field. Additionally, the following basic rules must be adhered to:  An article is either sterile or unsterile; there is no in-between. If there is doubt about the sterility of an item, consider it unsterile.  Any time the sterility of a field has been compromised, replace the contaminated field and setup.  Do not open sterile articles until they are ready for use.  Do not leave sterile articles unattended once they are opened and placed on a sterile field.  Do not return sterile articles to a container once they have been removed from the container.  Never reach over a sterile field.  When pouring sterile solutions into sterile containers or basins, do not touch the sterile container with the solution bottle. Once opened and first poured, use bottles of liquid entirely. If any liquid is left in the bottle, discard it.  Never use an outdated article. Unwrap it, inspect it, and, if reusable, rewrap it in a new wrapper for sterilization. Surgical Hand Scrub The purpose of the surgical hand scrub is to reduce resident and transient skin flora (bacteria) to a minimum. Resident bacteria are often the result of organisms present in the hospital environment. Because these bacteria are firmly attached to the skin, they are difficult to remove. However, their growth is inhibited by the antiseptic action of the scrub detergent used. Transient bacteria are usually acquired by direct contact and are loosely attached to the skin. These are easily removed by the friction created by the scrubbing procedure. Proper hand scrubbing and the wearing of sterile gloves and a sterile gown provide the patient with the best possible barrier against pathogenic bacteria in the environment and against bacteria from the surgical team. The following steps comprise the generally accepted method for the surgical hand scrub. 1. Before beginning the hand scrub, don a surgical cap or hood that covers all hair, both head and facial, and a disposable mask covering your nose and mouth. 2. Using approximately 6 ml of antiseptic detergent and running water, lather your hands and arms to 2 inches above the elbow. Leave detergent on your arms and do not rinse. 3. Under running water, clean your fingernails and cuticles, using a nail cleaner. 4. Starting with your fingertips, rinse each hand and arm by passing them through the running water. Always keep your hands above the level of your elbows. 5. From a sterile container, take a sterile brush and dispense approximately 6 ml of antiseptic detergent onto the brush and begin scrubbing your hands and arms. 6. Begin with the fingertips. Bring your thumb and fingertips together and, using the brush, scrub across the fingertips using 30 strokes. 7. Now scrub all four surface planes of the thumb and all surfaces of each finger, including the webbed space between the fingers, using 20 strokes for each surface area. 8. Scrub the palm and back of the hand in a circular motion, using 20 strokes each. 9. Visually divide your forearm into two parts, lower and upper. Scrub all surfaces of each division 20 strokes each, beginning at the wrist and progressing to the elbow. 10. Scrub the elbow in a circular motion using 20 strokes. 11. Scrub in a circular motion all surfaces to approximately 2 inches above the elbow. 12. Do not rinse this arm when you have finished scrubbing. Rinse only the brush. 13. Pass the rinsed brush to the scrubbed hand and begin scrubbing your other hand and arm, using the same procedure outlined above. 14. Drop the brush into the sink when you are finished. 15. Rinse both hands and arms, keeping your hands above the level of your elbows, and allow water to drain off the elbows. 16. When rinsing, do not touch anything with your scrubbed hands and arms. 17. The total scrub procedure must include all anatomical surfaces from the fingertips to approximately 2 inches above the elbow. 2-34