# Scrubbing & Gowning

## Overview

Infection Prevention and Control (IPC) during procedures includes the safe management of ‘sharps’, encompasses high-level measures such as health facility design and management, protocol-based measures such as adherence to national and facility level guidelines, and individual actions by each health care provider and ancillary staff member. The health care provider is encouraged to familiarise themselves with their facility’s specific IPC protocols and reporting systems, which is outside the scope of this module.

All clinical procedures pursue the IPC goal of asepsis. The traditional hierarchy of sterile, aseptic, and clean is outdated, poorly-defined and misleading, and is no longer recommended. This module describes how to perform surgical scrubbing, how to perform the closed gloving technique, and how to gown for theatre.

## Indications

1. Any theatre procedure or procedure requiring surgical asepsis

## Contraindications

1. Do not scrub in if you have

   open wounds
   open wounds

   If you can cover minor wounds with a waterproof dressing, you can still scrub safely.

   on your hands or forearms.

## Patient information and consent

### How do I explain this procedure?

“I need to wash my hands and dress in a gown and gloves for the operation, to create a sterile environment for your procedure.”

### What can my patient expect?

“Once I am wearing gloves and a gown, I cannot touch you apart from the cleaned site of the procedure.”

### What is my patient’s role?

“Cooperate with the anaesthetist and theatre staff who will make you comfortable and help you prepare for surgery.”

## Preparation

You must wear theatre scrubs, a hat and booties, and a plastic apron if necessary. Put on a

surgical mask

surgical mask

Ensure that your face mask is fitted correctly, applying a piece of tape over the mask at the bridge of the nose if needed to prevent fogging of your glasses or visor.

and eye protection, and remove any dangling objects such as stethoscopes and identity cards before scrubbing.

Make the theatre staff aware that you will be scrubbing in, and tell them your glove size and whether you prefer to double glove.

## Site and Positioning

Do not wear artificial nails or nail polish. To wash your arms up to your elbows, remove any jewellery or watches and roll up your sleeves if they cover your elbows.

## Scrubbing

1. If this is your first scrub of the day, take a nail brush and open it (if not, skip to step 8). Leave it in its open packet beside your scrubbing area.

2. Open the tap. Wet your hands and forearms with water and use your elbow to dispense soap into your opposite hand. Wash and rinse your hands and forearms up to your elbows.

3. Pick up the nail brush. If there is a

   nail pick
   nail pick

   Using a nail pick may not necessarily reduce bacterial carriage on the hands, but is not harmful, and should probably be done with the first scrub of the day.

   with it, use it now to clean under your nails and discard it in the bin.

4. Moisten the brush and use your elbow to dispense soap onto the sponge-side.

5. Use the sponge to wash

   each finger
   each finger

   Think of each finger as a long box and wash each of the four sides of the box.

   . Do not use the brush, as this may cause micro-abrasions.

6. Wash the nails of both hands with the brush-side.

7. Discard the nail brush.

8. Use your elbow to dispense one pump of soap into your hand.

9. Rub your flat palms together.

10. Rub the back of each hand with the palm of the other, fingers interlaced.

11. Rub your palms together, fingers interlaced.

12. Rub the backs of your fingers with your palms by interlocking your hands.

13. Rub each thumb by holding it with the other hand and making twisting movements.

14. Rub the fingertips of each hand in circles on each palm in turn.

15. Rub up each arm to just below the elbow.

16. Rinse, letting water run down from your hands to your elbows.

17. Repeat steps 8-16 twice more. For the first repetition, wash only halfway up your forearms. For the second repetition, wash only up to your wrists.

18. Go to the gowning area.

19. Take a sterile paper towel from the gowning area and dry from your fingertips to just below your elbow. Don’t dry back down your arm from your elbow. Use a blotting movement, not a rubbing movement.

20. Discard the paper towel and dry your other hand and arm with a new paper towel. Proceed to 'gowning'.

## Gowning

1. Grasp the gown by the inside of the back, step away from the gowning area, and allow it to fall open.

2. Grasp the insides of the shoulders and put your arms into the sleeves. Insert until your fingers are inside the cuffs, but not protruding from the cuff opening.

3. A theatre assistant will fasten your gown behind your back. Proceed to 'gloving'.

## Gloving & Tying

When gloving and gowning for theatre, use the closed method to glove.

1. With your hands still inside the cuffs (no fingers protruding), open the glove packet and remove the glove of your dominant hand. Hold items through the fabric of your gown.

2. Place the glove in your non-dominant hand with the palm of the glove facing down, fingers pointing towards you. Tuck the thumb of your non-dominant hand inside the bottom cuff.

3. Grasp the top of the cuff with your dominant hand, with your fingers on top and your thumb tucked in under the cuff (thumb to thumb).

4. Pull the glove over your dominant hand, finally letting your dominant hand’s fingers slide out of the gown and into the fingers of the glove. Help your fingers into the glove with your non-dominant hand through the fabric of the gown.

5. Put on the other glove in the same way as the first.

6. Adjust your gloves and sleeves for comfort.

7. Hand a theatre assistant the tie of your gown. They may take it by the white tag. They should not directly touch you.

8. Turn around so that the gown wraps closed around you.

9. While the assistant holds onto the tag, pull on the tie so the tag slips off and is discarded.

10. Make a bow with the two ties on the gown just above your hip.

11. To prevent accidental contamination, keep your hands above waist level and interlocked.

## Troubleshooting

I am unsure if I can use surgical hand rub for scrubbing.

Some theatres allow you to use surgical hand rub instead of soap and water as long as you used soap and water for your first scrub of the day. Follow the same steps as above, without using a nail brush.

I broke sterility.

Unfortunately, if you become contaminated, you may have to start over. Inform the assisting theatre nurse, who may guide you as to which parts need to be repeated.

I am unsure of my glove size.

Your glove size is roughly the measurement around the palm of your hand above your thumb in inches. Women are often a size 6-7 and men a size 7-8.

## Risks

1. Breaking sterility, risking surgical site infections

## References

1. The Association for Perioperative Practice. A guide to surgical hand antisepsis [Internet]. 2014.

2. The Association for Perioperative Practice. Infection control. In: Standards and Recommendations for Safe Perioperative Practice [Internet]. 2020.