171
diseases that a healthy individual rarely gets an infection. The acid mantle of the skin and our body’s resident normal flora constitute an important barrier to the growth of disease-producing germs. Enzymatic protection by lysozyme in the nasal secretions, tears, saliva, and other mucous membranes affords a defense of marvelous significance and complexity. From simple wound care to most complicated surgery, every individual should know how to avoid contamination by harmful germs. During the 19th century in Austria, Doctor Semmelweis began to encourage hand washing, requiring this of his residents after each post-mortem examination and before contact with maternity patients. The death rate from infection dropped precipitously. Although this brilliant physician was persecuted by his own profession for these “strange” doctrines, decades later he was acclaimed a medical trailblazer. Without doubt, the washing of hands is as important to safe surgery, as the use of water internally is to fighting fever. It is especially important to know how to wash the hands and prepare them to handle diseased or injured tissues. Usually before surgery, a soft disinfected bristle brush is used to scrub the hands starting first around each finger, the ends and sides of the fingernails, the palm and backside of the hand, the wrist, and then the forearm. To prepare for a delicate operation, ten minutes of this type of scrubbing is required, typically with an antibacterial soap. Sterile rubber or latex gloves should then be worn. Disinfectants such as organic iodine (Betadine), hexachlorophene (Phisohex), or other antibacterial soaps are used to prepare the patient’s skin for the incision. Where this is not available, soap and water are employed, however the scrubbing must be prolonged. It is well to remember, moreover, that the mere washing of the hands with any substance does not guarantee a totally germ-free skin. Sweating is especially common under rubber or latex gloves, with the natural bacteria present in hair follicles and around the nails. Thus the bacterial count is only transiently suppressed, while our real line of defense is our body’ s resistance. Several routines and techniques of skin preparation will be described in the accompanying table. In the treatment of skin wounds, copious irrigation with water is essential, With some force, the stream of water is directed at the contaminated areas. The wound is thereby cleansed, allowing germs, foreign debris, and blood clots to be washed away, making the area clean for closure or suturing. Preparation of the skin with appropriate antiseptics is also helpful. Proper nutrition to the injured area includes abundant oxygen and vitamin C to aid wound healing. Elimination of refined sugar assists in fighting infection. These measures, together with the avoidance of tobacco and other harmful substances that impair oxygen supply, will enable healing to occur rapidly.