SELF/Perioperative Nursing/Surgical Scrubbing/Psychomotor Skills Practice Instructions
Psychomotor Skills Practice Instructions
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for surgical scrubbing, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for each stage of surgical hand antisepsis.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for performing a surgical scrub, ensuring effective hand antisepsis, maintenance of aseptic technique, and readiness to don a sterile gown and gloves.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance |
|---|---|---|---|---|
| 1 | Preparation | Articulates the following: nails are short, clean, and free of polish or artificial nails; all jewellery removed; skin free from cuts, dermatitis, or skin infection | ||
| 2 | Assemble requirements for scrubbing-up procedure | Articulates the following: all required equipment assembled; wearing theatre scrubs with bare forearms, theatre cap, surgical mask, eye protection, and appropriate footwear | ||
| 3 | Put on disposable apron and adjust water to a comfortable temperature | Put on the disposable or reusable apron. Open the sterile scrub brush if required while maintaining its sterility. Turn on the water using the appropriate controls and adjust it to a comfortable temperature and moderate flow before beginning the scrub.
Good skills: Removes any remaining jewelry before beginning; opens the scrub brush without contaminating it; adjusts the water to an adequate flow and comfortable temperature. Result: ready to scrub without splashing or contamination |
Fails to wear the apron; opens the sterile brush incorrectly; uses water that is excessively hot or cold; creates excessive splashing that may contaminate clothing or surroundings | Water should be comfortable enough to allow the entire scrub without discomfort. Excessive water pressure increases splashing and contamination risk. |
| 4 | Pre-scrub social hand wash (WHO): wet hands with water and apply enough soap to cover all hand surfaces | Wet both hands completely. Apply enough soap to cover every hand surface. Begin the WHO social hand wash. Operate taps using elbows or feet whenever possible. Throughout the wash and rinse, keep your hands above your elbows so water flows from the cleanest area toward the less clean area.
Good skills: Begins the WHO social hand wash using soap and water; operates taps with elbows or feet; ensures cap and mask are secured before scrubbing begins; keeps hands above elbows throughout washing and rinsing. Result: gross soil is removed before the surgical scrub begins |
Allows hands to drop below elbows; allows contaminated water to flow back toward the hands; touches the tap or sink with clean hands; begins scrubbing before cap or mask is properly secured | Think about the direction water travels. Your hands should always remain higher than your elbows so contamination moves away from the cleanest part of your upper limbs. |
| 5 | Pre-scrub social hand wash (WHO): rub hands palm to palm; right palm over left dorsum with interlaced fingers and vice versa; palm to palm with fingers interlaced; back of fingers to opposing palms with fingers interlocked | Perform each WHO hand hygiene movement in the correct sequence. Use firm friction while covering every surface of the palms, backs of the hands, and fingers. Complete every movement before progressing to the next one.
Good skills: Follows the prescribed WHO sequence; applies adequate friction to all surfaces; respects the required timing or number of strokes. Result: all hand surfaces are mechanically cleaned |
Rushes through the sequence; skips hand surfaces; fails to maintain hands above elbows; allows contaminated water to flow back toward the hands; performs the sequence out of order | Focus on complete coverage rather than speed. Use deliberate, methodical movements to ensure every surface of both hands receives adequate friction before moving to the next step. |
| 6 | Pre-scrub social hand wash (WHO): rotational rubbing of left thumb clasped in right palm and vice versa | Clean each thumb separately using rotational rubbing while clasping it in the opposite palm. Rotate the thumb completely so all surfaces receive adequate friction. Repeat on the opposite thumb.
Good skills: Uses rotational rubbing to clean each thumb thoroughly; applies adequate friction to all thumb surfaces; follows the prescribed sequence and timing. Result: thumbs are thoroughly cleaned |
Rushes through the thumb cleaning step; misses parts of the thumb; allows hands to fall below the elbows; allows contaminated water or soap to flow back toward the hands | Thumbs are one of the most commonly missed areas during hand hygiene. Slow down and deliberately rotate each thumb to ensure complete coverage. |
| 7 | Pre-scrub social hand wash (WHO): rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa | Rub the fingertips of one hand backwards and forwards in the opposite palm using rotational movements. Repeat with the opposite hand. Ensure the fingertips and nail areas receive firm friction.
Good skills: Uses rotational rubbing to clean the fingertips and nail areas; follows the prescribed sequence and timing. Result: fingertips are thoroughly cleaned |
Rushes through the fingertip cleaning step; misses the fingertips or nail areas; allows hands to fall below the elbows; allows contaminated water or soap to flow back toward the hands | Fingertips carry the highest concentration of microorganisms during patient care. Concentrate on cleaning the fingertips and nail margins completely before proceeding. |
| 8 | Pre-scrub social hand wash (WHO): rinse hands with water | Rinse both hands and forearms from the fingertips toward the elbows in one continuous direction. Keep your hands above your elbows throughout the rinse. Do not retrace your hands through the running water or touch the sink or surrounding surfaces.
Good skills: Operates taps using elbows or feet; rinses from fingertips toward elbows in one direction only; maintains hands above elbows throughout the rinse. Result: soap is removed without recontamination |
Allows hands to fall below the elbows; moves arms back and forth through the water; touches the sink or surrounding surfaces; adjusts the mask or other PPE after completing hand antisepsis | Imagine the water carrying microorganisms away from your hands. Keep the water flowing in one direction only and avoid any action that could recontaminate the clean hands. |
| 9 | 1st, 2nd, and 3rd scrub: scrub hands, forearms, and elbows | Apply approximately 5 mL of antimicrobial scrub solution to your hands. Keep your hands above your elbows throughout the scrub. Using systematic circular motions, scrub from the hands toward the forearms and elbows, extending approximately 2–3 inches above the elbows. Repeat the required scrub cycles and maintain the required duration according to your local protocol.
Good skills: Applies approximately 5 mL of scrub solution; keeps hands above elbows throughout; scrubs using systematic circular motions from the hands toward the forearms and elbows; scrubs in one direction only; repeats the required scrub cycles and completes the required duration according to local protocol. Result: first three antimicrobial scrub cycles are completed using correct direction and technique, with the required antimicrobial contact time achieved |
Scrubs from the elbows back toward the hands; uses a non-systematic sequence; allows hands to fall below the elbows; misses areas of the forearms or elbows; fails to complete the required scrub duration | Follow the same sequence every time. Consistent technique is more important than speed. Maintain the correct direction of scrubbing throughout every cycle and avoid retracing over previously scrubbed areas. |
| 10 | 4th scrub (optional): clean fingernails with a sterile brush (follow local guidelines) | If your local protocol requires nail brushing, wet the sterile brush and apply scrub solution. Clean beneath each fingernail using the bristle side of the brush, then repeat on the opposite hand. Use gentle pressure to avoid skin trauma. If nail brushing is not part of your local protocol, omit this step.
Good skills: Wets the sterile brush before use; applies scrub solution to the brush; cleans beneath each fingernail using the bristle side; repeats for both hands without causing skin trauma. Result: nail beds are cleaned without skin trauma |
Uses the sterile brush incorrectly; applies excessive pressure causing skin trauma; fails to clean beneath all fingernails; contaminates the sterile brush during use | Use only enough pressure to remove debris beneath the nails. Excessive scrubbing can damage the skin and increase the risk of bacterial colonization. Follow your institution's policy regarding whether nail brushes are routinely used. |
| 11 | 5th scrub: reapply scrub solution and clean all hand surfaces | Apply approximately 5 mL of antimicrobial scrub solution and work it into a rich lather. Thoroughly scrub the palms, backs of the hands, thumbs, interdigital spaces, and wrists using firm friction. Ensure every surface is covered before proceeding to the next step.
Good skills: Applies approximately 5 mL of scrub solution; produces adequate lather; thoroughly scrubs the palms, backs of the hands, interdigital spaces, thumbs, and wrists using friction. Result: all hand surfaces receive complete antimicrobial coverage |
Uses insufficient scrub solution; produces inadequate lather; misses the thumbs, web spaces, backs of the hands, or wrists; uses poor aseptic technique | Use a systematic routine every time so that no area is missed. Complete coverage is more important than speed, and repeating the same pattern helps develop consistent technique. |
| 12 | 6th scrub: scrub the hands between the fingers and palms only | Perform the final scrub concentrating on the fingers, interdigital spaces, and palms. Use a back-and-forth motion on all four sides of each finger, ensuring every finger and web space receives adequate friction before completing the scrub.
Good skills: Scrubs the fingers using a back-and-forth motion on all four sides of each finger, including the interdigital spaces. Result: fingers are fully scrubbed |
Fails to scrub all four sides of each finger; misses the interdigital spaces; performs the motion too quickly or incompletely | The spaces between the fingers are commonly missed. Separate the fingers fully during scrubbing and deliberately clean every side of each finger before moving to the next one. |
| 13 | Rinse hands and arms twice | Rinse the hands and forearms twice, allowing the water to flow from the fingertips toward the elbows in one continuous direction. Do not move the arms back and forth under the running water or allow the hands to contact the sink.
Good skills: Rinses the hands and arms by passing them through the water from the fingertips toward the elbows without retracing; avoids contact with the sink throughout the rinse. Result: soap is completely removed without recontamination |
Moves the arms back and forth through the water; retraces previously rinsed areas; touches the sink or surrounding surfaces during rinsing | Allow gravity to carry water away from the cleanest areas. Maintain your hands above your elbows and keep the rinse smooth, controlled, and in one direction only. |
| 14 | Close tap using the elbows or feet | Turn off the water using your elbows or feet while keeping your hands above your elbows and away from your body. Do not allow your hands or forearms to touch the tap or surrounding surfaces.
Good skills: Turns off the tap using the elbows or feet while maintaining hands above the elbows and away from the body. Result: hands remain uncontaminated |
Touches the tap with the hands or forearms; touches surrounding objects while turning off the water; lowers the hands below the elbows during tap closure | Before turning off the tap, plan your movement. Keep your hands elevated and use only your elbows or feet so your scrubbed hands remain uncontaminated. |
| 15 | Move to the OR without contamination | Before moving, explain why scrubbed hands must remain above the elbows and identify situations that would require repeating the surgical scrub. Then proceed to the operating room while keeping your hands elevated and away from your body. Use your back or an assistant to open doors if necessary and avoid touching any non-sterile surfaces until you reach the gowning area.
Good skills: Enters the operating room using the back to open the door or with assistance; maintains hands above the elbows without touching the body or surrounding surfaces; proceeds directly to the sterile drying and gowning area. Result: surgical scrub is maintained during transfer to the operating room |
Touches the door, walls, clothing, or other non-sterile surfaces; lowers the hands below the elbows; contaminates the scrubbed hands during transfer, requiring the surgical scrub to be repeated | Think of your scrubbed hands as sterile from this point forward. Keep them in sight, above your elbows, and away from your body. If contamination occurs at any point, stop and repeat the surgical scrub according to your institutional protocol. |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Surgical Scrubbing/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 15, 2026. |