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The Aims of Surgical Hand Scrubbing

Dec. 26, 2022

The human hand is the most important tool of care. Hands feel, diagnose, treat, stimulate and provoke when placed on each patient who wants answers, understanding and therapeutic medication. Hands can also be the gateway and transmitter of infection. While hand washing may be the easiest way to control infection, it is not usually done when it is necessary.


Surgical site infections contribute significantly to nosocomial infections. Some risk factors for nosocomial infections include the behaviour of operating room personnel in relation to decontamination practices, hand hygiene/sterilisation and adherence to universal precautions. Most surgical professionals agree on the importance of good surgical hand washing practices in preventing infections. Hand transmission is a key factor in the spread of bacteria, pathogens, viruses and hospital-acquired infections in general that cause disease.


The aims of surgical hand scrubbing are to

remove debris and transient microorganisms from the nails, hands and forearms.

minimise the number of resident microorganisms, and

inhibit the rapid rebound growth of microorganisms.

Dry Surgical Scrub Brush

 Dry Surgical Scrub Brush 

Characteristics of surgical scrubs

The performance characteristics of surgical scrubs are usually divided into four categories.


1. Anti-microbial action - the ideal agent has broad-spectrum anti-microbial activity against pathogenic organisms. The agent must work quickly. Agents that do not work quickly may not provide adequate bacterial reduction until they are rinsed off.


Dry Surgical Scrub Brush

 Dry Surgical Scrub Brush

2. Persistent activity - Agents that provide persistent activity will keep bacterial counts under gloves low. It is not uncommon for surgeries to last longer than two hours. Studies have shown that the incidence of glove failure (no visible holes) increases with the duration of the procedure. In addition, studies have shown that bacteria grow faster with gloves than without gloves on the hands.


3. Safety - The ideal agent should be non-irritating and non-sensitizing. It must have no apparent ocular toxicity or ototoxicity, be safe to use on the body and not cause damage to the skin or the environment.


4. Acceptance - Probably the most important thing for achieving compliance with the use of a new product is its acceptance by health care professionals. A product with desirable antimicrobial action and excellent safety is of little value for good infection control if the user community does not support its use. While each is important, all four characteristics should be present for a complete package.


Dry Surgical Scrub Brush

 Dry Surgical Scrub Brush

Surgical scrubs come in many forms. Not all forms meet all characteristics.


1. Liquid or foaming soap. These are the most common surgical scrub products and are used with water and a dry scrub brush or sponge. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor or PCMX (p-chloro-m-xylene phenol). These agents are very dry and repeated scrubbing with a brush can cause skin damage.


2. Impregnating brush/sponge. The scrubbing brush/sponge is pre-loaded with CHG, iodophor or PCMX and is a water-assisted product.


3. Brushless surgical scrubs. These products use an antimicrobial agent and water, but do not use a brush.

 Dry Surgical Scrub Brush

 Dry Surgical Scrub Brush     


Regardless of the agent used, or the scrubbing technique employed, there is only one goal: to prevent infection. Effective surgical scrubbing is one of the most effective infection prevention strategies in the operating room. Wearing gloves can give a false sense of safety from germs. Gloves provide the ideal environment for bacterial growth, moisture and warmth, making good hand scrubbing techniques and sterile gowns and gloves an important part of the overall infection prevention platform. For healthcare management, it is important to help personnel understand the causal cycle associated with surgical scrubbing and infection prevention.

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