TREND TERKINI TEKNIK

KEBERSIHAN TANGAN DI
KAMAR BEDAH

Dr. Budi Rahmat, SpBTKV

Unit Bedah Jantung Pediatrik dan Kongenital Pusat
Jantung dan Pembuluh Darah Nasional
Harapan Kita
WHEN?

YOUR 5
MOMENTS
FOR HAND
HYGIENE
HOW TO
HANDRUB?
HOW TO
HANDWASH?
SURGICAL HAND HYGIENE
 Summary CDC Surgical Hand
Antisepsis Recommendations
- Use and antimicrobial soap (AS) or alcohol-
based hand rub(ABHR) with persistent
activity
If using AS scrub hands and forearms for
between 2-6 minutes
If using ABHR pre wash with soap and dry
completely. Allow arms and forearms to dry
completely before gloving

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002, vol. 51, no. RR-16.
SUMMARY WHO SURGICAL HAND HYGIENE
RECOMMENDATIONS

Use a solution with broad antimicrobial activity

against bacteria and fungi
Generally soaps with chlorhexidine gluconate or
povidone-iodine
Debate about required time for scrub (depends on
the agent used).
Discourage use of brushes.

WHO guidelines on hand hygiene in health care, 2009

 Most freauentiy missed

aalr ouwn of a ess mussed a innp hand warshinfl

(Rcl. Tay w L I ,SRN,SCU An evaIuaaon of
handoYashing ten^.,hniques, Wrynq Tines, Jan ISM). -11W

BACK OF HAND d HAH3 PCU 2W3 FRONT OF HANn

 SURGICAL HAND ANTISEPSIS USING
MEDICATED SOAP
The most commonly used products for surgical hand antisepsis
are chlorhexidine or povidone-iodine-containing soaps.

povidone-iodine :
Remains one of the widely-used products for surgical hand antisepsis
Induces more allergic reactions
At the end of a surgical intervention, can have even more
microorganisms than before surgical scrubbing.

Warm water makes antiseptics and soap work more effectively,

while very hot water removes more of the protective fatty acids from
the skin. Therefore, washing with hot water should be avoided
 ALCOHOL BASED HAND RUB
(INCLUDING GELS, LIQUID RUBS & FOAMS)
 REQUIRED TIME FOR THE PROCEDURE

Immediate and postoperative hand bacterial counts after 5- minute

and 10-minute scrubs with 4% chlorhexidine gluconate before total hip
arthroplasty procedures the difference between postscrub and
postoperative mean CFU counts was higher for the 10-minute scrub
than the 5-minute scrub in longer (>90 minutes) procedures. The
study recommended a 5-minute scrub before total hip arthroplasty.

O'Farrell DA et al.
Evaluation of the optimal hand-scrub duration prior to total hip arthroplasty. Journal of
Hospital Infection, 1994, 26:93-98
 REQUIRED TIME FOR THE PROCEDURE

A study by OShaughnessy and colleagues used 4% chlorhexidine

gluconate in scrubs of 2, 4, and 6-minutes duration This study
recommended a 4-minute scrub for the surgical teams first
procedure and a 2-minute scrub for subsequent procedures

O'Shaughnessy M, O'Maley VP, Corbett G.

Optimum duration of surgical scrub-time. British
Journal of Surgery,1991, 78 : 685-686
 USE OF BRUSHES

Almost all studies discourage the use of brushes. Scrubbing with a

disposable sponge or combination sponge- brush has been shown to reduce
bacterial counts on the hands as effectively as scrubbing with a brush

Dineen P. An evaluation of the duration of the surgical scrub. Surgery,

Gynecology & Obstetrics, 1969, 129:1181-1184

Bornside GH, Crowder VH,Jr., Cohn I, Jr.

A bacteriological evaluation of surgical scrubbing with disposable iodophorsoap impregnated
polyurethane scrub sponges. Surgery,1968, 64 : 743-751

McBride ME, Duncan WC, Knox JM. An evaluation of surgical scrub brushes. Surgery, Gynecology & Obstetrics, 1973, 137 : 934-
936

Recently, even a randomized, controlled clinical trial failed to demonstrate

an additional antimicrobial effect by using a brush
Loeb MB et al.
A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone. American Journal of Infection Control,
1997, 25:11-15
 DRYING OF HANDS

Sterile cloth towels are most frequently used in operating

theatres to dry wet hands after surgical hand antisepsis.

Several methods of drying have been tested without

significant differences between techniques.

Gustafson DR et al.
Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial. Mayo Clinic
Proceedings, 2000, 75:705-708
 Key Steps before starting surgical
hand preparation

Keep nails short and pay attention to them when washing your
hands - most microbes on hands come from beneath the
fingernails.
Do not wear artificial nails or nail polish.
Remove all jewellery (rings, watches, bracelets) before entering
operating theatre
Wash hands and arms with a non-medicated soap before entering
the operating theatre area or if hands are visibly soiled. Clean
subungual areas with a nail file. Nail brushes should not be used as
they may damage the skin and encourage shedding off cell.
If used, nailbrushes must be sterile, once only (single use).

WHO Guidelines on Hand Hygiene in Health Care, 2009

Procedure of surgical scrub with a
medicated soap (movie)

WHO Guidelines on Hand Hygiene in Health Care, 2009

Surgical hand preparation technique with an
alcohol-based handrub formulation
12 I \ 13 N \ 14
cover the whole srxtaa d ft barbs Rub ft bads d ft IeR hand. indudmg Rub palm against palm back and brth
up b the wnst with McohoHased han- the wnst, rrrovrrg the nght palm bads with fingers mtedmked
drub. nibbing par agamst palm with a and forth. NW vrowvarsa
rotating movement

1s l 16 l 17
Rub Ire bads of me fingers by trotdrrg When the barbs are dry. stece surgical
Rub the thumb d the teR hand by rota.
Nn in the palm d are other hand wdh bng R m the dasped palm of the nght dottwr g and gloves can be dared
a sideways back and b h movement hand and vice versa

Repeat the above-dustrated sequence (averagedurat n. 60 sec) acoadrrg b the number d sines
oorrespon vig b the total duration reconwnended by the manufacturer br surcal hand preparation
with an aloohol-based handrub.
 GLOVES
Healthcare workers (HCW) should wear gloves to : reduce the risk of
acquiring infections from patients to prevent HCW's skin flora from
being transmitted to patients and the health care environment (HCE)

to reduce transmission of micro organisms from one patient to

another.

Gloves must be changed / removed:

between dirty & clean body sites
between patients
IMMEDIATELY after is complete.
Remember, you cannot perform hand hygiene (wash / gel) while
wearing gloves !
 GLOVES
Gloves should NOT:
Be worn for all patient care activities(provide an ideal environment for
bacterial growth, moisture and warmth) Have Alcohol-Based Hand Rub (gel)
applied over them Be worn "continuously". Once the task for which they were
donned is complete, gloves should immediately be removed & discarded.

Hand Hygiene (ie washing or applying Hand Gel) is necessary immediately

before donning gloves and immediately after removing
them.

GLOVES ARE NOT A SUBSTITUTE for hand hygiene !!! Hand hygiene is essential
every time gloves are donned & removed!
The Glove
Pyramid

To aid decision
making
on when to wear
(and not
wear) gloves
Gloving and Gowning
(movie)