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Summary

The Black Belt Academy of Surgical Skills provides an on-demand teaching session for medical professionals to learn about soap and hand washing as an effective measure to reduce infections. Led by cardiac surgeon Dave Landrigan, who is the past director of the Faculty of Surgical Trainers for the Royal College of Surgeons of Edinburgh, and a visiting professor at Imperial College, this session covers the history and science behind soap, including tips on the best temperature and steps for proper handwashing. Ignace Summer wise is highlighted as the "father of hand washing," while interesting anecdotes and debunking of common misconceptions complete the comprehensive session.

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Description

hand hygiene, is the act of cleaning one's hands with soap and water to remove microorganisms., or other harmful and unwanted substances stuck to the hands. Drying of the washed hands is part of the process as wet and moist hands are more easily recontaminated. If soap and water are unavailable, hand sanitizer that is at least 60% alcohol in water can be used if hands are not visibly excessively dirty or greasy. Hand hygiene is central to preventing the spread of infectious diseases in home and everyday life settings.

The importance of hand washing for human health – particularly for people in vulnerable circumstances like mothers who had just given birth or wounded soldiers in hospitals – was first recognized in the mid 19th century by two pioneers of hand hygiene: the Hungarian physician Ignaz Semmelweis who worked in Vienna, Austria and Florence Nightingale, the English "founder of modern nursing". At that time most people still believed that infections were caused by foul odours called miasmas.

BBASS discusses the sterile theatre and describes how to scrub up, dry hands and put on a gown. There are simple principles that must be adhered to but often forgotten.  The action and ritual of washing the hands can be used as an opportunity for clearing the mind and setting focus on the task in hand.

Learning objectives

  1. Explain the history and importance of handwashing in reducing the transmission of infection.
  2. Discuss the chemical and physical reactions that take place when making soap.
  3. Describe the advances in handwashing techniques and results since Ignace Semmelweis.
  4. Analyze current guidelines and practices for effective handwashing with soap and water.
  5. Demonstrate proper handwashing techniques with soap and water.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, good evening. Good morning. Good afternoon. Good day, wherever you are in the world. And thank you very much for joining the Black Belt Academy of Surgical Skills. My name is Dave Landrigan. I'm a cardiac surgeon in Yorkshire in the United Kingdom. The past director are the Faculty of Surgical Trainers for the Royal College of Surgeons of Edinburgh and a visiting professor at Imperial College. If this is your first time joining the Black Mount Academy. Thank you and welcome. And if you're one of the 3300 Facebook followers or 297 Instagram followers. Thank you very much. I think it's 597 Instagrams follows. Thank you very much. Indeed. Yeah. Tonight we're going to cover an important element and that is summarized basically by a bar of soap. No a matter analysis in 2007 determined that soap and water is better than anything else for cleaning hands and reducing infection. And soap has actually been around since 2800 B C was found in the Babylonian Times described in Roman literature in 77 A D. It's spread in use was particularly around the Mediterranean climate perhaps because that is hot and dusty. And then 13th century Marseille in France had to be the capital of soup making Castella in Spain, producing the castile soap from olive oils. Was it close? Second at the time in the 18th century, Nicholas Leblanc made a discovery of converting salt, too high quality. So do rush that is used for making soup until then animal fats were mixed with ash from a fire. And indeed, if you're on a survival trip, what you can use to wash your clothes is the white ash from the fire because it has that alkaline content. And it was a chemist, another Frenchman several who made soap in 18 11 from pig fats and was the Americans in 18 50 that took over making soup led by Colgate Proctor and Gamble and Johnson and Johnson. And the rest is history. But so is a specific reaction of combining fats or oils where they're from animals or plants, olive oils or vegetable oils with lie sodium hydroxide or potassium hydroxide. And when you combine the two, you get psa pontification soup and glycerin, which you need to then rinse to get rid of the hydroxide and the glycerin and mold it then into bars of soup. There's only later on that they started putting in moisturizes and fragrances. This is a lavender soup to add to the appeal. Now, so is particularly useful as it is as surfactant. And of course, it acts on bacterial lipid layers, d and denatures proteins. But the father of hand washing was Ignace. Summer wise, was born and hungry. In 18 18, he started his business actually in wholesale and spices before going into law and he was a wealthy man. At the time, we don't know why, but he left law to do medicine. And one of his first jobs was an assistant to the Professor Klein at Vienna General Hospital. And at the time, there were two maternity units, they were open for charity for childbirth. For those less fortunate. The one run by the teaching hospital had a mortality rate of 10%. But the other run by the midwives have a mortality rate of 4%. And that puzzled summer wise. But this went further because even the patient's new and the patient's begged not to go to the teaching hospital for childbirth. And some of us do not understand and was a friend of his in 18 47 that accidentally cut himself following a cadaver dissection and died of gangrene. And some of us thought of this is due to cadaveric particles and introduced chlorinated line as part of the hand washing and cleaning to reduce per puerile infection. And it did significantly and was published at the time and the runs chart showed a dramatic fall in infection but so stayed was the medical fraternity in his thinking of diseases causes by evil humors and my asthma. They dismissed his work. The British adopted it earlier perhaps because Florence Nightingale had done the same in Crimea War. But one of his students presented at the Royal Society of Medicine and the article was published in the lancet, he tried hard to get attention to the fact that handwashing will actually reduce infection. But he was banging his head against the wall and leading names like ver cough laughed him out of the lecture theatres with his crazy ideas. He wasn't good at publishing. He tried for 20 years to actually make an impact. And by 18 65 his behavior has become somewhat disruptive, perhaps to, to fatigue and frustration. But his thought maybe because of booze and brothels and it could have been dementia or tertiary syphilis. There was common amongst observations at the time, they lured him to an asylum where on reaching the asylum, he realized that he was going to be locked up for being mad. He tried to escape and he was beaten senseless. And in that beating and straitjacket, he sustained an injury to his hand and paradoxically, he died of sepsis. But we all recognize him now as the father of hand washing and the World Health Organization stool quotes that paper from 2007, soap and water is the best thing to use. Now, you, you, the temperature is according to your comfort. Obviously, high temperatures do kill bugs but high temperatures will also burn your hands. So the temperature of the water doesn't matter. And that's a personal preference. Washing hands is mandatory before you see a patient before you do an aseptic procedure after handling anybody fluids after coming into contact with any of the surrounding area of a patient, because they're feeding themselves toilet ing themselves and reaching out all the areas. And after you make contact with any patient, it's before and after. And if you use the telescope or piece of recruitment, please wipe that down with a 60% alcohol rub. I have often looked at people scrubbing up in the theater and sat behind the perfusion machine to watch people scrub and we take it so for granted, and people have become lazy in their habits and that is why I wanted to go through my washing up process, which takes five minutes but didn't have five minutes of washing up. It has also become a ritual, a ritual to actually set your mind for the task in hand to communist to plan the operation and reflect on what you're going to do. I think of it is my quiet time before operating. It's interesting in this day and age. Even if you go to surgical conferences, I've stood not for a prolonged period, but notice people coming into the gents at a conference doing their business and leaving without washing their hands. And the most remarkable thing I've seen of late is this habit of being able to take a P at the same time, send messages and text on your mobile phone, pop it in your pocket and leave. I do like the invention by the Japanese of putting an ultrasound sterilizing machine in the loop for your mobile phone because your hands are the worst things of contaminating everything everywhere. And I did ask following COVID if we'd seen a reduction in wound infection, I haven't got that information. But if, you know, I'd be delighted to find out. But one study I did think was amusing that at a conference they had a couple of hosts at the door, greeting the attendance and as they did, they shook hands. But before they did reached into their pocket and cover the hand with a bit of glitter and shook their hand. At the end of the day, they turned out the lights and had ultraviolet light on the audience and almost everybody had elements of glitter on their ties. I tell you that story because I don't think we can or should ever be complacent. Let's get on and wash your hands. I choose the tap as part of my ritual as you know, the taps enable you to open and close them with your elbows. And the very simple principle is, is the tips of your fingers are going to be clean in the cleanest part and the album's are going to be dirty and running water needs to run from your fingers off your elbows. All the time I note some people when washing end up quite wet on their theater blues and of course, wet theater blues, not only is uncomfortable, but actually increases the risk of you passing bugs. So you need running water. And one of the worst things I've noticed is that the wash troughs and taps are down at this level and you start the day trying to wash your hands with three operations a day. I found that I had severe backache, not because of operating, but because the ergonomics of the wash trough and the height of the taps wet your hands under a temperature of water that's comfortable for you and keep your hands up. I keep my elbows out to the side so that it's dripping into the wash trough and not on to me. But I have been accused of having so much water on the floor, which may be a trip hazard, but there's certainly keeping the floor clean in doing that. But I've put a towel on the floor, use enough soap to actually cover the whole of your arms down to the albums and get a good larger up. Whether you use Povidon Irene or clot vaccine. Really depends on you. I don't think there's any evidence for what is better. I certainly find Chlorhexidine wash feels a bit funny what I personally, the Povidon iodine wash because I get a nice lather and it feels good. You're washing, rinsing, washing, rinsing and keeping your hands up all the time within it. The brush said is what's called a Narco Ringer. And I like that term as German. It is a little plastic scraper for your fingernails. And if you've ever seen crime scene investigates where they scraping the fingernails, it's amazing. The debris that collects. So under running water. First start with your knuckle ringer. A plastic thing and ashore your nails are clean. I know colleagues who enjoyed working on cars and others working in the garden may have suggested that this is your hobby. It is easier to wear gloves to do your car and your garden to prevent the build up of debris underneath your nails. But first and foremost, your nails are clean. The sponge often comes with a brush the other side, but this is a sponge from the kitchen and there's an abrasive edge and that will damage the skin and increase the bacterial count as well. A brush, the brush will make the skin worse. So I would not use anything but the soft sponge on my arms. But I prefer a good lather. I would never use an abrasive surface and I would not use a brush from the skin reserve that from the nails. That Lane Salmon cleaned the nails and then brush the nails. I'm ready to wash. You know that I've got a ring on this ring doesn't have any patterns on it. And in theory, you could keep it on but I think it is always better to take it off. But if you do wash your hands, ensure that you move the ring and you clean properly underneath it. We start off with the hands, the palms, the back of the hands between the digits, the back of the digits round the base of the thumb. We interlock our hands to get the tips of our fingers into our palms as well. So I do that for the hands and then I do a good lava all the way down to my elbows since one minute from my nails, one minute for the full arm, another minute for the full arm. And then I focus on the hands and repeat that for another three minutes. Now, you're gonna be disciplined with yourself. If you touch a tap at a wash, if you touch something else, add a wash, but the whole thing should take about five minutes no longer than 10 minutes because then you start damaging the skin as well. If you've got any irritation to the soups, there are hyper allergenic so it's available, but you may indeed need to ask for some professional advice. So now you've got clean hands, the water has been dripping off your elbows at no stage is your hands drop below your elbows. And if you're careful, you haven't got water on your front, you'll find in your down PAC that has been opened on a sterile trolley that the inside is clean. So and opening it out, you do not touch the inside. Hi, David. Sorry to interrupt. It seems that we're experiencing some technical issues. People can only see um your video on the side of the screen. Um I'm wondering maybe it would help if we would refresh um the feet or change the settings. Um I am not connected to that Gabrielle if we can, if people can still see the small screen, I think we should continue a small screen because I will be up close and oh, they're saying it's fixed now. So we're all good to go. It was a query issue. We're all good. Thank you very much. Indeed. So to recap, I've done a five minute wash the tips of my fingers. Cleanest water has been running off my elbows. NFL have been careful is going in the wa ostroff not down my front or on the floor. When opening the gown pack. Remember it clean on the inside. So you're opening, holding the towels from the outside to reveal the clean pack inside. You will have to towels and I take the one towel top half I use and dab do not rub a dab around the fingers to make sure it's dry eye drop that half and then take it around my wrist in a circular diving motion all the way down to the bottom, off to the top of my elbow. And this is where the first mistake happens because often people are doing that elbow to rest, elbow to rest. Remember it's clean at the top, dirty at the bottom. So it's a one direction down to the elbow. And the second mistake people make then scrunch this up and throw it away, scrunching it up. You are actually going to make your hands dirty again. Do not scrunch you're given to. So do the same for the other hand as well. Again, I use one half for my fingers and I doubt making sure I get all the moisture off, particularly between the fingers. Block that half. Put it over my hand and dad all the way down know, rubbing to the elbow and discard. I now have got clean hands. Should you touch anything or anybody touch new? Please wash again. Another wash. The gown is beautifully folded. I opened a gown recently to explain this and try to reuse it by folding it again. I could not afford it again. The outside of this gown is on the inside. That's the outside and it's folded on the inside. So when you pick it up, the two corners is where the shoulders are and the armholes, my hands go in to the armholes and I put it down on closed. In other words, my hands do not leave the sleeves, hold the cuff between index finger and thumb and you shrugged the gown on and this is where you ask somebody to tie it up at the back. Remembering that you now on the outside is completely sterile. The gloves come in pairs clearly marked left hand and right hand and the putting on gloves closed is something to be practiced. So that's the left glove, I'm going to put it down, there's the thumb, thumb to thumb and I'm going to grab the cuff between my index finger and thumb with the fingers pointing down my arm towards me. Without my hand leaving the gown, I take the cuff and I fold it over my hand and extend my hand into the glove. So at no stage during this procedure has my hand left the inside of the glove glove doesn't go on completely. We can readjust it in a moment. Do the same for the other side again. Right glove, there's a thumb, thumb to thumb, pinch the cuff halfway down between the thumb and index finger and then fold the cuff over your hand and the gown take both. And as you pull both and the sleeve, you pull your glove down onto the hand now because my hands are not dry and slightly sweaty, they have actually not gone on a smelting. Uh Ignore me. It does. Then I just, it's a tension in the fingers and assure that they're sitting comfortably and my hand is comfortable. What side gloves should you wear? Well, you do not want them tight such that your fingertips become numb. Remember, in Savior, as we've discussed with the Black dot Academy so far is that your fingertips are giving you the feel of the tissues and more century information than the eyes themselves. So, there you go. And I've usually got the cuff pathway down my hand and that feels comfortable for me. I would not recommend double gloving at all. I did a patient with Hepatitis C and the registrar who's taking the radio artery, double gloved and I asked him that's him. Normally double glove ambience. What's new, advise them not to double glove because you lose the sensation. Ignore that advice and run. As I did the Salata Me, I had a plaintiff whale from the corner they made and I looked out and this registrar had taken 22 blade straight through the skin into the radio artery. There was now spring hepatitis C infected blood around the room in surgery. It's unlikely that you're going to pick up an infection from a needle, stick into it because it's not a hypodermic needle. And usually the needles are not big enough to go deep into the tissue. And therefore the inoculation risk in surgery is certainly less than other medical areas. That's not to say there's any room for complacently or you should not pay attention to safety and handling. So the father of handwashing Sam or vice sadly, banged his head against the wall for 20 years and described candidate every particles that was later that century described by Louis Pasteur is Jan theory. And Robert Cock Walser described staphylococcus pia Ginny's that commensalism in the nose and throat. They gave Ben Charles bed fever, handwashing needs to be part of your daily ritual. And certainly as a surgeon, I enjoy my quiet time scrubbing up for five minutes, going through the ritual of all the areas of the hand gardening properly, gloving properly and entering theater. It is useful to get somebody to watch. You do this on a regular basis to ensure that you have not picked up any bad habits. And the nursing staff in theater were particularly good at attention to detail. As were the staff at that second maternity unit in Vienna. There's something about being a medic. They're breeds in arrogance and complacency that is not becoming when it comes to attention to detail. You too apply these principles in everything you do in surgery. I believe we're an infection should be prevented and all costs and can be reduced significantly by seeking out the 1% improvement in everything. Infection is not a bug problem. It is a people problem, a human factors problem because we do not attend to the details that were described by Ignace. Some advice, Florence Nightingale Joseph Lister, all of whom have made surgery safe today. It is said that we're in an era where there no more antibiotics being produced and worked with the increase in bacteria that resistant to antibiotics. We could enter the dark ages again. When infection becomes a problem, it could be a bit like the Crimea War. But history has taught us that soap and water are excellent and killing bugs. I'd like to thank you for joining the Black part Academy of Surgical Skills this evening. I hope the next time you scrub up at the table. Do you think about what you're doing and do not hesitate to pick people up if you see sloppy practice. Oh, poor behaviors in this group technique. Next week, we're going to be talking about assisting. Why we bring it forward on the agenda is I'm delighted to see my son's return from boarding school in Malaysia and he's kindly agreed to help us next week with the program going through the basics of assisting. We are then going to take a holiday as it turns out Gabrielle who's in the production team behind the scenes is going to be away for two weeks and I am going to be away as well. We resume broadcast from a new venue all being well at the beginning of May I need to confer with the team that they are available because the third is the bank holiday and the following week and is the king's coronation. But the show will go on. Thank you very much indeed for following the Black Brown Academy. And thank you for joining me wherever you are.