Traditionally surgeons follow a preoperative hand wash to an above elbow level. I am trying to search evidence for this practice. Will it make any difference if hand washing is above elbow or below elbow?
Interesting question. In my country no one wash the hands above elbow. I am not sure that there is any evidence regarding this topic. Actually the level of scrubbing im my team included distal two thirds of the forearm.
I strongly don't believe that it shall make any difference if a surgeon were to scrub above (i.e. proximal to) the elbows. Also, remember that if the surgical gown and gloves are impermeable (e.g. to water), then they should also prevent things from 'going out' from 'under' them!
More than how high the scrubbing should be, nowadays the main issue related to the surgical scrub is which substance is used to do so. In this sense there are many references that support the use of clorhexidine for both hand hygiene and for the preparation of the surgical area.
On the other hand, it is important to note that vigorous scrubbing is related to the development of infection, since the skin is injured and the habitual flora is removed.
What is gaining more attention is actually the practice of no longer having to use brushes to scrub as this has now been found to cause minor trauma to the skin that could also result in causing infection The tradition of having to scrub above the elbow seems to have stuck-using Chlorhexidine and Methylated Spirit
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