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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Surgical Technology › OR Clinicals: Scrub Role Practice in the Surgical Suite › Lesson 2
HLT-SURG65-06 · Lesson 2 · 28 clock hours · demo

Surgical Attire, Hand Antisepsis, and Gowning/Gloving

Objective. Students perform a surgical hand scrub or waterless handrub and don a sterile gown and gloves using closed-glove technique without contaminating the sterile field.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Why Surgical Attire and Hand Antisepsis Matter

The surgical suite is a controlled environment designed to protect the patient from healthcare-associated infections. Every item a scrub surgical technologist (ST) wears or touches near an open wound can introduce microorganisms. Surgical site infections (SSIs) are a leading cause of patient harm. Your attire, your hands, your gown, and your gloves are the first line of defense. Mastering these skills before you touch a sterile field is not optional—it is a patient-safety imperative.

Surgical Attire: Dressing for the OR

Before entering the semi-restricted or restricted areas of the surgical suite, change into facility-laundered or single-use scrub attire. Cover all head and facial hair completely with a surgical cap or hood. Wear a surgical mask properly fitted over your nose and mouth whenever a sterile field is open or being set up. Shoe covers or designated OR shoes protect both you and the environment. Jewelry, nail polish, and artificial nails are prohibited—they harbor microorganisms that routine hand hygiene cannot reliably remove. Keep your scrubs clean and tucked to minimize particle shedding.

Surgical Hand Antisepsis: Scrub or Waterless Handrub

Surgical hand antisepsis reduces the resident and transient microbial flora on your hands and forearms so that, if a glove tears during a case, the patient's wound is not immediately exposed to high numbers of organisms.

Timed brush-stroke method (traditional scrub): Use a sterile, single-use brush or sponge impregnated with an approved antiseptic such as chlorhexidine gluconate (CHG) or povidone-iodine. Begin by cleaning under each fingernail with the nail pick. Then scrub all surfaces of each finger, the web spaces, the palm, the back of the hand, the wrist, and the forearm up to two inches above the elbow. A common facility standard is a timed scrub of three to five minutes for the first scrub of the day; follow your facility protocol exactly. Keep hands higher than elbows throughout so rinse water flows away from clean hands toward the elbow. Rinse without touching the sink or faucet.

Counted-stroke method: Instead of timing, you apply a set number of strokes to each anatomical area on each hand and arm. The sequence and count are facility-specific; follow the written protocol posted at the scrub sink. The goal is the same—thorough, consistent coverage.

Alcohol-based surgical handrub (waterless method): Some facilities use an alcohol-based product that does not require a brush. Clean under your nails with a nail pick and wash your hands with plain soap and water first. Then apply the product according to the manufacturer's directions, covering all hand and forearm surfaces and rubbing until completely dry. Do not wipe your hands dry with a towel—allow full evaporation. Check your facility's policy, because not all settings have approved this method.

After any surgical scrub method, carry your hands above elbow level and proceed directly to the OR without touching non-sterile surfaces.

Drying and Gowning

Inside the OR, a circulator will open your sterile gown pack onto a clean surface. Pick up the gown by the inside neck edge only. Step away from any table, unfold it away from your body, and identify the armholes. Slide both arms in simultaneously, keeping hands inside the cuffs—do not let your hands push through the cuff openings. The circulator fastens the back ties; you do not touch the back because it is not considered sterile. The front of the gown from the chest to table level and the sleeves to the cuff edge are sterile once donned.

Closed-Glove Technique

Closed-glove technique is the standard self-gloving method for the scrub ST and is required by most facilities. Your hands stay inside the gown cuffs throughout the entire process.

1. With your right hand still inside the cuff, pick up the left glove from the wrapper by grasping the cuff fold through the gown sleeve.

2. Lay the glove palm-down on your left forearm, fingers pointing toward your elbow, cuff fold facing outward.

3. Use your left hand (inside the sleeve) to hold the glove cuff open while your right hand (inside its sleeve) helps pull the glove cuff over the left gown cuff.

4. Work your left fingers into the glove as you extend your hand through the cuff.

5. Repeat the mirror process for the right glove using your now-gloved left hand to manage the cuff.

Critical safety rule: During closed-glove technique, your bare skin must never touch the outer surface of the sterile glove. Any such contact is a contamination break that requires starting over.

Assisted Gloving (Open-Glove Technique for a Partner)

When you assist another team member after you are already gloved and gowned, use open-glove assisted technique. Hold the glove open with your fingers under the cuff's exterior fold, thumbs out, and offer it to your partner. Look away as they insert their hand to avoid breathing toward the sterile field.

Common Contamination Errors to Avoid

If you are ever unsure whether contamination occurred, treat the item as contaminated. When in doubt, change out.

Key terms10

Surgical hand antisepsisThe process of cleaning the hands and forearms with an antimicrobial agent before a surgical procedure to reduce resident and transient microbial flora, using either a timed/counted scrub or an approved alcohol-based handrub.
Chlorhexidine gluconate (CHG)A broad-spectrum antimicrobial agent commonly used in surgical scrub solutions; it provides persistent residual activity on the skin after application.
Closed-glove techniqueThe method of donning sterile gloves in which the scrub person's hands remain inside the gown cuffs throughout the process, preventing bare skin from contacting the outer glove surface.
Open-glove assisted techniqueA method by which an already-gowned and gloved team member holds a sterile glove open for a partner to insert their hand, with the assistant's fingers placed under the cuff's exterior fold.
Sterile fieldA designated area—including drapes, instrument tables, gowns, and gloves—that has been prepared and maintained to be free of microorganisms; anything that contacts this area must be sterile.
Resident floraMicroorganisms that normally live on the skin and cannot be completely removed but can be significantly reduced by surgical hand antisepsis.
Transient floraMicroorganisms recently acquired on the skin surface through contact with the environment or patients; more easily removed than resident flora by hand hygiene.
Timed brush-stroke methodA surgical scrub approach in which the practitioner scrubs each anatomical area of the hands and forearms for a specified number of minutes according to facility protocol.
Counted-stroke methodA surgical scrub approach in which a set number of brush strokes is applied to each surface of the fingers, hands, and forearms rather than scrubbing for a fixed time.
Contamination breakAny event during sterile technique in which a sterile item contacts a non-sterile surface or person, rendering that item no longer sterile and requiring it to be replaced before use.
In class: Instructor demonstrates the timed brush-stroke method and the counted-stroke method of surgical scrub at the scrub sink; students observe, then verbalize the steps before attempting. · Students practice closed-glove technique on a mannequin hand form at least six times, with a peer using a contamination-detection checklist to flag breaks. · Students practice gowning and gloving a partner using open-glove assisted technique, then debrief using video playback of their own performance.
Materials: Sterile gown packs, sterile glove sets in multiple sizes, surgical scrub brushes, CHG-based scrub solution, alcohol-based hand antiseptic, scrub sink, peer-assessment checklist, video camera or tablet for playback
Check: Instructor evaluates each student's closed-glove technique on a pass/fail skills checklist; zero critical errors (touching outer glove surface or unsterile area) required to pass; students with errors repeat until no critical errors in two consecutive attempts.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Sterile Technique and Aseptic Practice
1. During the closed-glove technique, why must the scrub ST's hands remain inside the gown cuffs until the gloves are fully seated?
Sterile Technique and Aseptic Practice
2. A scrub ST completes the surgical hand scrub, rinses, and then realizes the faucet handle is motion-sensor controlled and did not require touching. She carries her hands above elbow level and enters the OR. Which action should she take next?
Sterile Technique and Aseptic Practice
3. Which of the following is the correct direction for water to flow when rinsing after a traditional surgical scrub at the sink?
Sterile Technique and Aseptic Practice
4. A student using the alcohol-based surgical handrub (waterless method) begins rubbing the product into her hands and forearms. Before the product is fully dry, she picks up the sterile gown. What error has she made?
Sterile Technique and Aseptic Practice
5. During a skills check, a peer observer notes that the scrub student's right fingertips briefly exited the gown cuff and touched the outer surface of the left sterile glove before the glove was fully seated. The correct response is to:
Infection Control and Aseptic Technique
6. Which personal practice is MOST likely to increase a patient's risk of surgical site infection (SSI) from the scrub surgical technologist?
Sterile Technique and Aseptic Practice
7. Which area of the sterile gown is considered NON-sterile after the scrub ST has properly gowned?
Sterile Technique and Aseptic Practice
8. A scrub ST is already gowned and gloved and needs to assist a surgeon in donning sterile gloves. Using open-glove assisted technique, where should the scrub ST place her fingers when holding the glove open?
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