Aseptic Technique: Surgical Scrub, Gowning, and Gloving

Why Aseptic Technique Matters

Surgical site infections are a serious threat to patient recovery. In veterinary surgery, the scrub technician or assistant is one of the last lines of defense between environmental pathogens and an open surgical wound. Aseptic technique — the set of practices that prevents contamination of a sterile field — must be performed correctly every single time, without exception. A single break in sterile technique can introduce bacteria that cause wound dehiscence, sepsis, or death. Patient safety begins before the first incision.

The Surgical Hand Scrub

The goal of the surgical hand scrub is to reduce the number of microorganisms on the hands and forearms to as low a count as possible and to keep them suppressed throughout the procedure. Two methods are commonly used:

Anatomical (counted stroke) method: Each surface of each finger, the hand, and the forearm is scrubbed a prescribed number of strokes. This method is thorough and consistent.

Timed method: All surfaces are scrubbed continuously for a set period (commonly three to five minutes for subsequent scrubs; a longer initial scrub may be used). Follow your facility's written protocol for timing.

General steps for either method:

1. Remove all jewelry, watches, and nail polish. Nails should be short and clean.

2. Open the sterile scrub brush package without touching the brush itself, or use a pre-packaged sterile brush with integrated scrub solution.

3. Wet hands and forearms to two inches above the elbow.

4. Apply chlorhexidine gluconate scrub solution (or the facility-approved antimicrobial agent).

5. Scrub fingertips and nails first — the highest-contamination area — then each finger, the web spaces, palm, dorsum of hand, wrist, and forearm, working in a consistent direction toward the elbow. Do not return to a clean area after scrubbing a less-clean area.

6. Rinse with hands elevated above elbows so water runs from fingertip toward elbow, not the reverse. Contaminated water must never flow back over cleaned skin.

7. Keep hands raised above waist level and away from your body from this point forward. Anything below waist level or touched inadvertently is considered contaminated.

8. Dry hands with a sterile towel using a patting, not wiping, motion; use one end for one hand and the other end for the other hand.

Donning the Sterile Gown

Sterile gowns create a barrier between the wearer's non-sterile scrubs and the sterile field. The sterile portions of a gown are the front from chest to table level and the sleeves from two inches above the elbow to the cuffs. The back of the gown, the neckline, and areas below table level are never considered sterile.

Steps:

1. The circulator (non-scrubbed assistant) opens the gown package onto a clean surface without contaminating the gown inside.

2. Pick up the gown at the neckline, step back from the table, and allow it to unfold without touching non-sterile surfaces.

3. Slide both arms into the sleeves simultaneously, keeping hands inside the cuffs (closed gloving position).

4. The circulator ties or fastens the back of the gown — you never reach behind yourself.

5. For wraparound gowns, hand the sterile tie card or tag to the circulator using a sterile clamp or gloved hand; the circulator wraps the tie and you receive and tie it yourself in the front.

Applying Sterile Gloves

Closed gloving method (preferred when already gowned): Because your hands remain inside the gown cuffs, bare skin never contacts the outside of the gloves. Use the cuffed sleeve as a barrier to pick up each glove, fold the glove cuff over the sleeve cuff, and work fingers into position. This method provides the greatest protection against contamination.

Open gloving method (used when only gloves are needed, such as adding a sterile glove in the field): Expose your hands outside the cuffs. Use your non-dominant hand covered by the inside (non-sterile surface) of the glove to pick up the first glove. Slide it on, touching only the inside. Use your gloved fingers to pick up the second glove by its outer (sterile) surface; slide on and adjust. Once both gloves are on, touch only sterile surfaces.

Recognizing and Responding to Critical Breaks

A critical break is any direct contact between a sterile surface and a non-sterile item or person. Common breaks include:

• Gloved hand drops below waist or table level
• Glove touches non-sterile gown back, neck, or any ungloved person
• Gown cuff is exposed and contacts the glove exterior during open gloving
• A glove is punctured or torn
• Anything unknown is touched — if in doubt, it is contaminated

Response protocol: Stop immediately. Verbalize the break to the team. The circulator assists with re-gloving, re-gowning, or a full re-scrub, depending on what was contaminated. Never proceed with a known or suspected break. Patient safety is always the priority over speed or convenience.

Maintaining the Sterile Field

• Keep sterile-gloved hands above waist and in sight at all times.
• Face the sterile field; never turn your back to it.
• Only scrubbed, gowned, and gloved personnel pass items within the sterile field.
• Moisture is a pathway for contamination — a wet or strike-through drape is considered contaminated.
• Speak minimally and avoid coughing or sneezing toward the field.