Surgical scrubbing

 

APPROPRIATE DRESSING TO ENTER THE OPERATION THEATRE

- Cap

- Mask

- Eye shield 

- Surgical scrubs (bare hands below elbow)

- Protective footwear 

 

PREPARING TO SCRUB

- Pre-sterilized gown is generally kept on the sterile surface
- Peel the plastic glove packet open over the gown and drop the gloves onto the sterile gown without touching them
- This will ensure your gloves and gown are sterile
- Finally, put on a surgical mask and eyewear protection

PRE-SCRUB WASH

Run the tap to an adequate flow (to avoid water splashing) and temperature (Warm water makes antiseptics and soap work more effectively, while very hot water removes more of the protective fatty acids from the skin).

Povidone Iodine and Chlorhexidine are commonly used.

SCRUBBING

1. Wet hands and forearms

2. Back of hands

3. Palms

4. Fingers

5. Thumbs

6. Fingertips 

7. Forearms 

During each of the following steps keep hands (clean area) above the elbows (dirty area) allowing water to drain away, making sure to avoid splashing surgical attire.

Each step of surgical ‘scrubbing’ consists of five strokes rubbing backwards and forwards.

• Rinse keeping hands above elbow and repeat the above steps again.

• The second wash should only cover two-thirds of the forearms to avoid compromising cleanliness of hands.

• Local policy may include repeating these steps a third time but to wrists only.

• The scrub procedure should last for 5 minutes, with further scrubs during the day lasting 3 minutes.

• Rinse the hands.

• Turn the tap off (if necessary) with your elbow and keep your hands up, allowing water to drip from your elbows. Dry your hands with sterile towels.

** Some centres follow “Dry Scrubbing” – i.e., Scrubbing without water using by using Chlorhexidine gluconate 1 %+ Ethyl alcohol 61% w/w solution

GOWNING

- With one hand, pick up the entire folded gown by grasping the gown through all layers, being careful to touch only the inside top layer which is exposed

- Once your hands are securely pinching the gown in these slots, step back from the shelf and allow the gown to drop
- Keep at least 1 arm free space so that the gown does not touch any surrounding unsterile objects
- Grasp the inside shoulder seams and open the gown with the armholes facing you
- Carefully insert your arms part way into the gown one at a time, keeping hands at shoulder level away from the body
- Slide the arms further into the gown sleeves
- When the fingertips are level with the proximal edge of the cuff, grasp the inside seam at the cuff hem using thumb and index finger
- Be careful that no part of the hand protrudes from the sleeve cuff
- A theatre assistant will fasten the gown behind you, positioning it over the shoulders by grasping the inside surface of the gown at the shoulder seam and back. (The theatre assistant’s hands should only ever be in contact with the inside surface of the gown.)
- A sterile plastic gown is generally worn over it to avoid splash soiling

GLOVING

Pick up glove by the cuff touching only the inner side of the cuff. Pull back the sleeve only once you start wearing the glove on that particular hand.

• Keep your hands above your waist and in front of you

• Ensure you do not touch anything around you that is not sterile – this includes your face, mask, and hat!

** During Covid-19, donning and doffing of PPE is done inside the OT as shown here (REFER FIGURES 1, 3 & 4):

 https://docs.google.com/document/d/16uwMGAiXpYGAdPDcd_C4-e7azAULVIetOb-ODNd1W9A/edit?usp=drivesdk 

REFERENCE VIDEO LINK: (**NAIL BRUSH AND PICK MAY NOT BE AVAILABLE)

 (OPEN GLOVING TECHNIQUE AS SHOWN ABOVE MAY BE USED)

https://youtu.be/MPjA6Sx7_i8 

REFERENCES:

1. National Institute for Health and Care Excellence 2008 Clinical Guideline 74 – Surgical Site Infection: Prevention and treatment of surgical site infection London, NICE

2. World Health Organisation 2009 WHO Guidelines on Hand Hygiene in Health Care (revised Aug 2009) [online] www.who.int/gpsc/en [Accessed August 2018]

3. The Association for Perioperative Practice. A guide to surgical hand antisepsis 2014. [Accessed August 2018]

Information sourced from:

https://geekymedics.com/surgical-scrubbing-gowning-gloving-guide/ 

https://www.infectioncontroltoday.com/view/how-perform-surgical-hand-scrubs

 

Written by our guest author Pranav Survase

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