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Surgical Hand Washing Steps

Discussion in 'General Discussion' started by Nada El Garhy, Nov 26, 2016.

  1. Nada El Garhy

    Nada El Garhy Golden Member

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    Surgical scrub - traditional scrub and alcohol-based handrub

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    When performing a procedure that requires sterile technique, it is important to perform hand hygiene with an antimicrobial agent that will remove debris and transient micro-organisms from the nails, hands, and arms. This reduces the resident microbial count to a minimum and inhibits the rapid regrowth of micro-organisms. Traditionally, the surgical hand scrub was performed by using an antimicrobial agent and a sterile sponge and brush to clean the nails, hands, and forearms. In recent years, a brushless technique using an agent with 50% to 90% alcohol combined with chlorhexidine gluconate has been introduced as an alternative to the traditional surgical hand scrub. This brushless technique is as effective for preventing surgical-site infections as the traditional surgical hand scrub is.

    Prior to the surgical hand scrub, perform a short pre-scrub wash and rinse to remove superficial micro-organisms and gross debris. Wash the hands and forearms with a surgical scrub for approximately 1 minute, or per agency protocol, and then rinse. Clean the subungual area and around each cuticle with a nail-cleaning tool during the first scrub of the day or when visibly soiled.

    Before performing the pre-scrub wash and rinse, don surgical attire and remove all jewelry. Fingernails must be well groomed and nails must be no longer than ¼ inch. Avoid artificial nails, and if you wear nail polish, it must not be chipped or worn longer than 4 days. Wearing nail polish longer than 4 days fosters bacterial growth.

    To avoid delays in the process, make sure a sterile towel, a sterile gown, and sterile gloves in the appropriate size are on the sterile table. A scrub nurse or technologist will be available to assist with donning the sterile gown.

    Since the hands are in direct contact with the sterile field, the surgical scrub must begin with the hands and end with the elbows. Keep your hands higher than the elbows so that the water flows from the cleanest area (the hands) to a less clean area (the elbows). The scrub sink must be deep and wide enough so that you can hold both arms over the sink and so that water won't splash out onto the surgical attire. Moisture can contaminate the sterile gown when donned over wet scrub attire.

    Once the pre-scrub wash and rinse is complete, begin the surgical hand scrub by using an antimicrobial agent with a sponge and brush or by using an alcohol-based rub. When performing the traditional scrub, use either the timed scrub method or the counted stroke method. The timed scrub method involves scrubbing each surface of the fingers, hands, and arms for a certain length of time. The counted stroke method involves scrubbing each surface of the fingers, hands, and arms with a certain number of strokes, for example, 15 strokes for the fingernails, 10 strokes for each palm and each side of the thumb and fingers, 10 strokes for the back of each hand, and 10 strokes for each forearm. The recommended length of time or number of strokes used for the surgical hand scrub varies from agency to agency. Familiarize yourself with your agency's protocol and follow it each time you perform a surgical hand scrub.

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    When performing a surgical hand scrub using a brushless alcohol-based rub, dry the hands and forearms thoroughly after the pre-scrub wash and rinse. Damp or wet hands and forearms can reduce the effectiveness of the alcohol-based rub. Cover each surface of the thumbs, fingers, hands, and forearms to 2 inches above the elbow with the alcohol-based product. Pay particular attention to the areas between the fingers and around the nails. Rub the product until the skin feels dry. Apply the rub thoroughly prior to donning the sterile gown and sterile gloves. To ensure surgical asepsis, follow the manufacturer's recommendations when using an alcohol-based rub.

    Once the surgical hand scrub is complete, prevent contamination of the hands and forearms when moving from the scrub sink to the sterile table by keeping the hands in front of the body and above the waist. If there is potential for contact with the door of the surgical suite, it may be necessary to back through the door.
    Surgical hand scrub - traditional method

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    1. With all jewelry removed, pre-scrub and wash the hands and arms with an antimicrobial soap and warm water.


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    2. Clean the subungual areas of the nails with a nail tool.


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    3. 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.

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    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.

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    5. Wash the sides of the arm and up to 2 inches above the elbow for at least 1 minute.

    Repeat the process for the other arm.

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    6. From the fingertips to the elbow, rinse the hands and arms by passing them through the water in one direction only.

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    7.With hands held up, proceed to the surgical area. It may be necessary
    to back through the door of the surgical suite.

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