NAME DATE

PROCEDURE SURGICAL SCRUBBING TOTAL

TITLE SCORE

PURPOSES 1. To remove or destroy transient microorganisms

2. To inhibit the growth of resident microorganisms

EQUIPMENTS 1. Deep sink with knee and foot controls for dispensing water and soap (faucets)
should be high enough for hands and forearms to fit comfortably
2. Antimicrobial agent approved by the health care facility
3. Surgical scrub sponge with plastic nail pick (optional)
4. Paper face mask, cap, or hood surgical shoe covers
5. Sterile towel
6. Sterile pack containing sterile gown
7. Protective eyewear (glasses or goggles)

NOT DONE REMARKS

STEPS
DONE
1. Consult manufacturer policy regarding required
length of time and antiseptic to use for hand
antiseptics. Chlorhexidine has been found to be more
effective then povidone iodine (WHO 2009)

Rationale: Guidelines vary regarding time

needed and antiseptic to use for surgical
scrub. Most facilities in the US follow 5
minutes for hand scrub (WHO 2009)

2. Remove bracelets, rings, and watches.

Rationale: Jewelry may harbor or protect

microorganisms from removal. Allergic skin
reactions may occur as a result of scrub
agent or powder accumulating under
jewelry (Messano, 2013)
3. Be sure that fingernails are short, clean and healthy.
Artificial nails should be removed. Natural nails
should be less than ¼ inch long from the fingertips.

Rationale: Long nails and chipped or old

polish increase number of bacteria residing
on nails. Long fingernails can puncture

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gloves, causing contamination. Artificial nails
are known to harbor gram negative
microorganism and fungus (AORN, 2014:
CDC 2008a)
4. Inspect condition of cuticles, hand and forearms
for abrasions, cuts or open lesions.

Rationale: These conditions increase

likelihood of more microorganisms residing
on skin surfaces. Broken skin permits
microorganisms to enter layers of the skin,
providing deeper microbial breeding
grounds (AORN, 2014)
5. Apply surgical shoe covers, cap or hood, face
mask, and protective eyewear.

Rationale: Mask prevents escape into air of

microorganisms that can contaminate
hands. Other protective wear prevents
exposure to blood and body fluid splashes
during the procedure.
6. Turn on water using knee or foot controls and
adjust to comfortable temperature.

Rationale: Knee or foot controls prevent

contamination of hand after scrub.
7. Prescrub, wash/ rinse: Wet hands and arms under
running lukewarm water and lather detergent to 5cm
(2 inches) above elbows. (Hands need to be above
elbows at all times)

Rationale: Water runs by gravity from

fingertips to elbows. Hands become cleanest
part of the upper extremity. Keeping hands
elevated allows water to flow from least to
most contaminated areas. Washing a wide
area reduces risk of contaminating overlying
gown that the nurse later applies.

8. Rinse hands and arms thoroughly under

running water. Remember to keep hands above
elbows.

Rationale: Rinsing removes transient bacteria

from fingers, hands and forearms.
9. Under running water clean under nails of both
hands with nail pick. Discard after use.

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Rationale: Removes dirt and organic material
that harbor large numbers of
microorganisms.
10. Surgical scrub with sponge or sponge brush

a. Wet clean sponge and apply antimicrobial agent.

Visualize each finger, hand and arm as having our
sides. Wash all four sides effectively. Scrub the nails
of one hand with 15 strokes. Scrub the palm, each
side of thumb and fingers and posterior side of hand
with 10 strokes each.

Rationale: Friction loosens resident bacteria

that adhere to skin surfaces. Ensure
coverage of all surfaces. Scrubbing is
performed from cleanest area (Hands) to
marginal area (upper arms).

b. Divide the arm mentally into thirds: scrub each

third 10 times (AORN, 2014). Some health care
facility, policies require scrub by total time (e.g. 5
minutes) rather than number of strokes. Rinse brush
and repeat sequence for the other arm. A two sponge
method may be substituted (check health care
policy).

Rationale: Eliminates transient

microorganisms and reduces resident hand
flora.

c. Discard brush. Flex arms and rinse from fingertips

to elbow in one continuous motion, allowing water to
run off at elbow.

Rationale: Hands remain the cleanest part of

upper extremities.

d. Turn off water with feet or knee control, with

hands elevated in front of and away from body.
Enter operating room suite by backing into the
room.

Rationale: Keeps hands free of

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microorganisms.

e. Approach sterile setup, grasp sterile towel, taking

care not to drip water onto sterile set up.

Rationale: Water contaminates sterile set up.

f. Bending slightly at waist, keeping hands and

arms above waist and out-stretched, grasp one end
of sterile towel and dry one hand, moving from
fingers to elbow in a rotating motion.

Rationale: Avoids sterile towel from

contacting unsterile scrub attire and
transferring contamination to hands. Dry skin
from cleanest (hands) to least clean
(elbows).

g. Repeat drying method for other hand by carefully

reversing towel or using anew sterile towel.

Rationale: Prevents accidental

contamination.

h. Drop towel into linen hamper or circulating

nurse’s hand.

Rationale: Prevents accidental

contamination.

11. Optional: Brushless antiseptic hand rub

a. After prescrub wash, dry hands and

forearms thoroughly with paper towel.

Rationale: Promotes reduction in

microorganisms on all surfaces of hands and
arms.

b. Dispose 2 mL of antimicrobial agent hand

preparation into palm of one hand. Dip fingertips of
opposite hand into hand preparation and work it
under nails. Spread
remaining hand over hand and up to just above
elbow covering all surfaces.

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c. Using another 2 mL of hand preparation, repeat
with other hand.

d. Dispense another 2mL of hand preparation into

either hand and reapply to all aspects at both hands up
to wrist. Allow to dry thoroughly before donning
gloves.

Rationale: Ensures complete antiseptic

coverage of all hand surfaces.

RECORDING AND REPORTING

 It is not necessary to record or report this
procedure.
 Report any skin dermatitis to employee
health or infection control per agency policy.

CHECKED BY:

DATE:

CLINICAL INSTRUCTOR

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