SURGICAL SCRUB

 SURGICAL SCRUB
o is the removal of as many bacteria as possible from the hands and arms by mechanical washing
and chemical disinfection before participating in the operation. The surgical scrub is done prior
to gowning and gloving for each operation.
 PURPOSE:
 to help the possibility of contamination of the operative wound by bacteria on
the hands and arms.
 PREPARATION PRIOR TO SURGICAL SCRUB
 Skin and nails should be kept clean and in good condition and cuticles uncut,
Fingernails should not reach beyond fingertips to avoid gloves puncture.
o Rationale: The subungual region harbors the majority of microorganism
found on the hand. The hand of tearing gloves increases if fingernails
extend past the fingertips.
 Nail polish & Artificial nails should not be worn.
o Rationale: Artificial nails may harbor organisms and prevent effective
handwashing
 Inspect hands for cuts and abrasion. Skins of hands and forearms should be
intact, without open lesions or cracked skin.
o Rationale: Breaks in skin integrity and open lesions increase the risk of
patient and surgical team member infection. Cuts, abrasions, exudative
lesions, and hangnails tend to ooze serum, which may contain pathogens.
Broken skin permits microorganisms to enter the various layers of skin,
providing deeper microbial breeding grounds
 Remove all finger jewelry Rings, watches, and bracelets should be removed
before beginning the surgical hand scrub.
o Rationale: During hand washing, rings, watches, and bracelets may
harbor or protect microorganisms from removal. Allergic skin reactions
may occur as a result of a scrub agent or a glove powder accumulating
under the jewelry.
 Be sure all hair is covered by headgear. Pierced ear studs must be contained by
the head cover.
 Adjust disposable mask snugly and comfortably over nose and mouth.
 Adjust eyeglasses comfortably in relation to mask
 Adjust water to a comfortable temperature.
 The length of the surgical scrub varies from one institution to another as does
the scrub procedure. Variation in length may depend on frequency of scrubbing
and the agent use, if timed scrub technique is used, a clock should be visible for
the timed scrub.
o Rationale: Standard timing is necessary for effective preparation of the
surgical team's hands and arms.
 An effective antimicrobial surgical hand scrub agent approved by the health care
facility should be used for all surgical hand scrubs. The agent should be used
according to the manufacturer's instructions.
 o Rationale: An antimicrobial agent kills microorganisms and reduces the
level further by its residual effect but can be inactivated by organic
material. Efficacy of all agents depends on its proper use.
 The selected antimicrobial hand scrub agent should:
o Significantly reduce selected microorganisms on intact skin
o Contain a nonirritating antimicrobial preparation
o Be broad spectrum
o Be fast acting
o Have a residual effect
 Rationale: Organisms reproduce in the moist environment of
gloves, and gloves frequently become damaged during
procedures; therefore, persistent chemical activity is desirable to
suppress microbial growth. No agent is ideal in every situation.
Agents should be selected based on these factors and their
acceptability to the surgical team for their consistent use
according to the manufacturer's direction
 A nonmedicated soap scrub followed by application of an alcohol-based hand
cleanser may be used.
o Rationale: The primary action of cleansing with soap is the mechanical
removal of transient organisms. Vigorous rubbing with enough alcohol-
based hand cleanser to cover the hands and forearms completely has
been shown to be an effective method of antisepsis.
 Surgical hand scrub agents should be stored in clean, closed containers. Reusable
containers should be washed and dried thoroughly before refilling. Adding
surgical hand scrub agents to partially filled reusable containers should be
avoided. Disposable containers should be discarded when empty.
o Rationale: Refilling before cleaning dispensers and adding surgical hand
scrub agents to partially filled containers may cause contamination and
contribute to the spread of potentially harmful microorganisms.
 Procedure:
o Remove rings, watches and bracelets before beginning surgical scrub.
o Use a deep sink with side or foot pedal to dispense antimicrobial soap
and control water temperature and flow.
o Have two surgical scrub brushes and nail file.
o Apply surgical shoe covers and a cap to cover hair and ears completely.
o Apply mask
o Before beginning surgical scrub:
 Open sterile package containing gown; using aseptic technique,
make a sterile field with inside of gown’s wrapper
 Open sterile towel and drop it onto center of field.
 Open outer wrapper from sterile gloves and drop inner package of
gloves onto sterile field beside folded gown and towel.
o At a deep sink under warm, flowing water, wet hands, beginning at tips of
finger, to forearms – keeping hands at level above elbows. Prewash
hands and forearms 2 inches above elbow.
o Apply liberal amount of soap onto hands and rub hands and arms to 2
inches above elbows.
o Use nail fail under running water; clean under each nail of both hands
and drop file under sink when finished.
o Wet and apply soap to scrub brush, if needed. Open prepackaged scrub
brush, if available. Hold brush in dominant hand, use a circular motion to
scrub nails and all skin areas of nondominant hand and arm (10 strokes to
each following areas).
 Nails.
 Palm of hand and anterior side of fingers.
o Rinse brush thoroughly and reapply soap
o Continue to scrub nondominant arm with a circular motion for 10 strokes
each to lower, middle and upper arm; drop brush into sink.
o Maintaining hands and arms above elbow level, place fingertips under
running water and thoroughly rinse fingers, hands and arms (allow water
to run off elbow to sink); take care not to get uniform wet.
o Take second scrub brush and repeat actions 10-13 on dominant arm and
hand.
o Keep arms flexed and proceed to area (operating or procedure room)
with sterile items.
o Secure sterile towel by grasping it on one edge, opening towel, full
length, making sure it does not touch uniform.
o Dry each hand and arm separately; extend one side of towel around
fingers and hand and dry in a rotating motion up to elbow.
o Reverse towel and repeat same action on other hand and arm,
thoroughly drying skin.
o Discard towel into a linen hamper.