Are we following the WHO recommendations for surgical scrubbing?

Background: Surgical site infections have an incidence as high as 10%. To reduce this, the World Health Organisation (WHO) recommends guidelines for surgical scrubbing.

Aims: We assessed adherence of surgical staff scrub practice before gowning to current WHO recommendations.

Methods: A prospective study conducted in operation theatres in a university hospital. Participants comprised of consultant surgeons, trainees and scrub nurses. Variables included staff grade, scrub order, length of scrub time and appropriate dress code. Data were collected anonymously and analysed.

Results: We assessed 303 surgical scrub-episodes (95 scrub nurses, 123 trainees and 85 consultant surgeons). Mean time for first scrub of the day was 239 s, SD=99, 95% CI 218, 259 and range=530 (scrub nurses=297 s, trainees=204 s, consultant surgeons=202 s). Mean time for subsequent scrubs was 161 s, SD=63, 95% CI 152, 170, range=312 (scrub nurses=184 s, trainees=158 s, consultant surgeons=143 s). Statistical significance was found between staff grades based on scrub time, with WHO breaches in remaining variables.

Conclusions: No written local guidelines on hand scrubbing exist in the hospital and staff were unaware of WHO guidelines. In this study, mean scrub times were less than WHO guidelines with significant variation in practice across grades of staff. Clear written guidelines are needed.