Surgical scrubbing is a precise hand hygiene procedure performed by medical professionals before invasive medical procedures. It is a fundamental step in preventing the spread of microorganisms in the operating room. This practice significantly reduces the risk of infection for patients, preparing surgical personnel’s hands and forearms to be as free from microorganisms as possible.
Purpose of Surgical Hand Antisepsis
Surgical hand antisepsis aims to lower the number of microorganisms on the hands and forearms of surgical staff. This reduction is essential for preventing surgical site infections (SSIs). Medical professionals perform this procedure to destroy transient microorganisms and inhibit the growth of resident microorganisms.
The skin harbors two main types of microorganisms: transient flora and resident flora. Transient flora colonize the superficial layers of the skin and are often acquired through contact with patients or contaminated surfaces; these are easily removed by routine handwashing. Resident flora reside in deeper skin layers and are more challenging to eliminate. Surgical scrubbing targets both, minimizing the risk of transferring bacteria from the surgeon’s hands to the patient, even if gloves are perforated during a procedure.
Key Materials and Solutions
Surgeons use specific antiseptic agents and tools for surgical scrubbing to achieve a high level of microbial reduction. The primary antiseptic solutions are chlorhexidine gluconate (CHG) and povidone-iodine, both known for their broad-spectrum activity against various microorganisms. CHG is effective against a wide range of bacteria, fungi, and viruses, and it offers a residual effect, continuing to inhibit microbial growth on the skin for several hours after application.
Povidone-iodine also exhibits broad-spectrum antimicrobial properties. While it does not provide the same prolonged residual effect as CHG, it is highly effective at reducing microbial counts during the scrub. Some facilities may also use alcohol-based solutions, applied as a rub. In addition to these solutions, sterile brushes or sponges, though less commonly used now in favor of brushless methods, historically aided in mechanical removal of microorganisms. A sterile water source is essential for rinsing during traditional scrubbing methods.
The Surgical Scrubbing Process
The surgical scrubbing process involves a series of methodical steps to ensure thorough antisepsis of the hands and forearms. Personnel begin by washing hands and forearms with soap and water to remove visible dirt and transient microorganisms. Following this pre-wash, the antiseptic solution is applied.
The scrub covers the hands and forearms, extending up to approximately two inches above the elbow. The technique involves systematically applying the antiseptic solution, often using a timed or counted stroke method for each surface of the fingers, hands, and arms. Throughout the scrub, hands are kept elevated above the elbows to prevent contaminated water from running back down the arms. After the prescribed scrub duration, hands and forearms are rinsed thoroughly under running water, keeping them elevated. Finally, sterile towels are used for drying, starting from the fingertips and moving towards the elbows, to maintain cleanliness before donning sterile gowns and gloves.