title: A quick and effective method of limb preparation with health, safety and efficiency benefits.
abstract: BACKGROUND
  Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between  toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large  throughput of cases, such as day-case hand surgery lists.
  
  
  METHODS
  We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs  of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery.
  
  
  RESULTS
  The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85  seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken.
  
  
  CONCLUSIONS
  The sterile bag technique is effective in achieving asepsis, has the potential  to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.
authors.affiliation: Welsh Centre for Burns and Plastic Surgery, Swansea, UK.
authors.forename: N
authors.initials: N
authors.lastname: Naderi
authors.forename: K
authors.initials: K
authors.lastname: Maw
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: D E
authors.initials: DE
authors.lastname: Boyce
authors.forename: K
authors.initials: K
authors.lastname: Shokrollahi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001132:Arm / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D061214:Patient Safety; D011206:Povidone-Iodine / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D013242:Sterilization; D013530:Surgical Wound Infection / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine