It is imperative that during surgical procedures, infection control and prevention are maintained at all times. The area immediately around the patient and the instrument trolley is known as the ‘sterile field’. Only those staff who have put on sterile gloves and gowns after washing and decontaminating their hands and forearms (‘scrubbing up’) can enter the sterile field. Pre‐surgical hand washing or scrubbing up (Figure 16.29) is an essential step in the prevention of infection during surgery (see Chapter c04: Infection prevention and control).

The aims of surgical hand antisepsis are to remove dirt and transient micro‐organisms and to reduce (to a minimum) resident micro‐organisms on the hands, nails and forearms (AORN [20]). For minor surgical procedures, current research supports 1‐minute hand washing with a non‐antiseptic soap followed by hand rubbing with liquid aqueous alcoholic solution prior to the first procedure of the day and before any subsequent procedures (Liu and Mehigan [108], Santacatalina Mas et al. [182], Tanner et al. [199]). This has been shown to be as effective as traditional hand scrubbing with an antiseptic soap containing 4% chlorhexidine gluconate or 7.5% povidone‐iodine in preventing surgical site infection (Santacatalina Mas et al. [182], Tanner et al. [199]). However, for more major cases it is usual to perform surgical hand antisepsis using a solution containing either chlorhexidine or iodine. The duration of the wash is usually 2–5 minutes (AfPP [9]). The steps of hand scrubbing and hand rubbing are demonstrated in Figure 16.30.

Surgeons and staff who are working within the sterile field wear sterile surgical gowns. These gowns are designed to function as a sterile barrier between the wearer's body and the surgical field, and as protection for the wearer against exposure to blood, body fluids and tissue. The gown should be resistant to microbial and liquid penetration and minimize the release of particles (AfPP [9]).

Surgical gloves have a dual role, acting as a barrier to personal protection from the patient's blood and other exudates and preventing bacterial transfer from the surgeon's hands to the operating site. Surgical gloves must conform to international standards and different types are used for different procedures. It is essential that the glove is the correct size, not only for reasons of comfort but also for dexterity and sensitivity. It is common practice for surgeons and theatre staff to double glove. Evidence suggests that double gloving significantly reduces the number of perforations to the innermost glove, thus possibly reducing infection rates during surgical procedures (Tanner and Parkinson [200]).

Prior to skin incision, the skin of the patient is cleaned with an antiseptic solution. The purpose of this is to reduce the number of both transient and resident skin bacteria. Most surgical wound infections are caused by bacteria living on the patient's own skin. Several types of skin preparation are used; common choices include povidone‐iodine and chlorhexidine gluconate. These agents are included in either aqueous or alcoholic solutions. Which is used depends on both the condition of the patient's skin and whether they are allergic to either of the agents (AfPP [9]).

When a patient is transferred between the trolley or bed and the operating table, appropriate personnel should be present to ensure patient and staff safety (AfPP [9]). It is recommended that an approved sliding device is used to transfer patients from trolley to operating table, in compliance with national legislation on manual handling and local hospital policy and guidelines.

Safe manual handling and the safety of the patient depend on the participation of the correct number of staff in the specified handling manoeuvre. There should be a minimum of four staff: one at either end of the patient to support the head and the feet, and one on either side (Figure 16.31). Additional staff and/or specialist transfer devices may be required if the patient weighs over 90 kg.

Once the patient is in position, thromboprophylaxis devices can be applied (antiembolic stockings and/or pneumatic intermittent compression machine), as well as any pressure‐relieving devices (Figure 16.32).