Hand scrubbing

[Coach]

I'm really curious (as someone who knows nothing about surgery) why physicians need to wash/scrub their hands to the extreme before surgery considering the fact they wear surgical gloves.

 

Anyone able to explain why (in layman's terms)?

[A-Stark]

The gloves are certainly sterile (on the outside), but additional disinfection as with a surgical scrub gets rid of even more bugs. Gloves do break from time to time too, after all.

[dh79]

Gloves frequently break or are punctured (depending on the procedure I suppose). Also, if you've ever been zapped by a cautery you can testify that gloves occasionally have defects such as pores/holes.

[bones]

Above and beyond all the real reasons for scrubbing, the scrubbing ritual is a relaxing way to get one's mind focused for the upcoming surgery. It's a release, a chance to clear the mind, and a psychological preparation to do one of the most intimate things imaginable: cut into someone and remove/move/replace/fix their insides.

[a41]

Above and beyond all the real reasons for scrubbing, the scrubbing ritual is a relaxing way to get one's mind focused for the upcoming surgery. It's a release, a chance to clear the mind, and a psychological preparation to do one of the most intimate things imaginable: cut into someone and remove/move/replace/fix their insides.

 

Lol I've never seen an attending scrub for the full 5 minutes...plus after the first time they just use avagard...

 

The real question you should ask is: after all that scrubbing, why do you rinse your hands off with non-sterile water?

[A-Stark]

Huh. An interesting question, that, but then the point of the surgical scrub is not sterility but disinfection. But still...

[D-Rock]

It has been shown in the emergency department setting that using tap water is equally effective to sterile water for preventing wound infections when irrigating simple lacerations.

[Coach]

Thanks so much for all the replies. Much appreciated!

[ploughboy]

It has been shown in the emergency department setting that using tap water is equally effective to sterile water for preventing wound infections when irrigating simple lacerations.

 

Moscati, Academic EM, early 2000s I think.

 

(f- me for knowing that, but I was just reading around that topic the other day...)

[Andrew]

It would be excellent if someone could confirm/deny the following and please PM me the references/papers if you find them:

 

The primary reduction in intra/post-op infection is due to pre-op ANTIBIOTICS.

 

Mechanical barriers gown+gloves+mask are also important.

 

Handwashing/scrubbing only come into play should a breach occur in gown/gloves, or during longer cases where gloves almost always develop "micro tears". (need reference).

 

To summarize the above, I've heard some residents/surgeons quote to me that the antibiotics+mechanical barriers are the primary reduction in intra/post op infections and that scrubbing contributes to less than 5% of the reduction.

 

Finally, one last interesting point, which I've thought about a fair bit, but haven't done any formal literature search:

The actual METHOD of scrubbing.

 

Scrubbing works by 2 principles.

The first is the mechanical disruption of the outer layers of skin by vigorous rubbing, sloughing off bacteria at the same time.

 

The second is the contact-killing action of the scrub solution itself, which works to disrupt the cell membrane ON CONTACT.

 

Now, in medical school the "nurses" that do the scrub session tend to insist that you start with the fingernails, rub the front+back of your hands a certain number of times and then work your way down to the elbows. They also insist that you scrub for 5 minutes.

 

I've also had surgeons tell me that the most important thing when scrubbing, is to get the scrub solution over every surface from fingers to elbows early on, and let it sit there to maximize contact time. After you have convered every surface, then you can work your way from fingers to elbows using the mechanical disruption.

In theory, maximizing contact time is especially important for waterless scrub solutions (Avagard, and also the ethanol based handpumps on the wards).

 

Anyway, to summarize, I probably should do a formal literature search at some point. But nevertheless, after thinking about the above, I've been scrubbing by first applying scrub solution to every part from fingers to elbows initially. Then I go back and scrub from fingers down to elbows after that.

This makes the most "sense" to me.

[Andrew]

I conducted a manual literature review of pubmed using "scrubbing" with limits English and Humans.

There were 213 papers, of which I manually reviewed the abstracts of all relevant papers.

 

Conclusions based on this are:

 

-Sterile water not necessary.

-Nail picks/brushes are a waste of time.

-Theatre shoes probably recommended (and by extension, probably shouldn't wear scrubs from home, although many of us are guilty of this).

-Scrub time should be 30sec to 2min (2 articles).

-Alcohol based is superior to CHG which is superior to Povidone

-When using alcohol or CHG, "rubbing" and not scrubbing should be used.

 

 

J Nippon Med Sch. 2005 Jun;72(3):149-54.

Are sterile water and brushes necessary for hand washing before surgery in Japan?

Furukawa K, Tajiri T, Suzuki H, Norose Y.

Surgery for Organ Function and Biological Regulation (Surgery 1), Nippon Medical School Graduate School of Medicine, Tokyo, Japan. seiken-f@nms.ac.jp

PURPOSE: To examine whether sterile water and brushes are necessary for hand washing before surgery. METHOD: Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. RESULTS: No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. CONCLUSIONS: Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

 

 

J Hosp Infect. 2009 Mar;71(3):234-8. Epub 2009 Jan 21.

Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.

Tanner J, Khan D, Walsh S, Chernova J, Lamont S, Laurent T.

De Montfort University, Leicester, UK. jtanner@dmu.ac.uk

Though brushes are no longer used on the hands and forearms during the surgical scrub, they are still widely used on the nails. The aim of this study was to determine whether nail picks and nail brushes are effective in providing additional decontamination during a surgical hand scrub. A total of 164 operating department staff were randomised to undertake one of the following three surgical hand-scrub protocols: chlorhexidine only; chlorhexidine and a nail pick; or chlorhexidine and a nail brush. Bacterial hand sampling was conducted before and 1h after scrubbing using a modified version of the glove juice method. No statistically significant differences in bacterial numbers were found between any two of the three intervention groups. Nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers and are unnecessary.

 

 

Ann R Coll Surg Engl. 2007 Sep;89(6):605-8.

Theatre shoes - a link in the common pathway of postoperative wound infection?

Amirfeyz R, Tasker A, Ali S, Bowker K, Blom A.

Department of Trauma and Orthopaedics, Musgrove Park Hospital, Taunton, UK. ramirfeyz@yahoo.com

INTRODUCTION: Operating department staff are usually required to wear dedicated theatre shoes whilst in the theatre area but there is little evidence to support the beneficial use of theatre shoes. PATIENTS AND METHODS: We performed a study to assess the level of bacterial contamination of theatre shoes at the beginning and end of a working day, and compared the results with outdoor footwear. RESULTS: We found the presence of pathogenic bacterial species responsible for postoperative wound infection on all shoe groups, with outdoor shoes being the most heavily contaminated. Samples taken from theatre shoes at the end of duty were less contaminated than those taken at the beginning of the day with the greatest reduction being in the number of coagulase-negative staphylococcal species grown. Studies have demonstrated that floor bacteria may contribute up to 15% of airborne bacterial colony forming units in operating rooms. The pathogenic bacteria we isolated have also been demonstrated as contaminants in water droplets spilt onto sterile gloves after surgical scrubbing. CONCLUSIONS: Theatre shoes and floors present a potential source for postoperative infection. A combination of dedicated theatre shoe use and a good floor washing protocol controls the level of shoe contamination by coagulase-negative staphylococci in particular. This finding is significant given the importance of staphylococcal species in postoperative wound infection.

 

Surgical Scrub time 30s-2min.

 

Aust N Z J Surg. 1998 Jan;68(1):65-7.

Studies of the surgical scrub.

Poon C, Morgan DJ, Pond F, Kane J, Tulloh BR.

Division of Surgery, Echuca Regional Health, Victoria, Australia.

BACKGROUND: To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. METHODS: Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. RESULTS: The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora. CONCLUSIONS: These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.

 

AORN J. 1997 Jun;65(6):1087-92; 1094-8.

Effect of surgical hand scrub time on subsequent bacterial growth.

Wheelock SM, Lookinland S.

Community Hospitals of Central California, Fresno, USA.

Comment in:

AORN J. 1997 Oct;66(4):574.

AORN J. 1997 Oct;66(4):574.

In this experimental study, the researchers evaluated the effect of surgical hand scrub time on subsequent bacterial growth and assessed the effectiveness of the glove juice technique in a clinical setting. In a randomized crossover design, 25 perioperative staff members scrubbed for two or three minutes in the first trial and vice versa in the second trial, after which the wore sterile surgical gloves for one hour under clinical conditions. The researchers then sampled the subjects' nondominant hands for bacterial growth, cultured aliquots from the sampling solution, and counted microorganisms. Scrubbing for three minutes produced lower mean log bacterial counts than scrubbing for two minutes. Although the mean bacterial count differed significantly (P = .02) between the two-minute and three-minute surgical hand scrub times, it fell below 0.5 log, which is the threshold for practical and clinical significance. This finding suggests that a two-minute surgical hand scrub is clinically as effective as a three-minute surgical had scrub. The glove juice technique demonstrated sensitivity and reliability in enumerating bacteria on the hands of perioperative staff members in a clinical setting.

 

 

Surg Gynecol Obstet. 1977 Sep;145(3):415-6.

Studies of the surgical scrub.

Tucci VJ, Stone AM, Thompson C, Isenberg HD, Wise L.

A study comparing the relative efficacy of a five versus a ten minute surgical scrub was carried out using random sampling of personnel scrubbing for routine scheduled hospital surgical procedures. Scrubbing for five minutes was found to be equally as effective as scrubbing for ten minutes. Betadine was compared to pHisoHex as a scrubbing agent and found to be statistically more effective in degerming the skin following a five minute scrub. As a result of this study, a routine preoperative surgical scrub of five minutes' duration, using Betadine as the scrubbing agent, is recommended.

 

Alcohol based superior to CHG which is superior to Povidone.

“rubbing”. Scrubbing not necessary with CHG/Alcohol.

 

Am J Infect Control. 2001 Dec;29(6):377-82.

 

Evaluation of a waterless, scrubless chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy.

Mulberrry G, Snyder AT, Heilman J, Pyrek J, Stahl J.

Hill Top Research, Inc., Miamiville, Ohio 45147, USA.

A new waterless surgical hand preparation containing 1% chlorhexidine gluconate (CHG) and 61% ethyl alcohol was evaluated for antimicrobial efficacy in comparison with a standard 4% CHG surgical scrub and a 61% ethyl alcohol control. Clinical studies were based on the Tentative Final Monograph for Health-Care Antiseptic Drug Products (TFM) (proposed rule) and the Standard Test Method for Evaluation of Surgical Hand Scrub Formulations (ASTM E1115-91). Two randomized, blinded, well-controlled clinical studies involving 137 healthy subjects were conducted to evaluate the antimicrobial effectiveness of the CHG/ethanol hand preparation in producing an immediate and persistent reduction in the normal bacterial flora of the hands. The CHG/ethanol hand preparation was applied without scrubbing or the use of water, and a standard 4% CHG reference product was applied with a scrub brush in 2 traditional 3-minute surgical scrubs. In 1 study, a 61% ethanol vehicle control treatment was applied without scrubbing or use of water. During a 5-day period, each study subject performed a series of 11 surgical scrubs with 1 of the test treatments. After the first treatment on days 1, 2, and 5, surgical gloves were worn for 3 or 6 hours. Bacterial samples were taken with the glove-juice technique at 1 minute, 3 hours, and 6 hours after treatment. The immediate bactericidal effect of the CHG/ethanol hand preparation after a single application resulted in a 2.5-log reduction in normal flora. This bactericidal effect persisted throughout the studies and eventually increased to a 3.6-log reduction after the 11th scrub on day 5. The log reductions of the CHG/ethanol hand preparation proved to be significantly better (P <.05) than that of the 4% CHG product at each sampling interval on days 1 and 2 and the sampling at 6 hours on day 5 and significantly better than the 61% ethanol vehicle at all times. The combination of 1% CHG and 61% ethanol had significantly greater microbial reduction than either the 4% CHG (without ethanol) or the 61% ethanol vehicle (without CHG).

 

 

JAMA. 2002 Aug 14;288(6):722-7.

Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study.

Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, Bouvet A, Lemarchand F, Le Coutour X; Antisepsie Chirurgicale des mains Study Group.

Departments of Infectious Diseases and Intensive Care Unit, Côte de Nacre University Hospital Centre, 14 033 Caen Cedex, France. parienti@u444.jussieu.fr

Erratum in:

JAMA 2002 Dec 4;288(21):2689. Bensadoun, Hervé [corrected to Bensadoun, Henri].

Comment in:

Evid Based Nurs. 2003 Apr;6(2):54-5.

JAMA. 2002 Dec 4;288(21):2688; author reply 2688-9.

CONTEXT: Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce. OBJECTIVE: To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice. DESIGN: Randomized equivalence trial. SETTING: Six surgical services from teaching and nonteaching hospitals in France. PATIENTS: A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001. INTERVENTIONS: Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate. MAIN OUTCOME MEASURES: Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points. RESULTS: The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P =.008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use. CONCLUSIONS: Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand-scrubbing.

 

 

J Hosp Infect. 1997 May;36(1):49-65.

An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts.

Pereira LJ, Lee GM, Wade KJ.

Department of Biological Sciences, Faculty of Health Sciences, University of Sydney, Australia.

Five protocols for surgical handwashing (scrubbing) were evaluated for their efficiency of removal of micro-organisms and their drying effect on the skin. The scrubbing protocols tested were: (1) an initial scrub of 5 min and consecutive scrubs of 3.5 min with chlorhexidine gluconate 4% (CHG-5); (2) an initial scrub of 3 min and consecutive scrubs of 2.5 min with chlorhexidine gluconate 4% (CHG-3); (3) an initial scrub of 3 min and consecutive scrubs of 2.5 min with povidone iodine 5% and triclosan 1% (PI-3); (4) an initial scrub of 2 min with chlorhexidine gluconate 4% followed by a 30 s application of isopropanol 70% and chlorhexidine gluconate 0.5%, and a 30 s application of isopropanol 70% and chlorhexidine gluconate 0.5% for consecutive scrubs (IPA); and (5) an initial scrub of 2 min with chlorhexidine gluconate 4% followed by a 30 s application of ethanol 70% and chlorhexidine gluconate 0.5%, and a 30 s application of ethanol 70% and chlorhexidine gluconate 0.5% for consecutive scrubs (EA). A convenience sample of 23 operating theatre nurses completed each scrub protocol for one week in a randomized order. A week of normal work activities intervened between each protocol. Subjects were assessed before commencing and after completing the week of each protocol to determine changes in the microbial counts and skin condition of the hands. Specimens for microbial analysis were collected before, immediately after and 2 h after an initial scrub, and 2 h after a consecutive scrub. The CHG-5, CHG-3 and PI-3 protocols, which used detergent-based antiseptics only, were compared with protocols incorporating an alcohol-based antiseptic (IPA and EA). The protocols incorporating alcohol-based antiseptics and the CHG-5 protocol were generally associated with the lowest post-scrub numbers of colony forming units (cfu). No difference between the CHG-5 protocol and the alcohol-based antiseptics was found at the beginning of the test week, but after exclusive use of the respective protocols for a week, the alcohol-based antiseptics were associated with significantly lower cfu numbers in two out of the three post-scrub samples (P = 0.003, P = 0.035). Although virtually no statistically significant differences in skin condition were found, many subjects reported the alcohol-based antiseptic protocols to be less drying on the skin. The findings of this study support the proposition that a scrub protocol using alcohol-based antiseptics is as effective and no more damaging to skin than more time-consuming, conventional methods using detergent-based antiseptics.

 

Am J Infect Control. 1997 Feb;25(1):11-5.

A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone.

Loeb MB, Wilcox L, Smaill F, Walter S, Duff Z.

Department of Laboratory Medicine, Chedoke- McMaster Hospital, McMaster University, Hamilton, Ontario.

BACKGROUND: The difference between use of a scrub brush versus soap alone in reducing hand bacterial counts has never been established by a prospective, comparative study. METHODS: Fifteen volunteers were taught the 5-minute surgical scrub. Baseline specimens were obtained by the glove fluid sampling procedure. Subjects were randomized to (1) scrub with an inert scrub brush and 4% chlorhexidine soap with isopropyl alcohol or (2) wash with 4% chlorhexidine soap with isopropyl alcohol alone. Specimens were obtained immediately after the scrub was completed and 45 minutes later. The experiment was repeated by use of a cross-over design after a 1-week washout period. The data were analyzed by three methods that took into account the broad range of baseline hand counts (5 x 10(1) to 11.2 x 10(4): method 1, the discordance between presence/absence of hand bacterial counts within individuals at 45 minutes for soap versus soap and brush; method 2, the absolute reduction of bacteria (baseline vs 45 min.) for soap versus soap and brush; and method 3, the proportional change in bacterial counts at 45 minutes from baseline for soap versus soap and brush. RESULTS: Although there was no statistically significant difference for any method, the point estimates for the odds ratio (OR) showed that up to twice the number of subjects had a greater reduction in bacterial counts when they washed with soap than when they scrubbed with a brush, as evidenced by the following data: method 1, OR 2.3 (95% confidence interval [CI] 0.53, 13.99) for soap alone; method 2, OR 1.0 (CI 0.23, 4.35); and method 3, OR 2.0 (CI 0.54, 9.10) for soap alone. CONCLUSIONS: The effect of use of soap alone in reducing hand bacterial counts at 45 minutes was similar to use of soap and brush. Soap can be used alone and the surgical infection rate prospectively monitored.

 

J Hosp Infect. 1991 Jun;18 Suppl B:29-34.

Evaluation of surgical scrubbing.

Kobayashi H.

Surgical Centre, University of Tokyo Hospital, Japan.

Chlorhexidine and povidone-iodine have been compared for bacteriological effect and skin damage when used with brushes. Chlorhexidine used with a single-use brush was significantly more effective than povidone-iodine. Transepidermal water loss, skin surface conductance and image analysis were used to assess skin damage.

[beng]

I vote this for most comprehensive response of the year. Personally, I find most posts aren't nearly publishable...

 

Interesting read though, thanks!

[Jochi1543]

They live on everyone's hands, but are so small germs that you can't see them.

The dirty hand germs are very bad - they like to make people ill so they have prefer to wash their hand before any extreme surgery.

 

LOL. 10char

[ploughboy]

They live on everyone's hands, but are so small germs that you can't see them.

The dirty hand germs are very bad - they like to make people ill so they have prefer to wash their hand before any extreme surgery.

 

It's like poetry! The end of the last line kinda falls apart, but the first 2/3rds could totally be set to music.

[Jochi1543]

Note, only EXTREME SURGERY....if you are just suturing someone up, no big deal.

[D-Rock]

I love it. The ambiguity of whether it is the germs or the surgeons who prefer to wash their hands really makes me think. And then to envision doing some extreme surgery--rock climbing hip pinning, parachute chole--really lets my imagination soar.

[ploughboy]

I love it. The ambiguity of whether it is the germs or the surgeons who prefer to wash their hands really makes me think.

 

I agree. This post has reframed my entire perspective on the medical paradigm. Which one is the pathogen, and which is the healer?

 

Deep, man.

[bj89]

for anyone who has experienced scrubbing, is it really irritating on the hands? these past 2 years, i have been getting the worst dry hands ever (only in the winter) and "vigorous scrubbing" sounds like its going to be torture for others who have extremely dry, cracking hands

[A-Stark]

I typically use the chlorhexidine (the pink one) scrub, and though I get dry hands too, I don't find it irritating at all. Just the opposite in fact. But I do avoid the Manorapid (alcohol-based) scrub, as alcohol does tend to dry out skin more. Having said that, I think your hands "get used" to repeat washings and applications of Purell, so it's probably more important to make sure you're using hand soap that's not too drying in non-medical situations. I prefer liquid soaps (especially the Soft Soap brand) or at least something like Dove.

 

I do also get winter-related eczema in a small area on my right hand. But I can't say that scrubbing or hand sanitizer use aggravate at all.

[bj89]

I typically use the chlorhexidine (the pink one) scrub, and though I get dry hands too, I don't find it irritating at all. Just the opposite in fact. But I do avoid the Manorapid (alcohol-based) scrub, as alcohol does tend to dry out skin more. Having said that, I think your hands "get used" to repeat washings and applications of Purell, so it's probably more important to make sure you're using hand soap that's not too drying in non-medical situations. I prefer liquid soaps (especially the Soft Soap brand) or at least something like Dove.

 

I do also get winter-related eczema in a small area on my right hand. But I can't say that scrubbing or hand sanitizer use aggravate at all.

 

excellent!

[jwp2000]

I get a horrible reaction to chlorhexidine and a lot of other people I know seem to have the same problem. I have eczema in the winter and it definitely exacerbates the problem. Alcohol is often bad as well. The best thing for your skin is the iodine scrub, which is the only thing I use now, but it does have a tendency to stain your hands/arms orange.

[roggerham]

Hand scrubbing is very important because we have make to learn right from the childhood that alwya wash your hand before you eat something it will help to fight many diseases and to get rid of germs.

[NewfieMike]

As people suggest you and everyone start learning from their childhood. The hand scrubbing is very important before eating anything , drinking water, or before touching any child.

 

-------------------------------

Home drug test

 

strange comment...

[case_sensitive]

I typically use the chlorhexidine (the pink one) scrub, and though I get dry hands too, I don't find it irritating at all. Just the opposite in fact. But I do avoid the Manorapid (alcohol-based) scrub, as alcohol does tend to dry out skin more. Having said that, I think your hands "get used" to repeat washings and applications of Purell, so it's probably more important to make sure you're using hand soap that's not too drying in non-medical situations. I prefer liquid soaps (especially the Soft Soap brand) or at least something like Dove.

 

I do also get winter-related eczema in a small area on my right hand. But I can't say that scrubbing or hand sanitizer use aggravate at all.

 

I actually find dry hands really irritating, especially in the winter time when everyone has dry hands anyway. I find the smell of chlorhexidine kind of nauseating, so I tend do use alcohol based srubs.

 

Does anyone know of a really good moisturizer that works really well for them?

[Bemby]

In my undergrad I conducted a research lab exp. on human pathogens and did a study of bacteria on the hands before and after washing hands with antibacterial soap, with common tap water (toronto), and then used alcohol based hand sanitizer. Found out that uni students have a lot of bacteria on there hands even after washing with soap (must be the toronto water), and some fairly harmful stuff after identifying it. So lets say someone were to get a tear in their glove and the bacteria, got into the patients blood stream during surgery; presto you have a perfect incubation temp.......24-48hrs later and the patient might have sepsis. Not that likely, but might as well scrub with a little enthusiasm to prevent having some post opt complications that don't look to good on the surgeon. But who knows might just be the recycled toronto water.