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:
- Remove rings, watches, and bracelets before beginning surgical hand antisepsis.
- Remove debris from underneath fingernails using a nail on the other hand.
- Natural nails should be kept short (tips < 0.5 cm long).
- Artificial fingernails or extenders should not be worn
- Wet hands and forearms with warm running water.
- Apply plain soap to hands and forearms.
- Wash hands and forearms by rubbing vigorously (frictional scrub) - see Figure 1.
- Usually 40 to 60 seconds.
- Dry hands and forearms thoroughly with a single-use towel.
- Use towel to turn off the faucet.
- Stage II steps:
- Apply enough alcohol-based product to the palm of one hand to cover all surfaces (hands/forearms).
- Rub hands and forearms vigorously (frictional scrub) until dry – see Figure 2.
- Usually 20 to 30 seconds
- When hands and forearms are dry, don sterile surgical gloves.
Option 2 - Surgical antiseptic handwash
- Steps:
- Remove rings, watches, and bracelets before beginning the surgical hand antisepsis.
- Remove debris from underneath fingernails using a nail on the other hand.
- Natural nails should be kept short (tips < 0.5 cm long).
- Artificial fingernails or extenders should not be worn.
- Wet hands and forearms with warm running water.
- Apply a 5 to 10% povidone iodine formulation to hands and forearms.
- Wash the hands and forearm by rubbing vigorously (frictional scrub) – see Figure 1.
- Usually 2 to 5 minutes.
- Rinse hands and forearms with warm running water.
- Dry hands and forearms thoroughly with a single use towel.
- Use towel to turn off faucet.
- When hands and forearms are dry, don sterile surgical gloves.