THE EFFECTS OF IN-USE SURGICAL HANDWASHING ON THE PREOPERATIVE AND POSTOPERATIVE FINGERTIP FLORA DURING CARDIOTHORACIC AND ORTHOPEDIC-SURGERY

Two operating teams (25 persons) were followed for two months with fin gerprint samples taken preoperatively; before and after 'in-use' surgi cal handwashing; and immediately postoperatively, with and without sur gical gloves. The mean time for handwashing for the cardiothoracic tea m (CT) was 2 min and for the orthopaedic team (OT) was 3.5 min. A clos er observation of 10 persons revealed a great individual variation in washing techniques, in spite of standard guidelines. The CT team perfo rmed eight, and the OT team nine sterile operations with an average du ration of 3 h and 20 min and 2 h and 40 min, respectively. Surgical ha ndwashing resulted in fingertip sterility in 111/118 (94.1%) cases; in 61/66 (92.4%) samples from the surgeons and in 50/52 (96.2%) samples from the assistants. Postoperative fingerprinting with gloves on showe d sterile conditions in 85/91 (93.4%) samples; 57/59 (96.6%) from the surgeons and 28/32 (87.5%) from the assistants. Immediately after remo val of the gloves, 43/67 (64.2%) of fingerprint samples from the surge ons and 13/48 (27.1%) from the assistants were still sterile. Coagulas e-negative staphylococci (CNS) and Bacillus species predominated in fi ngerprint samples. Of the 105 CNS strains tested, 11.4% were methicill in resistant. Only five strains of Staphylococcus aureus were isolated ; in 4/5 cases from the OT. This study illustrates that in spite of st andard guidelines, there is great individual variation in surgical han dwashing. However, in most instances, the bacteria are eradicated from the fingertips. Even after surgery for 2-3 h, there may still be a re sidual effect of the hand disinfecting agent in half of the cases.