Whether an anesthesiologist “scrubs in” for surgery depends on the specific procedure. For the majority of the surgical case, they do not perform a surgical scrub, gown, and glove. As perioperative care specialists, their primary focus is on the patient’s physiological stability before, during, and immediately after the operation. However, specific, invasive procedures they perform necessitate full sterile technique, including the formal surgical scrub.
Understanding the Surgical Scrub Standard
“Scrubbing in” is a strict, time-based protocol designed to prepare the hands and forearms of the surgical team for entry into the sterile field. This process is far more rigorous than routine hand hygiene. It typically involves a timed scrub (three to five minutes) using an antimicrobial solution like chlorhexidine or povidone-iodine and a sterile brush.
The ultimate goal is not to achieve true sterility—which is impossible on living tissue—but to remove transient microorganisms and significantly reduce the resident microbial count on the skin. This reduction minimizes the risk of introducing pathogens if a surgical glove tears or becomes compromised. After the scrub, the team member dons a sterile gown and sterile gloves before touching instruments or the patient’s incision site. This standard is followed by surgeons, surgical assistants, and scrub nurses who work directly within the sterile field.
Core Duties That Keep Anesthesiologists Unscrubbed
The anesthesiologist’s typical position is at the patient’s head, outside the sterile surgical field established around the incision site. Their primary function is the continuous medical assessment and control of the patient’s vital life functions. This includes monitoring heart rate, blood pressure, oxygen saturation, body temperature, and administering necessary medications.
Their work involves constant interaction with non-sterile equipment, which makes a prolonged sterile state impossible to maintain. They must frequently adjust settings on the anesthesia machine, intravenous pumps, and complex physiological monitors. They also handle documentation, often using keyboards or charts, and prepare additional medications or fluids, all of which are considered non-sterile tasks.
If an anesthesiologist performed a full surgical scrub, they would immediately compromise that sterility by touching the necessary monitoring and administration equipment. Therefore, for the majority of the procedure, they focus on meticulous hand hygiene and glove changes, rather than the full surgical scrub, to manage their non-sterile environment safely. This allows them to manage rapid changes in the patient’s condition without being restricted by sterile limitations.
Procedures Requiring Sterile Technique
While the anesthesiologist avoids the sterile field during the main surgery, their role frequently includes performing specific invasive procedures that require them to adopt full sterile technique. Any procedure that involves penetrating the skin to access a sterile area of the body necessitates a surgical scrub. The intent is to prevent a serious complication called a healthcare-associated infection.
Common examples include the placement of central venous catheters (inserted into large veins like the internal jugular or subclavian) and arterial lines for continuous blood pressure monitoring. These procedures involve a significant infection risk because the catheter remains in the body, creating a pathway for bacteria. For these tasks, the anesthesiologist performs the full surgical scrub, dons a sterile gown and gloves, and uses maximal sterile barrier precautions, including a large sterile drape.
Furthermore, all regional anesthesia techniques, such as spinal blocks, epidurals, and peripheral nerve blocks, demand a strict sterile approach. Inserting a needle near the spinal cord or major nerves requires the anesthesiologist to follow the same rigorous scrubbing, gowning, and gloving protocols as the surgical team. In these specific moments, the anesthesiologist temporarily becomes a member of the sterile team for the duration of the invasive placement.