#Disinfection of the Hands.#—­It is now generally recognised that one of the most likely sources of wound infection is the hands of the surgeon and his assistants.  It is only by carefully studying to avoid all contact with infective matter that the hands can be kept surgically pure, and that this source of wound infection can be reduced to a minimum.  The risk of infection from this source has further been greatly reduced by the systematic use of rubber gloves by house-surgeons, dressers, and nurses.  The habitual use of gloves has also been adopted by the great majority of surgeons; the minority, who find they are handicapped by wearing gloves as a routine measure, are obliged to do so when operating in infective cases or dressing infected wounds, and in making rectal and vaginal examinations.

The gloves may be sterilised by steam, and are then put on dry, or by boiling, in which case they are put on wet.  The gauntlet of the glove should overlap and confine the end of the sleeve of the sterilised overall, and the gloved hands are rinsed in lotion before and at frequent intervals during the operation.  The hands are sterilised before putting on the gloves, preferably by a method which dehydrates the skin.  Cotton gloves may be worn by the surgeon when tying ligatures, or between operations, and by the anaesthetist during operations on the head, neck, and chest.

The first step in the disinfection of the hands is the mechanical removal of gross surface dirt and loose epithelium by soap, a stream of running water as hot as can be borne, and a loofah or nail-brush, that has been previously sterilised by heat.  The nails should be cut down till there is no sulcus between the nail edge and the pulp of the finger in which organisms may lodge.  They are next washed for three minutes in methylated spirit to dehydrate the skin, and then for two or three minutes in 70 per cent. sublimate or biniodide alcohol (1 in 1000).  Finally, the hands are rubbed with dry sterilised gauze.

#Preparation of the Skin of the Patient.#—­In the purification of the skin of the patient before operation, reliance is to be placed chiefly in the mechanical removal of dirt and grease by the same means as are taken for the cleansing of the surgeon’s hands.  Hair-covered parts should be shaved.  The skin is then dehydrated by washing with methylated spirit, followed by 70 per cent. sublimate or biniodide alcohol (1 in 1000).  This is done some hours before the operation, and the part is then covered with pads of dry sterilised gauze or a sterilised towel.  Immediately before the operation the skin is again purified in the same way.

The iodine method of disinfecting the skin introduced by Grossich is simple, and equally efficient.  The day before operation the skin, after being washed with soap and water, is shaved, dehydrated by means of methylated spirit, and then painted with a 5 per cent. solution of iodine in rectified spirit.  The painting with iodine is repeated just before the operation commences, and again after it is completed.  The final application is omitted in the case of children.  In emergency operations the skin is shaved dry and dehydrated with spirit, after which the iodine is applied as described above.  The staining of the skin is an advantage, as it enables the operator to recognise the area that has been prepared.