Abstract: Surgical hand scrub is essential in preventing surgical site infections The traditional water-based scrubbing method is costly both financially and environmentally. A six-minute scrub can consume up to 45 liters of water per person, per case. In a tertiary hospital, this translates to thousands of liters daily. Alcohol-based hand rub (ABHR) offers a safe, cost-effective, and sustainable alternative. Despite alcohol agents costing less per use ($0.36 vs $0.50–$0.71) and saving nearly 900,000L of water annually, barriers persist. We surveyed 64 operating theatre staff on their scrubbing preferences and perceptions at the Royal Melbourne Hospital. Most understand that ABHR is guideline-approved, yet traditional methods remain preferred. Key concerns included skin irritation, dispenser availability, and unfamiliarity with the technique. 36% of staff underestimated water usage from traditional methods. Multiple randomised trials and meta-analyses have shown no difference in surgical site infection rates when alcohol rub is used after an initial scrub or simple hand wash. ABHR reduces water consumption and may offer an environmental advantage over traditional surgical scrub by reducing chemical discharge into wastewater, and it is better tolerated by users. In conclusion, wider adoption of ABHR represents a pragmatic shift towards environmentally sustainable surgical practice. A culture shift supported by education and infrastructure addressing practical concerns is key to bridging the gap between awareness and practice. Reference: 1. Kara A, Yasar C, Birinci M, Gulenc B, Sener B. Don't let our operating theatre to be desert. Acta Chir Orthop Traumatol Cech. 2021 Jan 1;88(3):229-32. 2. South Australia Infection Control Service. Hand Hygiene Clinical Guideline [Internet]. 2020 May 5; Version 1. Clinical Guideline Number: CG165. Canberra: AIHW. 3. Widmer AF. Surgical hand hygiene: scrub or rub?. Journal of Hospital Infection. 2013 Feb 1;83:S35-9.