Surgical Scrub in operation theatre (

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Surgical Scrub in operation theatre (“Actions must affirm the critical areas of concerns” ):

Surgical Scrub in operation theatre ( “ Actions must affirm the critical areas of concerns” ) Conducted by : Ms.Monika clinical instructor Army college of nursing

introduction :

introduction It is not possible to make the skin surface of the hands sterile. Therefore washing & scrubbing are done to clean the hands for preparation of doing or assisting in sterile procedure or handling sterile supply.

Define surgical scrub:

Define surgical scrub Surgical scrub is defined as a process of removing or decreasing ,from the hands & the forearms as many no: of bacterial count & resident skin flora as possible to a safe level of surgical acceptance by mechanical scrub with the help of a scrub brush & with a chemical antiseptic soap.


Cont………..d Washing the hands & the forearms with plain water under a running tap before participating in a surgical procedures. By this procedures the skin becomes free from many micro-organisms & this decreases the contamination of the surgical field as well as the surgical site. The surgical scrub is done before gowning & gloving & before each surgical procedures.

Surgical scrub process :

Surgical scrub process Surgical scrub consist of two processes. these are as follows: A) MECHANICAL SCRUBBING PROCESS B) CHEMICAL PROCESS


A) MECHANICAL SCRUBBING This process removes micro-organisms by friction & reduces resident flora & bacterial count from the skin.


2) CHEMICAL PROCESS This process inactivates micro-organism with a chemical antiseptic or antimicrobial agent. This prevents the growth of micro-organism by its antiseptic action but may not kill the micro-organism.

Purposes :

Purposes To remove soil ,debris ,natural oils from the skin of the hands & the forearms. To decrease the no: of resident micro-organism on the skin. To keep the population of micro-organism minimum by inhibiting their growth & multiplication. To prevent transfer of micro-organism to the surgical wound of the pt. To arrest the hazard of microbial contamination of the surgical wounds during operation.


SCRUB FACILITY Scrub Area : The operation theatre usually keeps a wide area for scrubbing & hand washing near the operation theatre for safety & convenient scrub. Scrub sink : The characteristics of the scrub sink should be such that it is deep & wide enough to prevent splash of water in the surrounding floor surface. The water tap : The tap should be such that it can be operated to open & close either by the elbow or by foot to avoid contamination of the hands after scrubbing & washing.


Cont………d Scrub –Brush : To scrub the skin surface of the hands & the forearms the scrub brush is used for mechanical friction. Nail Brush : a nail brush is to be used to clean the surrounding area of the nails. Chemical Soap : An antiseptic or antimicrobial soap or soap solution is used for reducing the no: of micro-organism bi its antiseptic action. Running water : A free & adequate force of running water is necessary for thorough rinsing of the hands & the forearms after scrubbing with soap.

Before the scrub following preparations is necessary :

Before the scrub following preparations is necessary Nails are to be cut short & should be free of dirt. Check for skin of the hands & the forearms for infections ,cuts ,bruises ,lesions or abrasions ,burns ,& skin break on the skin surface. All jewelleries such as finger ring ,bangles ,wrist watch etc are to be removed.

Procedure of surgical scrub :

Procedure of surgical scrub The following are the step of the scrub: Wet the hands & the forearms Apply the antiseptic detergent Apply the antiseptic detergent or soap solution thoroughly & liberally from the two inches (5cm) above the elbow to fingertips ,around & in b/w the fingers to generates a lather of soap which will facilitate the scrub.


Cont………….d 3) Take a clean scrub brush & follow the technique mentioned below: Scrub each individual finger back ,front & around. Scrub the palm & back of the hands. Scrub the skin of the forearm moving from the fingertips to the elbows. The mechanical friction & the action of the antiseptic soap help removing the micro-organism from the skin surface. Then take a clean nail brush ,scrub around the nail beds ,remove the dirt & debris from under the nail of each finger.

4) Duration of scrub :

4) Duration of scrub Major Operation: For a major operation a long scrub is required. The duration of the scrub should be 6-7 mins. For one hand & forearm : Scrub the nails of one hand --- 30 strokes Scrub the sides of each fingers ---- 20 strokes Scrub back of the hands ----- 20 strokes Scrub palms of the hands ------ 20 strokes Scrub forearms ----- 20 strokes Then repeat the same steps for the other hands & the forearms

b) Minor operation :

b) Minor operation For minor operation a short scrub is required. the duration of the short scrub should be of 3-5 minutes: For one hand & forearm: Scrub the nails of the hands ----------- 15 strokes Scrub the skin areas of hands & forearms---- 10 strokes Then repeat the same for the other hands & the forearms.


Cont…………..d After the scrubbing is complete rinse the hands & the forearms thoroughly under running water with the hands upward. After scrubbing & rinsing is over hold the hands in a clasp with flexed elbows in front ,above the waist line. Hands should be above the elbow level & held upward. this will prevent contamination water running down from above the elbow to hands & fingertips. The hands & the forearms should be thoroughly dried with a sterile towel– drying from the fingertips to hands & then moving towards elbow using each side of the towel for each hand.


Cont………….d Discard the towel in the soiled linen bucket without touching he bucket--- drop it into the bucket from a distance.

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Steps for surgical hand wash::

Steps for surgical hand wash: Remove all jewelry on hands and wrists. Adjust water to a warm temperature and thoroughly hands and forearms to 5 cm above the elbows in order to remove dirt and transient flora. Clean under each fingernail and around the nail be with a nail cleaner prior to performing the first surgical scrub of the day


Cont………….d Holding hands up above the level of the elbow, apply antimicrobial agent to hands and forearms up to the elbows. Using a circular motion, begin at the fingertips of one hand and lather and wash between the fingers, continuing from fingertip to 5 cm above the elbow. Repeat this process for the other hand and arm. Continue rubbing for 3-5 minutes


Cont……….d Rinse each arm separately, fingertips first, holding hands above the level of the elbow. Using a sterile towel, dry the fingertips to 5 cm above the elbow. Use one side of the towel to dry the first hand and the other side of the towel to dry the second hand. 7. Keep hands above the level of the waist and do not touch anything before putting on sterile gown and surgical gloves.

Steps for Alcohol-Based Surgical Handrub: :

Steps for Alcohol-Based Surgical Handrub: 1. Wash the hands. 2. Make sure hands are dried completely and then apply 5 ml of alcohol hand rub into palm of one hand. 3. Rub into the hand making sure to rub the alcohol product under the nails and up the forearm. Continue rubbing till alcohol is dry. 4. Repeat for the other hand and forearm. 5. Put on sterile gloves.

Surgical hand scrub tips :

Surgical hand scrub tips Brushing: Recent studies have shown that using a brush during surgical scrub provides no greater reduction of microorganisms on the hands than washing with antiseptic soap alone. Surgical hand antisepsis wash may be performed using either a soft brush or sponge or using an antiseptic alone. Avoid using a hard brush, which is not necessary and which may irritate the skin. The brush should be single use and should be discarded (if disposable) or sent for autoclaving (if reusable). Do not share brushes between personnel

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