Previous section | Next section

Surgical hand antisepsis

Evidence‐based approaches

Surgical hand antisepsis is the antiseptic surgical scrub or antiseptic handrub performed before donning sterile attire pre‐operatively. The aim is to reduce the number of resident and transient flora to a minimum and also to inhibit their regrowth for as long as possible, not just on the hands but also on the wrists and forearms (AfPP [2]).
Surgical hand antisepsis can be performed using an approved antiseptic surgical scrub such as chlorhexidine gluconate or povidone‐iodine, or an approved alcohol‐based handrub. There is evidence that alcohol‐based handrub is favourable over soap and water as it has a wide spectrum of activity and better dermal tolerance, and removes the risk of contamination from rinse water (NHS England and NHSI [82]). The practitioner should choose between use of soap and water or alcohol‐based handrub as the two procedures should not be combined.
Whichever cleansing agent is used, the hands should be physically clean prior to surgical antisepsis, so any dirt should be removed from the skin or under the nails using ordinary soap and water and a nail pick before entering the theatre (Box 4.2).
Box 4.2
Key steps before starting surgical hand preparation
  • Keep nails short and pay attention to them when washing hands – most microbes on hands come from beneath the fingernails.
  • Do not wear artificial nails or nail polish.
  • Remove all jewellery (rings, watches and bracelets) before entering the operating theatre.
  • Wash hands and arms with a non‐medicated soap before entering the operating theatre area or if hands are visibly soiled.
  • Clean subungual areas with a nail file. Preferably nailbrushes should not be used as they may damage the skin and encourage shedding of cells. If used, nailbrushes must be sterile and single use. Reusable autoclavable nail brushes are available.
Source: Adapted from WHO ([124]).
The principle behind surgical hand antisepsis is to clean the skin thoroughly, moving from the cleanest part (the hands) to the least clean part (the forearm). The procedure should be carried out immediately prior to gowning and gloving for a surgical intervention (AfPP [2]). Each step consists of five strokes rubbing backwards and forwards (AfPP [2]). Hands and forearms should be washed for the length of time recommended by the manufacturer of the alcohol‐based handrub or antimicrobial antiseptic solution (WHO [124]).
Previous section | Next section