Surgical Hand Scrub, Gowning & Gloving

The surgical hand scrub is the first step in preparing yourself as a sterile team member. Combined with gowning and gloving, it creates the sterile barrier between you and the patient.

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Surgical Hand Scrub Methods

Traditional (Timed) Scrub

• Duration: 3-5 minutes (per facility policy; no longer than 5 minutes — prolonged scrubbing damages skin)
• Uses an antimicrobial soap (CHG or povidone-iodine)
• Scrub from fingertips to 2 inches above the elbows
• Fingernails are cleaned with a disposable nail pick
• Use a sterile scrub brush/sponge for the first scrub of the day

Counted Stroke Method

• 30 strokes per surface (each finger has 4 surfaces, palm, back of hand, forearms)
• Provides a standardized, reproducible scrub regardless of timing
• Uses the same antimicrobial soap

Waterless (Alcohol-Based) Hand Antisepsis

• Accepted alternative under WHO and AORN guidelines
• Apply alcohol-based hand rub to dry hands (wash with soap and water first if visibly soiled)
• Rub hands and forearms until dry
• Faster than traditional scrubbing and less irritating to skin

Key Scrub Rules

• Remove all jewelry (rings, watches, bracelets) before scrubbing
• Fingernails must be short, clean, and free of artificial nails or nail polish
• Keep hands above elbows at all times during and after scrubbing
• Enter the OR with hands elevated and use a sterile towel to dry (pat, do not rub)
• Dry hands first, then forearms — always clean to dirty

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Gowning

After drying hands with a sterile towel, the surgical technologist dons the sterile gown:

1. Grasp the gown at the neckline and allow it to unfold fully, keeping it away from unsterile surfaces
2. Slide both arms into the sleeves simultaneously
3. Do NOT push hands through the cuffs if using closed gloving — keep fingertips inside the sleeves
4. The circulating nurse ties the back of the gown from behind

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Gloving Techniques

Closed Gloving (Preferred for scrubbed team members)

1. Keep hands inside the gown sleeves (fingertips at the cuff edge)
2. Using the gown-covered hand, pick up the glove for the opposite hand
3. Place the glove palm-down on the upturned gown cuff with the glove fingers pointing toward your body
4. Grasp the glove cuff through the gown material and stretch it over the gown cuff
5. Push your hand through the gown cuff and into the glove simultaneously
6. Repeat for the other hand

Open Gloving

• Hands are pushed through the gown cuffs before gloving
• Skin contacts only the inner surface of the glove during donning
• Used for procedures requiring gloves only (no sterile gown)

Assisted Gloving

• A scrubbed team member holds the glove open for another person (usually the surgeon)
• The glove is held with the fingers pointing down and the cuff stretched wide
• The surgeon pushes their hand into the glove while the assistant pulls the cuff over the gown cuff