title: Are we following the WHO recommendations for surgical scrubbing?
abstract: BACKGROUND
  Surgical site infections have an incidence as high as 10%. To reduce this, the World Health Organisation (WHO) recommends guidelines for surgical scrubbing.
  
  
  OBJECTIVE
  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.
authors.affiliation: Year 5 MBChB, University of Aberdeen, UK ahmed.ezzat.12@aberdeen.ac.uk.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ezzat
authors.affiliation: Year 4 MBChB, University of Aberdeen, UK.
authors.forename: Muhammad Muneeb
authors.initials: MM
authors.lastname: Safdar
authors.affiliation: Consultant Hepatico-pancreatico-biliary (HPB) Surgeon, Aberdeen Royal Infirmary, UK Honorary Lecturer, University of Aberdeen, UK.
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
mesh_terms: D002710:Chlorhexidine / Q000031:analogs & derivatives; D002985:Clinical Protocols; D013502:General Surgery; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D009741:Nursing Staff, Hospital; D009873:Operating Rooms; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012606:Scotland; D013337:Students, Medical; D066231:Surgeons; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D014944:World Health Organization
chemical_list: C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: Surgical site infections; hand washing; scrub time; surgical scrub