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Standards for surgical hand scrubs
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Standards for surgical hand scrubs Objectives of the surgical hand scrub are: 1. To remove dirt, skin oil, and microbes from hands and lower arms 2. To reduce the microbial count to as near zero as possible 3. To leave an antimicrobial residual on the skin to prevent growth of microbes for several hours’ Standards: 1. Prior to beginning surgical hand scrub a. Inspect hands to assure that nails are free of polish and trimmed short, cuticles are in good condition, and no cuts or skin problems exist b. Adjust operating room cap to ensure complete hair coverage; place clean mask over nose and mouth and tie securely to prevent venting at sides c. Ascertain that the scrub dress is fitted at the waist or the scrub shirt is fitted, tied, or tucked into the trousers to avoid contamination of scrubbed hands and arms by brushing against loose garments and to reduce shedding 2. Use antimicrobial soap or detergent that is rapid acting, has a broad spectrum, and does not depend on cumulative action; wash the hands and arms for a few minutes to remove gross contamination from the skin 3. Clean nails and subungual areas with a disposable plastic nail cleaner or metal nail file (Do not use wooden sticks) 4. Rinse hands and arms thoroughly 5. Apply antimicrobial soap or detergent solution to hands 6. Using either a terminally sterilized reusable brush or a sterilized disposable brushlsponge, scrub the hands and arms to two inches above the elbow for five minutes or use the anatomical time and counted brush stroke methods a. Brush stroke method2 b. Anatomical time scrub p r o c e d ~ r e ~ ~ ~ 7. Rinse hands and arms thoroughly 8. Discard brush or sponge in sink or appropriate container 9. Hold hands and arms up and out from scrub clothes and proceed into operating room 10. The five-minute anatomical scrub or the counted brush stroke method is utilized for subsequent scrubs5 Rationale: 1. Nail polish cracks and peels easily under the stress of a good mechanical scrub, thereby providing microscopic niches in which microbes can find perfect conditions for breeding microbese
AORN Journal,May 1976, Vol23, No 6
2. Microbes of the skin can be removed by two actions a. Physical separation of microorganisms by washing with a detergent or soap and water b. Chemical disinfection of microorganisms by application of an antimicrobial s01ution~~~ 3. Predominance of Gram-negative nosocomial infections necessitates the use of a broad-spectrum microbicidal solutiong*lo 4. The anatomical time and counted brush stroke methods of scrubbing assure sufficient exposure of all skin surfaces to friction and the antimicrobial solution; individual attention to detail is essentials*11 5. Numerous studies indicate that there is no significant difference in bacterial reduction between the five-minute and ten-minute scrubs’ 6. There is no difference in microbe removal between reusable brushes and disposable brustVspongesB 7. An efficient hand scrub technique is necessary because holes in gloves develop during surgical procedures and not all new gloves are without defect Notes 1. Peter Dineen, ”Prevention of infection in the operating room,” Bulletin of American College of Surgeons (December 1969) 18-21. 2. Frances Ginsberg, Lillian S Brunner, Vernita Cantlin, A Manual of Operating Room Technology (Philadelphia:J B Lippincott ti Co, 1966) 90-92. 3. Mary Louise Hoeller, Surgical Technology (St Louis: C V Mosby Co, 1974) 159. 4. Edna C Berry, Mary L Kohn, lntroduction to Operating Room Technique, 4th ed (New York: McGraw Hill, 1972) 53-54. 5. Peter Dineen, “An evaluation of the duration of the surgical scrub,” Surgery, Gynecology & Obstetrics (December 1969) 1181-1184. 6. Frances E Reeser, “OR fact and principle,” AORN Journal (September 1969) 85.
7. “Aseptic methods in the operating suite,” The Lancet (April 6, 1968) 708-709. 8. M E McBride, W C Duncan, J M Knox, “An evaluation of surgical scrub brushes,” Surgery, Gynecology & Obsfetrics (December 1973) 934936. 9. Virgil H Crowder, el al, “Bacteriological comparison of hexachlorophene and p l y vinylpyrrolidone-iodinesurgical scrub soaps,” The American Surgeon 33 (November 1967) 906-91 1. 10. Raymond W Vanderwyk, Mictvbiocidel Effectiveness of Betadine Surgical Scrub (povidone-Iodine) versus Hexachlorophene (Yonkers, NY: The Purdue Frederick Co, 1971). 11. Doris C MacClelland, “Are current skin preparations valid?” AORN Journal 21 (January 1975) 55-60.
AORN Journal, May 1976, Vol23, No 6
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Standards for surgical hand scrubs Objectives of the surgical hand scrub are: 1. To remove dirt, skin oil, and microbes from hands and lower arms 2. To reduce the microbial count to as near zero as possible 3. To leave an antimicrobial residual on the skin to prevent growth of microbes for several hours’ Standards: 1. Prior to beginning surgical hand scrub a. Inspect hands to assure that nails are free of polish and trimmed short, cuticles are in good condition, and no cuts or skin problems exist b. Adjust operating room cap to ensure complete hair coverage; place clean mask over nose and mouth and tie securely to prevent venting at sides c. Ascertain that the scrub dress is fitted at the waist or the scrub shirt is fitted, tied, or tucked into the trousers to avoid contamination of scrubbed hands and arms by brushing against loose garments and to reduce shedding 2. Use antimicrobial soap or detergent that is rapid acting, has a broad spectrum, and does not depend on cumulative action; wash the hands and arms for a few minutes to remove gross contamination from the skin 3. Clean nails and subungual areas with a disposable plastic nail cleaner or metal nail file (Do not use wooden sticks) 4. Rinse hands and arms thoroughly 5. Apply antimicrobial soap or detergent solution to hands 6. Using either a terminally sterilized reusable brush or a sterilized disposable brushlsponge, scrub the hands and arms to two inches above the elbow for five minutes or use the anatomical time and counted brush stroke methods a. Brush stroke method2 b. Anatomical time scrub p r o c e d ~ r e ~ ~ ~ 7. Rinse hands and arms thoroughly 8. Discard brush or sponge in sink or appropriate container 9. Hold hands and arms up and out from scrub clothes and proceed into operating room 10. The five-minute anatomical scrub or the counted brush stroke method is utilized for subsequent scrubs5 Rationale: 1. Nail polish cracks and peels easily under the stress of a good mechanical scrub, thereby providing microscopic niches in which microbes can find perfect conditions for breeding microbese
AORN Journal,May 1976, Vol23, No 6
2. Microbes of the skin can be removed by two actions a. Physical separation of microorganisms by washing with a detergent or soap and water b. Chemical disinfection of microorganisms by application of an antimicrobial s01ution~~~ 3. Predominance of Gram-negative nosocomial infections necessitates the use of a broad-spectrum microbicidal solutiong*lo 4. The anatomical time and counted brush stroke methods of scrubbing assure sufficient exposure of all skin surfaces to friction and the antimicrobial solution; individual attention to detail is essentials*11 5. Numerous studies indicate that there is no significant difference in bacterial reduction between the five-minute and ten-minute scrubs’ 6. There is no difference in microbe removal between reusable brushes and disposable brustVspongesB 7. An efficient hand scrub technique is necessary because holes in gloves develop during surgical procedures and not all new gloves are without defect Notes 1. Peter Dineen, ”Prevention of infection in the operating room,” Bulletin of American College of Surgeons (December 1969) 18-21. 2. Frances Ginsberg, Lillian S Brunner, Vernita Cantlin, A Manual of Operating Room Technology (Philadelphia:J B Lippincott ti Co, 1966) 90-92. 3. Mary Louise Hoeller, Surgical Technology (St Louis: C V Mosby Co, 1974) 159. 4. Edna C Berry, Mary L Kohn, lntroduction to Operating Room Technique, 4th ed (New York: McGraw Hill, 1972) 53-54. 5. Peter Dineen, “An evaluation of the duration of the surgical scrub,” Surgery, Gynecology & Obstetrics (December 1969) 1181-1184. 6. Frances E Reeser, “OR fact and principle,” AORN Journal (September 1969) 85.
7. “Aseptic methods in the operating suite,” The Lancet (April 6, 1968) 708-709. 8. M E McBride, W C Duncan, J M Knox, “An evaluation of surgical scrub brushes,” Surgery, Gynecology & Obsfetrics (December 1973) 934936. 9. Virgil H Crowder, el al, “Bacteriological comparison of hexachlorophene and p l y vinylpyrrolidone-iodinesurgical scrub soaps,” The American Surgeon 33 (November 1967) 906-91 1. 10. Raymond W Vanderwyk, Mictvbiocidel Effectiveness of Betadine Surgical Scrub (povidone-Iodine) versus Hexachlorophene (Yonkers, NY: The Purdue Frederick Co, 1971). 11. Doris C MacClelland, “Are current skin preparations valid?” AORN Journal 21 (January 1975) 55-60.
AORN Journal, May 1976, Vol23, No 6
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