This is a UKMLA-centred article about surgical scrubbing.

Introduction

• Surgical scrubbing, gowning and gloving are crucial steps in maintaining sterile conditions during surgical procedures. These steps are essential in preventing surgical site infections and other complications.
• In this guide, we will take you through the correct techniques for the surgical scrub which involves decontamination of the hands, donning a sterile surgical gown and a pair of sterile gloves.
• Before you begin this process, it is good practice to ensure you confirm with the surgical team, especially the surgeons whether you are able to scrub into the surgery. Once permission is obtained, you can begin preparing your gown and gloves.

Preparation

1. You must open your gown and gloves before you start cleaning your hands, as not to contaminate the equipment. Start off by ensuring you are working on a sterile table.
2. Open the gown by using the edges of the paper to open the packet and expose the surgical gown.
3. Next, you may choose your glove size, open the packet of gloves and place the sterile gloves onto the surgical gown without touching them.
4. You are now ready to perform your Surgical Scrub.

Surgical Scrub (5 mins)

1. Remove Items

• Remove all jewellery and watches from your hands and arms.
  

2. Open Packaging

• Run the tap at an adequate temperature and semi-open the package containing a nail brush and nail pick and lie it near the edge of the sink, ensuring the equipment is still in its package.

3. Apply Soap

• Wet your hands and arms. Using your elbow, dispense the soap usually located above the sink. Use a sufficient volume of scrub solution and work up a heavy lather for a minimum of 20 seconds.
  

4. Clean Nails and First Rinse

• Rinse the hands and arms and remove the sterile nail brush and nail pick from the semi-opened package. Clean under your nails using a nail cleaner, again applying more antimicrobial solution, but this time onto the sponge-side of your nail brush.
• After cleaning under the nails of all 10 fingers, rinse your hands and forearms thoroughly with warm water.

5. Wash Hands

• Rub the back of the hands by place one hand on top of another and work them in an upwards and downwards manner.
• Rub between the fingers by interlacing your fingers.
• Rotationally rub the fingers backwards and forwards whilst they are clasped.
• Clean the thumbs by twisting your finger around the opposite thumb and vice versa.
• Clean the palms by rubbing the fingertips of the left hand on the palm of the right hand.
• Work down your arms with a rotating action, working to just below the elbows.

6. Repeat Hand Washing

• It is good practice to repeat these 6 steps once more. Once you have finished, rinse the hands under running water and place your forearms at a 90 degree angle to the sink to ensure the water flows from your fingers to your elbows, with minimal spillage.

7. Dry Hands

• To dry your hands, pick up a hand towel and holding one end of the towel with one hand, dry the fingers on the opposite hand using a blotting, rotational motion. Move down your arms in this manner until you have dried all parts of your hand and arm.
• Repeat with another towel for the other hand and arm.

Gowning (5 mins)

Gowning is the process of donning a sterile surgical gown. The purpose of the gown is to create a sterile barrier between the surgical team and the patient. The steps are as follows:

1. Open out Gown

• With one hand pick up the opened gown and hold the back of the gown by the neckline, ensuring it is securely held out in front of you. Allow the gown to drop down without touching any surrounding unsterile equipment.

2. Step into Gown

• Step into the gown by carefully inserting your arms into the gown one at a time until you reach the cuffs at the end, ensuring no part of your hand protrudes from the sleeve cuff.

3. Secure Gown

• A theatre assistant will help secure the back of the gown by pulling the gown over your shoulders and fastening it at the waist by either ties, buttons or velcro tabs.

Gloving (2 mins)

Gloving is the process of donning sterile surgical gloves. The purpose of the gloves is to prevent contamination of the surgical field by the surgical team’s hands. The steps are as follows:

1. Open Glove Packet

• Open the inner glove packet that you previously opened out in front of you.

2. Glove Dominant Hand

• With your non-dominant hand, grasp the cuff of the first glove and carefully pull it over your dominant hand over the sleeve cuff, being careful not to touch anything except the glove.

3. Glove Non-Dominant Hand

• Use your gloved dominant hand to grasp the cuff of the second glove. Pull the second glove over your non-dominant hand, over the sleeve cuff.

4. Adjust Glove

• Adjust the gloves as needed to ensure a comfortable fit.

Final Steps

1. It is important you keep your hands above your waist and in front of you. Ensure that you do not touch anything around you that is non-sterile, including your scrub cap, eyes or face.
2. The final step involves approaching a theatre assistant and passing them a cardboard slip that holds two ties together across the front of the gown, making sure not to touch their hand.
3. Turn slowly to face your back to the assistant so they are able to cross the tie behind your gown. Let them pull the carboard off the tie so that you can tie a bow at your waist.
4. Now that you have finished the process of gowning and gloving you are ready to approach the patient.

References
 
1. https://www.bmj.com/content/341/sbmj.c3274.abstract

2. http://www.lhp.leedsth.nhs.uk/detail.aspx?id=3936

3. https://teachmesurgery.com/skills/theatre-basics/scrubbing-gowning/

Author – Mohona Sengupta 

Editor – James Mackintosh

Last updated 31/01/24