Comparison of the effectiveness of painting onto the hand and immersing the hand in a bag, in pre-operative skin preparation of the hand.

The main goal of pre-operative skin preparation is to reduce the risk of postoperative wound infections by removing transient and commensal organisms from the skin. The aim of this study was to compare two methods of application of antiseptic solution in their effectiveness in removing these organisms from the skin. Fifty volunteers participated in the study. In 25 patients, the left hand was prepared using a standard paint technique and the right hand using the bag technique; in the other 25 the right was painted and the left was prepared using the bag technique. Three areas of the hand were examined: the paronychium of the thumb, the second web space and the hyponychium of the middle finger. Bacterial cultures were assessed after 5 days for growth. The bag technique proved better at removing organisms from the skin when comparing each site, and when comparing the total number of colony forming units (P = 0.002 for the thumb, P = 0.013 for the second web space and P = 0.003 for the middle finger). We concluded that pre-operative application of povidoneiodine to a hand using a non-sterile bag technique is more effective in removing skin organisms than the standard paint technique.

Evaluation of thyroid shields for reduction of radiation exposure to orthopaedic surgeons.

BACKGROUND: A perceived increase in the incidence of thyroid carcinoma in orthopaedic surgeons prompted an assessment of the use and value of thyroid shields in the operating theatre. METHODS: The radiation exposure to the thyroid area of 19 orthopaedic trainees was measured over a 3-month period, while they were operating. The results were correlated with thyroid function tests and the number of emergency operative cases performed. RESULTS: Thirteen trainees received radiation exposure within the guidelines set for the general population. Two trainees received exposure above this but within the guidelines set for occupational exposure. A thyroid shield reduced radiation exposure of the neck in one trainee by a factor of 13. The availability and usage of thyroid shields was low: only seven out of 13 trainees used shields. CONCLUSIONS: A thyroid shield should be worn by orthopaedic surgeons if radiation is used during the operative procedure.