Chapter 6 Three main developments in surgical hand antisepsis have occurred in the past decade. These include (1) no longer using scrub brushes (Fig. 6-2), (2) the introduction of alcohol rubs (Box 6-1), and (3) a reduction in the duration of the scrub. In veterinary schools, instructions for surgical hand antisepsis have, until recently, included scrubbing the hands and arms with a brush. This practice is no longer recommended because studies have determined that scrubbing hands and arms results in skin damage and increased bacterial counts. Scrubbing with a brush has been demonstrated to remove epidermal layers, increase shedding of bacterial squamous cells, increase (not decreases) microbial counts, and change microbial flora, Thus, most experts agree that the time-honored convention of vigorously scrubbing off the uppermost layers of skin with a brush is not only unnecessary, but also unwise. Investigators in one study concluded that nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers and are unnecessary (Tanner et al, 2009). In this study, the following three surgical hand scrub protocols were compared: chlorhexidine only; chlorhexidine and a nail pick; and chlorhexidine and a nail brush. No statistically significant differences in bacterial numbers were found between any two of the three intervention groups.
Preparation of the Surgical Team
Surgical Scrub
Scrub Technique
Preparation of the Surgical Team
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