SURGICAL HANDWASHING / SCRUBBING

Good evening ladies and gentlemen and welcome to perioperative nursing. My name
is Ivan Matthew Superio from RLE group 6 from section 3B. Today Im about to
show you various procedures that we usually perform in the operating room
following the principles of aseptic technique. These include surgical handwashing or
scrubbing, gowning and glovinmg. So sit back, relax, and enjoy the video!

So first lets prepeare for the surgical hand scrub,

We begin with proper attire. First we have a newly laundered tucked in scrub suit, a
loose fitted uniform may contaminate the hands if your hands ever come in contact
with it.

Always remember to remove any jewelry, earrings, rings, or watches since they
might harbor microorganisms along the way.

If you have long hair remember to tie it in place before wearing your cap since Hair is a gross contaminant and
is also a source of electrostatic spark.

A mask to prevent spread microorganisms by filtering out any droplets from coughing sneezing or talking.

Make sure that the nails are short to prevent puncturing of gloves and you’re good to go.

For the handwashing, its important to keep these reminders in mind.

1. Always hold the hands higher than the elbows and above waist at all times.

2. The length of the surgical scrub varies, as does the scrub procedure. Variations depend on frequency of
scrubbing the agent used. and the method.

3. Hands should be washed as soon as gloves are removed because resident microorganisms multiply
rapidly in warm, moist environment under gloves.

4. Everyone should scrub according to a standardized written procedure.

5. Surgical handwashing or scrubbing should take at least 5 minutes before the first procedure of the day. The
CDC does not recommend a duration for surgical scrubs between procedures. However, 2-5 min is
probably acceptable.

SUGGESTED ACTION RATIONALE

2. Use deep sink-’with foot pedals or knee controls for Minimizes risk of hands and lower arms touching
dispensing soap and controlling water temperature and dirty surface. Warm water enhances action of soap and
flow. (At this time, use whatever type of sink you have removes protective oils from skin. Excessively hot
in your homes. However, oberve asepsis when doing the water open pores to bacteria; Knee or foot controls
procedure.) Turn on the water and adjust water flow to prevent contamination of hands after scrub.
lukewarm temperature (if possible) using knee or foot
controls and adjust to comfortable temperature.
3. Prescrub wash/rinse: Holding hands above the level Water runs by gravity from fingertips to elbows.
of the elbow, wet hands and forearms liberally so that Hands become cleanest part of upper extremity.
the lukewarm water runs from the fingertips to the Keeping hands elevated allows water to flow from
elbows. least to most contaminated areas. Washing a wide area
reduces risk of contaminating overlying gown that the
nurse later applies.
4. Dispense liberal amount of soap/antiseptic solution. Antiseptics alter the physical and chemical properties
(2-5 ml) into hands- Beginning at the fingertips, lather of the cell membrane of microorganisms, thus
hands and arms to 5 cm (2 in.) above elbows, using firm, destroying or inhibiting cellular function. Washing
rubbing, circular and interlaced-fingers technique. Move wide area reduces risk of contaminating overlying
from fingertips to the elbows of one hand and repeat for gown that nurse later applies. Circular strokes clean
the second hand. Continue washing for 20-25 seconds. most effectively and rubbing ensures a thorough and
(Hands need to be above elbows at all times.) mechanical cleaning action.

5. Rinse off lather on each hand and arms separately and Rinsing removes transient bacteria from fingers,
thoroughly, keeping the hands up and allowing water to hands, and forearms. Water should flow from area of
drip from the elbows. least contamination to area of most contamination

6. Under running water clean under nails of both hands Removes dirt and organic material that harbor large
with nail pick. Discard after use. numbers of microorganisms.

7. Obtain sterile brush from container. Rinse brush and

saturate with antiseptic agent, if not previously
impregnated.
8.A. Surgical hand scrub (with brush)
(Brush stroke method)

a. Wet clean sponge and apply antimicrobial Friction loosens resident bacteria that adhere to skin
agent. Visualize each finger, hand, and arm as surfaces. Ensures coverage of all surfaces. Scrubbing
having four sides. Wash all four sides is performed from cleanest area (hands) to marginal
effectively. Scrub the nails of one hand with 15 area (upper arms).
strokes. Scrub the palm, each side of thumb and
fingers, and posterior side of hand with 10
strokes each.

b. Divide the arm mentally into thirds: scrub Eliminates transient microorganisms and reduces
each third 10 times (AORN, 2007). Some resident hand flora.
health care facility policies require scrub by
time rather than 10 strokes. Rinse brush and
repeat sequence for the other arm. A two-brush
method may be substituted.

c. After completing second arm, rinse brush Hands remain the cleanest part of upper extremities.
and discard brush or put it on the side of the
sink without touching any part of the sink. Flex
arms and rinse from fingertips to elbows in one
 continuous motion, allowing water to run off at
elbow.

d. Rinse hands and arms one at a time, from Rinsing removes resident and transient bacteria and
fingertips to elbow. Hold arm upward leading sediment.
water drip to the elbows. Be careful not to
contaminate new surgically clean hands and
arms.

e. Turn off water with foot or knee control, Keeps hands free of microorganisms.
with hands elevated in front of and away from
body. Enter operating room suite by backing
into room.

f. Approach sterile setup; grasp sterile towel (A Water contaminates sterile setup.
clean towel will do at this time)., taking care
not to drip water onto sterile setup.

g. Bending slightly at waist, keeping hands and Avoids sterile towel from contacting unsterile scrub
arms above waist and outstretched, grasp one attire and transferring contamination to hands. Dry
end of sterile towel and dry one hand, moving skin from cleanest (hands) to least clean (elbows).
from fingers to elbow in a rotating motion

h. Repeat drying method for other hand by Prevents accidental contamination.

carefully reversing towel or using a new sterile
towel.

i. Drop towel into linen hamper or circulating Prevents accidental contamination.

nurse’s hand.

8.B. Optional: Brushless Antiseptic Hand Rub

a. After pre scrub wash, dry hands and Promotes reduction in microorganisms on all surfaces
forearms thoroughly with paper towel. of hands and arms.

b. Dispense 2 mL of antimicrobial agent hand

preparation into palm of one hand. Dip
fingertips of opposite hand into hand
preparation and work it under nails. Spread
remaining hand preparation over hand and up
to just above elbow, covering all surfaces.

c. Using another 2 mL of hand preparation, Ensures complete antiseptic coverage of all hand
repeat with other hand. surfaces.

d. Dispense another 2 mL of hand preparation

into either hand and reapply to all aspects of
both hands up to wrist. Allow to dry before
donning gloves.

9. Proceed with sterile gowning.

 And lastly we have the closed gloving procedure. It is putting on a sterile gown and gloves
without the outside of the gown or gloves touching the skin.

Throughout this procedure, here are some general principles we should follow. Sterile objects should
only touch sterile objects. Fingers should not come in contacts outside the sterile gown. Only do so until
you have secured the gloves covering the entirety of the hand.

2. Using the nondominant hand, pick up the right glove, by grasping the folded cuff.

3. Extend the right forearm with palm upward. Using the non-dominant hand, place the gloves with the
fingers pointing towards you. This is to ensure that your fingers will be in the right position when glove
the hand

4. Grasp the glove and glove the hand following the principles if said earlier. The cuff of the glove is now
over the stockinet cuff of the gown, with hand still inside the sleeve.

5. making sure that your fingers have aligned with the gloves, tug the gown to adjust and secure your fingers
in place.

6. Do the same with the other hand ensuring sterility by following the principles mentioned.

7. to make sure that your fingers are secured, interlace your now sterile gloved fingers ang tug onto each of
the fingers securing it in place.

This is to remove as many microorganisms as possible from the hands and arms by mechanical washing and
chemical antisepsis before participating in an operation

Your goul in this procedure is To scrub hands and arms in a thorough manner in order to decrease the bacterial
count, preparatory to participating in procedures that require surgical technique

Specifically, you have three goals namely, to decrease number of microorganisms to a minimum

To apply an antimicrobial residue to minimize growth of microorganisms

And lastly to remove any debris that may cause growth of microorganisms to multiply

Here I have a sink assuming it is foot pedal operated, an antimicrobial solution, a surgical scrub face mask, cap
ang shoe covers, sterile towel, a sterile pack, and protective eye wear.
Please note that any nail polish should be removed to decrease the risk of harboring microorganisms.

Note that this procedure isn’t to be documented and report any skin dermatitis per agency policy

In preparation for scrubbing we begin with a proper attire to provide barriers and prevent dissemination of
microorganisms

These include a newly laundered scrub suit, which should be loose fitted to prevent contamination, a cap to prevent
hair contamination, an appropriately fitted mask to filter microorgs from the nasal and oralcavities, shoes for
protection, and eye wear to prevent foreign fluid from entering the eyes.

Remove any jewleries to decrease risk or harboring microorgs

Note any cuts, and lesions in the hand and arms since broken skin may permit mircoorgs to enter the ksin

Fingernails should also be short to reduce the risk or bacterial growth uder the fingaernails

So now lets start with the procedure,