From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.tv.er,sci.med
Subject: Re: Scrubbing for surgeons
Date: 10 Nov 2005 17:20:02 -0600
Message-ID: <4373d54a$0$9169$bb4e3ad8@newscene.com>

<richardfangnail@excite.com> wrote in message
news:1131646847.904190.224190@o13g2000cwo.googlegroups.com...
>I saw an ER episode where a doctor was spending a huge amount of time
> scrubbing his hands and forearms.  What are the rules for scrubbing?
> Can't you just use soap and water like usual?
>
> Do you scrub both before and after an op?
>

There are a variety of procedures. The days when it was a ritualized 10
minute procedure are long gone.

The particular disinfecting agent is variable and related to cost,
performance and preference. Recomendations vary from place to place and also
depend on what antimicrobial agent is being used to scrub. Some surgeons
prefer betadine-soaked packaged sponges with a nylon bristle brush on the
other side. Some prefer the same sponge with no disinfecting agent and use
it with a different agent such as chlorhexidine (Hibiclens). Three minute
scrub starting with nails and working upward to elbow. Most of the agents
have a persistent antimicrobial action for  2-4 hours and after the first
scrub with the brush, many surgeons prefer to use a foam or other liquid
antimicrobial that is just worked into the hand like hand lotion for
subsequent operations. Hands are generally kept elevated to drain down the
arms, and don't touch anything with the hands on your way into the room.

Generally, it's a good idea to wash hands after an operation too.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.tv.er,sci.med
Subject: Re: Scrubbing for surgeons
Date: 10 Nov 2005 19:53:01 -0600
Message-ID: <4373f938$0$6839$bb4e3ad8@newscene.com>

"Sharon Three" <nobody@nowhere.com> wrote in message
news:T4Rcf.11918$4l5.4112@dukeread05...
>
>
> To properly scrub for the first time during the day takes 5-7 minutes,
> subsequently, the scrub can be shortened to 3-4 minutes.
>

It depends on the product. A 5-7 minute scrub will usually leave more active
bacteria on the skin than a three minute scrub. Longer than 3 minutes is
past the point of diminishing returns. There is a paucity of objective data
on the subject and mostly, the concepts of scrubbing one's hands for surgery
are based on dogma, history, and tradition rather than real reasoning. Best
approach is read the package insert of the scrub product you are using and
follow the instructions on it.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.tv.er,sci.med
Subject: Re: Scrubbing for surgeons
Date: 11 Nov 2005 14:37:02 -0600
Message-ID: <43750087$0$6840$bb4e3ad8@newscene.com>

"Ellen K Hursh" <ekhursh@yahoo.com> wrote in message
news:1131740180.351158.301550@g47g2000cwa.googlegroups.com...
> Howard McCollister wrote:
>> "Sharon Three" <nobody@nowhere.com> wrote in message
>> news:T4Rcf.11918$4l5.4112@dukeread05...
>> >
>> > To properly scrub for the first time during the day takes 5-7 minutes,
>> > subsequently, the scrub can be shortened to 3-4 minutes.
>>
>> It depends on the product. A 5-7 minute scrub will usually leave more
>> active
>> bacteria on the skin than a three minute scrub.
>
> Why is that, exactly?
>

Stirs 'em up out of crypts, crevices, pores and hair follicles. Not to
mention unnecessarily abrading the surgeon's hands.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.tv.er,sci.med
Subject: Re: Scrubbing for surgeons
Date: 11 Nov 2005 17:08:03 -0600
Message-ID: <43752407$0$6799$bb4e3ad8@newscene.com>

"Brad Filippone" <al019@chebucto.ns.ca> wrote in message
news:dl34ut$qol$3@News.Dal.Ca...
> richardfangnail@excite.com wrote:
> : I saw an ER episode where a doctor was spending a huge amount of time
> : scrubbing his hands and forearms.  What are the rules for scrubbing?
> : Can't you just use soap and water like usual?
>
> : Do you scrub both before and after an op?
>
> I seem to recall a first season episode (forget the title) in which Carter
> was going to see he first OR, although not participate.  Peter gave him
> step by step instructions, only to have him (Carter) tap Peter on the
> shoulder in the OR and therefore have to go through the whole thing again.
> Which always raised the question to me, wouldn't Peter's scrubs be clean
> anyway?  Are they really that paranoic in an OR?
>
> Brad

Once hands are scrubbed and/or gloved, you can't touch anything that's not
sterile. "Clean" isn't good enough...the scrubs aren't sterile. And a
resident's scrubs might not even be clean.

What always amused me, back in the days I used to watch that show, was how
the "surgeons" always scrubbed their hands at the scrub sink with their
masks down.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.tv.er,sci.med
Subject: Re: Scrubbing for surgeons
Date: 11 Nov 2005 14:33:03 -0600
Message-ID: <4374ff99$0$6860$bb4e3ad8@newscene.com>

"John Graeme" <jdgraeme@my-deja.com> wrote in message
news:1131740472.994448.98420@g44g2000cwa.googlegroups.com...
> Why is it necessary to go thru that extensive amount of scrubbing when
> the hands and body are going to be covered in sterile coverings?  Is it
> just a precaution in case there's a break?

Yes. Or strike-through from the sleeves. If the sleeves become soaked in
blood or other body fluids, bacteria can be transmitted through that soaked
fabric or paper from the forearms. It would not be unusual for a surgeon to
be inside a patient up to his/her elbows.

HMc