SURGICAL HAND SCRUB

Definition: It is a vigorous and lengthy cleaning of the skin of the hands and forearms with water,
antiseptic agent and scrub / sponge to create friction. It is called counted – stroke scrub.

Equipment:

1. surgical cap
2. surgical mask
3. antimicrobial soap
4. plain scrub brush
5. sink with foot, knee or elbow control and high faucet
6. sterile towels (optional)

Purposes:
1. To remove dirt and skin oil from the hands and lower arms.
2. To reduce the count of microorganisms count to as near zero as possible.

Elements:
1. water 3. scrub or sponge
2. antiseptic agent 4. friction

Anatomical Timed Scrub Method

Area Time

1. Nails - 30 sec. ĉ brush

2. Fingers - 1 min. ĉ sponge
3. Palmar surface 15 sec. ĉ brush
4. Dorsal surface - 15 sec. ĉ sponge
5. Forearm , divided in half to 2 - 1 min. ĉ sponge
inches above elbow. - (30 sec. each half.)
6. Repeat process for each other hand

Counted Brush Stroke Method

Area Time

1. Nails - 20 strokes ĉ brush

2. Fingers , each side & web space. - 10 strokes ĉ sponge
3. Palmar surface. - 10 strokes ĉ brush
4. Dorsal surface - 10 strokes ĉ sponge
5. Forearm , divided in half to 2” above - 40 strokes each half ĉ sponge
elbow.
6. Repeat process for other hand.
Procedure
Action
1. Check for completeness of supply.
2. Remove all pieces of jewelry,
including the wedding ring.
3. Trim nails if needed. No nail polish
or artificial nails should be worn.
4. Wear a surgical cap and a disposable
mask.
5. Stand before the sink keeping the
body away from it.
6. Turn on the faucet and adjust the
pressure using the foot, knee or
elbow control.
7. Holding your hands above your
elbow, wet the skin from the
fingertips down to the elbow.
8. Wet and apply approximately 1 tsp of
antimicrobial soap on the palm using
foot, knee or elbow control and work
up a lather.
9. When using a pre-packaged scrub
brush-sponge pad, open the package,
remove the nail cleaner and clean the
nails and discard.
Remove the brush and discard the
wrapper. Do not put down the brush
once the scrub has begun.
If the brush or sponge is not
impregnated with the cleaning agent,
moisten the brush or sponge and
dispense the soap into it.
Rationale
Prevents having to stop to obtain those
materials needed.
Jewelry harbors microorganism.
Microorganisms collect in nails.
Provides a barrier to reduce the spread of
microorganisms from the hair or respiratory
tract.
The sink is considered to be contaminated.
Frees hands from touching anything.
The water should remain running.
Water splashed from the contaminated sink
may come in contact with your uniform, thus,
contaminating it.
Since the hands will be the cleanest area once
the scrub is completed it follows the principle
of allowing water to flow from the cleanest to
the most contaminated area.
Soap emulsifies skin oils and contaminants
and facilitates their removal.
Once the scrub has begun, the brush is never
put down until the scrub is complete as it
would then be contaminated.
10. Using the brush, make 20 circular Scrubbing action loosens resident bacteria
strokes on the nails (starting with the and contaminants, thus facilitating the
less dominant hand). removal. Circular motion removes
microorganisms.

11. Scrub all skin surfaces using circular Scrubbing action loosens resident bacteria
strokes: and contaminants, thus facilitating the
a. each finger removal. Circular motion removes
b. palm microorganisms.
c. back of the hand
d. forearms (divide into 2 then 10
strokes on each of the 4 parts of the first
half of the forearm then another 10
strokes on each 4 parts of the second half
of the forearm paying extra attention on
the elbow)

12. After scrubbing the less dominant The brush contains lather that may contain
hand, rinse the brush and transfer it to microorganisms. Rinsing will remove the
the other hand. lather from the brush.

13. Continue procedure on the dominant

hand following steps 8 to 10.

14. When the scrub is finished on the

dominant hand, drop the brush on the
sink.

15. With the use of foot, knee or elbow
control, turn on the faucet and rinse
the arms starting from the fingertips
to the elbow.
To avoid contamination of your hands.
Water should flow from the area of least
contamination to the area of most
contamination.

16. Turn off the water using the foot, To avoid contamination of your hands.
knee or elbow control.

17. Dry each hand and arm with opposite Drying prevents irritation of the skin. Dry
ends of sterile towel, working from from the cleanest area to the more
the fingertips towards the elbow. contaminated area.

18. Discard towel properly.

19. Position the hands and elbow above After surgical hand scrubbing, the hands are
the waist without touching any part considered to be surgically clean. Keeping it
of the scrub uniform. in your line of vision will prevent
contamination.

20. Enter the operating room using the Using this manner when entering the OR
back or the buttocks. prevent contamination of the scrubbed hands.
 SAN PEDRO COLLEGE
Davao City

PERFORMANCE CHECKLIST
SURGICAL HANDSCRUBBING

Name: _______________________________________ Grade: ___________

Year and Section: ______________________________ Date: ____________

Legend: 5 – Excellent 4 - Very Good 3 - Good 2 – Fair 1 – Poor

Rating 5 4 3 2 1
1. Checks for completeness of supply.
2. Removes all pieces of jewelry, including the wedding ring.

3. Trims nails if needed. Removes nail polish or artificial

nails.
4. Wears surgical cap and disposable mask.
5. Stands before the sink keeping the body away from it.

6. Turns on the faucet and adjusts the pressure using the foot,
knee or elbow control.
7. Holds hands above elbow, wets the skin from the
fingertips down to the elbow.
8. Wets and applies approximately 1 tsp of antimicrobial
soap on the palm using foot, knee or elbow control and
works up a lather.
9. Using a pre-packaged scrub brush-sponge pad, opens the
package, removes the nail cleaner and cleans the nails and
discard.
10. Removes the brush and discards the wrapper without
putting down the brush.
11. Moistens the brush or sponge and dispense the soap into it.
12. Using the brush, makes 20 circular strokes on the nails
(starting with the less dominant hand).
13. Scrubs all skin surfaces using circular strokes:
a. each finger
b. palm

c. back of the hand

d. forearms (divide into 2 then 10 strokes on each
of the 4 parts of the first half of the forearm then
another 10 strokes on each 4 parts of the second
half of the forearm paying extra attention on the
elbow)
14. After scrubbing the less dominant hand, rinses the brush
and transfers it to the other hand.
15. Continues the procedure on the dominant hand following
steps 11 to 13.
16. When the scrub is finished on the dominant hand, drops
the brush on the sink.
17. With the use of foot, knee or elbow control, turns on the
faucet and rinses the arms starting from the fingertips to
the elbow.
18. Turns off the water using the foot, knee or elbow control.
19. Positions the hands and elbow above the waist without
touching any part of the scrub uniform.
20. Enters the operating room using the back or the buttocks.
21. Maintains body mechanics throughout the performance of
the procedure.
22. Manifests neatness in the performed procedure.
23. Receptive to criticisms.
24. Observes courtesy.
25. Shows calmness while performing the procedure.
26. Uses correct English.
27. Shows mastery of the procedure.

Comments:

_________________________________ _________________
Student’ Signature Over Printed Name Date

_________________________________ __________________
Instructor’s Signature Over Printed Name Date
 DONNING A STERILE GOWN AND CLOSE GLOVING

The nurse must wear a sterile gown in the Operating Room, so sterile objects can be comfortably
handled with less risk of contamination. A nurse assisting physician with invasive procedure in a
treatment room may also wear a sterile gown. A gown is applied after surgical handwashing and after
the nurse has donned a mask and surgical cap. He/She either picks a gown from a sterile field or has a
gown assistant hand him/her one.The entire surface of the gown is not considered sterile. Only the area
form the anterior waist to the collar including anterior sleeves is sterile.

Equipment:
1. sterile gloves 3. surgical cap
2. disposable mask 4. sterile gown

Procedure:

Action Rationale
1. Wear cap and surgical mask. Cap and mask reduce chances of
transmitting organism to gown by
direct contact or airborne transmission.

2. Perform the surgical hand scrubbing. Scrubbing eliminates microorganisms

from surface of hands.

3. Enter the sing door of the OR using the After surgical hand scrubbing, hands
back or the butt. are rendered to be surgically clean.
therefore, it should not touch any part
of the OR door.

Contact of outer surface of gown with

4. Stand on the side of the table where the a dirty or clean surface would result in
sterile gowns are positioned. Grasp one sterile
contamination of the gown.
gown with the dominant hand and stand in an
area where the gown may be opened without
risk of contamination.

If a sterile OR towel is not available,

5. Hold the sterile gown away from the
body. Hold the bottom part of the gown with
the other hand to be used in wiping the
dominant hand. Bend a little while wiping
the hand, wrist, forearm to the elbow
extending about 2 inches.
the bottom part of the gown can be
used in wiping the hands, making sure
that it will not swing or come in
contact with a portion of your body,
thus, causing it to be contaminated.
6. Do the same procedure on the
non-dominant hand, this time the dominant
hand holds the bottom part of the gown to
wipe the non- dominant hand, to the forearm,
running through the elbow and 2 inches
beyond that.

Raising the gown a little higher

7. Raise up the gown a little higher to locate
the armholes. The non- dominant hand grasps
the armholes by inserting the fingers securely
while bringing it up and lowering the bottom
part of the gown.
facilitates easier location of the
armholes and prevents the risk of
touching the floor.

Extension of arms straight ahead keeps

8. Slip the hands inside the armholes while the
sterile outer surface of the gown in
gown is held away from the body. Keep the
hands at shoulder level and allows it to unfold view and reduces risk of
with the inside of the gown toward the wearer contamination.

Since closed gloving technique will be

9. Push the hands and forearms into the used, keeping the hands at the
sleeves of the gown. Advance the hands only proximal edge of the cuff will prevent
to the proximal edge of the cuff. contamination to the sterile gloves
during donning.

Call for the circulating nurse to pull the

Working from behind the scrub nurse
gown over the shoulder touching only
the inner aspect of the gown and tie the prevents contamination by the
strings of the gown. circulating nurse.

10. Lift the first glove and grasp it through the Cuff of glove facilitates easier
fabric or sleeve. Place the glove palm down handling of glove. Only sterile items
along the forearm of the matching hand, with
come in contact with each other.
thumb fingers pointing toward elbow. Glove
cuff lies over gown wristlet.

11. Hold glove cuff securely by hand on Prevents the hands from
which it is placed. Sleeve to cover gown contaminating the sterile gloves.
wristlet entirely.

12. As cuff is drawn back onto wrist, fingers Provides a closed sterile method of
are directed into their cots in glove, and donning gloves.
glove is adjusted to hand.
13. Use the gloved hand to position remaining Provides a closed sterile method of
glove on the opposite sleeve in the same donning gloves.
fashion. Place glove cuff around gown cuff.
Draw second glove onto hand, and pulls cuff
into place and adjusts fingers of gloves.

14. After donning of the sterile gown and

Gloved hands are held above the waist
gloves, position or place the gloved hands at
the chest or on the sterile top of the back or at the level of the sterile table to
table. prevent it from becoming unsterile.
 PERFORMANCE CHECKLIST FOR GOWNING AND CLOSED GLOVING

Name: ____________________________ Yr./Section: __________ Date: _________ Grade: ________

Legend:
5 - Excelent 4 - Very Good 3 - Good 2 - Fair 1 - Poor
RATING 5 4 3 2 1
1. Wears cap and surgical mask.
2. Performs the surgical hand scrubbing.
3. Enters the swing door of the OR using his/her back or with the
butt.
4. Stands on the side of the table where the sterile gowns are
positioned. Grasps one sterile gown with the dominant hand and
stands in an area where the gown may be opened without risk
of contamination.
5. Holds the sterile gown away from the body. Holds the bottom
part
of the gown with the other hand to be used in wiping the
dominant
hand. Bends a little while wiping the hand, wrist, forearm to the
elbow extending about 2 inches.
6. Does the same procedure on the nondominant hand, this time the
dominant hand holds the bottom part of the gown to wipe the
non-
dominant hand, to the forearm, running through the elbow and
2
inches beyond that.
7. Raises up the gown a little higher to locate the armholes. The non-
dominant hand grasps the armholes by inserting the fingers
securely
while bringing it up and lowering the bottom part of the gown.
8. Slips the hands inside the armholes while the gown is held away
from the body. Keeps the hands at shoulder level and allows it to
unfold with the inside of the gown toward the wearer.
9. Pushes the hands and forearms into the sleeves of the gown.
Advances the hands only to the proximal edge of the cuff.
Calls the circulating nurse to pull the gown over the shoulder touching
only the inner
shoulder and side seams. Ties or clasps the neckline and ties the inner waist strings
of the
gown touching only the inner aspect of the gown.
10. Lifts the first glove. Grasps it through the fabric or sleeve. Cuff of
glove facilitates easier handling of glove. Places the glove palm
down along the forearm of the matching hand, with thumb
fingers
pointing toward elbow. Glove cuff lies over gown wristlet.
11. Holds glove cuff securely by hand on which it is placed. Sleeves
to cover gown wristlet entirely.
12. As cuff is drawn back onto wrist, fingers are directed into their
cots in glove, and glove is adjusted to hand.
13. Uses the gloved hand to position remaining glove on the
opposite
sleeve in the same fashion. Place glove cuff around gown cuff.
Draws second glove onto hand, and pulls cuff into place and
adjusts fingers of gloves.
14. After the student have donned the sterile gown and closed gloving,
the gloved hands are held together at the chest or rest in the
sterile
top of the back table.

_________________________________ _____________
Student's Printed Name and Signature Date
_________________________________
_____________
Instructor's Printed Name and Signature Date