When a surgical team prepares for an operation, the simple act of washing hands is transformed into a precise, regulated procedure. This process, known as surgical hand antisepsis or the surgical scrub, is a foundational element of infection control within the operating room. The primary goal is to reduce microorganisms on the hands and forearms to the lowest possible level before donning sterile attire. This rigorous approach is necessary because skin bacteria are a common source of pathogens that can cause surgical site infections, which pose a significant risk to patient recovery.
The Time Requirement
The duration of a surgical scrub is not universal but varies based on the specific product and facility protocol. Historically, scrubbing times were much longer, sometimes up to ten minutes, but modern research has led to shorter, more effective protocols. Current recommendations from bodies like the Association of Perioperative Registered Nurses (AORN) and the Centers for Disease Control and Prevention (CDC) typically suggest scrubbing with an antimicrobial soap and water for two to six minutes.
For a traditional scrub using antimicrobial soap, the time is generally determined by the manufacturer’s guidelines for the specific agent being used. After the first scrub of the day, subsequent scrubs between cases may sometimes be shorter, provided the hands are not visibly soiled. An alternative method is the use of waterless, alcohol-based hand rubs, applied to dry hands and forearms for one to two minutes until completely dry. These products achieve a faster and more effective reduction in bacterial counts, with duration dictated by the drying time and product instructions.
The Difference Between Washing and Scrubbing
The surgical scrub is a far more intensive procedure than routine hand washing, both in the products used and the anatomical area covered. Routine hand washing removes transient microorganisms and dirt using plain or antibacterial soap up to the wrist. In contrast, the surgical scrub aims to remove transient flora and significantly suppress the resident microorganisms that live deep in the skin layers of the hands and forearms.
The cleaning extends systematically from the fingertips up to two inches above the elbow, ensuring all surfaces are treated. This methodology involves an anatomical approach, where each finger, palm, back of the hand, and forearm are treated as having four distinct sides that must be thoroughly cleaned. Specialized attention is given to the areas under the fingernails, which harbor high concentrations of bacteria, requiring the use of a nail pick under running water before the main scrub begins.
The agents used are persistent antimicrobial solutions, such as chlorhexidine gluconate or povidone-iodine, which continue to suppress microbial growth for several hours after the procedure. The former standard of using stiff, abrasive brushes has largely been replaced by brush-free or non-abrasive sponge techniques to minimize skin damage. Damaged skin can actually harbor more bacteria, so minimizing irritation while maximizing microbial reduction is a key consideration. The process requires the surgical team member to keep hands elevated higher than the elbows during rinsing to ensure water flows from the hands to the elbows.
Maintaining Asepsis Post-Scrub
The goal of the scrub is to achieve a state of surgical cleanliness, or antisepsis, but the hands are still technically considered clean, not sterile. The final steps are crucial to maintaining this state of low microbial count until the hands are covered. Immediately after the scrub and final rinse, the surgical team member proceeds to the operating room suite, holding hands elevated above the waist and away from the body to prevent accidental contamination.
Drying is performed using a sterile towel, which is typically found folded within the sterile gown pack. The technique involves drying one hand and arm completely with one end of the towel, moving from fingers to elbow, and then using the opposite, unused end to dry the second hand and arm. This method prevents cross-contamination between the two sides. The sterile towel is then discarded without touching any non-sterile surfaces.
The final barrier against contamination is the sterile gown and gloves, which are donned immediately after drying. The closed-gloving technique is the standard for surgical procedures, where the hands remain fully enclosed within the cuffs of the sterile gown sleeves while the gloves are pulled over the cuffs. This method ensures that the bare skin of the hand never touches the outside, sterile surface of the glove. The sterile gloves function as the final barrier to maintain sterility throughout the surgical procedure.