A surgical scrub is a defined procedure for washing the hands and forearms of surgical personnel to minimize the risk of microbial contamination in a sterile surgical environment. The purpose is to significantly reduce the transient and resident microbial flora on the skin, making the skin surgically clean. Achieving and maintaining this cleanliness requires precise technique, including a specific hand positioning integral to the process, to prevent the spread of infection to the patient.
Essential Pre-Scrub Preparation
Several preparatory steps must be completed to ensure the maximum effectiveness of the antiseptic agent. All jewelry, including rings, watches, and bracelets, must be removed from the hands and forearms, as these items can harbor microorganisms and protect them from cleansing agents. Fingernails must be kept short, clean, and healthy, since the area beneath the nail harbors the majority of microorganisms. Artificial nails or extenders are prohibited due to their potential to harbor pathogens and interfere with effective hand washing.
A preliminary wash using soap and water is performed to remove gross surface debris and transient microorganisms, especially if the hands are visibly soiled or for the first scrub of the day. The hands and forearms are then thoroughly moistened under running water at a dedicated surgical scrub sink. The skin must also be inspected for any cuts, abrasions, or open lesions, as these increase the risk of infection to both the patient and the team member.
The Critical Hand Posture
The specific position of the hands relative to the elbows is the most important physical requirement during the scrubbing and rinsing procedure. The hands must be held up and away from the body, remaining in view at all times. The fingertips must be the highest point of the arm, keeping the hands elevated above the level of the elbows. This posture ensures that water and soap flow only from the fingertips down toward the elbows.
This gravitational principle ensures that water runs from the cleanest area (the hands) to the least clean area (the elbows and lower forearm). If the hands drop below the elbows, potentially contaminated water or soap from the upper arm would flow back over the newly scrubbed hands and fingers. Keeping the hands elevated ensures constant drainage, preventing backflow contamination and preserving the integrity of the antiseptic scrub. The forearms are often held at an angle near chest level and away from the surgical attire to avoid splashing or contact with non-sterile scrub clothes.
Maintaining Asepsis After Scrubbing
Following the final rinse, scrubbed personnel must maintain the elevated hand posture while moving to the area designated for gowning and gloving. The immediate next step is the thorough drying of the hands and forearms using a sterile towel, which is typically contained within the sterile gown pack. Asepsis must be continuously maintained throughout this process to prevent the transfer of microbes.
The sterile towel is picked up by one corner, and the hands are dried sequentially, starting with the fingertips and moving down the arm to the elbow. One end of the towel is used for the first hand and arm, and the opposite, unused end is used for the second. The drying motion is a gentle dabbing or blotting action, moving only in one direction from the hand toward the elbow, and never returning to a previously dried area.
The hands must remain elevated during the drying process, and the towel must not touch the non-sterile scrub attire. After drying, the hands are held in the elevated posture until sterile gowning and gloving are completed, preparing the individual for the surgical procedure.