1. Entering the Sterile Field: Scrubbing, Gowning, and Gloving
Concorde Career College

2. Entering the Sterile Field
Objectives:
State the purpose of performing the surgical scrub, list the steps of the surgical scrub utilizing the counted brush stroke method, and explain the related sterile concepts.
Describe the technique utilized when drying and gowning oneself and explain the related sterile concepts.
Describe the technique utilized when closed gloving and explain the related sterile concepts.

3. Entering the Sterile Field
Objectives:
Describe the technique utilized when assisting a team member with gowning and gloving and explain the related sterile concepts.
Describe the technique utilized when removing and replacing the gown and gloves intraoperatively and explain the rationale.
Describe the technique utilized when removing the gown and gloves postoperatively and explain the rationale.

4. Practices in Sterile Technique
Surgical Scrub
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

5. Method
Traditionally, both timed and counted brush stroke methods have been used
The method demonstrated is the counted brush stroke method

6. Please Note the Following
Recent studies suggest that the use of alcohol solutions may be as or more effective than traditional scrub solutions.
More studies are warranted.

7. Preparation for the Surgical Scrub
Attend to personal needs
Don all personal protective equipment
Tear open the packet containing the scrub brush
Adjust water temperature if necessary

8. Scrubbing: Step 1
Hands and arms should be visually inspected for wounds or infections of any type

9. Scrubbing: Step 2
Nails and cuticles, also, should be carefully inspected

10. Scrubbing: Step 3
Apply water to the arms for the pre-scrub
hand-wash

11. Scrubbing: Step 4
Apply antimicrobial solution

12. Scrubbing: Step 5 Perform a 30 second standard handwash
Rinse from finger tips to elbows

13. Scrubbing: Step 6 Secure the previously opened scrub brush
Reapply antimicrobial solution
Remove the nail cleaner

14. Scrubbing: Step 7 Clean each nail thoroughly under running water
Note: You will need to hold the brush at the same time you are cleaning the nails

15. Scrubbing: Step 8
Rinse the end of the nail cleaner after each nail

16. Scrubbing: Step 9 Discard the nail cleaner into the waste receptacle
Add an antimicrobial solution to the brush if necessary or wet and squeeze brush if it is soap impregnated

17. Scrubbing: Step 10 Begin with scrubbing the nails Use 30 strokes
1 stroke is the combined movement in both directions

18. Scrubbing: Step 11 Scrub all fingers 10 strokes per plane per digit
(Planes = superior, medial, lateral, inferior)
Scrub web between fingers

19. Scrubbing: Step 12 Continue to scrub the hand covering all planes
Continue proximally along the arm, scrubbing 1/3 the arm at a time
Keep arms away from scrub top and other objects

20. Note
While several different practices are used, we recommend scrubbing one hand and arm completely, changing the brush to the other hand, and repeating the process with the second hand and arm.

21. Scrubbing: Step 13
When scrub of both arms is completed, drop brush into waste receptacle
Keep arms away from the body
Rinse from finger tips toward elbow
Note blue path of water run-off

22. Scrubbing: Step 14 Rinse arms thoroughly using a dipping maneuver
Note all the environmental dangers
Keep arms out
Note the blue path of water run-off

23. Practices in Sterile Technique
Drying the Hands and Arms
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

24. Step 1
Watch the sterile field and verify that no water drops fall onto the sterile field from wet hands
Reach directly to the center of the towel and grasp it firmly

25. Step 2 Lift the towel directly from the Mayo stand
Step back as the towel is lifted

26. Step 3 Bend at the waist Unfold the towel
Maintain distance from sterile fields
Use one end of the towel

27. Step 4 Be aware of the lower ends of the towel
Begin to dry the hand at the fingers working toward the elbow

28. Step 5
Rotate the hand and arm being dried to ensure that all surfaces are contacted
Use a squeezing and/or patting motion with the towel hand
Watch the lower end of the towel

29. Step 6 Stop drying the first arm at the elbow
Place the dry hand on the sterile end of the towel (unused part)

30. Step 7
Reverse the ends so that the contaminated / wet end is now the lower end

31. Step 8 Repeat the process on the second hand
When finished drying, do not regrasp or refold the towel
Drop the towel into the linen hamper without changing hand positions on the towel

32. Practices in Sterile Technique
Putting on a Gown
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

33. Gowning: Step 1 Observe the placement of various sterile fields
Approach the Mayo stand with gown and gloves opened upon it
Keep your body away from the sterile field
Reach from above down to the gown

34. Gowning: Step 2 Reach directly onto the gown
Avoid touching the glove package or gown wrapping
“Pinch” the gown, controlling all layers

35. Gowning: Step 3 Lift the gown vertically from the Mayo stand
Keep your body away from the Mayo stand

36. Gowning: Step 4
Once the gown is lifted from the sterile field, step back from the Mayo stand
Beware other sterile fields and do not back into them

37. Gowning: Step 5 Identify the collar of the gown
Confirm that the gown is oriented properly - inside of gown facing toward you
Grasping the gown at the collar and sleeves, release the lower portion

38. Gowning: Step 6 Identify the arm openings
Place one hand inside each opening
Move hand into the sleeve
Remain conscious of all items around you

39. Gowning: Step 7 Slip the first arm into the sleeve
Stop before the hand reaches the edge of the cuff
Flexing the arm slightly will help hold the gown in place
Repeat on other side

40. Gowning: Step 8
Stop the second arm movement before the hand reaches the edge of the cuff
Flex both arms to hold the gown in place
Prepare to put on gloves

41. Donning a Surgical Gown
Donning a surgical gown requires some “big” movements; therefore the surgical technologist must have a heightened awareness of the total environment around her/him.

42. Closed Glove Technique
Gloving Oneself
Closed Glove Technique
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

43. Step 1 After gowning, approach the Mayo stand
Hands should be contained within the gown sleeve and distal to linen cuff
Keep distance between body and Mayo stand

44. Step 2
Be aware of the gown front and do not allow it touch the gown wrapper
Open the glove package with covered hands
Stop as soon as one glove is exposed

45. Step 3 Lift first glove from glove package by the cuff of the glove
Place it on the hand to be gloved so that the edge of the glove cuff is at the union of gown and cuff
Palm to palm; thumb to thumb

46. Close-up View
Cuff to cuff
Palm to palm
Thumb to thumb

47. Step 4
Grasp lower edge of glove cuff with fingers on the hand being covered
Grasper upper edge of glove cuff with fingers of other hand
Stretch and extend the glove cuff
Roll wrist of hand being covered so glove cuff covers the linen cuff of the gown

48. Step 5 Be sure glove covers all of the gown cuff
Do not touch gown cuff with other hand
Extend fingers into glove fingers
Pull glove onto hand

49. Step 6
Repeat for the other hand

50. Step 7
Note: always step back from the Mayo stand in order to perform gowning and gloving tasks
Complete gloving process

51. Practices in Sterile Technique
Turning a Wrap-around Gown
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

52. Turning a wrap-around gown
Most gowns are designed to wrap around the person working in the sterile field. The practices described should be used for all gowns turned. No one should turn their back to the sterile field while the gown is being turned.

53. Turning: Step 1
Grasp the tab in the right hand and the tie in the left hand
Separate the two
Hand the distal end of the tab to the circulator
To avoid contamination watch the circulator’s hand as you make the exchange

54. Turning: Step 2
The circulator moves the tab behind the gowned person, keeping the “tie” extended
The gowned person rotates the shoulders to the left in order to receive the “tie”
Beware of other sterile items

55. Turning: Step 3
While rotating the shoulders to the left, transfer the tie held in the left hand to the right hand

56. Turning: Step 4
Circulator continues circling the gowned person, keeping the tie extended
Both parties observe areas of potential contamination

57. Turning: Step 5
Gowned person takes the tie, NOT the TAB, from the circulator
Circulator keeps and discards the tab

58. Turning: Step 6 The ties are secured
The gowned person should maintain appropriate distance from the other sterile areas until the gown is completely secured

59. Assisting Other Team Members
Gowning and Gloving Another
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

60. Handing a Towel to an Unsterile Team Member
Maintain safe distance
Allow the unsterile team member to reach out into neutral zone
Keep towel close to body until ready to hand

61. Handing a Towel to an Unsterile Team Member
Open the towel
Keep hands spread and towel taut at the top
Keep hands away from unsterile team member’s hands

62. Handing a Towel to an Unsterile Team Member
Keeping your hands spread, place the towel across the unsterile team member’s hands
Apply slight pressure so the unsterile team member can feel the towel in his/her hand
Unsterile team members dries hands and arms and discards towel into linen hamper

63. Gowning the unsterile team member
Maintain a safe distance
Be aware of the position of the unsterile team member’s hands

64. Gowning the unsterile team member
Allow the bottom of the gown to unfold toward the floor
Hold the gown near the neck line

65. Gowning the unsterile team member
Spread the gown so the unsterile team member can identify the sleeve entrances
Cuff the neck of the gown over your hands to protect them from contamination

66. Gowning the unsterile team member
Allow the unsterile team member to place both arms in the sleeve entrances

67. Gowning the unsterile team member
Once the unsterile team member’s arms are well started in the sleeve, step back and remove your hands from the gown

68. Gloving the unsterile team member
Maintain a safe distance
Unfold the cuff of the first glove

69. Gloving the unsterile team member
Orient the glove so the palm faces the team member to be gloved
Unfold the cuff of the glove
Refold the cuff over your fingers to protect your hand

70. Gloving the unsterile team member
With the fingers of both hands protected under the cuff, pull laterally opening the glove for the other team member

71. Gloving the unsterile team member
Repeat steps for the other hand
Allow the team member to help open the glove with his/her sterile hand

72. Gloving the unsterile team member
Release the glove after the cuff of the gown is completely covered

73. Practices of Sterile Technique
Disrobing with a contaminated gown
(Technique used when re-gowning and gloving during a procedure)
Asepsis and Sterile Technique is the third publication in the educational library of the Association of Surgical Technologists. Visit for more information about AST and their educational resources.

74. Disrobing: Step 1
The sterile person stands with her/his back to the circulator
The circulator wears non- sterile gloves
Keeping appropriate distance from the gown, the circulator unfastens top of the gown

75. Disrobing: Step 2
Continuing to maintain a safe distance, the circulator unties the inside back tie

76. Disrobing: Step 3 The gowned team member turns to face the circulator
Care is taken not to touch the circulator with the hands or front of the gown
The circulator grasps the contaminated gown at the shoulders

77. Disrobing: Step 4
The circulator pulls the gown forward and down over the arms
Both team members watch the gown carefully
Gloves will normally role slightly at the cuff

78. Disrobing: Step 5
The gloves are presented to the circulator with the palms turned up
Circulator grasps gloves by pinching the palmar surface of the gloves

79. Disrobing: Step 6 The gloves are pulled forward slowly over the hands
Care is taken not to snap the gloves and produce airborne debris or contaminates

80. Disrobing: Step 7
As the gloves are removed, the hands are moved away from the circulator
Gloves are placed in the proper contaminated receptacle

81. Scrubbing Video