How To Perform Surgical Hand Scrubs (2023)

Human hands are the most important tools for caring. Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers, understanding, and healing remedies. The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to control infection, it is often not practiced where warranted.

Surgical site infections greatly contribute to nosocomial infections. Some of the risk factors for nosocomial infections include the behavior of OR personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions. Most surgical professionals agree on the importance of good surgical hand-washing practices in infection prevention. Hand transmission is a critical factor in the spread of bacteria, pathogens, viruses that cause disease, and nosocomial infections in general.

The purpose of surgical hand scrub is to:

  • Remove debris and transient microorganisms from the nails, hands, and forearms,
  • Reduce the resident microbial count to a minimum, and
  • Inhibit rapid rebound growth of microorganisms.1

Surgical Scrub Techniques

All sterile team members should perform the hand and arm scrub before entering the surgical suite. The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less clean area (the arm). A systematic approach to the scrub is an efficient way to ensure proper technique.

There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.

The procedure for the timed five minute scrub consists of:

(Video) Anatomical Surgical Hand Scrub

  • Remove all jewelry (rings, watches, bracelets).
  • Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
  • Clean subungual areas with a nail file.
  • Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
  • Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
  • Wash each side of the arm to three inches above the elbow for one minute.
  • Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one 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.
  • Proceed to the operating room suite holding hands above elbows.2
  • If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
  • At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
  • Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to don your gown and sterile gloves.

When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown.

Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the shoulders and tying it.

To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.

The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub. After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the person being gloved.

  • Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff.
  • The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
  • Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.

Formal guidelines and recommended practices for hand washing have been published by professional organizations (e.g., Association for Professionals in Infection Control (APIC), Association of periOperative Registered Nurses, Inc. (AORN). AORN recommends the use of a traditional standardized anatomical timed scrub or counted stroke method for surgical hand scrub and encourages institutions to follow the scrub agent manufacturer's written recommendations when establishing policies and procedures for scrub times. On this basis, for example, the typical scrub procedure for a PVPI-containing product based on manufacturer's labeling would require the use of a scrub brush and two applications of five minutes each, whereas the typical procedure for a CHG-based product would require a three-minute scrub followed by a three-minute wash. In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons:

  • Staff time constraints.
  • Desire to reduce poor hand health.
  • Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate.3

Hand condition is emerging as an increasingly important factor in personnel compliance and infection control. Frequent surgical scrubbing can cause dermatitis of the hands and arms. Most antimicrobial agents are drying to the skin, especially when coupled with a scrub brush.

(Video) Proper Surgical Hand Rub

Characteristics of a Surgical Scrub

Performance characteristics for a surgical scrub agent generally fall into four categories:

1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work 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. It is not unusual for a surgery to last in excess of two hours. Studies have shown the rate of glove failures (non-visible holes) increases with the duration of surgery.4 In addition, studies show bacteria grow faster under gloved than ungloved hands.5,6,7

3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.

4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. Although each is important in its own right, all four characteristics should be present for a complete package.

Surgical scrub agents come in many forms. Not all forms meet all characteristics.

(Video) WWL Surgical Scrub and Gowning -A Step by Step Guide

1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol). These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.

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.


No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. Effective surgical scrubs are one of the most powerful strategies of infection prevention in the OR. Glove usage gives a false sense of security against bacteria. Gloves provide an ideal environment for bacterial growth, moisture and warmth, which makes good hand-scrub techniques and aseptic gowning and gloving an important part of the total infection prevention platform. It is important for healthcare management to help the personnel understand the cause/effect cycle of surgical scrubs as they relate to infection prevention.

Ellen Anderson-Manz, RN, BSN, a technical service specialist, and Deborah Gardner, LPN, OPAC, work for 3M Healthcare in St. Paul, Minn.

For a complete list of references visit

(Video) Scrub Technique


  • To be able to list the three purposes of surgical hand scrubs.
  • To describe correct scrub technique.
  • To list the different characteristics of products used for surgical scrub.
  • To be able to demonstrate the correct aseptic technique when gloving and gowning.

True or false questions

  1. Surgical site infections contribute to nosocomial infections.
  2. A timed scrub should last for one to three minutes.
  3. The best water temperature is very hot; this tends to kill bacteria more quickly.
  4. Vigorous scrubbing causes skin to become damaged and should be avoided.
  5. The surgeon is normally gloved and gowned by the circulating nurse.
  6. The purpose of surgical hand scrub is to sterilize the hands prior to gowning and gloving.
  7. An ideal surgical scrub agent would have a broad spectrum of antimicrobial activity against pathogenic organisms.
  8. Bacteria grow faster under gloved than ungloved hands.
  9. When donning sterile gloves, the surgical scrub becomes less important.
  10. Effective surgical scrubs are one of the most powerful strategies of infection prevention.


1. T.
2. F.
3. F.
4. T.
5. F.
6. F.
7. T.
8. T.
9. F.
10. T.

For a complete list of references click here


What is the first step in performing a surgical scrub? ›

The surgical scrub involves first decontaminating the hands, then donning a sterile surgical gown and pair of sterile gloves.

How many strokes is a surgical hand scrub? ›

The brush should be approximately three inches lengthwise. Use the sponge-side of the brush lengthwise to apply soap around wrist. Scrub 20 circular strokes on all four sides; move up the forearm--lather, then scrub, ending two inches above the elbow.

What are the two methods for performing surgical hand antisepsis? ›

The two most common forms of hand antisepsis involve aqueous scrubs and alcohol rubs. Aqueous scrubs are water‐based solutions containing antiseptic ingredients such as chlorhexidine gluconate or povidone iodine.

When performing a surgical scrub the forearm and hands must be? ›

A. The skin of the hands and forearms should be intact with no burns, lesions, abrasions, and cuts present. The surgical team member should inspect the hands and forearms prior to performing the surgical scrub to confirm the skin is intact.

How long should a surgical hand scrub take? ›

When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2–6 minutes.

What is the first surgical hand scrub of the day? ›

The first scrub of the day is typically a traditional, timed, 3-to-5-minute surgical scrub with a facility-approved antimicrobial product. For this procedure, staff will: Remove all jewelry from hands and wrists before beginning. Open the disposable scrub brush/sponge set and antimicrobial soap.

What are the three methods of surgical scrub? ›

The process of scrubbing, gowning, and gloving is one that all members of the surgical team must complete before each operation. In the surgical scrub, the hands and forearms are decontaminated.

How many minutes should the entire hand scrubbing for both hands should last? ›

Scientific studies show that you need to scrub for 20 seconds to remove harmful germs and chemicals from your hands. If you wash for a shorter time, you will not remove as many germs. Make sure to scrub all areas of your hands, including your palms, backs of your hands, between your fingers, and under your fingernails.

How many steps is a surgical hand wash? ›

In 1894, three steps were suggested: 1) wash hands with hot water, medicated soap, and a brush for 5 minutes; 2) apply 90% ethanol for 3–5 minutes with a brush; and 3) rinse the hands with an “aseptic liquid”.

Can you scrub for surgery with an open wound? ›

Open lesions increase the risk of infection to both patient and the surgical team member. Avoid scrubbing if you have open lesions or a cold.

What disinfectant is used for surgical hand scrubs? ›

There are two well-recognized methods for performing surgical hand preparation. The most traditional one is scrubbing hands and forearms with antimicrobial soap, usually 2% chlorhexidine or 10% povidone-iodine (PVPI).

What is the difference between a surgical hand scrub and surgical hand rub? ›

In the past, washing hands with antimicrobial soap and water (surgical scrub) was the norm, mainly with chlorhexidine or iodine. More recently, alcohol-based hand rub has been successfully introduced, showing greater effectiveness, less irritation to the hands, and requiring less time than washing hands.

Why do surgeons put their hands up after scrubbing? ›

After scrubbing, keep both hands above waist and below neckline. Keep them in view at all times. Scrubbed hands and arms are considered contaminated once they fall below waist level. On the other hand, surgical gowning and gloving provide a barrier between the patient and healthcare provider.

What are the 3 types of hand washing? ›

This depends on the circumstances and level of decontamination required. There are 4 main types of cleansing agent: soap & water, alcohol based hand rub, hand wipes and antiseptic cleansing agents. There are 3 methods of hand decontamination: social, antiseptic hand decontamination and surgical scrub technique.

What is the CDC guideline for hand hygiene? ›

Wash hands with soap and water for at least 20 seconds. Use the cleanest water possible, for example from an improved source. *If soap and water are not available use an alcohol-based hand rub that contains at least 60% alcohol. 1.

How long is the first scrub? ›

When starting to scrub, note the time. Your hands should start the day 'thoroughly clean', then the first scrub of the day should be for at least 5 minutes. Subsequent scrubs should be for at least 3 minutes.

Where should scrub sinks for the or team be located? ›

Scrub sinks shall be located outside of sterile areas. A minimum of two scrub sinks shall be provided in a surgical unit containing one operating room. Four scrub sinks shall be provided in surgical units containing two operating rooms. One additional scrub sink shall be provided for each additional operating room.

How should a surgical hand rub be applied? ›

When the hands are dry, sterile surgical clothing and gloves can be donned. Rub palm against palm back and forth with fingers interlinked. Rub the back of the left hand, including the wrist, moving the right palm back and forth, and vice-versa.

What is glove technique? ›

Closed Glove Technique-In the closed-glove technique, the scrub person's hands remains inside the sleeves and should not touch the cuffs. In the open-glove technique, the scrub person's hands slide all the way through the sleeves out beyond the cuffs.

What is the scrubbing pattern used in surgery? ›

The back, palm, and sides of the hand are scrubbed. Then the wrist and forearms are scrubbed, working toward the elbow. This scrubbing process is usually repeated again. After each scrub, the hands and arms are rinsed with running water so that the water runs down off the elbows and not back up to the hands.

WHO guidelines for surgical hand washing? ›

Before subsequent operations, hands should be washed using either an alcohol-based handrub (ABHR) or an antiseptic surgical solution. If hands are visibly soiled, they should be washed again with an antiseptic surgical solution.

Which parts of the hand are frequently missed during cleaning? ›

Areas frequently missed include the tips of the fingers, palms of your hands and thumbs.

How to do pre surgical hand preparation? ›

Prewash hands and forearms with non-antimicrobial soap and dry thoroughly then apply the rub as per manufacturer's instructions. 2. Apply the rub to all surfaces of the hands and forearms. The volume of rub should be enough to wet all surfaces throughout the entire procedure (approximately 15 mls).

How long should you scrub your hands Servsafe? ›

Apply enough to build up a good lather. 3 Scrub hands and arms vigorously. Scrub them for 10 to 15 seconds. Clean under fingernails and between fingers.

What are the fundamentals of nursing surgical handwashing? ›

Surgical Antisepsis

Wet hands using sterile water with water closest to your body temperature. Wash hands using antimicrobial soap and/or povidone-iodine. Clean subungual areas with a nail file. Scrub each side of each finger, between the fingers, and the backs and fronts of the hands for at least 4 minutes.

Why must you perform a surgical scrub before donning sterile gloves? ›

Studies have shown that skin bacteria rapidly multiply under surgical gloves if hands are not washed with an antimicrobial soap, whereas a surgical hand scrub will inhibit growth of bacteria under gloved hands (Kennedy, 2013).

Can nurses scrub in on surgery? ›

Some hospitals rely on surgical techs entirely for the scrubbing role, some use scrub nurses, some may have both. That said, scrub nurses can monitor patient vitals, administer medication, perform injections and other tasks that surgical technologists cannot typically perform.

How long do surgeons scrub before surgery? ›

Surgical hand scrubbing will be performed in 1 minute and 2 minutes using a disposable nail brush. Surgical hand scrubbing will be performed in 2 minute without using a brush. The effect of brush usage and time on bacterial flora in hand during surgical hand.

Can I scrub in with a cut on my hand? ›

Persons with cuts, burns or open lesions on the hands or arms must not scrub for surgical procedures because broken skin increases bacterial count. 2. Care must be taken to prevent water splashes on the scrub suit or gown.

What antiseptic is the most effective for a surgical hand scrub? ›

The traditional surgical antisepsis involves scrubbing the skin with povidone-iodine or chlorhexidine gluconate. Recently, a waterless surgical hand rub formulation containing 61% ethyl alcochol, 1% chlorhexidine and moisturizers was developed to provide a comparable antiseptic effect.

What soap do surgeons use scrubs? ›

Hibiclens soap is an antiseptic, antimicrobial skin cleanser used by medical professionals before surgical procedures and by patients before a surgical procedure. This special soap cleans the surgeon's own skin as well as their patients'.

What temperature should water be for surgical scrub? ›

enough. The temperature of the water was 70˚F (21˚C), when it should have been at least 100˚F (38˚C). hands and arms with soap. Bill scrubbed for only 3 seconds when he should have spent at least 10-15 seconds performing this important step.

How long is surgical hand scrub Aorn? ›

As a general rule, 2 to 6 minutes should suffice when performing a timed scrub. Clinical data has not demonstrated that longer scrubs are more effective in eliminating microorganisms from the hands. Hit all areas. Scrub the arms, keeping your hand higher than the elbow at all times.

What is the first step in performing a surgical scrub quizlet? ›

Begin the surgical scrub by scrubbing the fingers, the area between the fingers, the hands, and the back of the hands for at least 2 minutes. 4. Scrub the arms, making sure the hands are higher than the arms at all times so that bacteria from the soap and water cannot contaminate the hands.

What should you do first when cleaning the surgical suite? ›

Before the day's surgery begins

Clean and disinfect the following: All flat surfaces (wipe from top to bottom, then from the centre outwards). The patient bed and its attachments, positioning devices, and patient transfer devices.

What is the correct technique for performing the surgical skin prep? ›

Preoperative/Preadmission Skin Preparation:

On the day of surgery, gently wipe the skin with either an alcohol or chlorhexidine based solution (i.e. 70% isopropyl alcohol, chlorhexidine gluconate) in the preoperative area or in the operating room to provide a preliminary cleanse of the entire surgical field.

What is the last step in a scrub of a surgical site? ›

Final rinse

The alcohol is often mixed with the antiseptic of choice (used in the scrubbing process). Rinse solution can be applied by spraying in a spray bottle (Figure 9) or wiping with a swab (avoid cotton wool at this stage). Figure 9 - Final rinse of the surgical site.

What garments must be put on before performing a surgical scrub? ›

Scrubs must be worn, hair covered, and masks worn, if a sterile field is opened. Examples of restricted areas include operating room suites and scrub sink areas. Semirestricted area: This is an area that is restricted to specific personnel and patients, but not where sterile fields are established.

What are the 5 steps in cleaning operation? ›

General procedures for manual cleaning and sanitizing are as follows:
  • Pre-scrape utensils and equipment of food debris.
  • Wash in a warm solution of approved detergent.
  • Rinse in clear water or running water.
  • Sanitize in an acceptable chemical solution or hot (171°F) water.
  • Air dry before reusing.

What is the preferred method of pre surgical hand preparation? ›

Handwash with soap and water on arrival to OR, after having donned theatre clothing (cap/hat/bonnet and mask). Use an alcohol-based handrub (ABHR) product for surgical hand preparation, by carefully following the technique illustrated in Images 1 to 17, before every surgical procedure.

What are the two methods to prepare your hands before a surgery OR procedure? ›

Prewash hands and forearms with non-antimicrobial soap and dry thoroughly then apply the rub as per manufacturer's instructions. 2. Apply the rub to all surfaces of the hands and forearms. The volume of rub should be enough to wet all surfaces throughout the entire procedure (approximately 15 mls).

What are the three types of skin prep? ›

Topical antiseptics may be applied to the patient as a preoperative skin preparation to reduce the risk of SSIs. The three main types of antiseptics are iodine or iodophor, alcohol, and chlorhexidine gluconate.

What are the three main positions for surgical procedures? ›

The five basic positions used for surgery are supine, lithotomy, sitting, prone, and lateral.


1. How to Scrub for Surgery
(Mater Misericordiae University Hospital Surgery)
2. How Do Surgeons Scrub In?
(Northwestern Medicine)
(Surgical Tech Tips)
4. Wash your hands with surgical precision
5. Surgical Scrub | Learn How to Prepare for the OR
(Surgical Teaching)
6. Behind Hospital Doors- how do surgeons scrub before surgery?
(Western Sydney Health)


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