The process of scrubbing, gowning, and gloving is one that all members of the surgical team must

complete before each operation.

 In the surgical scrub, the hands and forearms are decontaminated. A sterile surgical gown and
pair of gloves are subsequently donned, creating an aseptic environment.
 ‘Scrubbing in’ dramatically reduces the risk of infection and significantly improves patient
outcomes. As such, it is a skill that should be taken seriously and always performed to the highest
standard.
 In this article, we shall look at the procedure for surgical scrubbing, gowning, and gloving.

Procedure

Preparation

 Remove any watches and rings from your hands

 Ensure that your sleeves are at least two to the inches above your elbows
 Open out your gown pack onto a clean table, only grabbing the outermost edges to maximize the
sterile field
 Open your glove packet and let it drop onto the clean area
 Collect a nail pick and brush
 Put on a face mask, securing appropriately

Scrubbing

 Allow the water to run and cover the nail pick and brush with soap, using your elbows on the
soap dispenser; clean your nails and remove any gross debris from your hands.
 Start by scrubbing your hands and forearms, down to your elbows, using the WHO hand washing
procedure for the hands and a rotational action for your forearms; this should last for at least one
minute
 Wash the soap from your hands and forearms by holding up your arms with your hands elevated
under the tap, such that the water runs off into the sink from your elbows
 Repeat this procedure a further three times, initially down to the mid-forearm, then down to the
wrists, then just for the hands each time lasting for at least one minute
 Keeping your arms elevated, dry your hands and forearms with the sterile towels in the gowning
pack, using a dabbing motion instead of a wiping motion; use one towel for each hand, before
throwing them away

Gowning and Gloving

 Take the sterile gown and gently shake it out, taking care not to let anything else touch it.
 Open it up and place your hands into the sleeves; keep your hands inside the sleeves.
 Ask an assistant to help pull it up over your shoulders and fasten it up at the back
 Take the right hand glove and place it, palm down, fingers facing your body.
 Grasp the bottom of the cuff with the thumb and index finger of your right hand, still inside the
sleeve; grasp the top of the cuff with your left hand (also inside the sleeve) and pull the glove
around and over your right hand
  Pull gently on the sleeve of the gown to help move your hands into the gloves and straighten out
the fingers; the sleeves of the gown should remain over most of your palm
 Repeat this technique for the left hand

To Complete

 It is advised to rest your hands on your front as you move around to ensure you remain sterile
 Make sure you do not touch any non-sterile equipment as you move to the operating area
The surgical scrub is an important procedure required to reduce the risk of contamination by
microorganisms during operative procedures.

The surgical scrub involves first decontaminating the hands, then donning a sterile surgical gown and pair
of sterile gloves.

This guide will take you through the important considerations when scrubbing for theatre, in particular:

1. Preparing to scrub

2. Surgical hand wash

3. Gloving and gowning

Preparing to scrub

 You should be dressed appropriately to enter the operating theatre. Although this may vary from
hospital to hospital, generally you must wear:
 Surgical scrubs (bare below the elbows, including removing watches and rings)
 Footwear such as clogs
 Theatre hat (with hair tied up if necessary)
 ID badge
 Ensure you ask the Lead Surgeon whether or not they would mind you scrubbing in, then make
your way to the scrub area.

You must open your gown and gloves before you scrub, so as not to contaminate your hands:

 First, open the gown. Carefully use the edges of the paper to open the packet and expose the
surgical gown.
 Next, choose your gloves. Peel the plastic glove packet open over the gown and drop the gloves
onto the sterile gown without touching them.

This will ensure your gloves and gown are untouched, and therefore sterile.

 Finally, put on a surgical mask and eyewear protection. Make sure you are comfortable, as you
cannot adjust these once you are scrubbed.

1. Operating theatre scrubs

2. Operating theatre attire
3. Surgical gown and gloves
4. Open the gown packet and gloves
5. Surgical mask
Surgical scrub

Pre-scrub wash

1. Run the tap to an adequate temperature and flow (to avoid water splashing). Then test the water before
starting to scrub to ensure the temperature is comfortable.

2. Open the package containing the nail brush/scrub sponge and nail pick, then lie it on the back of the
scrub sink still in the opened package.

3. Wet the hands and arms for an initial pre-scrub wash. Use several drops of scrub solution and work up
a heavy lather, then wash the hands and arms to the elbows.

Cleansing solutions are non-irritating to most people and include:

 Povidone Iodine
 Chlorhexidine

Some hospitals use dispensable alcohol gel, which can be used between short, ‘clean’ procedures. Check
with the operating surgeon if they are happy for you to use this.

4. Rinse the hands and arms thoroughly, allowing the water to run from the hands to the elbows.

5. Remove the sterile nail brush and nail pick from the opened package. Clean under the nails with the
nail pick and then discard in the bin (making sure not to touch the bin by using a foot-pedal).

6. Moisten the nail brush and dispense antimicrobial solution onto the sponge-side.

7. Lather the fingertips with sponge-side of brush, washing all four sides of the fingers.

8. Then using the bristle side of the nail brush, scrub the spaces under the fingernails of the right or left
hand. Repeat the process on the other hand.

Scrubbing procedure

 During each of the following steps keep hands (clean area) above the elbows (dirty area) allowing
water to drain away, making sure to avoid splashing surgical attire.
 Each step of surgical ‘scrubbing’ consists of five strokes rubbing backwards and forwards.

Step 1

 Wet the hands and forearms.

 Apply the specified amount of appropriate antimicrobial solution, according to the manufacturer’s
recommendations, from the dispenser (one downward stroke action).
 Work the cleaning solution into the hands palm to palm, creating a lather.
 Surgical scrub - rinse hands and forearms
 Rinse hands and forearms
Step 2

 Rub the right palm over the back of the left and vice versa with the fingers interlaced.
 Surgical hand scrub
 Rub the right palm over the back of the left and vice versa with the fingers interlaced

Step 3

 Rub hands palm to palm, with fingers interlaced.

 Surgical hand scrub - palm to palm
 Rub hands palm to palm, with fingers interlaced.

Step 4

 Perform rotational rubbing backwards and forwards with clasped fingers of the right hand into the
left palm hand and vice versa.
 Surgical hand scrub, clasped fingers
 Perform rotational rubbing backwards and forwards with clasped fingers of the right hand into the
left palm hand and vice versa.

Step 5

 Perform rotational rubbing of the right thumb clasped in the left hand and vice versa.
 Surgical hand scrub - clasp thumb
 Perform rotational rubbing of the right thumb clasped in the left hand and vice versa.

Step 6

 Rub the fingertips of the left hand on the palm of the right hand and vice versa.
 Surgical hand scrub - fingertips
 Rub the fingertips of the left hand on the palm of the right hand and vice versa.

Step 7

 Continue with the rotating action down opposing arms, working to just below the elbows.
 Surgical hand scrub - elbows
 Continue with the rotating action down opposing arms, working to just below the elbows.

Step 8

 Rinse and repeat steps 1-7 keeping hands raised above elbows at all times.
 The second wash should only cover two-thirds of the forearms to avoid compromising the
cleanliness of the hands.
 Local policy may include repeating these steps a third time but to wrists only.
  The scrub procedure should last for 5 minutes, with further scrubs during the day lasting 3
minutes.

Step 9

 Rinse the hands under running water, allowing the water to run from fingertips to elbows.
 Turn the tap off (if necessary) with your elbow and keep your hands up, allowing water to drip
from your elbows.
 Surgical scrub - rinse hands and forearms
 Rinse hands and forearms

Step 10

 Pick up one hand towel from the top of the gown pack and step back from the surface.
 Grasp the towel and open it fully. Do not allow the towel to touch any unsterile object or unsterile
parts of your body.
 Hold your hands and arms above your elbow, and keep your arms away from your body.

Step 11

 Holding one end of the towel with one hand dry the fingers of the opposite hand using a blotting
rotational motion.
 Move to the dry area of the towel and continue in this manner down the forearm to the elbow.
 Ensure you do not retrace from the forearm back up to the hands and do not wipe the skin dry.
This may contaminate your hands with micro-organisms from your proximal forearm – you will
be asked to re-scrub.
 Repeat with the other towel from the pack for the other hand and arm.

Surgical hand scrub - drying hands

 Dry each arm, starting at the fingertips, working towards the elbow.
 If you accidentally touch the tap or any surrounding objects, you must re-scrub.

Gowning

Picking up the gown

1. With one hand, pick up the entire folded gown from the wrapper by grasping the gown through all
layers, being careful to touch only the inside top layer which is exposed.

2. Once your hands are securely pinching the gown in these slots, step back from the shelf and allow the
gown to drop.

3. Make sure the gown does not touch any surrounding unsterile objects.
  Pick up gown pack
 Open the gown
 Inserting your arms into the sleeves of the gown

4. Grasp the inside shoulder seams and open the gown with the armholes facing you.

5. Carefully insert your arms partway into the gown one at a time, keeping hands at shoulder level away
from the body.

6. Slide the arms further into the gown sleeves and when the fingertips are level with the proximal edge of
the cuff, grasp the inside seam at the cuff hem using thumb and index finger. Be careful that no part of the
hand protrudes from the sleeve cuff.

 Put hands in gown sleeve

 Put your hands into the sleeves
 Put arms fully into gown sleeve
 Slide your arms further down the gown sleeves
 Fastening the gown

7. A theatre assistant will fasten the gown behind you, positioning it over the shoulders by grasping the
inside surface of the gown at the shoulder seam. The theatre assistant’s hands should only ever be in
contact with the inside surface of the gown.

8. The theatre assistant then prepares to secure the gown at the neck and upper back. Gowns differ in how
they are secured, but most with have either ties, buttons or velcro tabs.

 An assistant should fasten the gown behind you

Gloving

Step 1

 Open the inner glove packet that you previously dropped onto your sterile field.
 Surgical Scrubbing Gloving
 Open the inner glove packet

Step 2

 Pick up one glove by the folded cuff edge with your sleeve-covered hand.
 Surgical Scrubbing Gloving
 Pick up one glove by the folded cuff edge

Step 3

 Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing
towards you. The palm of the hand inside the gown sleeve must be facing upward toward the
palm of the glove.
  Place the glove’s rolled cuff edge at the seam that connects the sleeve to the gown cuff. Grasp the
bottom rolled cuff edge of the glove with the thumb and index finger of the hand the glove is on
top of.

Surgical Scrubbing Gloving

 Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing
towards you.

Step 4

 While holding the glove’s cuff edge with one hand, grasp the uppermost edge of the glove’s cuff
with the opposite hand.
 Surgical Scrubbing Gloving
 Grasp the uppermost edge of the glove’s cuff with the opposite hand.

Step 5

 Continuing to grasp the glove, stretch the cuff of the glove over the hand.
 Using the opposite sleeve covered hand, grasp both the glove cuff and sleeve cuff seam and pull
the glove onto the hand. Pull any excessive amount of glove sleeve from underneath the cuff of
the glove.
 Surgical Scrubbing Gloving
 Pull the glove over the hand.

Step 6

 Using the hand that is now gloved put on the second glove in the same manner. Check to make
sure that each gown cuff is secured and covered completely by the cuff of the glove.
 Surgical Scrubbing Gloving
 Pick up the glove
 Surgical Scrubbing Gloving
 Place it on the sleeve, fingers pointing towards you
 Surgical Scrubbing Gloving
 Pull the gloves over the hand

Step 7

 Adjust the fingers of each glove as necessary so that they fit appropriately.
 Surgical Scrubbing Gloving
 Adjust the gloves to ensure they fit well.
 1. Keep your hands in your sleeves so that you do not touch the glove on the outside of the gown
with your bare hands.
2. Keep your hands above your waist and in front of you
3. Ensure you do not touch anything around you that is not sterile – this includes your face, mask,
and hat!

Final tie

1. There is a cardboard slip holding two ties together across the front of the gown.

2. Detach the cardboard slip from the short tie, ensuring you keep hold of the short tie in your left hand.

3. Now pass the cardboard slip to the theatre assistant, ensuring not to make direct contact with their
hand.

4. They will pass the tie around your back – now take the tie, and let them pull the cardboard off the tie so
that you can tie a bow at your waist.

Surgical gowning

 Detach cardboard slip from short tie and pass to assistant

 Surgical gowning
 Turn whilst the assistant holds the cardboard
 Surgical gowning
 Detach the tie from the cardboard