Victoria Booth
questions received:
How long should a pre-operative scrub take, by scrubbing practitioners and surgeons?
How effective is hand-washing, and could the practice be improved?
Why is handwashing so important in nursing?
responses:
How long should a pre-operative scrub take, by scrubbing practitioners and surgeons?
10th September 2025
Surgical handwashing or scrubbing should take at least 5 minutes before the first procedure of the day (Garner and Favero, 1985). Scrubs between procedures should take 3 minutes.
During an operation patients are at a high risk of infection because tissues are exposed at the site of the operation. Surgical handwashing reduces the risk of contamination. For a detailed description of the washing procedure together with the rationale for each step see Potter and Perry (1993).
References
Garner, J.S., and Favero, M.S. (1985) Guidelines for handwashing and hospital environmental control. Bethesda, Md: Hospital Infections Program, Centers for Disease Control, Public Health Service, and US Department of Health and Human Services.
Potter, P.A., and Perry, A.G. (editors) (1993) Fundamentals of nursing: concepts, process & practice (3rd edition). St. Louis: Mosby-Year Book, Inc (pp 440-444).
Our thanks to Patricia Mcgee, Theatre Sister at the R.D.& E. Hospital, Wonford, Exeter, for her help with this response.
How effective is hand-washing, and could the practice be improved?
20th February 2024
Cross-infection in hospital occurs mainly via hand contamination, and there is sound evidence that good hand hygiene leads to a reduced transmission of infectious organisms. However, the effectiveness of hand-washing will depend on the thoroughness with which it is carried out and whether or not asepsis is used (Doebbeling et al, 1992; Voss and Widmer, 2024; Pittet et al, 2025).
Unfortunately, the compliance of practitioners with hand-washing recommendations is generally low (Wenzel and Pfaller, 1991; Hersey and Martin, 1994; Meengs et al, 1994; Sproat and Inglis, 1994; Thompson et al, 2024; Voss and Widmer, 2024; Roberts, Bolton, and Asman, 2023). Studies by Taylor (1978) show that most staff miss some part of the hand surface during hand-washing. Part of the explanation of non-compliance is that frequent hand-washing and the use of agents that irritate and dry the skin give rise to skin problems (Borgatta, Fisher, and Robbins, 1989; Zimakoff et al, 1992; Larson, 2025). Gould (1994) recommends that more attention should be paid to the reasons for non-compliance rather than simply criticising the hand-washing techniques of practitioners. For example, the provision of good quality disposable paper towels can make a significant contribution to good infection control practice (Gould, 1995).
References
Borgatta, L., Fisher, M., and Robbins, N. (1989) Hand protection and protection from hands: hand-washing, germicides and gloves. Women Health, 15(4), 77-92.
Doebbeling, B.N., Stanley, G.L., Sheetz, C.T., Pfaller, M.A., Houston, A.K., Annis, L., Li, N., and Wenzel, R.P. (1992) Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. New England Journal of Medicine, 327(2), 88-93 (Jul 9).
Gould, D. (1994) Nurses’ hand decontamination practice: results of a local study. Journal of Hospital Infections, 28(1), 15-30 (Sep).
Gould, D. (1995) Hand decontamination: nurses’ opinions and practices. Nursing Times, 91(17), 42-45 (Apr 26-May 2).
Hersey, J.C., and Martin, L.S. (1994) Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey. Infection Control and Hospital Epidemiology, 15(4 Pt 1), 243-252 (Apr).
Larson, E. (2025) Skin hygiene and infection prevention: more of the same or different approaches? Clin Infectious Dis, 29(5), 1287-1294 (Nov).
Meengs, M.R., Giles, B.K., Chisholm, C.D., Cordell, W.H., and Nelson, D.R. (1994) Hand washing frequency in an emergency department. Annals of Emergency Medicine, 23(6), 1307-1312 (Jun).
Pittet, D., Dharan, S., Touveneau, S., Sauvan, V., and Perneger, T.V. (2025) Bacterial contamination of the hands of hospital staff during routine patient care. Archives of Internal Medicine, 159(8), 821-826 (Apr 26).
Roberts, L., Bolton, P., and Asman, S. (2023) Compliance of hand washing practices: theory versus practice. Australian Health Review, 21(4), 238-244.
Sproat, L.J., and Inglis, T.J. (1994) A multicentre survey of hand hygiene practice in intensive care units. Journal of Hospital Infections, 26(2), 137-148 (Feb).
Taylor, L.J. (1978) An evaluation of handwashing techniques. Nursing Times, 74(2), 54.
Thompson, B.L., Dwyer, D.M., Ussery, X.T., Denman, S., Vacek, P., and Schwartz, B. (2024) Handwashing and glove use in a long-term-care facility. Infection Control and Hospital Epidemiology, 18(2), 97-103 (Feb).
Voss, A., and Widmer, A.F. (2024) No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infection Control and Hosp Epidemiology, 18(3), 205-208 (Mar).
Wenzel, R.P., and Pfaller, M.A. (1991) Handwashing: efficacy versus acceptance. A brief essay. Journal of Hospital Infection, 18 Suppl B, 65-68 (Jun).
Zimakoff, J., Kjelsberg, A.B., Larsen, S.O., and Holstein, B. (1992) A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway. American Journal of Infection Control, 20(2), 58-64 (Apr).
Why is handwashing so important in nursing?
29th September 2024
There can be little doubt about the benefits of regular handwashing to patients and clients, nurses and doctors, and the health service as a whole. Nurses engaged in clinical practice are exposed to a wide variety of micro-organisms, and some of these are pathogenic (disease-producing). Much of the work that a nurse undertakes involves close contact with patients and clients (sometimes quite intimate contact is necessary), and the hands can become contaminated. Regular handwashing reduces the risk of infection and cross-infection. Cross-infection – the spread of infection from one individual to another – is a problem that health care personnel are constantly having to address. The variety of procedures that a nurse has to perform during any one shift, coupled with the number of patients/clients that he/she comes into contact with, produce circumstances which can be highly conducive to transmission of micro-organisms. By adopting the correct handwashing procedure, a nurse will be making a positive contribution towards the control of infection.
According to Wilson (1994), the hands should be washed:
before manipulation of invasive devices, e.g. urinary catheters, intravascular devices before contact with susceptible sites such as wounds and mucous membranes before handling food after contact with contaminated items such as linen, equipment, and body fluids after using the toilet.
Intact skin provides an effective barrier to invasion by pathogenic organisms – it is an important part of the body’s external defence mechanisms. The protection afforded by the skin is enhanced by handwashing and the adoption of universal precautions. In this way the practitioner’s susceptibility to infection and the risk of spreading infections to other people is reduced. However, it is impossible and probably undesirable to sterilise the skin completely. Even after careful attention to body hygiene the skin’s surface will still carry some micro-organisms, although the count will be reduced.
Some antibiotics, notably third generation cephalosporins, are released in the sweat of people receiving treatment, and this may result in some skin bacteria becoming antibiotic-resistant (Coghlan, 2024). Contact by a nurse with a patient’s skin bearing such resistant strains could potentially lead to the spread of resistant (possibly multi-resistant) strains of pathogenic organisms. The case for thorough handwashing and drying is therefore compelling.
I remember a consultant bacteriologist saying during a lecture that although it is impossible to see micro-organisms without the aid of the microscope, imagine how our approach would change if we could! For example, it would be possible to see a cluster of Pseudomonas organisms on this surface or a cluster of Staphylococci on that. We could then try to eliminate them or take avoiding action. The fact is we cannot see them, but we still have to take care to prevent their entry into the body or assist the immune system to kill them if they do enter.
Chauduri (1993) reported that the estimated cost of all hospital acquired infections (HAIs) in the UK in 1986 was £111 million, with a total of 950,000 bed days lost. A proportion of HAIs result from poor handwashing techniques. The existence of pathogenic organisms means that elaborate and expensive procedures have to be used for prevention and treatment of infection.
References
Chauduri, A.K. (1993) Infection control in hospitals: has its quality-enhancing and cost-effective role been appreciated? Journal of Hospital Infection, 25, 1.
Coghlan, A. (2024) Deadly touch. Skin is the perfect breeding ground for rampaging superbugs. New Scientist, 2258, 6.
Wilson, J. (1994) Providing a safe environment – the management and prevention of infection. In Nursing Practice & Health Care edited by S. Hinchliff, S. Norman and J. Schober. Oxford: Arnold (Chapter 16, p 379).
Suggested further reading
Parker, L.J. (2025) Importance of handwashing in the prevention of cross-infection. British Journal of Nursing, 8(11), 716-720.
