A surgical scrub is a procedure of washing and disinfecting the hands and forearms up to the elbow. This preparation is a required step for any surgical team member working within the sterile field. It is performed to significantly reduce the number of microorganisms on the skin before donning sterile gloves and a gown. This process protects the patient from infection by preventing the introduction of pathogens into the surgical site.
The Necessity of Aseptic Preparation
The skin harbors a complex population of microorganisms, which are broadly categorized into two types: transient and resident flora. Transient flora consists of surface-level microbes acquired through environmental contact, which are relatively easy to remove with simple handwashing. Resident flora presents a more difficult challenge, as these microbes live deeper in the skin layers, such as beneath the nails and in hair follicles.
The goal of the surgical scrub is to eliminate the transient flora and substantially reduce the resident microbial count. Even though sterile gloves are worn, a glove tear or puncture could allow skin microbes to enter the wound. Reducing the baseline number of organisms minimizes the risk of a surgical site infection (SSI) if the sterile barrier is compromised. The antiseptic agents used also provide a persistent antimicrobial effect that inhibits the rapid regrowth of microbes beneath the gloves during a lengthy procedure.
Standard Techniques and Duration Requirements
Surgical scrub duration is determined by two primary methods: the timed method and the counted stroke method. The exact duration often depends on a facility’s specific policy and the type of antiseptic product being used. Historically, scrubs lasted up to ten minutes, but current research shows that shorter times are effective, reducing skin irritation and promoting compliance.
The Timed Method
The Timed Method is the most common approach, and contemporary guidelines generally recommend a total scrub time between two and five minutes per hand and forearm. For instance, a common protocol may require a four-minute scrub for the first case of the day and a shorter two- or three-minute scrub for subsequent cases. This timed period begins after the initial pre-wash and once the antiseptic agent is applied to the hands and forearms.
The Counted Stroke Method
The Counted Stroke Method focuses on mechanical friction and coverage rather than the clock. This technique dictates a specific number of brush strokes—often ten—to be applied to each of the four surfaces of the fingers, hands, and forearms up to the elbow. While it is not strictly timed, a properly executed counted scrub typically falls within the same two- to five-minute window as the timed method.
The specific duration can also be influenced by the antiseptic solution, such as those containing chlorhexidine gluconate or povidone-iodine. Chlorhexidine is known for its persistent activity, continuing to kill microbes for hours after the scrub, while povidone-iodine is valued for its fast-acting, broad-spectrum effect. Manufacturers’ instructions provide the exact contact time necessary for their product to achieve the required level of microbial reduction.
Completing the Sterile Barrier
Once the prescribed time or stroke count is complete, the hands and forearms must be rinsed correctly. The surgical team member holds their hands elevated above the elbows throughout the rinsing process. This posture ensures that the water and any remaining microbes run off the elbows, preventing contaminated water from flowing back down toward the newly cleaned hands.
The next step involves drying the hands and forearms with a sterile towel, typically found within the sterile gown package. The drying is performed by blotting, not rubbing, to minimize skin cell shedding, starting systematically from the fingertips and working toward the elbow. A separate, sterile section of the towel or a second sterile towel is used for the other arm to prevent cross-contamination.
The team member then proceeds to don a sterile gown and gloves, usually employing the closed gloving technique. This method keeps the hands covered by the gown cuffs until the gloves are completely placed over the sterile gown. This meticulous sequence ensures that the scrubbed skin never touches the outside of the sterile gown or gloves, thereby establishing the final, secure sterile barrier for the procedure.