Will sweaty hands be a problem for a surgeon (neurosurgeon or cardiosurgeon) ?

[john mason]

So i've had slightly damp hands since high school.They're not dripping with sweat but they often get humid.Sometimes when i hold an object for too long my hands get slightly wet.It can be felt when i handshake someone.I know that this is probably palmar hyperhidrosis and i know what are the treatments(for me botox will probably be the best).My question is:could this slightly clammy hands be a problem when i perform a surgery?Do you know any physicians with this condition who are still successful ?I appreciate your help.

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[QofQuimica]

I don't mean to make light of your concern, but you do realize you would be wearing gloves while performing surgery, right?

 

[john mason]

I know that,but could it still be a problem ?For example can you get really uncomfortable to the point where it limits your movements(keep in mind that my case is not severely DRIPPING hands but just often damp).

 

[Mad Jack]

If anything it'll just make the gloves stick to your hands even harder lol- have you ever tried putting on surgical gloves with even slightly damp hands?

 

[john mason]

I bought dotor's gloves from a pharmacy store.They were not easy to put on (it took me around 30-40 seconds),my main concern was that i didn't feel very comfortable (they were a little oversized) and my hand felt damp all the time.After i removed the glove my hand was not sweaty but the inside of the glove was slightly clammy and when put to the sun i could see little trails of sweat(they were not on the whole glove but on certain places).All in all,do you think this is normal ?Will it be a problem in the future?

 

[Psai]

If anything it'll just make the gloves stick to your hands even harder lol- have you ever tried putting on surgical gloves with even slightly damp hands?

You wash your hands before putting gloves on and dry them

 

[Mad Jack]

You wash your hands before putting gloves on and dry them

Obviously. But there's situations outside of the OR where I've needed to throw on sterile gloves very quickly (suctioning a plugged airway, for instance), and you don't really have time to worry about whether your hands are completely dry when your patient is satting 80 and dropping with zero ventilation and you've got to wash your hands and throw on some sterile gloves. I assure you, it is no fun.

 

[Law2Doc]

So i've had slightly damp hands since high school.They're not dripping with sweat but they often get humid.Sometimes when i hold an object for too long my hands get slightly wet.It can be felt when i handshake someone.I know that this is probably palmar hyperhidrosis and i know what are the treatments(for me botox will probably be the best).My question is:could this slightly clammy hands be a problem when i perform a surgery?Do you know any physicians with this condition who are still successful ?I appreciate your help.

For the reasons mentioned above this is a silly thing to worry about. You'll wear gloves of the appropriate size after drying your hands for all sterile procedures.
The only issue will be on interview day when you shake someone's hand.

 

[john mason]

Even though my hands are washed with sterile procedures the problem will probably occur.Thank you for encouraging me but do you think that this perspiration could still not be a problem if i operate for example for more than 3 hours ?

 

[LucidSplash]

Your question, in its varied forms, has been answered multiple times over. In short, it will be fine. Don't worry about it.

Even though my hands are washed with sterile procedures the problem will probably occur.Thank you for encouraging me but do you think that this perspiration could still not be a problem if i operate for example for more than 3 hours ?

 

[john mason]

Thank you all.

 

[Psai]

Obviously. But there's situations outside of the OR where I've needed to throw on sterile gloves very quickly (suctioning a plugged airway, for instance), and you don't really have time to worry about whether your hands are completely dry when your patient is satting 80 and dropping with zero ventilation and you've got to wash your hands and throw on some sterile gloves. I assure you, it is no fun.

Why do you need sterile gloves to suction an airway?

 

[shoal]

Why do you need sterile gloves to suction an airway?

if the patient is actively dying, sterile technique and gloves be damned.. save your patient

Sent from my VS986 using Tapatalk

 

[Mad Jack]

Why do you need sterile gloves to suction an airway?

https://www.saskatoonhealthregion.ca/about/nursingmanual/1056.pdf

3.3 Ensure that the following equipment is at the bedside and in good working order:
• oxygen flow meter
• manual resuscitation bag with reservoir and face mask of appropriate size
• suction regulator
• suction catheters of appropriate size [usually 2 times the diameter of the endotracheal or tracheostomy tube (in mm.) equals the appropriate French sized catheter. See Appendix A]
• Neonates 5 – 8 Fr.
• Pediatrics 8 – 12 Fr.
• Adolescents 12 – 14 Fr. Note: Catheter should be no more than 2/3 of lumen of tube to prevent hypoxemia and atelectasis. 2,4,6 However, if secretions are very thick and copious, use larger suction catheter to minimize number of suction passes and ensure secretions cleared2, 5.
• suction canister and connecting tubing
• 0.9% saline for instillation
• mask, sterile gloves, face shield for open suction
• clean gloves for closed suction
• mouth care supplies
• stethoscope
• monitoring equipment (if possible)- HR & SaO2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1540438/
http://ccn.aacnjournals.org/content/28/3/83.full

Basic hygiene principles of infection control (hand washing/disinfection just before and after each patient contact, the use of glove and sterile equipment) remain important for the prevention of VAP.

Suctioning the secretions in the trachea is another approach to VAP prevention. Two types of tracheal suction catheters are used on ventilated patients; the open, single-use catheters and the closed, multiple-use catheters. In single-use system, HCWs have to use sterile solutions during rinsing these catheters and have to care aseptic technique when suctioning endotracheal secretions. In closed suctioning systems, secretions can be suctioned without removal of mechanical ventilation support. This may cause less hypoxia, hypotension and arrhythmias, and also less environmental contamination [115,116]. However similar VAP rates with closed and open system were suggested in the earlier trials [115,117], Combes and colleagues [116] reported a 3.5 times greater risk of VAP in open suctioning system than closed suctioning system in a recent study. Indeed, closed suction catheter is an extension of the ventilator circuit, daily change of this catheter is not necessary for infection control, and in one study no significant difference in VAP rate was reported when daily changes were compared with no routine changes, that may decrease the costs [118]. The use of closed suction system is recommended as part of a VAP prevention program [104].

The number one nosocomial cause of death in ventilator-bound patients is ventilator associated pneumonia. 13% of patients ventilated for more than 48 hours will die of it, so it's something you do everything you can to avoid. I can quickly clean my hands and throw on a set of sterile gloves in less than 30 seconds- not nearly enough time for a person to die unless they are extremely hemodynamically unstable. If they get a VAP, however, their chance of dying is 20-41%. I've had exactly zero patients die in the time it takes me to practice proper sterile technique, but I've seen dozens die of ventilator associated pneumonia. Closed suction systems, while convenient and well-designed for use in a patent airway, are absolutely terrible when you're trying to clear an ETT blockage- you really need an open suctioning system and good technique if you want to clear an obstruction quickly and effectively. When you go open, you go sterile unless there is absolutely no other way to do so, because the infection risk is actually quite high. If you want to risk killing a patient because you'd rather use contaminated equipment, that's on you. but I treated my patients the same way I'd prefer my own family to be treated- I'd probably strangle someone if I saw them open-suctioning without sterile gloves on my own family members.

What do I know though, I just did ICU vents for like, six years.

 

[Psai]

Am I supposed to care about nursing manuals or the journal of critical care for nursing? lmao

How do you know that your amazing 6 years of suctioning skills aren't actually pushing bacteria already in the tube into the lungs and causing vap? Are patients with vap dying from staph epi on your hands? Or are your nonsterile gloves just covered in e coli, pseudomonas and acinetobacter? Do you have evidence that putting on sterile gloves is superior to regular gloves?

And if you have time to put on gloves, you have time to dry your hands. It adds what, 5 seconds? Or are you doing some sort of sterile wash with chlorhexidine that leaves you absolutely dripping and unable to put on gloves in a timely fashion

 

[Raryn]

There's times when I had an urgent (but not absolutely emergent) need to sterilely glove up. Lines or whatnot. If that's the case, you can dry your hands with a damn paper towel and then put on the sterile gloves. No one is doing a full scrub to the elbow outside the OR.

If it's absolutely emergent and you have to suction a plugged airway while the patient is desatting, how the hell do you have time to set up a fully sterile suction system anyway? And if the yankaur isn't sterile, your hands certainly don't have to be. Save the patient, figure out the rest later.

 

[MediCane2006]

If you are in the OR, you dry your hands with a VERY absorbent towel before putting your gloves on. In any other situation, dry your hands with a paper towel before gloving.

 

[J ROD]

I knew someone that had it a little worse than what you are describing and he went ahead and got the botox.

He is much happier now not having to worry about it. I would consider that as an option.

 

[Hangry]

If you are in the OR, you dry your hands with a VERY absorbent towel before putting your gloves on. In any other situation, dry your hands with a paper towel before gloving.

Except when the freaking scrub tech decides the med student doesn't deserve the nice absorbent towels and hands you a sh*tty blue towel after the attending and resident got nice absorbent ones, then huffs while you take extra time trying to actually dry your hands and gets pissed off when your hands still stick to the gloves cause they're still freaking wet...
Third year problems

 

[john mason]

I knew someone that had it a little worse than what you are describing and he went ahead and got the botox.

He is much happier now not having to worry about it. I would consider that as an option.

I have alreafy written that Botox will probably by best.Thank you for your answer.

 

[austintr]

I don't mean to make light of your concern, but you do realize you would be wearing gloves while performing surgery, right?

Yeah, but...have you ever seen The Knick?! Those guys never wear gloves!

 

[Psai]

Yeah, but...have you ever seen The Knick?! Those guys never wear gloves!

Which is ridiculous because Halsted wore gloves

 

[QofQuimica]

Yeah, but...have you ever seen The Knick?! Those guys never wear gloves!

Is that a TV show? I don't watch TV. I work at a job where, among other things, I regularly must listen to people's bizarre ideas about medicine, but I get paid to listen to it. I draw the line at listening to laypeople pretend they know anything about medicine on my time off.

 

[Crayola227]

too many hours too damp of hands inside gloves.... I could see leading to skin breakdown

it's not a "nothing" concern in my mind but as others said is not likely going to really come up or be something you can't work around

and I encourage people not to go into surgery anyway
not only will your hands thank you, but so will most of your body (feet, knees, back come to mind) and likely your friends and family!

 

[ThoracicGuy]

too many hours too damp of hands inside gloves.... I could see leading to skin breakdown

it's not a "nothing" concern in my mind but as others said is not likely going to really come up or be something you can't work around

and I encourage people not to go into surgery anyway
not only will your hands thank you, but so will most of your body (feet, knees, back come to mind) and likely your friends and family!

Why not encourage people to go into what appeals to them instead of encouraging people NOT to go into something?

 

[Raryn]

Why not encourage people to go into what appeals to them instead of encouraging people NOT to go into something?

*nods*

I would never go into surgery. Ever. But someone has to, and if someone enjoys that sort of thing, more power to them. If they ask me for advice for whatever reason, I just make sure that they adequately consider both the +s and -s.

 

[john mason]

too many hours too damp of hands inside gloves.... I could see leading to skin breakdown

My hands are not TOO damp.Don't surgeons always wash their hands after surgery ? How can then this lead to skin breakdown ?

 

[Crayola227]

My hands are not TOO damp.Don't surgeons always wash their hands after surgery ? How can then this lead to skin breakdown ?

yes, everyone washes their hands all the time

all the hand sanitizer, water, and soap can lead to skin issues for anyone but that's a universal risk

the average hospitalist, if following hand hygeine practices perfectly which many don't, I believe would be sanitizing/washing up to 200 times in the course of a normal day at work (I think I saw that number somewhere, I could be wrong, so let's just say it's a LOT)

are you wondering how constantly exposing your hands to alcohol, soap, water can lead to skin breakdown?

 

[marty mcfly]

i skimmed.....i thought this was a medical forum, so many idiots in this world. And a sympathectomy is unethical...iontophoresis is a real option that works. Drionic is the company that has worked for me.

 

[Crayola227]

um, I didn't see a sympathectomy suggested, I did see botox suggested, which is a temporary fix anyway

 

[ThoracicGuy]

i skimmed.....i thought this was a medical forum, so many idiots in this world. And a sympathectomy is unethical...iontophoresis is a real option that works. Drionic is the company that has worked for me.

So how much does Drionic pay for your "assistance" here?

 

[MediCane2006]

too many hours too damp of hands inside gloves.... I could see leading to skin breakdown

it's not a "nothing" concern in my mind but as others said is not likely going to really come up or be something you can't work around

and I encourage people not to go into surgery anyway
not only will your hands thank you, but so will most of your body (feet, knees, back come to mind) and likely your friends and family!

LOL. Bless your heart.

 

[john mason]

Do you know any doctors with this condition ?

 

[Crayola227]

no but skin breakdown is always mentioned in healthcare because of the importance of hand hygeine, we are all called upon to wash/rub sanitizer on our hands many many times a day and it can be a real issue for people which is why skin care in addition to hygeine is frequently covered

I don't mention it because it should be a barrier but to validate that it is a valid concern, and by concern I don't mean freak out I mean don't wait for a problem with your skin to act, that I would merely be proactive and do research online on the topic, you could talk to your PCP, you could talk to a dermatologist even

head it off at the pass is all I'm saying

I'll tell you a story of a doc with "normal" moisture hands, hands that didn't spend lots of time wet or in gloves, but did see lots of hand santizer going in/out patient rooms
my med school all the hand sanitizer was chock full of lotion making your hands disgustingly slimy to where you would use soap and water by choice despite that not being required from an infection control standpoint, and that traditional washing takes longer, so they didn't feel gross

then after a 5 week rotation at the VA where all they have posted outside the doors is ethanol laden Purell with less moisturizing agents, you are grateful your hands feel normal at first but towards the end you can feel the difference, those cuticles start to get angry and the skin dry.... that's when you notice they put containers of lotion by the computers to compensate

anyway, one place it was slimy hands, the other they got chapped.... I had some cuticle cream I kept by the computer and when it was toward the end of my shift (less in/out with patients) & I was finishing up a little "break" I would take from work was rubbing some in...

for scrubbing into surgery many preferred chlorhexidine to iodine.... the reason is that iodine santizes with *drying*... literally dehydrates the bugs to death... chlorhexidine does it by time of contact and can remain wet and still be effective... most surgeons don't want to stand outside the OR with their hands covered in iodine waiting to dry before rinsing

so if it's not as fast and convenient why have iodine for surgical hand scrubbing? well, it's gentler which doesn't matter to most, I turned out to be very allergic to chlorhexidine and *had* to use iodine, which is really why it's always available somewhere, incidentally it is gentler on the skin

many surgeons also don't take the lil bit of extra time and gentleness I did with the towel from the scrub nurse to dry.... and the drying part of hand washing is equally important to the process as all the other steps for getting the germ count down on your hands

I started paying attention to how hot the water was I used to wash my hands, dishes, using gloves when I used household cleaners at home, I started to pat my hands dry with towels rather than rub them

what does all this mean for you? if I expected to have wet hands inside gloves all the time, I would be mindful of my hands' skin care from day one of med school
I recommend you pay attention to tempurature of water you use to scrub, use little force (you don't have to "scrub"), there's a range of recommended time you should be aiming for the minimum time, use iodine, consider what hand sanitizer is available at your institution, place/carry lotion if possible, do some hand care at the end of the day, and at home try to minimize wear and tear on your hands by chemicals, water, temperature

this mindset is actually meaningful medicine I'm teaching you!!! skin breakdown is always *way* easier to prevent than treat and is a *very* important topic that comes up again and again in the hospital, everyone coming through the hospital doors is going to need 2 systems addressed no matter what primary problems they have, skin & bowel

TLDR:
we learned about infection control, hand hygeine, surgical scrubbing, proper prep with chlorhexidine vs iodine (goes not just for hands but surgical site prep as well), and the importance of skin care in the hospitals for healthcare professionals and patients alike, also threw in a word for bowel care just cuz
/lecture

 

[Psai]

no but skin breakdown is always mentioned in healthcare because of the importance of hand hygeine, we are all called upon to wash/rub sanitizer on our hands many many times a day and it can be a real issue for people which is why skin care in addition to hygeine is frequently covered

I don't mention it because it should be a barrier but to validate that it is a valid concern, and by concern I don't mean freak out I mean don't wait for a problem with your skin to act, that I would merely be proactive and do research online on the topic, you could talk to your PCP, you could talk to a dermatologist even

head it off at the pass is all I'm saying

I'll tell you a story of a doc with "normal" moisture hands, hands that didn't spend lots of time wet or in gloves, but did see lots of hand santizer going in/out patient rooms
my med school all the hand sanitizer was chock full of lotion making your hands disgustingly slimy to where you would use soap and water by choice despite that not being required from an infection control standpoint, and that traditional washing takes longer, so they didn't feel gross

then after a 5 week rotation at the VA where all they have posted outside the doors is ethanol laden Purell with less moisturizing agents, you are grateful your hands feel normal at first but towards the end you can feel the difference, those cuticles start to get angry and the skin dry.... that's when you notice they put containers of lotion by the computers to compensate

anyway, one place it was slimy hands, the other they got chapped.... I had some cuticle cream I kept by the computer and when it was toward the end of my shift (less in/out with patients) & I was finishing up a little "break" I would take from work was rubbing some in...

for scrubbing into surgery many preferred chlorhexidine to iodine.... the reason is that iodine santizes with *drying*... literally dehydrates the bugs to death... chlorhexidine does it by time of contact and can remain wet and still be effective... most surgeons don't want to stand outside the OR with their hands covered in iodine waiting to dry before rinsing

so if it's not as fast and convenient why have iodine for surgical hand scrubbing? well, it's gentler which doesn't matter to most, I turned out to be very allergic to chlorhexidine and *had* to use iodine, which is really why it's always available somewhere, incidentally it is gentler on the skin

many surgeons also don't take the lil bit of extra time and gentleness I did with the towel from the scrub nurse to dry.... and the drying part of hand washing is equally important to the process as all the other steps for getting the germ count down on your hands

I started paying attention to how hot the water was I used to wash my hands, dishes, using gloves when I used household cleaners at home, I started to pat my hands dry with towels rather than rub them

what does all this mean for you? if I expected to have wet hands inside gloves all the time, I would be mindful of my hands' skin care from day one of med school
I recommend you pay attention to tempurature of water you use to scrub, use little force (you don't have to "scrub"), there's a range of recommended time you should be aiming for the minimum time, use iodine, consider what hand sanitizer is available at your institution, place/carry lotion if possible, do some hand care at the end of the day, and at home try to minimize wear and tear on your hands by chemicals, water, temperature

this mindset is actually meaningful medicine I'm teaching you!!! skin breakdown is always *way* easier to prevent than treat and is a *very* important topic that comes up again and again in the hospital, everyone coming through the hospital doors is going to need 2 systems addressed no matter what primary problems they have, skin & bowel

TLDR:
we learned about infection control, hand hygeine, surgical scrubbing, proper prep with chlorhexidine vs iodine (goes not just for hands but surgical site prep as well), and the importance of skin care in the hospitals for healthcare professionals and patients alike, also threw in a word for bowel care just cuz
/lecture

Yeah I sometimes see people drying iodine by blotting and it always struck me as the wrong thing to do

 

[Winged Scapula]

The main reason that most surgeons (that I know) use Chlorhexidine over Betadine is the data that show reduced CFU initially after scrubbing and after a sustained period of time with the former. Most hospitals switched out their central line kits to carry Chlorhex as did ORs.

Darouiche RO et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18-26.
Noorani A et al. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010;97(11):1614-20.
Chaiyakunapruk N et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta analysis. Ann Intern Med 2002;136(11):792-801.

 

[Crayola227]

The main reason that most surgeons (that I know) use Chlorhexidine over Betadine is the data that show reduced CFU initially after scrubbing and after a sustained period of time with the former. Most hospitals switched out their central line kits to carry Chlorhex as did ORs.

Darouiche RO et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18-26.
Noorani A et al. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010;97(11):1614-20.
Chaiyakunapruk N et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta analysis. Ann Intern Med 2002;136(11):792-801.

My take home would be that we still have Betadine around because of allergies then, on the part of both patients and surgeons. You think? Does your institution still have it available?

 

[Winged Scapula]

My take home would be that we still have Betadine around because of allergies then, on the part of both patients and surgeons. You think? Does your institution still have it available?

We still have it available and its widely used to prep open wounds.

Some surgeons still prefer it and every hospital I've been at still has it available (hell, I even saw one place that had dishwashing liquid for one surgeon).

 

[ThoracicGuy]

The main reason that most surgeons (that I know) use Chlorhexidine over Betadine is the data that show reduced CFU initially after scrubbing and after a sustained period of time with the former. Most hospitals switched out their central line kits to carry Chlorhex as did ORs.

Darouiche RO et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18-26.
Noorani A et al. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010;97(11):1614-20.
Chaiyakunapruk N et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta analysis. Ann Intern Med 2002;136(11):792-801.

I use a betadine scrub rather than chlorhexadine as the chlorhexadine tends to irritate my skin... For surgical prep, I tend to use chlorhexadine mostly.

 

[Crayola227]

We still have it available and its widely used to prep open wounds.

Some surgeons still prefer it and every hospital I've been at still has it available (hell, I even saw one place that had dishwashing liquid for one surgeon).

that's acceptable to use for surgical scrub? sweet

I couldn't always get the betadine color off my cuticles etc
sounds even gentler

 

[Crayola227]

thanks for clarifying why there's both....

for the record I wasn't just trying to be a dick.... at my institution when I asked about why we had different types, what I said is what I was told

sometimes I get more EBM from SDN than what I got in med school

 

[Winged Scapula]

I use a betadine scrub rather than chlorhexadine as the chlorhexadine tends to irritate my skin... For surgical prep, I tend to use chlorhexadine mostly.

I mix it up for surgical scrub - one day I might use Betadine, other days Chlorhex and many days that stuff that has the lotion in it.

I've never used dishwashing liquid though.

 

[resiliens]

For those of you who went with the botox treatments, did you find that the treatments inhibited your surgical abilities? I recall there being potential adverse effects involving motor control, grip strength, etc.