When surgeons and other medical staff sterilize themselves as much as possible to enter an operating room, the process is known as “scrubbing in.” This scrubbing in process involves thoroughly washing the hands and arms, donning a sterile surgical gown, cap, and face mask, and putting on surgical gloves. Scrubbing in is designed to make the operating room as clean as possible, and once someone has scrubbed in, he or she is known as “sterile,” which means that it is safe to work in the surgical field. “Nonsterile” people and objects, by the way, are still extremely clean, they just aren't clean enough to be safe for the patient.
The order of the steps involved in scrubbing in vary, depending on the hospital, but usually the process starts with donning a “scrub cap,” a cap which covers all of the hair to ensure that it does not contaminate the surgical field, followed by a face mask. Then, the hands and arms must be meticulously cleaned with antibacterial soap, with care being taken to avoid coming into contact with anything non-sterile, such as the edges of the sink, the doors into the operating room, and the garments worn into the operating room. A nail brush is used to scrub the nails and clean under them, and often a specific number of strokes are prescribed to ensure that the hands and arms are as clean as possible.
Once someone has finished washing his or her hands and arms, the operating room is entered, and a surgical nurse helps the person “gown up.” The nurse holds an autoclaved gown open so that the surgeon can slip into it, and helps the surgeon secure the gown. Next, gloves are held out for the surgeon's hands. Once this process is complete, the person is considered fully scrubbed in and sterile.
Scrubbing in is time-consuming, but it contributes significantly to patient safety, by ensuring that patients are not exposed to anything dangerous. During the procedure in the operating room, medical staff also look out for each other, checking to make sure that no one has touched anything nonsterile. If someone does come into contact with something considered nonsterile, he or she will have to go through the scrubbing in process all over again.
Medical students often struggle with scrubbing in, because it is an unfamiliar and painstaking process. It can also be quite exciting for students, as it puts them into immediate contact with the practice of medicine, giving them a taste of what surgery is like. Most medical students make mistakes the first few times they scrub in to observe surgeries, because they are unfamiliar with the process and the delicate dance which takes place in the operating room, but this is nothing to worry about. Even experienced and awe-inspiring surgeons can tell stories about gaffes they made while scrubbing in, such as touching a nonsterile instrument and being told to scrub in again.