It is the process of removing as many

bacteria as possible from the hands and

arms by mechanical and chemical
antisepsis before participating in an
operation.

2.1. All personnel participating in sterile operative procedure shall

perform a hand scrub.
2.2. Only approved surgical antiseptic agent shall be used for surgical
hand scrub.
2.3. Staff with acute infection, such as a cold or sore throat, or skin
lesion, such as furuncle or any contagious condition, should not be
permitted scrub. Skin integrity of hands and forearms should be intact
and nails in good condition.
2.4. A clean OR attire including facial hair cover, and face mask must be
worn prior to scrubbing. Plastic apron must be worn if necessary.
2.5. Face masks must fit snugly and comfortable over mouth and nose.
Adjust eyeglasses comfortably in relation to mask.
2.6. Finger nails should be short, polish free and no artificial nails.

2.7. Jewelry, ring bracelets and watches should be removed prior

to scrubbing. Pierced ear studs must be contained inside head
cover.
2.8. Water must be adjusted to a comfortable temperature and
flow to prevent strike through.
2.9. Scrub sink should be used only for scrubbing. It should not
be used to clean or rinse contaminated instruments or
equipment.
2.10. During and after scrubbing, keep the hands higher than the
elbows to allow water flow from the cleanest area, the hands, to
the marginal area of the upper arms.
2.11. An alternative hospital infection control committee
approved hand antiseptic agent shall be available those having a
sensitive skin (e.g. hand washed with antimicrobial mild soap
followed by alcohol).
2.12. All shall comply with the Surgical Hand Antisepsis Policy.

1. ANATOMIC TIME METHOD:

Apply an antiseptic agent to the scrub or sponge (if it is
not impregnated in the brush).
Scrub

each individual finger, nails and hands, a half

minute for each hand.
Again

scrub each individual finger, nails, and hands with

the brush a half minute for each hand, maintaining lather,
up to 2 inches (5 cm) above the elbow.
Rinse

brush.

the hands and brush, and discard the sponge or

Reapply

the antimicrobial agent, and wash the hands and

arms with friction to the elbow for 3 minutes. Interlace the
fingers to cleanse between them.

2. COUNTED BRUSH STROKE METHOD:

Apply

an antiseptic agent to the scrub or sponge (if it is not

impregnated in the brush).
Scrub

the nails of one hand for 30 strokes

Scrub

all the sides of each finger for 20 strokes

Scrub

the back of the hand for 20 strokes for each third of the arms, up
to 2 inches (5 cm)
above the elbow.
Repeat

step 6 for the other hand and arm.

Rinse

hands and arms thoroughly under running water one at a time

from the fingertips to the elbow, with the hands up-ward, allowing water
to drip from flexed elbows.
Maintain

hand in upward position and proceed immediately inside the

operating room.

The patient will be free from signs and symptoms

of infection.

All personnel shall practice general hand

hygiene.

Surgical hand antisepsis shall be approved by the

infection control committee.

Srugical hand antisepsis/ hand scrub shall be

performed before donning sterile gloves for
surgical or other invasive procedure.

Standardized hand scrub procedure and

application of alcohol based surgical hand rub
product.

Standard I: All personnel shall practice hand hygiene

Standard II: Surgical hand antiseptic agent shall be

approved by the hospital infection control committee
and shall be used for all surgical hand antisepsis/hand
scrubs.

Standard III: Surgical Hand antisepsis/hand shall be

performed before donning sterile gloves for surgical
or other invasive procedures. Use of either an
antimicrobial surgical scrub agent intended for
surgical hand antisepsis or an alcohol-based
antiseptic surgical hand antisepsis is acceptable

Standard IV: Surgical hand antisepsis/hand

scrub using traditional antimicrobial scrub
agent shall include a standardized hand
scrub procedure that follows the
manufacturers written directions for use
and is approved by the hospital infection
control committee.

Standard V: Surgical hand antisepsis/hand

rub with an alcohol based surgical hand rub
product shall follow a standardized
application according to the manufacturers
written direction for use.

Standard VI: This policy and procedure

reviewed periodically, and readily available
in the practice setting.

Length of Scrubbing:
Anatomic Time method
Counted Brush method

All personnel participating in sterile operative

procedure shall comply with this policy.

Sterile gown and gloves shall only be donned

after hands have been thoroughly clean and
surgically scrubbed.

Hands and arms shall be thoroughly dried

before the sterile gown is donned to prevent
contamination of the gown by strike-through
of organisms from the wet skin.

Techniques used for sterile gloving:

Closed glove technique
Open glove technique
Gloving by open glove technique shall use a skin to
skin, glove to glove technique. The hand, although
scrubbed, is not sterile and must not contact the exterior
of the sterile gloves. The everted cuff on the glove exposes
the inner surfaces. The first glove is put on with skin to
skin technique, bare hand to inside cuff. The sterile fingers
of the glove hand then may touch the sterile exterior of
the second glove, that is, glove to glove technique.

Double-gloving is indicated during activities

when gloves may tear or puncture and as a
protective barrier for operative infectious cases.

Drying Hands and Arms:

Stand away from objects and people.
Reach down to the opened sterile package
and pick up the towel swiftly. Be careful not
to drip water onto the pack. Be sure no one
is within arms reach.
Open the towel full-length, holding one end
away from non-sterile scrub attire. Bent
slightly forward to avoid letting the towel
touch the attire.

Dry both hand thoroughly but

independently. To dry one arm, hold the
towel to the opposite hand and, using an
oscillating motion of the arm, draw the
towel up to the elbow.
Carefully reverse the towel, still holding it
away from the body. Dry the opposite arm
on the unused (now uppermost) end of the
towel.
Discard the towel at appropriate waste bin.

Reach down the sterile package and lift the

folded gown directly upward.
Step back away from the table, into an
unobstructed area, to provide a wide margin of
safety while gowning.
Holding the folded gown, carefully locate the
neckband.
Holding the inside front of the gown just below
the neckband with both hands, let the gown
unfold, keeping the inside of the gown toward the
body. Do not touch the outside of the gown with
bare hands.

Holding the hands at the shoulder level, slip

both arms into the armholes
simultaneously,
without touching the sterile exterior of the
gown with bare hands
The circulators bring the gown over the
shoulders by reaching inside to the shoulder
and arm seams. The gown is pulled on,
leaving the cuff of the sleeves extended
over the hands. The back of the gown is
securely tied or fastened at the neck and
waist; touching the outside of the gown at
the line of ties or fasteners, in the back only

Using the left hand ad keeping it within the cuff

of the left sleeve, pick up the right glove, from
the inner wrap of the glove package by grasping
the folded cuff.
Extend the right forearm with the palm upward.
Place the palm of the glove against the palm of
the right hand, grasping in the right hand the top
edge of the cuff, above the palm. In correct
position, glove fingers are pointing toward you
and the thumb of
the glove is to the right. The thumb side of the
glove is down.

Grasp the top of the right glove and

underlying gown sleeve with the covered
left hand. Pull the glove over the extended
right fingers until it completely covers the
stockinette cuff.
Glove the left hand in the same manner,
reversing hands. Use the glove right hand
to pull on the left glove.

Reach down the sterile package and lift the folded

gown directly upward.
Step back away from the table, into an
unobstructed area, to provide a wide margin of
safety while gowning.
Holding the folded gown, carefully locate the
neckband.
Holding the inside front of the gown just below the
neckband with both hands, let the
gown unfold, keeping the inside of the gown
toward the body. Do not touch the
outside of the gown with bare hands.

Holding the hands at the shoulder level, slip

both arms into the armholes
simultaneously, without touching the sterile
exterior of the gown with bare hands.

The circulator reaches inside the gown to

the sleeve seams and pulls the sleeves over
the hands to the wrists. The back of the
gown is securely tied or fastened at the
neck and waist; touching the outside of the
gown at the line of ties or fasteners in the
back only.

With the left hand, grasp the cuff of the

right glove on the fold. Pick up the glove
and step back from the table. Look behind
you before moving.
Insert the hand into the glove and pull it on
leaving the cuff turned well down over the
cuff.
Slip the fingers of the glove right hand
under the everted cuff of the left glove. Pick
up the glove and step back.
Insert the hand into the left glove and pull it
on, leaving the cuff turned well down over
the hand.

With the fingers of the right hand, pull the

cuff of the left glove over the cuff of the left
sleeve. If the stockinette is not tight, fold a
pleat, holding it with the right thumb while
pulling the glove over the cuff. Avoid
touching the bare wrist.
Repeat step 5 for the right cuff, using the
left hand, and thereby completely gloving
the right hand.

Gowning another person

Open the hand tow and lay it on the surgeons
hand, being careful not to touch the hand.
Unfold the gown carefully, holding it at the
neck band.
Keeping your hands on the outside of the
gown under a protective cuff of the neck
and shoulder area, offer the inside of the
gown to the surgeon. He / she slip the arm
into the sleeves.

Release the gown. The surgeon holds arms

out-stretched while the circulator pulls the
gown onto the shoulders and adjusts the
sleeves so the cuffs are properly placed. In
doing so, only the inside of the gown is
touched at the seams.

Gloving another person

Pick up the right glove, grasps it firmly with
the fingers under the everted cuff. Hold the
palm of the glove toward the surgeon.
Stretch the glove sufficiently for the surgeon
to introduce the hand. Avoid touching the
hand by holding your thumb out.
Exert upward pressure as the surgeon
plunges the hand into the glove.
Unfold the everted glove cuff over the cuff of
the sleeve.
Repeat for the other hand.

Occasionally a contaminated gown must be

changed during a procedure. The circulator
unfastens the neck and waist. Grasped at the
shoulders, the gown is pulled off inside out.
The gown is always removed first. The gloves
are removed using glove to glove and
then skin to skin technique. If only the
sleeve is contaminated, a sterile sleeve may
be put on over the contaminated one.

If a glove becomes contaminated for any reason

during a surgical procedure, it must be changed
immediately. If you cannot step away
immediately, hold the contaminated hand away
from the sterile area. To change the glove:
Turn away from the sterile filed.
Extend the contaminated hand to the circulator
who, wearing protective gloves, grasp the
outside of the glove cuff about 2 inches (5cm)
below the top of the glove and pulls the glove
off inside out.

Preferably a sterile team member gloves another.

If this is not possible, step aside and glove the
hand using the open glove technique.

Removing of Gown and Gloves

Removing of Gown
The circulator unfastens the neck and back
closures of the gown so the wearer does not
contaminate his or her scrub suit. The gown is
always removed inside out to protect the arms
and scrub suit from contaminated outside of the
gown. To remove:

Grasp the right shoulder of the loosened gown with the

left hand and pull the gown downward from the shoulder
and off the right arm, turning the sleeve inside out.
Turn the outside of the gown away from the body with
flexed elbows.
Grasp the left shoulder with the right hand and remove
the gown entirely pulling it off inside out. Discard in an
appropriate trash receptacle.
Removing of Gloves The cuffs of gloves usually turn down
as the gown is pulled off the arms. Use glove-to-glove,
then skin-to-skin technique to protect the clean hands
from the contaminated outsideof the gloves, which bear
cells of the patient.

Grasp the cuff of the left glove with gloved

fingers of the right hand and pull it off
inside out.
Slip the ungloved fingers of the left hand
under the cuff if the right glove and slip it
off inside out.
Discard gloves in an appropriate trash
receptacle.
Wash hands.