Sterile Scrub Technique

Thorough and frequent hand and arm scrubbing is a relatively easy way of controlling the spread of infections caused by pathogens such as viruses and bacteria that exist in a person’s normal environment. It is an essential skill for any biologist or medical staff, but it is also a simple habit that should be practiced by anyone needing to maintain sterile skin-to-skin contact, such as a mother caring for a sick child.

Surgical Hand-Scrubbing Techniques

• Techniques used in surgical hand scrubbing are meant to eliminate as many pathogenic organisms and as much debris (such as dead skin cells and dirt) as possible. An antimicrobial detergent accomplishes this as well as prevents any pathogens that may be encountered after washing from growing rapidly.
  In surgical practice, two scrubbing techniques are common: the numbered stroke and the timed scrub. The former requires the practitioner to count a fixed number of scrub strokes covering the entire surface of an arm, the palm, fingers and topside of the hand. The latter simply requires the practitioner to maintain a scrubbing motion over all surfaces of the arm and hand for between three and five minutes.
  Have on hand either a motion-activated or low-contact dispenser for the detergent or soap so that no additional surface need to be touched, as these themselves may harbor some bacteria or dirt. Also prepare sterile (autoclaved) and heat-sealed bags of napkins or towels and lay these out for easy access before starting. To do this, open up the entire bag along its edges and lay it out flat, with the towel or napkin still in contact with the inner, sterile surface of the bag. Do not touch the inner surface of the towel until hand scrubbing is finished. Be aware that all external surfaces will have some bacteria or dust, so avoid contact with these.
  All jewelry and watches must be removed, as these will either prevent the detergent from contacting the skin or harbor pathogens, dirt or dust within surface grooves and cracks, etc.
  When applying the detergent, cover all visible surfaces and avoid using water that is too hot. Start at the top of the elbow, just beneath the bicep, and work the soap down toward the hands. Begin timing and ensure all skin surfaces are being thoroughly rubbed with the soap. Most pathogens and debris will be found near the fingertips and beneath the nails, so if required, use a nail file to clean these areas before scrubbing. During scrubbing, always hold the hands higher than the arms to prevent contaminated soap from dripping down to the hands. Continue scrubbing for up to five minutes and rinse the arm for at least a minute under continuously running water flowing either from the arm to the elbow or vice versa, but always in one direction only.
  If any accidental contact with a foreign surface (e.g., the tap or sink) occurs, then scrubbing must be repeated or increased by an additional minute for that section of the arm or hand. Also avoid splashing and soiling clothes or surgical gowns. If that happens, change into sterile or clean ones and repeat the scrubbing procedure.