Dorset Primary Care Trust

POLICY ON SCRUBBING UP, GOWNING AND GLOVING

Date of Issue February 2008

Date of Review December 2010

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DOCUMENT HISTORY

Document Status: Current

Developed by: Dorset Primary Care Trust Theatre Network Group

Policy Number ID 599, Version 2.0

Date of Policy February 2008

Next Review Date December 2010

Dorset Primary Care Trust Theatre Network
Sponsor
Group
Clinical Policy Review Group,
Approved by / on
22 January 2008
Clinical Governance and Risk Group,
Approved by / on
31 January 2008

Version Date Comments

1.0 March 2004

22 January 2008 Approved Clinical Policy Review Group

2.0
31 January 2008 Approved Clinical Governance and Risk Group

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CONTENTS

1. POLICY STATEMENT ................................................................................................ 1

2. INTRODUCTION ........................................................................................................ 1

3. RESPONSIBILITY ...................................................................................................... 1

4. BEFORE SCRUBBING UP......................................................................................... 1

5. SCRUBBING UP......................................................................................................... 1

6. GOWNING AND GLOVING ....................................................................................... 2

7. REFERENCES ........................................................................................................... 3

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POLICY ON SCRUBBING UP, GOWNING AND GLOVING

1. POLICY STATEMENT

1.1 Patient care will be delivered without discrimination, regardless of gender/

transgender, race, disability, sexual orientation, age, religion/belief or cultural
practice.

1.2 Information will be given to all patients and carers in a way in which they can
understand it.

2. INTRODUCTION

2.1 The scrub up procedure should be effective against resident flora as well as transient
micro-organisms, ensuring that hands and forearms are cleaned thoroughly prior to
donning sterile gown and gloves.

3. RESPONSIBILITY

3.1 All theatre personnel who ‘scrub up’ are responsible for ensuring that this policy is
followed.

4. BEFORE SCRUBBING UP

4.1 Before scrubbing up ensure that all nails are short, clean and free from varnish

4.2 Any staff with lesions on their hands or arms or any staff who are suffering from an
upper respiratory infection MUST report this to the Senior Nurse on duty before
scrubbing up. Any infection may endanger the patient by increasing the risk of post-
operative infection. Minor lesions should be covered by a waterproof occlusive
dressing.

5. SCRUBBING UP

5.1 The Scrubbing up procedure must only take place at sinks with elbow taps in situ.

5.2 Avoid splashing surgical attire, if surgical attire becomes excessively wet this can
compromise the protection afforded by the gown. It may be necessary to change
attire before scrubbing again.

5.3 Set the water running and adjust the flow so that it does not splash back on to theatre
clothing.

5.4 DO NOT allow hands to fall below elbow level from this point.

5.5 Hands should be washed with plain antimicrobial solution before beginning surgical
scrub at the start of the day.

5.6 Nails may be cleaned if necessary using a disposable pick under running water. Use
of a scrubbing brush is not recommended.

5.7 It is advocated that washing should last three minutes in total when using Hibiscrub
or Betadine according to manufacturers instructions.

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5.8 When rinsing between each wash, water MUST run from finger tips to the elbow
(i.e. clean to dirty.)

5.9 Starting with finger tips and working to the elbow crease, wet hands and arms, then
wash as follows:

5.10 The six steps of hand washing should be used for scrubbing .

• Palm to palm

• Right palm over left dorsum and left palm over right dorsum

• Palm to palm, fingers interlaced.

• Backs of fingers to opposing palms with fingers interlocked

• Rotational rubbing of right thumb clasped in left palm and visa versa

• Rotational rubbing backwards and forwards with clasped fingers of right hand
in left palm and visa versa.

Preliminary Wash Wet hands and arms before applying scrub solution. Using elbow,
dispense approximately 5 ml of Betadine or Hibiscrub and wash
hands and forearms to the elbows for one minute, then rinse.
Main Wash Dispense a further 5 ml of Betadine or Hibiscrub and wash to mid
forearms for one minute. Wash in a circular motion around the
circumference of the arm, then rinse.
Final Wash Dispense a further 5 ml or Betadine or Hibiscrub and wash to mid
forearms one minute ensuring adequate cleansing between digits and
skin folds, then rinse.

5.11 Turn off taps using elbows, whilst keeping hands elevated.

5.12 Approach the gown pack and pick up one towel. Dry hand and arm moving
progressively from fingertips to elbow (clean to dirty). DO NOT return to the finger
tips with the same towel. DO NOT at any time scrub the towel up and down the arm.

5.13 Pick up the remaining towel and repeat process on the other arm.

5.14 Each used hand towel should be discarded into the foot operated bin.

5.15 Alcohol rubs. These are an acceptable alternative to repeated washing and
proceeding directly from one case to another. This involves a simple hand wash at
the start of day or whenever hands are visibly soiled, then apply alcohol solution to all
areas of the hands and allow it to evaporate. Manufacturers recommend two
applications.

6. GOWNING AND GLOVING

6.1 Hands MUST NOT touch the outside of the gown or gloves, as they cannot be
rendered sterile.

6.2 Lift the gown from the pack and open it up away from any personal theatre clothing
and obstructions within the surrounding area.

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6.3 Plunge arms into the sleeves ensuring that hands are not pushed out past the
cuffs. Grip the inner side of the gown to prevent this from happening. The
circulating nurse will pull the gown over the shoulders and tie in.

6.4 Whilst keeping hands inside the gown, pick up the left glove with the right hand
and place it on the left hand. Ensure that the glove thumb is in line with the thumb
and that the glove fingers are facing up the forearm. Stretch the glove cuff over the
gown cuff and fist, pull back on the gown and slide digits into the glove fingers.

6.5 Repeat procedure for the other glove.

6.6 Walk into the theatre ensuring that hands are elevated and close into the body.
(clasping hands together helps).

6.7 The wrap around tie should be offered to an already scrubbed member of the team.
Where disposable gowns are used the paper tag may be taken by un-scrubbed
personnel.

7. REFERENCES

West Dorset General Hospital Policy, Policy for Scrubbing up March 2004

Tanner J, Blunsden C, Fakis A 2007 National Survey of Hand Antisepsis Practises Journal
of Perioperative Practice 17{1}27-37

NATN 2004 NATN Standards and Recommendations Harrogate, NATN

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POLICY APPROVED BY:

JOB TITLE PRINTED NAME SIGNATURE DATE

Clinical Policy
Review Group
Hilary Lawson
Signed by Chair on
Behalf of the Group

POLICY AUTHORISED BY

PRINTED NAME SIGNATURE DATE

Ian Brennan
AUTHORISING
Associate Director of
MANAGER
Community Health
(First)
Services

Brian Goodrum,
AUTHORISING
Associate Director of
MANAGER
Mental Health
(Second)
Services

AUTHORISING
MANAGER
(Third)*

DATE APPLICABLE

REVIEW DATE

PERSON
RESPONSIBLE
FOR REVIEW

* if applicable

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PART 1-Screening

EQUALITY IMPACT ASSESSMENT FORM

Department/Service area: Provider Services

Policy Sponsor: Theatre Network Group, Dorset Primary Care

Trust

Name of the policy/protocol: Policy on Scrubbing Up, Gowning and

(please attach a copy) Gloving

Which target groups are affected by

a) Gender/transgender
this policy/protocol
b) Race
(delete as appropriate)
c) Disability
d) Sexual Orientation
e) Age
f) Religion/Belief
Please indicate if this affects staff,
a) Staff
patients or both
b) Patients
(delete as appropriate)
c) Both
If any groups are excluded please Relevance to staff only
state why.

Can the policy be implemented on a differential basis to any of the following target groups?
Please tick 9yes or no and provide appropriate evidence.

Equality Target Evidence to support your decision

YES NO
Groups (see Apendix 1 for sources of evidence)

Gender/transgender 9

Race
(BME communities) 9

Disability 9
Sexual orientation
(lesbian, gay men or 9
bisexual)
Age
(older people, young 9
people/children)

Religion/Belief 9

1
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If you have identified evidence of an impact for any of the above target groups, consultation
with the appropriate organisations should take place to identify if there is any differential
impact from the service development or policy implementation.
EVIDENCE OF CONSULTATION
Equality Target Name of
Date
Groups Appropriate Outcome/Agreed Action
Consulted
Body

Gender/transgender

Race
(BME communities)

Disability

Sexual orientation
(lesbian, gay men or
bisexual)
Age
(older people, young
people/children)

Religion/Belief

If no evidence of differential experiences has been identified, the Equality Impact

Assessment has been completed. If differential experience has been identified then Part 2
the full assessment should be completed.

Signed by Writer/Reviewer:
Name (print) H Lawson T Deadman
Signed by Sponsor:
Name (print)
Date completed: 7 February 2008
Name (print) I Brennan
Date completed 11 February 2008
Date of next policy review: December 2010

Completed copies of Equality Impact Assessments should be sent to the nominated equality
coordinator within the Human Resources and Workforce Development.

A signed hard copy should be submitted with the policy or service development plan when it
is presented for approval. A hard copy and an electronic copy should be kept within your
department for audit purposes.

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