David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



Preventing Surgical Infections

Surgical infections are rare in general. They are even more rare in hand surgery. They are very rare in my practice. I have had approximately nine infections in approximately 24 years. Almost all of these infections happened in cases that were more than two hours long, involved bone surgery, involved patients who had significant other medical problems, and often when the patient had an open wound from trauma. On the other hand, one trigger finger got infected, so even simple surgeries can get infected. However, there is often a reason: the trigger finger infection occurred three months after surgery, in a patient in her 80's who never came back for follow up, and had a continually weeping wound that did not heal, yet she did not come back for care!

As rare as infections are in my practice, I would like to see it become even rarer. Here is how you can help yourself:

  1. Follow the protocol on the handout and use the medicated wipes I gave you. Trim your nails if you think they are too long (you be the judge, there is no right answer). Clean well under your nails. (You would be surprised how many patients come to the OR with dirt and grease on their hands, with nails that look like they were last cleaned after Noah's End-of-the-Flood Sale.) Note: if you have a cast on, you may not be able to wash your hands or the surgical site. Don't worry: in that case, I will do the wash for you, after I take the cast off and before the nurse does the regular surgical prep.
  2. In addition to the medicated wipes I gave you, you can use any standard antibacterial soap on the market (just read the labels), or you can use a product such as Hibiclens, which contains chlorhexidine gluconate. This is typically the antibacterial soap we use in the operating room (the other is povodine iodine). You can buy Hibiclens at the drugstore. A typical price is $8 for a 4 oz bottle. There is no clear evidence for which is better, but it probably would be better to wash with Hibiclens, available at many drug stores. If you don't want to get Hibiclens, just wash with any standard antibacterial soap.
  3. Keep your incision dry for three days after surgery. Then, unless directed otherwise, you can get it wet in the shower and wash the incision with soap and water (even if there are steel pins present). Be gentle. Do not soak in a hot tub (lots of bacteria and other organisms in the warm, recirculated water).
  4. The signs of an infection are swelling, redness, tenderness, and warmth. However, even normally healing incisions always have SOME swelling, redness, tenderness, and warmth, so read on and don't jump to conclusions. See the Incisions Home page for examples of what to look for. If you read the Incisions Home page and you think you have an infection (be sure to read the Incisions Home page first, because I will ask if you read it!), call me. The office is 925 0501, my beeper is 721-6718.

Remember, infections of my hand surgery incisions are very rare: about nine in 24 years.