Hand washing for surgery is the single most critical behavior to prevent surgical site infections and protect patient safety. This meticulous process reduces the transient and resident microorganisms on the skin to a level that minimizes the risk of contamination during invasive procedures. It is a non-negotiable foundation of the perioperative journey, demanding precision and adherence to established protocols.
Understanding the Surgical Scrub
The surgical scrub is distinct from routine handwashing performed at home or in general clinical settings. Its objective is not merely to clean but to disinfect by significantly reducing the microbial load. This process involves the mechanical removal of dirt and debris alongside the application of an antimicrobial agent, which continues to provide a residual inhibitory effect. The choice between an alcohol-based chlorhexidine gluconate solution and an iodophor often depends on institutional policy, provider preference, and evidence regarding skin flora reduction and skin compatibility.
Pre-Scrub Preparation
Before the actual scrubbing begins, specific preparatory steps are essential to ensure effectiveness. Healthcare professionals must remove all jewelry from hands and wrists, as these areas can harbor bacteria and interfere with the thorough cleaning of crevices. Nails must be kept short and clean, as they can serve as reservoirs for pathogens. Furthermore, the integrity of the skin is paramount; any open wounds, abrasions, or dermatitis on the hands or arms necessitate coverage or, in some cases, alternative participation in the procedure to prevent infection transmission.
The Six-Step Technique
The World Health Organization (WHO) outlines a six-step technique designed to cover all surfaces of the hands and forearms methodically. This systematic approach ensures no area is missed, creating a continuous barrier of protection. The following sequence should be followed meticulously, whether using a sponge, brush, or hands-free faucet technology.
Step-by-Step Breakdown
The process begins with wetting the hands and arms with water, followed by applying the appropriate amount of surgical scrub solution. The steps are as follows:
Palm to palm.
Right palm over left dorsum with interlaced fingers and vice versa.
Palm to palm with fingers interlaced.
Backs of fingers to opposing palms with fingers interlocked.
Rotation of left thumb clasped in right palm and vice versa.
Rotation backwards and forwards with clasped fingers of right hand in left palm and vice versa.
Duration and Rinsing Protocol
Adherence to the recommended scrub duration is non-negotiable. Most protocols mandate a minimum of two to three minutes for the entire procedure, ensuring sufficient contact time for the antimicrobial agent to achieve its maximal effect. Rinsing is equally critical and must be performed in a manner that preserves the cleanliness of the hands. Water should flow from the fingertips down to the elbows, ensuring that contaminants are washed away from the cleanest areas. Hands should never be allowed to drape below the elbows or come into contact with the sink surfaces.
Drying and Gowning
Upon completing the rinse, the drying process must commence without delay. Surgical towels are preferred, as they are absorbent and create a sterile barrier. Patting the skin dry is required; rubbing is strictly prohibited as it can cause micro-abrasions and recontaminate the skin. Once the hands are dry, the sterile gowning process begins. The individual must grasp the folded gown at the neckline, avoiding contact with the external surface, and proceed to don the sleeves without touching anything outside the immediate sterile field.
