Published: 2022-01-29

Adherence of surgeons to the World Health Organization recommendations of hand scrubbing in a tertiary care hospital in Peshawar

Misbah Riaz, Wasim Khan, Fazal Hussain, Danish Shah


Background: In an effort to combat the global rise of wound infection, the World Health Organization (WHO) has recommended hand scrubbing guidelines for surgeons. Our study aimed to determine the adherence of surgeons in Peshawar to these recommendations.

Methods: The method and duration of scrubbing for the first surgical procedure of the day was anonymously observed for 182 surgical consultants and residents in the operating theatre of Khyber Teaching Hospital Peshawar from July to August 2019 followed by a questionnaire which assessed the knowledge of the participants regarding scrubbing protocols. Data was analysed using SPSS 23. Students t test was used and p>0.05 was taken as statistically significant.

Results: Out of 182 participants, 41 (22.5%) were consultants and 141 (77.5%) were residents. A total of 3 (1.6%) participants were observed to strictly adhere to the WHO standards of scrubbing. Average time taken by each surgeon was 0.95±0.6 seconds. Students t-test showed no significant difference between the mean time of consultants and residents (p>0.05). The results of the questionnaire revealed that 90.7% of the staff was aware of the WHO recommendations of scrubbing and 82.6% had noticed relevant display charts in the OT. Majority of participants (69.8%) reported that patient load and limited time were the main cause of lack of compliance.

Conclusions: A serious lack of compliance to protocol was noted in the operating theatre of Khyber Teaching hospital. There is a dire need to improve scrubbing practices. 


Adherence, Hand hygiene, Operation theatre, Prevention of SSIs, WHO recommendations of surgical scrubbing

Full Text:



Qin Liu L, Mehigan S. The effects of surgical hand scrubbing protocols on skin integrity and surgical site infection rates: a systematic review. AORN J. 2016;103:468-82.

Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13(10):843-51.

Widmer AF. Surgical hand hygiene: scrub or rub? J Hosp Infect. 2013;83:535-9.

Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect. 2021;111:6-26.

World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenged clean care is safer care. Chapter 13: Surgical hand preparation: state-of-the-art. Geneva: WHO Press; 2009.

Creedon SA. Healthcare workers’ hand decontamination practices: compliance with recommended guidelines. J Adv Nurs. 2005;51:208-16.

World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenged clean care is safer care. Chapter 15: Factors to consider when selecting hand hygiene products. Geneva: WHO Press; 2009.

Zil e Ali A, Cheema MA, Wajih Ullah M, Ghulam H, Tariq M. A survey of handwashing knowledge and attitudes among the healthcare professionals in Lahore, Pakistan. Cureus. 2017;9:e1089.

Kampf G, Löffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009;106(40):649-55.

World Health Organization. Health care without avoidable infections: the critical role of infection prevention and control. Geneva: WHO; 2016. Available from: Accessed on 20 August 2016.

Khan A, Nausheen S. Compliance of surgical hand washing before surgery: Role of remote video surveillance. J Pak Med Assoc. 2017;67(1):92-6.

Schwartz X, Schmitz M, Safdar N, Pop-Vicas A. Adherence to surgical hand antisepsis: Barriers and facilitators in a tertiary care hospital. Am J Infect Control. 2018;46(6):714-6.

Paudel A, Bista B. Compliance of surgical hand scrub in operation theatre of teaching hospital, Chitwan. J Chitwan Med Coll. 2019;9(1):36-40.

Umit UM, Sina M, Ferhat Y, Yasemin P, Meltem K, Ozdemir AA. Surgeon behaviour and knowledge on hand scrub and skin antisepsis in the operating room. J Surg Educ. 2014;71(2):241-5.

Ezzat A, Safdar MM, Ahmed I. Are we following the WHO recommendations for surgical scrubbing? Scott Med J. 2014;59:214-9.

Knoll M, Lautenschlaeger C, Borneff-Lipp M. The impact of workload on hygiene compliance in nursing. Br J Nurs. 2010;19(16):18-22.

Abdollahi L, Tabrizi SJ, Jodati A, Safaie N, Moradi-Joo M, Daemi A. Quality of surgical scrub in a heart hospital: Do not take it for granted. J Cardiovasc Thorac Res. 2017;9(3):164-9.

Fouad M, Eltaher S. Hand hygiene initiative: comparative study of pre- and post-intervention outcomes. East Mediterr Health J. 2020;26(2):198-205.