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Hand Hygiene
Surgical Hand Antisepsis

Course Author(s): Barbara A. MacNeill, DMD, MS; Géza T. Terézhalmy, DDS, MA

Surgical Hand Antisepsis

The CDC concluded that performing surgical hand antisepsis by scrubbing the hands/forearms with a brush for 10 minutes can damage skin and result in increased shedding of microorganisms from the hands; scrubbing for 5 minutes is as effectively as a 10 minute scrub; scrubbing for 2 to 3 minutes reduces microbial counts to acceptable levels; and that neither a brush nor a sponge is necessary to reduce microbial counts on the hands of surgical personnel.2

The FDA, the CDC, and the WHO recommend performing either (1) a two-stage surgical hand antisepsis, i.e., handwashing with plain soap and water followed by antiseptic handrub, preferably with an alcohol-based formulation containing 0.5% to 1% chlorhexidine gluconate for persistent residual activity (Option 1); or (2) surgical antiseptic handwash with povidone iodine (Option 2).2,3,11,13 The use of antimicrobial-impregnated wipes (i.e., towelettes) in surgical hand antisepsis is inappropriate.

Option 1 – Two-stage surgical hand antisepsis

  • Stage I steps:
    1. Remove rings, watches, and bracelets before beginning surgical hand antisepsis.
    2. Remove debris from underneath fingernails using a nail on the other hand.
      1. Natural nails should be kept short (tips < 0.5 cm long).
      2. Artificial fingernails or extenders should not be worn
    3. Wet hands and forearms with warm running water.
    4. Apply plain soap to hands and forearms.
    5. Wash hands and forearms by rubbing vigorously (frictional scrub) - see Figure 1.
      1. Usually 40 to 60 seconds.
    6. Dry hands and forearms thoroughly with a single-use towel.
      1. Use towel to turn off the faucet.
  • Stage II steps:
    1. Apply enough alcohol-based product to the palm of one hand to cover all surfaces (hands/forearms).
    2. Rub hands and forearms vigorously (frictional scrub) until dry – see Figure 2.
      1. Usually 20 to 30 seconds
    3. When hands and forearms are dry, don sterile surgical gloves.

Option 2 - Surgical antiseptic handwash

  • Steps:
    1. Remove rings, watches, and bracelets before beginning the surgical hand antisepsis.
    2. Remove debris from underneath fingernails using a nail on the other hand.
      1. Natural nails should be kept short (tips < 0.5 cm long).
      2. Artificial fingernails or extenders should not be worn.
    3. Wet hands and forearms with warm running water.
    4. Apply a 5 to 10% povidone iodine formulation to hands and forearms.
    5. Wash the hands and forearm by rubbing vigorously (frictional scrub) – see Figure 1.
      1. Usually 2 to 5 minutes.
    6. Rinse hands and forearms with warm running water.
    7. Dry hands and forearms thoroughly with a single use towel.
      1. Use towel to turn off faucet.
    8. When hands and forearms are dry, don sterile surgical gloves.
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