Chapter 3
Hand washing and Surgical Antisepsis
James C Glasbey, Heman Joshi
Aims
By the end of the chapter you will be able to:
• understand the principles of surgical asepsis, and antisepsis
• learn an effective and safe technique for hand washing, gloving and gowning in theatre
• learn appropriate theatre etiquette for the maintenance of a sterile operating field
Introduction
Surgical site infection (SSI) remains the most common complication following surgery, affecting up to 25% of patients after open abdominal surgery.
1,2 Patients developing SSIs are twice as likely to die, 60% more likely to spend time in the Intensive Care Unit (ICU), and five times more likely to be readmitted to hospital.
3In the 1800s, up to 80% of surgical procedures resulted in nosocomial infection.
4 Joseph Lister, a Glaswegian surgeon, drew upon germ theory described by a French contemporary, Louis Pasteur, in a series of seminal papers on surgical antisepsis. Published in
The Lancet in 1967, ‘
On the antiseptic principle in the practice of surgery‘ described a sterilisation technique for instruments, hand washing and surgical site preparation using carbolic acid.
5 After implementation of Lister’s technique for surgical preparation, the surgical division at the Glasgow Royal Infirmary saw a rapid decline in their rates of surgical wound infection.
6 Today, we draw upon these principals in the processes of surgical scrubbing, gowning and procedural asepsis.
Surgical asepsis and antisepsis
Surgicalasepsis is the complete removal of micro-organisms (bacteria and fungi) and their spores from the operative site.Antisepsis is embodied by a number of perioperative practices performed to minimise the likelihood of microbial contamination of the surgical site. These include:
• appropriate theatre environment
• barrier protection
• surgical hand washing
• gloving and gowning
• skin preparation
• &n
