Disinfection of the hands of surgeons and nurses.

Abstract

The hands of the nurse and the surgeon are undoubtedly two of the chief vectors of hospital infection. They often carry pathogenic organisms, in particular Staphylococcus aurelus, which may be present in large numbers. Price (1938) has shown that scrubbing with soap and water for six minutes will reduce the numbers Df bacteria on the hands by only about 50'. Devenish and Miles (1939) and others have found that about 30', of the rubber gloves worn at operations become punctured without the surgeon's knowledge, and bacteria can readily escape through the small holes which appear. Though these facts about hand scrubbing and gloves are quite well known, additional safeguards against manual contamination of wounds are not often used by surgeons ; nurses, for their part, are generally not expected to do anything more to control their hand flora than washing with soap and water after certain ward duties. Various antiseptics have been found to reduce the numbers of bacteria on the hands. Hexachlorophane soap (Traub, Newhall, and Fuller, 1944; Seastone, 1947) and phisohex (Hufnagel, Walter, and Howard, 1948) have been used for some years by surgeons in the United States, and a British paper in support of the latter has recently appeared (Smylie, Webster, and Bruce, 1959). Price (1951) has stressed the limitations of hexachlorophane soap when used irregularly, and finds that a conventional scrub with soap and water followed by three minutes' rinse in 70') alcohol before putting on gloves is more effective. The regular use of a hand cream containing chlorhexidine has been found to reduce the skin flora (Murray and Calman, 1955; Laurell, 1959), and its use by nurses in surgical and obstetric wards has been associated with some reduction in the incidence of cross-infection (Cook, Parrish, and Shooter, 1958; Gillespie, Simpson, and Tozer, 1958). In this paper we describe experiments on the relative merits of several pre-operative antiseptic applications to the surgeon's hands, with particular reference to the numbers of bacteria emerging through holes in gloves. We also describe a study on the routine use of hexachlorophane soap and some other methods by nurses working in accident and burns wards.