The fact that hand cleaning with an antiseptic agent is more effective than simply using plain soap and water was first recognised in 1846 by Hungarian physician Ignaz Semmelweis. Semmelweis introduced hand disinfection into his practice and immediately mortality rates associated with infections fell. The surgical hand scrub continues to be one of the most important procedures in infection prevention.
Before starting, ensure that your facemask is comfortable and secure (this is non-sterile so cannot be adjusted once you are scrubbed) and your hands and arms are completely bare (unless you have been allowed to wear your wedding band). Your fingernails must be free of polish and of medium length.
Currently, three main types of preparations for hand hygiene are used: chlorhexidine gluconate (clear/pink solution); iodine based preparations (brown); and aqueous alcoholic solutions (clear). Multiple studies have compared the effectiveness of these preparations but the evidence for all forms is mixed. Iodine based preparations have been known to cause skin irritation; therefore, use an alternative preparation if this occurs.
Start the water taps and get a comfortably warm and adequate flow of water. During washing, use your elbows to release the soap and turn the taps off, because your hands must remain decontaminated.
Scrubbing begins at the fingernails, and a nail file and brush from a sterile pack can be used. Scrubbing then occurs in three washing cycles: (a) hands and arms extending to two inches above the elbow; (b) hands and half way up the forearms; and (c) hands only (fig 4). This follows the principle of washing from a clean area (the hand) in the direction of the less clean area (the arm). Your hands should always be held above the level of your elbows at all times in order to prevent dirty water from dripping from the upper arm onto lower sterile areas.
After scrubbing, use the sterile hand towels to dry each arm, starting at the hand and making your way up your arm, using one towel per arm in a dabbing motion.
an article from medscape. hazrilyas