Impact of methods and duration of surgical hand scrub on bacterial count: A randomized controlled trial


      • The nail brush used during surgical hand scrub is not necessary.
      • There was no difference between the effects of one-minute and two-minute scrub on bacterial count.
      • The findings help to avoid unnecessary practices of surgical hand scrub and minimize its duration.


      There is no standard protocol for surgical scrubbing. This study aims to compare the effectiveness of surgical hand scrub duration and method by analyzing their effects on bacterial count.


      The study was conducted on 180 surgical nurses and surgeons. While the duration of surgical hand scrub in Groups I and II was one minute, participants in Group I used a nail brush, whereas Group II did not. Similarly, the duration of surgical hand scrub in Groups III and IV was two minutes, but Group III used a nail brush, whereas Group IV did not. Bacterial count on the hands of all participants was measured before and after the surgical hand scrub and after the surgery by using the glove juice method.


      Bacterial count on the hands of the participants in Group III after surgical hand scrub was significantly higher than Group IV (P < .001). We did not find any statistically significant difference between Group II and Group IV in terms of bacterial count on the hands immediately after surgical hand scrub and after the surgery (P = .401, P =.658, respectively).


      This study found that brushing during surgical hand scrub increased the number of bacteria on the hand. Besides, one-minute surgical hand scrub was equally effective as two-minute scrub to reduce the number of bacteria on the hand.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gök F.
        • Kabu Hergül F.
        • Özbayır T.
        Surgical hand washing: a systematic review.
        Int J Antisep Disinfect Steril. 2016; 1: 23-32
        • Tanner J.
        • Khan D.
        • Walsh S.
        • Chernova J.
        • Lamont S.
        • Laurent T.
        Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.
        J Hosp Infect. 2009; 71: 234-238
        • Tanner J.
        • Dumville JC.
        • Norman G.
        • Fortnam M.
        Surgical hand antisepsis to reduce surgical site infection.
        Cochrane Database Syst Rev. 2016; 22 (No.: CD004288): 13-25
        • Abdelatiff DA.
        • El-Haiyk KS.
        • Noura HG.
        • El-Qudaa RF.
        • El-Sabouni RS.
        Comparing of using sterile brush during surgical scrubbing versus brushless for surgical team in operating room.
        Life Sci J. 2014; 11: 387-393
        • Okgün Alcan A.
        • Demir Korkmaz F.
        Comparison of the efficiency of nail pick and brush used for nail cleaning during surgical scrub on reducing bacterial counts.
        Am J Infect Control. 2012; 40: 826-829
        • da Cunha ÉR.
        • Matos FGOA.
        • da Silva AM.
        • de Araújo EAC.
        • Ferreira KASL.
        • Graziano KU
        The efficacy of three hand asepsis techniques using chlorhexidine gluconate (chg 2%).
        Revista da Escola de Enfermagem da USP. 2011; 45: 1440-1445
        • Carro C.
        • Camilleri L.
        • Traore O.
        • et al.
        An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing.
        J Hosp Infect. 2007; 67: 62-66
        • Loeb MB.
        • Wilcox L.
        • Smaill F.
        • Walter S.
        • Duff Z.
        A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone.
        Am J Infect Control. 1997; 25: 11-15
        • Hobson DW.
        • Woller W.
        • Anderson L.
        • Guthery E.
        Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application.
        Am J İnfect Control. 1998; 26: 507-512
        • Aksoy A.
        • Cağlayan F.
        • Çakmak M.
        • et al.
        An investigation of the factors that affect surgical hand disinfection with polyvidone iodine.
        J Hosp Infect. 2005; 61: 15-19
        • Atkinson Smith M.
        • Dahlen NR
        Clinical practice guideline surgical site infection prevention.
        Orthopaedic Nursing. 2013; 32: 242-248
        • World Health Organization (WHO)
        Global guıdelines for the prevention of surgical site infectıon.
        2018: 95-101 (Available at: November 2019)
      1. An APIC Guide, (2010) ‘‘Guide to the elimination of orthopedic surgical site infections’’, pp.43. Son erişim tarihi: 5 Mart 2020.

        • World Health Organization
        Guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care İs Safer Care.
        Switzerland World Health Organization, Geneva2009: 54-153 (Available at: March 2020)
      2. Centers for Disease Control and Prevention (CDC), Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force’’,2002, Available at:March 2020.

        • Goldberg JL.
        Guideline implementation: hand hygiene.
        AORN J. 2017; 105 (Available at:March 2020): 203-212
        • Spruce L.
        Back to basics: hand hygiene and surgical hand antisepsis.
        AORN J. 2013; 98: 449-460
        • National Institute for Health and Clinical Excellence (NICE)
        Surgical Site Infections: Prevention and Treatment.
        11 April 2019: 8 (Available at:March 2020)
        • Wheelock SM.
        • Lookinland S.
        Effect of surgical hand scrub time on subsequent bacterial growth.
        AORN J. 1997; 65: 1087-1098
        • O'shaughnessy M.
        • O'Malley V.P.
        • Corbett G.
        • Given H.F.
        Optimum duration of surgical scrub-time.
        Br J Surg. 1991; 78: 685-686
        • Pereira LJ.
        • Lee GM.
        • Wade KJ.
        An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts.
        J Hosp Infect. 1997; 36: 49-65
        • Pereira LJ.
        • Lee GM.
        • Wade KJ.
        The effect of surgical handwash routines on the microbial counts operating room nurses.
        Am J Infect Control. 1990; 18: 354-364
        • O'Farrell DA.
        • Kenny G.
        • O'sullivan M.
        • Nicholson P.
        • Stephens M.
        • Hone R.
        Evaluation of the optimal hand-scrub duration prior to total hip arthroplasty.
        J Hosp Infect. 1994; 26: 93-98
        • Matuka DO.
        • Binta B.
        • Carman HA.
        • Singh T.
        Staphylococcus aureus and escherichia coli levels on the hands of theatre staff in three hospitals in johannesburg, south africa, before and after handwashing.
        S Afr Med J. 2018; 108: 474-476
        • American Society for Testing and Materials
        ASTM E1115-10. Standard test method for evaluation of surgical hand scrub formulations.
        ASTM, West Conshohocken, PA2010
        • Tsai JC.
        • Lin YK.
        • Huang YJ.
        • et al.
        Antiseptic effect of conventional povidone–iodine scrub, chlorhexidine scrub, and waterless hand rub in a surgical room: a randomized controlled trial.
        Infect Control Hosp Epidemiol. 2017; 38: 417-422
        • Hsieh HF.
        • Chiu HH.
        • Lee FP.
        Surgical hand scrubs in relation to microbial counts: systemic literature review.
        J Adv Nursing. 2006; 55: 68-78
        • Kappstein I.
        • Schulgen G.
        • Waninger J.
        • Daschner F.
        Microbiological and economic studies of abbreviated procedures for surgical hand disinfection.
        Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 1993; 64: 400-405
        • Kramer A.
        • Hübner N.
        • Below H.
        • Heidecke C.D.
        • Assadian O.
        Improving adherence to surgical hand preparation.
        J Hosp Infect. 2008; 70: 35-43
        • Ataee RA.
        • Tavana AM.
        • Khatami SM.
        • Baghmaleki FA.
        • Miry LS.
        The study effects of the hand washing on hands bacterial flora in operating room.
        J Health Policy Sustainable Health. 2014; 1: 33-37
        • Dabare MI.
        • Dissanayake DMBT.
        • Weerasekera D.
        • Mahendra R.
        • Fernando N.
        The efficacy of surgical scrubs in reducing hand bacterial flora.
        Ceylon J Med Sci. 2004; 47: 1-6
        • Privitera GP.
        • Costa AL.
        • Brusaferro S.
        • et al.
        Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: a systematic review and meta-analysis.
        Am J Infect Control. 2017; 45: 180-189
        • Yoshii T.
        • Hirai T.
        • Yamada T.
        • et al.
        A prospective comparative study in skin antiseptic solutions for posterior spine surgeries: chlorhexidine-gluconate ethanol versus povidone-iodine.
        Clin Spine Surg. 2018; 31: 353-356
        • Furukawa K
        • Ogawa R
        • Norose Y
        • Tajiri T.
        A new surgical handwashing and hand antisepsis from scrubbing to rubbing.
        J Nippon Med School. 2004; 71: 190-197