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General reference information for laboratory, clinic and supply staff. It is not medical advice and not a procedure instruction; follow your facility’s infection prevention policy and the product’s labeling.
Short answer
A surgical scrub brush is a scrubbing tool used with an antiseptic soap during preoperative hand antisepsis. The CDC and HICPAC hand hygiene guideline states that several studies indicate neither a brush nor a sponge is necessary to reduce bacterial counts on the hands of surgical personnel to acceptable levels, especially when alcohol-based products are used. The guideline also notes that scrubbing with a brush can damage the skin of personnel and result in increased shedding of bacteria from the hands.
Definition and scope
The CDC guideline defines surgical hand antisepsis as an antiseptic handwash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. In the same document, the FDA product category surgical hand scrub is described as an antiseptic-containing preparation that substantially reduces the number of microorganisms on intact skin.
In 21 CFR 310.545, the FDA’s rule on drug categories, “Surgical hand scrub drug products” is one of the named topical antimicrobial categories (paragraph (a)(27)(viii)), alongside categories such as health care personnel hand wash drug products and patient antiseptic skin preparation drug products. That rule names no separate “surgical hand rub” category. So the product used for scrubbing is regulated as an antiseptic drug preparation, while the brush or sponge is only the applicator. For the antiseptic itself, see what an antiseptic is.
What the CDC guideline recommends for surgical hand antisepsis
The CDC guideline (Part II, surgical hand antisepsis) recommends surgical hand antisepsis using either an antimicrobial soap or an alcohol-based hand rub with persistent activity before donning sterile gloves for surgical procedures (category IB). Its recommendations do not call for a brush or a sponge. The guideline also describes a two-stage approach in which an antiseptic detergent scrub is followed by an alcohol-containing preparation. Product-specific use is set by the manufacturer’s labeling and the facility’s written protocol.
Brush, sponge and hand rub: how the terms line up
People search several names for overlapping things. This cross-walk shows how the CDC guideline and the CFR use each term.
| Term | What the source says | Source |
|---|---|---|
| Surgical hand antisepsis | Antiseptic handwash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. | CDC/HICPAC guideline |
| Surgical hand scrub (FDA category) | An antiseptic-containing preparation that substantially reduces microorganisms on intact skin; named as “Surgical hand scrub drug products” in the CFR. | CDC/HICPAC guideline; 21 CFR 310.545 |
| Surgical scrub brush or sponge | Several studies indicate neither is necessary to reduce bacterial counts to acceptable levels, especially with alcohol-based products; brush scrubbing can damage skin and increase shedding. | CDC/HICPAC guideline |
| Alcohol-based surgical hand rub product | The guideline recommends products with persistent activity. It notes alcohol solutions containing 60% to 95% alcohol are most effective, but alcohols have no appreciable persistent (residual) activity on their own. | CDC/HICPAC guideline |
| Antimicrobial soap | The other option the guideline recommends for surgical hand antisepsis. | CDC/HICPAC guideline |
“Waterless surgical scrub” is a trade and search term; the guideline’s wording for the alcohol-based option is “alcohol-based hand rub with persistent activity.” For related antiseptic ingredients, see chlorhexidine and 70% isopropyl alcohol.
Where it matters for supply records
Two points from the CDC guideline and the CFR bear on how staff describe and catalogue these items:
- The antiseptic preparation, not the brush, is the item the FDA categorizes (as a surgical hand scrub drug product).
- Because the guideline states a brush or sponge is not necessary, a facility’s written protocol, not the existence of a brush on a shelf, determines what is used.
Other items worn or used around the same procedures are covered in surgical gowns, surgical glove sizes and skin antisepsis before injection.
Common misunderstandings
“A brush is required for a proper surgical scrub.”
The CDC guideline states otherwise: several studies indicate neither a brush nor a sponge is necessary. Facility protocols may differ, so the guideline is a reference point, not a replacement for local policy.
“Alcohol alone gives lasting protection.”
The guideline says alcohols have no appreciable persistent (residual) activity, which is why it recommends alcohol-based hand rubs with persistent activity for surgical hand antisepsis.
FAQ
Is a surgical scrub brush necessary?
According to the CDC/HICPAC guideline, several studies indicate neither a brush nor a sponge is necessary to reduce bacterial counts on the hands of surgical personnel to acceptable levels, especially when alcohol-based products are used.
What is a surgical scrub sponge?
It is the sponge counterpart of the brush: a scrubbing applicator used with an antiseptic soap. The guideline groups brushes and sponges together and says neither is necessary.
What is a waterless surgical scrub?
Waterless surgical scrub is a common name for an alcohol-based surgical hand rub product. The guideline recommends an alcohol-based hand rub with persistent activity as one of two options for surgical hand antisepsis.
What is a surgical hand rub?
It is the antiseptic hand rub form of surgical hand antisepsis, as opposed to the antiseptic handwash form. Both appear in the CDC definition of surgical hand antisepsis.
Which FDA category covers surgical hand antiseptics?
21 CFR 310.545(a)(27)(viii) names “Surgical hand scrub drug products.” The rule has no separate surgical hand rub category.
Sources
- CDC/HICPAC, Guideline for Hand Hygiene in Health-Care Settings, MMWR Recommendations and Reports 2002;51(RR-16): https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm. Date checked: 2026-11-01.
- U.S. Code of Federal Regulations, 21 CFR 310.545, drug products containing certain active ingredients offered over-the-counter for certain uses: https://www.law.cornell.edu/cfr/text/21/310.545. Date checked: 2026-11-01.
