
5. Final step: Nail beds and folds are treated with a 5% alcoholic iodine solution.

Processing with Pervomur (C-4)

Perвомур is a mixture of formic acid and hydrogen peroxide. Their interaction forms performic acid, which possesses strong bactericidal activity.

The stock solution is prepared in a glass bottle with a ground-glass stopper and placed in a refrigerator for 2 hours for activation. The working solution is obtained by diluting the stock solution up to 10 liters with distilled water; its shelf life is 1 day.

Procedure:

1. Washing hands with soap under running water (1 minute).
2. Processing in a basin with Perвомур solution using wipes (1 minute). Boundaries: hands and forearms up to the middle third.
3. Drying with sterile wipes.

No more than 5 people are allowed to process their hands in a single basin.

Class and exam questions

What else to study on this topic

• Organization of operating unit work in the context of asepsis
• Differences between asepsis and antisepsis
• Historical methods: Fürbringer and Ahlfeld methods
• Use of phenol in historical surgery
• Preparation and processing of the surgical field

Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.