Interdisciplinary Clinical Practice Manual, Infection Control, Hand Hygiene, IFC001Effective Date: 05/26/2009 Page 1 of 4 Appendix A: Surgical Hand Scrub/Hand Rub Procedure Appendix A: Surgical Hand Scrub/Hand Rub Procedure A. An antiseptic surgical hand scrub or antiseptic hand rub shall be performed before gowning and gloving preoperatively. B. The purpose of the surgical hand scrub/rub is to: 1. Remove debris and transient microorganisms from the nails, hands, and forearms, 2. Reduce the resident microbial count to a minimum, and 3. Inhibit rapid rebound growth of microorganisms. C. All personnel performing or assisting with surgical procedures shall perform a surgical hand scrub/rub according to the procedure below. D. Hospital Epidemiology & Infection Control Committee (HEIC) shall approve antiseptics and/or surgical hand scrub/rub products. E. PROCEDURE 1. In preparation for surgical hand scrub or hand rub: a. All personnel shall meet the requirements of the surgical attire policy prior to beginning the surgical scrub or hand rub (see The JHH ICPM PAT009 Surgical Attire Policy) b. Apply mask covering nose and mouth, and facial hair, if applicable. c. Remove all jewelry from hands and arms. d. Tuck all hair, ear and neck jewelry into scrub cap/scrub clothes. e. Fingernails shall not extend past the fingertips. Artificial nails (including, but not limited to bonding, tips, wrappings and tapes), acrylics and foreign bodies embedded in nails are not permitted. Intact nail polish may be worn on short natural nails (i.e. no scratches, chips per the CDC Guideline for Hand Hygiene in Healthcare Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm ). f. The skin shall be free of cuts and/or draining wounds. g. Adjust water flow to a comfortable temperature. h. For surgical hand scrub procedure using a brush or sponge, proceed to Step 2. For hand rub procedure using surgical antiseptic hand prep, proceed to Step 3. 2. Surgical hand scrub using anatomical scrub or a counted brush stroke method (time to complete is 3 – 5 minutes). a. Tear open sponge and expose nail cleaner. b. Place packet on shelf above sink, open side up. c. Wet hands and arms. d. Wash with hospital-approved soap and water to remove transient flora and gross contamination. e. Clean fingernails under running water-using disposable nail cleaner. f. Discard nail cleaner into the trash can beside the scrub sink. g. Rinse hands and forearms under running water-keeping hands higher than elbow. h. Remove the sterile disposable surgical scrub brush-sponge from its wrapper. i. Moisten the sponge under running water by squeezing and releasing it. j. With the fingertips together, give the nails approximately 20-30 strokes with the brush. • The drawing below demonstrates the anatomical areas to be scrubbed. Approximately 10- 20 strokes are to be given to each skin area. This can be accomplished by scrubbing the outer Interdisciplinary Clinical Practice Manual, Infection Control, Hand Hygiene, IFC001Effective Date: 05/26/2009 Page 2 of 4 Appendix A: Surgical Hand Scrub/Hand Rub Procedure surface of the finger "A"; moving the brush to the front, "B"; over the tip of the back, "C", then to "D", or the webbed surface. This helps keep clean to clean throughout the scrub. k. Scrub the side surface of the hand, moving the brush to the palm, base of the thumb and to the back of the hand. A light but firm pressure is suggested. l. Scrub each plane of the forearm in a circular motion continuously from wrist to two (2) inches above the elbow (see below). • Note: During the procedure, arms are held at right angle to the body. This is to prevent recontamination of an area cleansed and allow solution to flow off the arm at the elbow level. m. Repeat the scrub to the other hand and arm (repeat Steps 2i-l). n. Discard scrub sponge in the proper receptacle, not the sink. Interdisciplinary Clinical Practice Manual, Infection Control, Hand Hygiene, IFC001Effective Date: 05/26/2009 Page 3 of 4 Appendix A: Surgical Hand Scrub/Hand Rub Procedure o. Rinse well under running water, always keeping hands raised above elbow level, beginning with the fingertips, then the hands, forearm, and elbow. Avoid splashing scrub attire. p. After the final rinse, turn water off with knee control, if applicable, and allow residual water to drip into the sink. • Note: Hold hands higher than elbows and away from scrub attire. Keep scrubbed hands and arms in view to avoid contamination; back into operating room. q. In the operating room, dry hands and arms with a sterile towel before donning a sterile surgical gown and gloves. 3. Surgical hand rub using waterless, alcohol-based antiseptic hand prep a. The first use of the day: i. Wash hands and arm with hospital-approved soap and water to remove transient flora and gross contamination. ii. Clean fingernails under running water-using disposable nail cleaner. iii. Discard nail cleaner into the trash can beside the scrub sink. iv. Rinse hands and forearms under running water. v. Dry hands and arms. b. Dispense 2 ml, one-foot pump, of antiseptic hand prep into the palm of one hand. Do not use water with hand prep. c. Dip the fingertips of opposite hand into hand prep and work it under the nails. d. Spread the remaining hand prep evenly over the hand and up to just above the elbow covering all surfaces. e. Using another 2 ml of hand prep, repeat Step 3c with the other hand and arm. f. Dispense another 2 ml of antiseptic hand prep into either palm and reapply to all aspects of both hands up to the wrists. g. To facilitate drying, continue rubbing antiseptic hand prep into hands until dry. h. Keep scrubbed hands and arms in view to avoid contamination; back into operating room. i. Allow to dry before donning gloves. 4. Follow Steps 3b-h for subsequent hand rub before gowning and gloving preoperatively. 5. Special Considerations a. Aseptic principles for surgical hand scrub include: i. Begin at the fingertips and continue on to the hands, forearms and elbow areas. ii. Once an area is completed, never return to an area previously scrubbed. iii. Keep hands and forearms at an angle allowing water to flow from clean to unclean areas. iv. Keep hands and arms in view above waist and below clavicle area. v. After completion of the hand scrub avoid touching non-sterile objects, faucet, sink, door handles etc. vi. Wash hands with soap and water after surgical procedure. b. Aseptic principles for surgical hand rub include: i. Begin at the fingertips and continue on to the hands, forearms and elbow areas. ii. Keep hands and arms in view above waist and below clavicle area. iii. After completion of the hand rub avoid touching non-sterile objects, faucet, sink, door handles etc. iv. Wash hands with soap and water after surgical procedure. Interdisciplinary Clinical Practice Manual, Infection Control, Hand Hygiene, IFC001Effective Date: 05/26/2009 Page 4 of 4 Appendix A: Surgical Hand Scrub/Hand Rub Procedure Communication and Education 1. Operating Room, Cardiovascular Diagnostic Lab, Obstetrics & Gynecologic Nursing shall disseminate policy to staff. References 1. AORN. (2009). Standards, Recommended Practices and Guidelines. AORN, Inc. 2. Healthcare Infection Control Practices Advisory Committee & HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. (2002). Guideline for hand hygiene in health-care settings. MMWR, 51(RR16), 1-44. Retrieved September 2, 2004 from Centers for Disease Control and Prevention website http://www.cdc.gov/ncidod/hip/ guide/InfectControl98.pdf.