Surgical hand scrub is a core principle in infection control within the operating room, playing a vital role in preventing the spread of microbes and hospital-acquired infections. Even minor contamination during surgery can lead to severe consequences, which is why thorough and proper surgical hand scrub is an essential part of preoperative preparation. This article explores the importance of hand scrub before surgery and outlines the crucial steps involved in the process.

Why is Surgical Hand Scrub Before Surgery So Important?

Surgical hand scrub is of great importance for several reasons:

• Hands as essential tools: Doctors’ hands are their primary instruments for diagnosing, treating, and caring for patients. They touch, diagnose, alleviate pain, and heal injuries.
• Infection transmission risk: Hands can inadvertently become carriers of bacteria, viruses, and other pathogens, easily transferring these harmful microorganisms to patients. Even seemingly clean hands may still harbor pathogens that can be transmitted through direct contact.
• Increased vulnerability during surgery: The risk of infection transmission is amplified during surgical procedures since patients’ skin is compromised due to incisions and cuts, making their bodies more susceptible to infections. Even minor contamination can spread to internal tissues and cause severe complications.

Fortunately, proper hygiene practices can largely prevent these infections. Surgical hand scrub is one of the most fundamental and effective methods of preventing hospital-acquired infections. Surgeons and operating room staff work diligently to wash their hands properly and use disinfectants to minimize the risk of transferring harmful pathogens, ensuring the safety and well-being of patients.

The Need for Surgical Hand Washing Despite Wearing Gloves

During surgery, gloves may tear or puncture due to the use of various instruments, and the surgeon or surgical team might not immediately notice the damage. In such cases, if hands are not properly washed and disinfected, the risk of infection transmission increases.

Additionally, sometimes the top of the gloves may gather, leaving parts of the hands exposed, which can also lead to contamination. Therefore, thorough hand scrub and disinfection before surgery are crucial to reduce any risk of contamination, even when gloves are worn.

Proper Surgical Hand Scrub Technique

The key steps in this process are as follows:

1-Initial Preparation

• Removing Jewelry: Surgeons and operating room staff must remove any jewelry or watches to prevent contamination underneath them.
• Trimming Nails: Nails should be trimmed and clean, with no artificial nails or nail polish, as they can harbor bacteria.

2-Initial Wash with Soap and Water

• Rinsing Hands and Forearms: Wet hands and forearms with warm water.
• Using Antiseptic Soap: Wash hands with antiseptic soap for at least 2 to 5 minutes, using surgical-grade solutions and soaps for effective elimination of microbes.

3-Thorough Washing of Fingers and Hands

• Palms: Cover and wash both palms thoroughly with soap.
• Between Fingers: Carefully wash areas between fingers to remove microbes.
• Back of the Hands and Fingers: Wash the backs of both hands and each finger with soap.
• Under the Nails: Use a nail brush to clean underneath nails and remove any dirt or microbes.
• Forearms to Elbows: Wash forearms up to the elbows, ensuring the entire arm, including wrist and fingers, is cleaned. Hold hands so that the fingertips are higher than the elbows, preventing contaminated water from flowing back.

4-Rinsing with Clean Water

After thorough scrubbing of hands and forearms, rinse them with clean water. Ensure that water flows from the fingertips toward the elbows to avoid contaminating cleaned areas.

5-Drying Hands

• Drying: Dry hands with a sterile towel.
• Dressing: Put on sterile clothing and gloves and avoid contact with non-sterile surfaces.

For proper drying technique, divide the towel into two imaginary sections. Use one side of the towel to dry one hand from the fingertips to the elbow, then use the other side for the second hand. Avoid dragging the towel over the hands to prevent transferring remaining microorganisms and causing contamination.

Key Points for Hand Hygiene

• The hand scrub process should last at least 5 minutes to ensure thorough removal of microbes and contaminants.
• Hold hands upwards, with elbows pointing down, allowing water to flow toward the elbows throughout the process.
• After handwashing, avoid contact with non-sterile surfaces to prevent re-contamination of the hands.
• By following these steps diligently, the risk of infection transmission to the patient is significantly reduced, ensuring a safe surgical environment.

When is Surgical Hand Washing Essential?

According to the World Health Organization (WHO), surgical hand scrub is mandatory in the following five situations:

1. Before Patient Contact: Hands should be washed before any contact with the patient, even in routine interactions such as approaching or shaking hands.
2. Before Performing a Sterile Procedure: Thorough handwashing is required before any sterile procedure, like dressing wounds, to maintain aseptic conditions.
3. After Contact with Body Fluids: After handling bodily fluids, mucous membranes, or broken skin, hands must be washed immediately following glove removal.
4. After Patient Contact: Hands should be washed after any patient contact to prevent potential transmission of microbes and infections.
5. After Contact with the Patient’s Environment: Hands should be washed after touching any item or surface in the patient’s vicinity, even if the patient did not directly touch it, to minimize the risk of contamination.