Surgical personnel are a major cause of microbial contamination during surgery. Careful preparation of the surgical team and nonsterile personnel reduces the number of bacteria in the surgical suite but does not eliminate them.


Since there is correlation between the number of people, their movement and the number of airborne bacteria in a surgical suite, if it is possible, surgical room personnel should be reduced to only those essential for anesthesia and surgical support.



  • Step 1 –  Surgical attire


Everybody who is entering the operating room suite should be appropriately clothed, regardless of whether surgery is in progress. To minimize microbial contamination from operating room personnel, should wear scrub clothes rather than street clothes (picture 1).




Picture 1. Scrub clothe


Nonscrubbed personnel should wear long-sleeved jackets over their scrub clothes.



  • Step 2 – Shoe covers


Any footwear that is comfortable can be worn in the surgery area. Shoe covers should be donned when first entering the surgical area and should be worn when leaving it to keep shoes clean.



Picture 2. Shoe covers



  • Step 3 – Hair covering and masks


Hair is significantly carrier of bacteria so it should be completely covered with surgical cap. Masks should cover the mouth and nostrils (picture 3). Major function of mask is to filter and contain droplets of microorganisms expelled from the mouth and nasopharynx during talking, sneezing and coughing. 



                                                                                         Picture 3. Wearing cap and mask



  • Step 4 – Surgical scrub


The surgical scrub is a procedure for cleaning the hands and forearms to reduce the number of bacteria that come in contact with the wound through scrubbed personnel during surgery.


All sterile surgical team members perform a hand and arm scrub before entering the surgical suite.


Of the commonly used surgical hand scrub solution, chlorhexidine gluconate has the greatest residual activity and persistence. Combining an alchocol preparation with chlorhexidine gluconate is the most effective means of reducing microbial counts.


Once the scrubbing has been started, nonsterile items cannot be handled. When the scrub has been completed, the hands and arms should be dried with a sterile towel.


Total scrub time is 2 – 3 minutes per hand and arm.


How to wash hands and arms




  1. Watches and rings should be removed before scrubbing because they are reservoirs for bacteria.
  2. Fingernails should be free of polish and trimmed shortly and cuticles should be in good shape.
  3. Never allow your fingertips to come below the level of your elbows.
  4. Never shake your hands to get rid of excess water; allow the water to drip from your elbows.
  5. Hold your hands upright and in front of you and proceed to the gowning and gloving area.



  • Step 5 – Gowning


Gowns serve as a barrier between the skin of the surgical team member and the patient. They are available as disposable (single use) or reusable.


Gowns are folded so that the inside of the gown faces outward. Once you take gown, do not shake it because this increases the risk of contamination.


When you wear gown keep your hands within the cuffs. Have an assistant pull the gown up over your shoulders and secure it by tying neck ties and tying the inside waist tie. If a sterile-back gown is used, do not secure front tie until you have sterile gloves on hands (picture 4).



Picture 4. Securing front tie



  • Step 6 - Glowing


Glowing can be preformed:


  • Gloving yourself using:

a)      closed method

b)      open method

  • Assisted gloving (picture 4)



Picture 4. Assisted gloving



Maintaining sterility during surgery


Once gowned, the surgical team members should always face the sterile field and should not touch or lean over a non-sterile area. Also should avoid changing the position level. The arms and hands should remain above waist and below shoulders levels. The arms should be clasped in front of the body, above waist.





  1. Theresa Welch Fossum; Small Animal Surgery (second edition); 2002 Mosby; Missouri