There's nothing new or revolutionary about proper hand hygiene, which remains the single most important factor in preventing and reducing surgical site infections. But there's a continued need to teach your staff the importance of correctly and consistently performing this simple procedure. Here's a rundown of the key steps.

1 Know the need
Many variables can contribute to the development of an incisional infection, including such uncontrollable patient factors as diabetes, nutrition, weight and other underlying co-morbidities. What can be controlled, however, are the administration of antibiotics, adherence to aseptic technique, strict quality control of sterilized instruments and, of course, compliance with hand hygiene standards.

Even as the technological advances of the surgical suite have risen around us, the basic concepts of asepsis have remained unchanged. But the truth remains that, despite a full awareness of the principles of asepsis, not every healthcare provider acts upon the fundamental basic step of washing her hands at the proper time, following the appropriate technique and with the recommended frequency.

Cleaning your hands is one of the simplest and most effective methods of reducing the transmission of pathogens and subsequent risk of infection. If we were able to visualize harmful pathogens, we'd all realize when our hands were contaminated and we'd see that everything we touch also becomes contaminated — a patient's intravenous catheter, which we manipulated without more than a moment's thought, or an instrument we placed on the sterile field, which is then used within the patient's body — upping the risk of infection. Since we can't see harmful pathogens, we have to anticipate the risk of their transmission and clean our hands routinely and based on the type of contact we have with a patient.

2 Know the methods
Proper hand hygiene is a ritualistic action that all staff members need to conduct before and after every patient contact. It minimizes the transmission of pathogens from providers to patients, environments to patients, or patients to patients by way of staff's hands. Knowing what methods are required at what times is essential.

Between pre- and post-op patient contacts, if your hands are not visibly soiled, washing or sanitizing your hands is adequate hygiene. Washing your hands entails 15 or 20 seconds of vigorous scrubbing with soap and water, or with an alcohol-based hand gel or rub. When using hand rubs, make sure you apply enough of the substance into the palm of your hand to be able to cover and wet both hands thoroughly. Rub the gel over all the surfaces of both hands, and let them dry without wiping them.

Surgical situations, however, demand the surgeons, anesthesia providers, nurses and techs involved at the sterile field to conduct a more intensive "surgical scrub" of their hands before they start in order to significantly reduce pathogen carriage on them.

Surgical scrub products should be fast-acting, broad-spectrum and have persistent activity against pathogens. Given the frequency with which surgical staff will use them, they should also be non-irritating to the skin. There are various product categories to choose from, including iodophors, chlorhexidine gluconate and parachlorometaxylenol, used either with or without a brush or sponge. There are also alcohol-based scrub solutions known as "waterless scrubs," which have in recent years simplified the surgical scrub process. Not to be confused with alcohol-based hand sanitizers, these scrub products don't even require a sink for use.

3 Establish a protocol
In order to ensure uniformity in surgical scrub practices and infection prevention efforts, you must outline a protocol and train your staff to faithfully observe it. Your hand scrub protocol may mandate a traditional, brush- or sponge-assisted surgical scrub using the timed or count method before each case. Or perhaps a traditional scrub just for the first case of the day, followed by a brushless or waterless scrub before each subsequent case. Clinical studies have demonstrated that each option, traditional, brushless and waterless scrub solutions, decrease pathogen counts to an acceptable level.

When establishing a hand hygiene protocol, assess the risks versus benefits of each method. For example, traditional scrubbing with a brush is associated with increased shedding of skin. That factor, plus the longer time it takes to thoroughly perform and fully complete the scrub, may lead to spotty compliance. On the other hand, while waterless scrubs are faster to use and, in their brushlessness, decrease the incidence of skin irritation, there's a greater likelihood that the scrub might not be done correctly. Remem-ber, more product doesn't necessarily mean a better scrub. Regardless of the products or methods selected as part of your protocol, remember to follow scrub product manufacturers' guidelines. Be sure your staff knows exactly how they're to be used, and that they do just that, each time.

4 The steps in action
Let's take a close-up look at the process involved in each method. The first scrub of the day is typically a traditional, timed, 3-to-5-minute surgical scrub with a facility-approved antimicrobial product. For this procedure, staff will:

• Remove all jewelry from hands and wrists before beginning.
• Open the disposable scrub brush/sponge set and antimicrobial soap.
• Clean the nail beds with the plastic fingernail cleaner and rinse well.
• Take the brush or sponge and wet it under the running water.
• Lather the hands and forearms.
• Visualize each finger, hand and forearm as having 4 sides, and wash all 4 sides thoroughly.
• Repeat this process for the opposite fingers, hand and forearm.
• Rinse hands and forearms under running water.
• Keep hands up and let water drip from the elbow.

If your protocol allows a waterless scrub before each of the day's subsequent surgeries, staff will:

• Remove all jewelry.
• Ensure that hands and fingernails are clean and dry before starting.
• Dispense the scrub solution into the palm of 1 hand.
• Dip the fingertips of the opposite hand into the solution and work it under the nails.
• Spread the solution over the hand and forearm to just above the elbow, covering all surfaces.
• Dispense another pump of scrub solution into the palm of the opposite, unscrubbed hand.
• Dip the fingertips of the scrubbed hand into the solution and work it under the nails.
• Spread the remaining solution over the unscrubbed hand and forearm, as you did with the first hand.
• Dispense 1 more pump of solution into either palm and reapply to all surfaces of both hands up to the wrists.
• Let hands dry (without wiping) before donning gloves.

In your hands
An estimated 1.7 million healthcare-acquired infections occur every year, causing an estimated 99,000 deaths and costing as much as $45 billion. With that kind of impact on both lives and budgets, why wouldn't healthcare providers do everything possible to reduce the risks of surgical site infections? The power is in your hands. OSM