True hands are a rather recently evolved trait found only among primates. The unrivaled range of motion between the structures of the hand and fully opposable thumb are complemented by nervous system adaptions which include a more robust and direct connection to the Primary Motor Cortex. This is what gives our hands such unrivaled dexterity.
Hands are our primary means of interacting with the world. They are also the primary portal and transmitter of infection. It wasn’t until half way through the nineteenth century that we realized the importance of hand washing. Hand washing is one of the easiest and most effective means to prevent infection and as such deserves the attention of anyone intending to perform even the most minor invasive procedure. Gloving is equally important. Gloves provide an additional barrier to infection for both the recipient and the technician.
The first thin rubber surgical gloves were developed when a surgeon developed an allergy to a hand disinfectant. A number of materials are used to make gloves. The most common is latex. Latex provides an excellent barrier and unrivaled sensitivity. Latex allergies have led to the development of comparable gloves made of nitrile, vinyl, or neoprene. Barring sensitivities, glove material is primarily a personal preference. There are two categories of gloves needed for a procedure: Exam and Surgical.
Exam gloves come loose in boxes and are used to clean and prepare the procedure area. The sizing scheme ranges from extra-small to extra-large. These can be bought at any drugstore. Avoid using powdered gloves. The purpose of the powder is to act as a lubricant making gloves easier to slip on and off. The powders used have been shown reactive in wound beds are inappropriate for our purposes.
Surgical gloves are sterile and used during the actual procedure.They differ from exam gloves in having a longer cuff and are at least 0.10mm thick. Each pair of gloves is individually packaged and the sizing system is different. A person can determine the correct size of surgical glove by measuring the circumference of the palm at its widest point. Correct glove sizes are important as too small a glove causes hand fatigue and too large results in a loss of dexterity. The easiest way to determine glove size is by printing sizing chart such as the one below.
Surgical Hand Washing Supplies
The material needed for a surgical hand scrub include an appropriate soap, brush, subungual pick (nail files work fine), and sterile drying towels.
Choices of scrub soap include Chlorehexidine, Iodine, and Chloroxylenol based products. Chlorehexidine is the agent of choice in most cases due to its broad antimicrobial action, comparatively low propensity to cause skin irritation, and its residual action which continues to prevent the growth of organisms hours after application.
Hand scrub brushes and nail files can be purchased at any drug store. They can be chemically sterilized by immersion in household bleach for 10 to 20 minutes. Brushes and files should not be stored in bleach as even a metal file will break down quickly. Alternatively, autoclavable scrub brushes and subungual picks are sold, as are one time use brushes which come impregnated with chlorehexidine soap.
Reusable towels for hand drying should be 100% cotton and must be sterilized prior to use. This can be performed in an autoclave if available. Alternatively, towels can be sterilized using dry heat in an oven at 340 degrees F (170 C) for 1 hour. The towels should be baked in an enclosed vessel such as in a covered baking dish which is opened immediately before use. Another option is to simply purchase disposable sterile towels.