The choice of surgical scrub and glove is critically important to a surgeon. This point is often not fully realised or appreciated.
Surgical handwashing using approved scrub solutions is a technique which involves an initial washing of the hands and forearms to remove transient micro-organisms and reduce the count of resident flora and then a second wash to further reduce the level of resident colonising flora.
Traditionally a sterile brush has been used for the first application of the day but continual use is inadvisable as damage to the skin may well occur. New alcohol-based formulations have been demonstrated to be suitable for use for surgical hand scrub and for brushless application.
Alcohol antiseptics are as effective and have as wide a spectrum of antimicrobial activity as the more conventional methods using antiseptic detergent solutions and are no more damaging to the skin. Therefore, scrub solutions should be chosen which:
Given the length and complexity of many operations it is obvious that gloves must fit securely and offer optimum sensitivity and durability without hand fatigue. They should not lose their shape or integrity during use.
Less well understood is the need for the glove to be of high quality, low in extractable latex proteins and powder-free. It is well-documented that adhesions and other postoperative complications including delayed wound healing can be attributed to glove powder which transfers latex proteins from the surface of the glove.
The surface of the glove must also be low in residual accelerators used in the manufacturing process as these can cause localised skin conditions which can occur up to 48 hours after contact. With increased latex glove usage, the incidence of latex allergy in the United States has now risen to between 28% and 67% in some high-risk healthcare workers and is estimated at 6% of the general population.
Latex allergy can often take time to develop, with exposure taking place over months or even years before any reaction occurs. Although it is recognised that latex is still the best barrier, latex-free alternatives should be considered when sensitisation to the proteins in natural rubber latex has occurred. Gloves should also be pyrogen-free, as pyrogens can induce pyrexia and misdiagnosis in some patients. This fact is also well documented.
Powder-free, latex-free synthetic gloves should also be available for:
These gloves should be of the same high quality as latex gloves to allow comfort and sensitivity and must be part of a total protocol within a surgical unit to eliminate risk to sensitised individuals.
Glove puncture is commonplace during surgery and occurs in over 50% of cases in some operative procedures. Studies show that between 50% and 88% of perforations pass undetected. Therefore, for some high risk procedures, e.g. some orthopaedic, cardiac or gastrointestinal procedures, it may be necessary to double glove using a green underglove to ensure added protection. The use of two surgical gloves has been shown to maintain the barrier between the wearer and patient in four out of five cases in which the outer glove has been breached. The system will allow early identification of up to 97% of all glove punctures. The inner glove is a half size larger than the outer to optimise sensitivity, dexterity and comfort. If the outer glove is punctured, fluid penetrates between the two gloves and a dark green patch alerts the wearer that a puncture has occurred and the outer glove can then be replaced.
In summary, therefore a surgeon should choose a glove which:
The scrub solutions and gloves you are offered for your Basic Surgical Skills course meet all these stringent criteria.
Powder-free, latex-free gloves should also be available for suitable emergency cases.