surgical hand prep

Re: surgical hand prep

Stigen — Fri, 07 Nov 2014 21:02:34 GMT

[quote user="Gillian Mostyn"]

Stigen... I never understand this idea that because some people in the developing world live on rubbish tips and SOME of them survive to adulthood then it mustn't be that bad for them....

The same argument is brought up about childbirth... Because women squat in fields, have a baby and then carry on working, we must all be too soft over here!

The mortality rates speak for themselves.

Sorry, just sayin'..... :-)

[/quote]

No....I was`nt saying that they are living "the good life" or anything...and living in unhygienic conditions is no goal in itself...but I do believe that the average person in the developing world would tolerate more than the average person in the industrial world, both inhalational and by ingestion.
Comparing mortality rates would not say much about their immune system,as the mortality is from much more than just diseases.
I know this discussion is completely off-track...but I think a moderate exposure Level to pathogens(significantly less that that which is on th dump) woruld be beneficial. A very large part of Our Dna is so called "junk-DNA" , and a large part of that is actually viral. The human genome Project showed that approximatley 50% of Our genome is viral. Without retroviruses we could never have developed.

I believe that a general antibiotic resistance among microbes is only decades away, no matter how careful we are in Our practice. I`m careful ,as careful as I can be With antibiotic use in my daily practice, but ultimately I don`t believe it will make much difference. In most parts of the developing world they sell any kind of antibiotic in grocery shops and markets. Poor People With a cough buy amoxicilling and clauv.acid at the supermarket for 10pence for a pack. Not to speak of the intensive rearing of cattle and pigs where they use millions og kg. of antibiotic every day as a Growth stimulant.

Sorry for ranting. I`m a nerd about certain Things.

Re: surgical hand prep

Stigen — Fri, 07 Nov 2014 20:22:06 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Stigen"]Iodine is considered carcinogenic in Norway, pretty much banned.[/quote]

Faintly ridiculous... what does the medical profession in Norway use for radiographic contrast medium for (for example) intravenous pyelogram, I wonder?

[/quote]

I meant there is no Betadine/Povidone Iodine. I honestly don`t know why,or if it`s even based on a study,or maybe just some politician has a personal agenda against it. I do use omnipaque/Iodine for contrast studies....but maybe this supposed carcinogenic effect is only supposed to take Place if you use it for scrubbing 4-5 times daily over many years...
I don`t know what the human doctors use for IV contrast....maybe they use different stuff...a fluoroscope or something..

Re: surgical hand prep

Martin Atkinson — Fri, 07 Nov 2014 16:19:19 GMT

[quote user="Gillian Mostyn"]I never understand this idea that because some people in the developing world live on rubbish tips and SOME of them survive to adulthood then it mustn't be that bad for them...[/quote]It is not the living on the rubbish tip that is inherently bad it is all the other factors that are associated with the poverty and squalor that leads them there like poor nutrition and exposure to toxins and disease that even the best immune system in the world can't cope with. They may die from toxin induced cancers, ricketts or cholera but they won't die from asthma.

Re: surgical hand prep

Gillian Mostyn — Fri, 07 Nov 2014 15:37:10 GMT

Stigen... I never understand this idea that because some people in the developing world live on rubbish tips and SOME of them survive to adulthood then it mustn't be that bad for them....

The same argument is brought up about childbirth... Because women squat in fields, have a baby and then carry on working, we must all be too soft over here!

The mortality rates speak for themselves.

Sorry, just sayin'..... :-)

Re: surgical hand prep

Evelyn Barbour-Hill — Fri, 07 Nov 2014 15:34:07 GMT

[quote user="Stigen"]Iodine is considered carcinogenic in Norway, pretty much banned.[/quote]

Faintly ridiculous... what does the medical profession in Norway use for radiographic contrast medium for (for example) intravenous pyelogram, I wonder?

Re: surgical hand prep

Stigen — Fri, 07 Nov 2014 10:59:51 GMT

[quote user="Julian Earl"]

I was disappointed when Manusept went off the market. 5mls of Triclosan/alcohol and two minutes produced surgical asepsis. Triclosan was declared carcinogenic, but it avoided scrubbing for several minutes with iodine and saved having pink arms for the rest of the morning. There was another aerosol-foam in a can based on chlorhexidine that was easy to use as well but the name escapes me. Both seemed to be effective, and I just scrubbed organic debris off with soap or chlorhexidine first, then one or two minutes allowing drying after the foam etc. and hey presto, job done.

[/quote]

Iodine is considered carcinogenic in Norway, pretty much banned. Could`nt find any of the stuff if I tried.

Re: surgical hand prep

Martin Atkinson — Fri, 07 Nov 2014 09:58:12 GMT

[quote user="Julian Earl"]There was another aerosol-foam in a can based on chlorhexidine that was easy to use as well but the name escapes me. Both seemed to be effective,[/quote]I can't remember the name but we had something similar. I never had total faith in it although it was useful for a procedure which didn't have to be hyper sterile like debriding an abscess but I recall the aerosol becoming rapidly ineffective and being reduced to a watery squirt then a dribble before giving up the ghost long before it was empty.

Re: surgical hand prep

Julian Earl — Fri, 07 Nov 2014 09:25:52 GMT

Re: surgical hand prep

Michael Woodhouse — Thu, 06 Nov 2014 17:45:43 GMT

[quote user="bob lehner"]Indeed - I can't abide those stupid ads on the tele urging diligent mothers to continually spray their kitchens with Dettol to protect their little treasures - what a load of cobblers.[/quote]

Bob - we are back to your 'dishwasher' pictures you posted.....

Re: surgical hand prep

Martin Atkinson — Thu, 06 Nov 2014 17:19:56 GMT

[quote user="bob lehner"]

[quote user="Stigen"]I honestly believe that people who let themselves be more exposed to bacteria in the everyday life are overall much healthier, and less sick than the hygiene-freak that wash his hands 10 times a day. We have a pretty adept immune system, and exposure to more pathogens will produce more memory cells,and a more active immune system[/quote]

Indeed - I can't abide those stupid ads on the tele urging diligent mothers to continually spray their kitchens with Dettol to protect their little treasures - what a load of cobblers.

[/quote]There is plenty of evidence to support this and that the current childhood asthma 'epidemic' is due to failure to give the immune system something normal to do so it turns on it's host. Sadly even my nurses who have some scientific knowledge have it so indoctrinated into them from the culture of being 'hyper-hygienic or your not a responsible parent' that everything is dirty. If they get some urine on them, which we know is sterile, they almost have to perform the equivalent of a pre-surgery scrub to get rid of the 'germs'.

Which has actually taken us a full circle and may be a neat way to sign off this thread, for me at least.

Re: surgical hand prep

bob lehner — Thu, 06 Nov 2014 15:44:16 GMT

Indeed - I can't abide those stupid ads on the tele urging diligent mothers to continually spray their kitchens with Dettol to protect their little treasures - what a load of cobblers.

Re: surgical hand prep

Martin Atkinson — Thu, 06 Nov 2014 15:31:02 GMT

[quote user="Stigen"]What`s a peripatetic orthos..? [/quote]One who travels around. Assuming he does mean orthopaedic surgeon one of my friends who is a Cert SAO FRCVS retired from practice and re-invented himself as a peripatetic surgeon who will come to your practice with his instruments. You agree a fee for the client to pay and take half each. A win/win situation.

Re: surgical hand prep

Stigen — Thu, 06 Nov 2014 13:45:20 GMT

[quote user="patrick murphy"]

one of my peripatetic orthos, and I noticed on tv last night another surgeon, appear not to scrub prior to gloving, just use hand prep with solution. is this true, did I miss an article or class?

[/quote]

What`s a peripatetic orthos..?
Maybe the hand prep was pure alcohol...and they figured it would be enough as long as the gloves remain intact...
In the first surgery I worked they did`nt use gloves during surgeries, and did`nt seem to have any problems with post.op infections either. Orthopedics was different however...never seen anyone do that without gloves.

Re: surgical hand prep

Stigen — Thu, 06 Nov 2014 13:37:21 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Stigen"] Look at the people in India, they can basically eat food off the ground without a problem. [/quote]

Something of a gross overgeneralisation. But never mind. [/quote]

I would`nt say it is an overgeneralisation. I have myself seen hundreds of people living on garbage dumping grounds, fighting eachother every time a new load of garbage comes in to see if there is anything to eat. Same thing in many African countries. Very sad, but unfortunately very true.

[quote user="Evelyn Barbour-Hill"] [quote user="Stigen"]Obviously the hygiene when scrubbing for surgery needs to be 100%. [/quote]

This is what we were talking about.

Semmelweiss taught the medical profession that they really ought to wash their hands before examining parturient women.( And was laughed at, pilloried and eventually driven to the madhouse. ) The point often missed is that getting your hands clean of gross contamination means considerably more than removing the dirt visible to the naked eye.

[/quote]

I know what we were talking about...which is why I included that sentence...but sometimes a digression can be fun too ,and it was a digression not entirely removed from the topic..

Re: surgical hand prep

Martin Atkinson — Thu, 06 Nov 2014 11:02:59 GMT

[quote user="Anthony Dennison"]This time of year is always good, cold weather causes a build up of the good stuff up the nostrils.[/quote]Cycling is the perfect activity for creating snot bombs. We cyclists are however (mostly) adept at ejecting them in a controlled manner so as not to hit the one behind or get it over our sleeves.

Which reminds me of a story Emma (Goodman) Milne told me about the time she was cycling behind her dad when she was young and he let go of a snot bomb which caught her full in the face. (Sorry Emma for bringing that up if you're reading this forum).

Re: surgical hand prep

Anthony Dennison — Thu, 06 Nov 2014 09:27:24 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Dennison"]No wonder I'm so healthy. Was constantly mining for snot-rocks as a kid.[/quote]Perhaps I'm so healthy because I still do. Ear wax is a favourite delicacy too, especially if if comes out with a hair attached (ditto bogies)!

[/quote]

Ear wax is a bit too bitter for me. This time of year is always good, cold weather causes a build up of the good stuff up the nostrils.

Re: surgical hand prep

Martin Atkinson — Wed, 05 Nov 2014 18:25:50 GMT

[quote user="patrick murphy"]

was very earnest when I started this link. had no idea where it was going to go, but I never thought for a second that it would involve bogies (wow, in my spellcheck).

[/quote]Patrick, surely you never start a thread expecting it not to get hijacked or for it to follow its true course. At least it hasn't involved politics or invoked Godwin's Law. Yet!

PS I'm very disappointed nobody has red starred my bogie post.

Re: surgical hand prep

patrick murphy — Wed, 05 Nov 2014 17:30:57 GMT

was very earnest when I started this link. had no idea where it was going to go, but I never thought for a second that it would involve bogies (wow, in my spellcheck).

Re: surgical hand prep

patrick murphy — Wed, 05 Nov 2014 17:28:26 GMT

not as bad as the wrinkled hands and goopy sweaty stuff after a long op yuk

Re: surgical hand prep

Martin Atkinson — Wed, 05 Nov 2014 14:09:52 GMT

Re: surgical hand prep

Evelyn Barbour-Hill — Wed, 05 Nov 2014 14:07:10 GMT

[quote user="Michael Woodhouse"]I thought the definition of gross contamination, was contamination that could be seen with the naked eye?[/quote]

Yeah I thought someone would come up with that.

Substitute "superficial crud" for "gross contamination".

(Actually at two feet from my naked eyes I can hardly see anything anyway )

Or, let me re-phrase.

There's a good deal more to the cleansing of hands necessary prior to disinfection than the removal of dirt visible to the naked eye (with or without spectacles.)

Re: surgical hand prep

Michael Woodhouse — Wed, 05 Nov 2014 14:00:40 GMT

I thought the definition of gross contamination, was contamination that could be seen with the naked eye?

Re: surgical hand prep

Evelyn Barbour-Hill — Wed, 05 Nov 2014 13:54:59 GMT

[quote user="Stigen"] Look at the people in India, they can basically eat food off the ground without a problem. [/quote]

Something of a gross overgeneralisation. But never mind.

[quote user="Stigen"]Obviously the hygiene when scrubbing for surgery needs to be 100%. [/quote]

This is what we were talking about.

Re: surgical hand prep

Anthony Dennison — Wed, 05 Nov 2014 12:23:36 GMT

[quote user="Stigen"]I remember an article about a german immunologist that was recommending everyone with children to encourage the children to pick their own nose and eat the bogeys, as his studies showed those children to be significantly less sick than the non-bogey-eating children. [/quote]

No wonder I'm so healthy. Was constantly mining for snot-rocks as a kid.

Re: surgical hand prep

Stigen — Wed, 05 Nov 2014 11:22:23 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Tim Charlesworth"]Interestingly, even if you are using hibi - the act of scrubbing (using a brush) was discredited quite a few years ago..[/quote]

Not quite true. It depends what you mean by scrubbing.

[quote user="Tim Charlesworth"]you do need clean hands to start and so need to wash any gross contamination (if present) off hands with neutral soap.[/quote]

And "gross contamination" in my book is something more than stuff you can see with the naked eye. My hands are apparently clean at this very moment as I sit typing at a probably horribly contaminated keyboard, and seeing as I've just changed my shoes too I would not dream of sitting down to my dinner (it's nearly ready, stuffed tomatoes, yum,) without washing my hands and that will include using a nailbrush.

[quote user="Tim Charlesworth"]ecological impact[/quote]

[/quote]

I honestly believe that people who let themselves be more exposed to bacteria in the everyday life are overall much healthier, and less sick than the hygiene-freak that wash his hands 10 times a day. We have a pretty adept immune system, and exposure to more pathogens will produce more memory cells,and a more active immune system. Look at the people in India, they can basically eat food off the ground without a problem.
I remember an article about a german immunologist that was recommending everyone with children to encourage the children to pick their own nose and eat the bogeys, as his studies showed those children to be significantly less sick than the non-bogey-eating children.

Obviously the hygiene when scrubbing for surgery needs to be 100%.