HAND

RUBBING &
SCRUBBING
DR. HELEN BONGALON AMO
UST Faculty of Medicine and Surgery
 SURGICAL HAND SCRUBBING
• Purpose:
– Essential to decrease incidence of surgical site
infection (SSI)
– Remove debris and transient microorganisms from
the nails, hands and forearms
– Reduce the resident microbial count to a
minimum
– Inhibit rapid rebound growth of microorganisms
Steps before starting Surgical hand
scrubbing:
• Keep nails short and pay attention to them
when washing your hands – most microbes
on hands come from beneath the fingernails

• Do not wear artificial nails or nail polish

• Remove all jewelry (rings, watches,

bracelets) before entering the operating
theater
Steps before starting Surgical hand
scrubbing:
• Wash hands and arms with a non-
medicated soap before entering the
operating theater area or if hands are
visibly soiled

• Clean subungual areas with a nail file

Remember to:
• Inspect your skin and nails ensure your skin is
free of any cuts and wounds

• Put on your personal protective equipment

prior to hand scrubbing

• Dawn proper eye protection and a surgical

mask covering your nose mouth
 SURGICAL SCRUBBING
Procedural Steps
• Start timing. Scrub each side of each finger, between
the fingers, and the back and front of the hand for 2
minutes.
• Proceed to scrub the arms, keeping the hand higher
than the arm at all times. This helps to avoid
recontamination of the hands by water from the
elbows and prevents bacteria-laden soap and water
from contaminating the hands.
• Wash each side of the arm from wrist to the elbow
for 1 minute.
 Procedural Steps
• Repeat the process on the other hand and arm,
keeping hands above elbows at all times. If the
hand touches anything at any time, the scrub
must be lengthened by 1 minute for the area that
has been contaminated.

• Rinse hands and arms by passing them through

the water in one direction only, from fingertips to
elbow. Do not move the arm back and forth
through the water.
 Procedural Steps
• Proceed to the operating theatre holding
hands above elbows.
• At all times during the scrub procedure, care
should be taken not to splash water onto
surgical attire.
• Once in the operating theatre, hands and
arms should be dried using a sterile towel and
aseptic technique before donning gown and
gloves.
Performance characteristics for a surgical scrub
agent generally fall into four categories:

1. Antimicrobial Action -- broad spectrum of

antimicrobial activity against pathogenic organisms
that works rapidly.
An agent that does not work rapidly may not
provide adequate bacterial reduction before being
rinsed off.

2. Persistent Activity -- an agent offering persistent

activity keeps the bacterial count low under the
gloves.
Studies show bacteria grow faster under gloved
than ungloved hands.
3. Safety -- the ideal agent would be non-
irritating and non-sensitizing.

4. Acceptance -- most important to achieving

compliance in using a new product is its
acceptance by the healthcare worker
The product should have ideal antimicrobial
action and an excellent safety profile
 Surgical Scrub Agents
1. Liquid or foam soaps
• These are the most common products for surgical
scrubs
• used in conjunction with water and dry scrub
brushes or sponges.
• The most common antimicrobial agents in these
products: chlorhexidine gluconate, iodophor, or
parachlorometaxylenol.
• These agents are very drying and with repeated
scrubbing with the scrub brush can cause skin
damage.
 Surgical Scrub Agents
2. Impregnated scrub brushes/sponges.
• Scrub brushes/sponges are preloaded with CHG,
iodophor, or PCMX and are water-aided products.

3. Brush-free surgical scrub

• These products use an antimicrobial agent and
water but no scrub brush.
SURGICAL HAND RUB
Procedural Steps
HOW TO: Surgical Handrub
https://www.youtube.com/watch?v=o8Ah0dCD
oTk
 References
• WHO Guidelines on Hand Hygiene in Health
Care: First Global Patient Safety Challenge
Clean Care Is Safer Care. Geneva: WHO; 2009