why do surgeons bother scrubbing all the way up to their elbows, but then it is covered by sleeves and gloves?
In: Biology
Best practice, and a bit of the old belt-and-suspenders approach – scrubbing and donning gown and gloves each help reduce contamination in the operating room, but both together help reduce the risk greatly. There is no perfect containment system – gloves and sleeves are very good at reducing transmission of pathogens, but are not perfect. Nothing is. The “cost” of thoroughly scrubbing up is an extra minute or two, which is very low, especially when compared to the hours and hours a typical surgical procedure can take. The benefit if it prevents even one infection over a surgeon’s entire career far, far outweighs the cost of scrubbing.
As others have mentioned gloves and gowns are not perfect, especially when it comes to moisture. Strikethrough happens when fabric is saturated, your sweaty arms after a 6 hour case wearing lead, or doused with blood/amniotic fluid etc. There are ‘levels’ of permeability to gowns based on what you expect during the surgery, but who’s to say there isn’t a tiny defect in that sleeve you couldn’t see?
Not to mention the chance that a glove tears. It’s good practice to double glove or wear a thicker pair anytime you don’t need optimal finger sensation/dexterity. But it’s not uncommon working with broken bones or even tying heavy suture that you notice a hole in your thumb.
The primary cause of surgical site infections is the patient’s own skin. That is why you prep the area with a cleansing solution that varies based on a multitude of factors. But just like a hand scrub, skin can never be sterile – only surgically clean. It’s about minimizing risks to near zero.
There are several factors to infection, but hygiene is all about the level of inoculation. Contaminating a wound with 1000 bacteria is less likely to get infected tham 1000000 bacteria.
Dilution is always the solution. Irrigating wounds also helps to prevent there from being a concentrated pathogen that will multiply quicker than the body can fight it off.
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