Purpose of the Surgical Scrub
The surgical hand scrub mechanically and chemically reduces resident and transient skin flora on the hands and forearms before donning sterile gloves and gown. It does not sterilize the skin - it is impossible to sterilize living tissue - but it substantially reduces the microbial load and rate of regrowth during the procedure.
Before You Scrub
- Remove all jewelry, including rings and watches.
- Nails should be short, clean, and free of artificial extensions or chipped polish per facility policy.
- Don a surgical mask, ensuring it covers the nose and mouth completely, and protective eyewear before beginning the scrub.
- Confirm hands and forearms have no open lesions or non-intact skin per facility exclusion policy.
Anatomical (Counted-Stroke) Scrub Sequence
- Wet hands and arms; apply antimicrobial scrub agent and clean subungual areas with a nail pick under running water.
- Scrub the nails with a brush (commonly about 30 strokes if using a brush method).
- Divide each finger into four sides and scrub each side with a set number of strokes, then move to the palm and back of the hand.
- Divide the arm into thirds (lower arm, mid, upper approaching the elbow) and scrub circumferentially, keeping hands higher than elbows throughout.
- Repeat the sequence on the second arm, then rinse each arm from fingertips to elbow in one continuous motion without reversing direction.
Timed Scrub Method
An alternative to counted strokes, the timed method allots a specific number of minutes to each anatomical area (commonly a total of 3-5 minutes depending on the antimicrobial agent's validated protocol) rather than counting individual strokes. Manufacturer instructions for the specific scrub agent dictate the exact timing.
Common Surgical Scrub Agents
| Agent | Note |
|---|---|
| Chlorhexidine gluconate (CHG) 4% | Broad-spectrum, persistent antimicrobial activity, fast acting |
| Povidone-iodine | Broad-spectrum, less residual activity than CHG; contraindicated with iodine allergy |
| Alcohol-based surgical hand rub | Waterless method; requires hands to be visibly clean and dry first, then applied per manufacturer's timed protocol |
After the Scrub
- Keep hands above elbows and away from the body while walking to the sterile field.
- Dry hands with a sterile towel, moving from fingertips to elbow, using a different section of the towel for each arm.
- Don the sterile gown and gloves using proper technique immediately after drying.
Key Exam Points
- Hands must remain above the elbows and away from clothing throughout and immediately following the scrub to prevent contamination.
- If contamination occurs during the scrub (touching a nonsterile surface), the scrub must restart per facility protocol.
- Surgical scrubbing is performed at the beginning of the day (first case) and often includes a full timed/counted scrub, while subsequent cases may follow an abbreviated protocol per facility policy.
- Skin cannot be rendered completely sterile; the goal is maximal reduction of transient and resident flora and slowed regrowth (residual activity) throughout the case.