Evaluation of antiseptic use in plastic and hand surgery

Despite the growing complexity of plastic surgical cases, antiseptics available for preoperative preparation do not always prove effective. In addition to the varied sites of plastic surgery, there is a likelihood of considerable contamination with microorganisms since surgical gloves are frequently punctured during surgical procedures. With an aim to find a solution to all of these problems, a study was conducted in 2 stages. First, antimicrobial effects on the normal flora of hands of 4 different surgical handwashing procedures, which consist of scrubbing with 7.5% povidone-iodine (PI) scrub by using the sponge/brush, 7.5% PI scrub alone, 0.5% benzalkonium chloride (BC) solution, and 0.1% BC solution, were compared. In the second stage, bacteriological samplings were obtained from fingertips of the operating team during the surgical procedure. At the end of the study, the following results were obtained: (1) scrubbing with 7.5% PI detergent by using a scrub sponge was significantly more effective than without using a scrub sponge (P < 0.05). (2) There was no statistically significant difference in scrubbing when povidone-iodine detergent and 0.5% benzalkonium chloride solution (P > 0.05) were compared. (3) At the end of the surgery lasting 1-5 hours, hands were found to be cleaner than previously washed hands for preoperative preparation, which was considered a consequence of the sustained effect of PI. (4) There was a statistically significant difference between the cultures taken from the gloves at the end of the operation and from the hands after the gloves were taken off (P < 0.01). At the end of the operation, the gloves themselves were found to be extremely dirtier than the hands inside them. As a conclusion, bacterial escape due to glove perforation occurs from outside of the glove to the inside, contrary to the generally accepted concept.