PERMORMING A SURGICAL SCRUB

Human hands are the most important tools for caring. Hands feel,
diagnose, cure, prod, and provoke as they are placed upon each patient who is
hoping for answers, understanding, and healing remedies. The hands can also be
a portal and transmitter of infection. While handwashing may be the simplest
way to control infection, it is often not practiced where warranted.
Surgical site infections greatly contribute to nosocomial infections. Some
of the risk factors for nosocomial infections include the behavior of OR
personnel regarding decontamination practices, hand hygiene/antisepsis, and
compliance with universal precautions. Most surgical professionals agree on the
importance of good surgical hand-washing practices in infection prevention.
Hand transmission is a critical factor in the spread of bacteria, pathogens,
viruses that cause disease and nosocomial infections in general.
All sterile team members should perform the hand and arm scrub before
entering the surgical suite. The basic principle of the scrub is to wash the hands
thoroughly, and then to wash from a clean area (the hand) to a less clean area
(the arm). A systematic approach to the scrub is an efficient way to ensure
proper technique.
There are two methods of scrub procedure. One is a numbered stroke
method, in which a certain number of brush strokes are designated for each
finger, palm, back of hand, and arm. The alternative method is the timed scrub,
and each scrub should last from three to five minutes, depending on facility
protocol.

DEFINITION:
Surgical hand washing is a procedure by which dirt and
microorganisms are destroyed and removed from hands and fingers by chemical
and mechanical friction.

PURPOSES:
1. To remove dirt and transient micro-organisms from hands.
2. To remove the risk of transmission of micro-organisms to patients.
3. To reduce the risk of cross infection among patients.
4. To reduce the risk of transmission of infection agents to oneself.
5. To prevent iatrogenic infections.

ARTICLE:
1. Soap/ antiseptic detergent.
2. Running warm water.
4. Towels (Sterile)
PROCEDURE

5 Moments when the hand washing is important:

7 Steps to Wash Your Hands Properly
 Step 1 - Wet your hands and apply enough soap.
 Step 2 - Rub your palms together.
 Step 3 - Rub the back of each hand.
 Step 4 - Rub both your hands while interlocking your fingers.
 Step 5 - Rub the back of your fingers.
 Step 5 - Rub the tips of your fingers.
 Step 6 - Rub your thumbs and the ends of your wrists.
 Rinse hands and arms by passing them through the water in one direction only,
from fingertips to elbow. Do not move the arm back and forth through the
water.
 Proceed to the operating room suite holding hands above elbows.
 If the hands and arms are grossly soiled, the scrub time should be lengthened.
However, vigorous scrubbing that causes the skin to become abraded should be
avoided.
 At all times during the scrub procedure care should be taken not to splash water
onto surgical attire.
 Once in the operating room suite, hands and arms should be dried using a sterile
towel and aseptic technique. You are now ready to done your gown and sterile
gloves.
 PROCEDURE OF APPLYING MASK AND STERILE GOWN

DEFINITION:
The procedure involves wearing of a mask entering the operation theatre
maintain asepsis and contamination of sterile area.

PURPOSES:
1. To prevent dispersal of droplets from wearer to environment and patients.
2. To prevent contamination of sterile field.

PROCEDURES:

Nursing action Rationale

1. After performing surgical hand washing take the sterile mask
handed to you by the circulating nurse. Hold it by top two strings
keeping top edge above bridge of nose.
2. Tie both top strings at back of head above ears as shown in
figure.

3. Tie the two lower strings snugly around neck well under the chin.
4. Gently pinch upper portion of mask around bridge of nose. Ensure proper fitting.

GOWNING

Nursing Action Rationale

1. Grasp the sterile gown from the sterile drum or sterile pack.
2. Grasp the sterile gown at the crease near the neck, hold it Prevents gown from
away from yourself and permit it to unfold freely without becoming unsterile.
touching anything including the uniform.

3. Hold the gown at the shoulder level from inside and put each Prevents the outer portion of
hand directly into the armhole. Extend the arms and hold hand gown from contamination.
upwards at shoulder level while putting through the arm hole

4. Circulating nurse pulls back the gown from inside. So that Prevents contamination of
the upper limbs go into the sleeves. The circulating nurse ties the outer portion of gown.
the gown from the back.

5. The waist ties are loosened by the scrub nurse and flap is The waist flap cover the
brought around the waist by the circulating nurse and it is tied. back, preventing
contamination area when
turning around

REMOVAL OF GOWN AND MASK

GOWN:
1. Untie strings at the back of the gown. Prevents contact with contaminated portion
Remove gown, folding inside out to cover of gown
outside of gown.
2. Dispose gown into designated receptacle.

MASK:
1. Wash hands. Untie lower strings first, then Avoid contact of the contaminated portion of
the top strings and pull mask away from face. mask to our body.
2. Hold mask by strings and discard into
appropriate receptacle.

PERFORMING STERILE GLOVING PROCEDURE

 Occupational Safety and Health Administration (OSHA) recommend wearing gloves
when coming in contact with blood, mucous membranes (e.g., mouth and eyes) and other
bodily discharges. Gloves provide a protective barrier against germs that cause infection. It is
recommended staff review the Bloodborne Pathogen Procedure and incorporate universal
precautions into their daily routine.

STEPS ON HOW TO PUT ON STERILE GLOVES

1. Ensure Your Hands are Clean

Choose the proper glove size for you. Sterile gloves come in a wide range of sizes. These
can vary by company. Try on several different pairs of sterile gloves until you find the right
fit. Once you've found the right fit, you will have to discard the gloves you tried on and put a
new, fully-sterile pair on. Feel for the following to identify when you have the right size for
your hand:

 Ability to move your hands comfortably

 No friction on your skin
 Little to no sweating
 Little or no hand muscle fatigue

2.Remove your all jewellery.

  Although not necessary, consider taking off any rings, bracelets or other jewellery on your
hands. These could contaminate your gloves or make them difficult to put on and
uncomfortable to wear. Removing your jewellery also minimizes the risk of your glove
tearing.Put your jewellery in a safe place where you can easily find it when you’re done with
your gloves.

3.Wash your hands thoroughly. 

Before you touch your gloves or slide on your sterile gloves, wash your own hands.
Lather up your hands `with soap and water. Rub your hands under the water flow for at least
20 seconds. Rinse your hands and wrists thoroughly and then dry them.

 Use an alcohol-based h`and sanitizer if you don’t have soap and water.
 Some types of sterile procedures require a different type of soap and a different amount of
scrubbing type.

4.Keep your hands above your waist. 

 Once you’re hands are thoroughly clean, avoid letting them fall below your waistline.
Holding them above this level can minimize the risk of contaminating them. If your hands do
fall below your waist, repeat the hand washing process before putting on your gloves.
 Standing up may help keep your arms above your waist.

Sliding on Your Gloves

1.Open the sterile glove package. 

Inspect the package for rips, discolouring, or dampness, and discard if the package is
compromised. Open the outer wrap of the pack. Make sure to open from top then bottom and
then on the side. Remember, you only have a 1 inch margin you can touch. This will expose
the sterile inner package that contains your gloves.

 Note that sterile gloves also have a shelf-life. Before putting on your gloves, ensure that
they're not expired.
2. Remove the inner wrap. 

Take out the inner wrap and place it on a clean surface. Make sure you can see both sterile
gloves through the packaging to ensure that you’ve opened the package properly.

3.Pick up your dominant hand glove. 

Using the hand you don’t use to write, grab the glove for your dominant hand. Touch only the
inside of the glove cuff (the side of the cuff that will be touching your skin). Putting on your
dominant hand glove first can minimize the risk of ripping or contamination to the hand
you’re likely using most.
 4. Place the glove onto your dominant hand. 

Let the glove hang with the fingers pointing downward. Make sure your hands are not below
the waist and above the shoulders to ensure the sterility. Then slide your dominant hand into
the glove with your palm facing up and fingers open.

 Remember to touch only the inside of the glove to prevent any potential contamination.
 Make adjustments only once the other glove is on

5. Slip on the second glove. 

Put the fingers of your gloved hand into the folded cuff of the other glove and lift it up.
Keeping your second hand flat and palm facing up, place the glove over your fingers. Then
pull the second glove over your hand.

 Hold your gloved hand up to prevent touching your bare palm or wrist.
6.Adjust your gloves. 

Once both gloves are on, you can adjust them.Reach under the cuffed part of each glove to
pull them up or make any other adjustments you may need. Do not reach between the skin
and the cuff. Smooth each glove out on your hands. They should feel snug without cutting off
your circulation or feeling uncomfortable.
7.Check the gloves for rips. 

Look over each hand and glove thoroughly. If you notice any visible rips, tears, or other
issues, re-wash your hands and put on new gloves.
Tips on Putting Sterile Gloves

 Nurses should never touch anything other than what is required for the procedure with
the sterile gloves.
 If the sterile gloving process is broken at any point, use new gloves from a new
package.
 Wear sterile gloves only when necessary.
 Never wash gloves and reuse them.
 Never use gels and alcohol to clean gloves, use a new pair each time.
 Use a new set of gloves on each patient and each procedure.
 Gloves do not substitute the proper cleaning of hands before using sterile gloves.
Complications with not Putting on Sterile Gloves Correctly

Sterile gloves act as a protective barrier between nurses and their patients.
Complications that can arise from not putting on sterile gloves correctly are the spread of
infection and diseases. The gloves can break during a procedure and the nurse and the patient
can be in immediate danger from exposure to hazardous materials and bodily fluids.

Nurses must be conscious of their actions when putting on sterile gloves to ensure
their own safety and the safety of their patients.
PREPARING AN OPERATION THEATER TROLLEY AND PATIENT
BEFORE SURGERY
DEFINITION:

Keeping the operating room ready and available for carrying out surgical procedures.

PURPOSES:

1. To ensure that appropriate equipment and machinery are available in working condition.
2. To clean required equipment and machines.
3. To disinfect room and work surfaces.
4. To collect necessary supplies of sterile and other items.
ARTICLES:

1. Operating room table and accessories like light, cautery and sponge rack etc.
2. Instrument trolleys
3. Articles required for positioning patients.
4. Sterile linen.
5. Instruments sets.
6. Cleaning solutions.
7. Waste disposal containers.
PROCEDURE:

Nursing actions Rationale

1. Acquire information about the surgery to Help in accurate, easy and quick preparation
be carried out. of operating room.
2. Assemble necessary equipment and To save time and energy in preparation.
machines. Minimize equipment as far as Provides an organised approach to task.
possible.
3. Disinfect room, work surfaces, walls and Ensures a sterile area and maintains sterile
floor including equipment and machines. field.
Carbolise the surfaces and equipment after
wet washing.
4. Collect sterile linen and instrument sets.
5. Account and collect other supplies.
6. Ensure that scrub room is ready with soap, Ensure those articles are ready for scrubbing.
running water and sterile brush.
7. Ensure that airconditioning, lighting and Preparation provides for an organised
power supply are adequate. approach to task.
8. Check table and accessories, lights and
cautery machine for proper functioning.
9. Connect suction apparatus to electric
source and check central suction equipment.
10. Receive patients from control
desk/reception to operating room.
 STERILE TECHNIQUE OF DRAPING TROLLEY

DEFINITION:Arranging appropriate sterile linen, instruments and supplies on designated

trolleys for carrying out surgical operation, using aseptic technique.

PURPOSES: 1. To create a sterile field for carrying out surgical operation.

2. To ensure successful barrier against bacterial invasion of surgical wound.
ARTICLE:
1. Instrument trolleys
2. Mayo stand
3. Basin stand
4. Square trolley
PROCEDURE:
Nursing action Rationale
1. Scrub nurse puts on sterile cap, mask, Interrupts chain of infection. Protects patient
gloves and gown after scrubbing her hands. and nurse.
2. Check outer labels of all sterile linen Ensure that correct instrument sets are
bundles and instrument sets. opened.
3. Follow principles of asepsis while sterile Maintains sterile field.
packs are opened.
4. Ensure that whole trolley is dry by using Moisture contaminates sterile field.
waterproofing beneath sterile packs.
5. Circulating nurse, open the sterile drum
and hands over the sterile towel with the
transfer forceps to the scrubbed nurse.
6. Scrubbed nurse spreads the towel very Maintains sterile field.
carefully on the trolley without touching
unsterile area.
7. Drape distal end of trolley first, then Moving from distal to proximal prevents
proximal. need to reach across the sterile field.
8. The circulating nurse opens the sterile Preparation provides for an organised
pack using transfer forceps and scrub nurse approach to task.
removes the instrument tray and instruments
from the sterile pack and gently places on the
instrument trolley.
9. Arrange instruments neatly according to
the order of use.
10. Circulating nurse pours sterile saline in Maintains sterile field.
sterile basin which is placed in basin stand.
11. Discard unnecessary wrappers and foils Maintains sterile field.
from sterile field.
12. Discard any contaminated A sterile work area promotes proper aseptic
drapes/instruments and substitute with sterile technique.
ones.
13. After arranging, cover the trolley with Maintains sterile field.
sterile towel till it is taken over for surgery.
 STERILE TECHNIQUE OF DRAPING PATIENT

DEFINITION: Receiving the preoperative patient on the theatre table, and replacing
patient’s linen with sterile, theatre linen, exposing operative site for preoperative skin
cleaning and placing sterile mackintosh and towels for barricading operative the from
surrounding areas.
PURPOSES: 1. To create a sterile field for carrying out surgical operation.
2. To ensure successful barrier against bacterial invasion of surgical wound.
3. To prevent contamination of operative site with unprepared skin surfaces.
EQUIPMENT: 1. Sterile bed linen
2. Big and small mackintosh
3. Surgical towels
4. Towels clips.
PROCEDURES:
Nursing action Rationale
1. Transfer the patients to theatre table
2. Replace patient’s linen with sterile linen. Sterile field is maintained.
3. Expose operative site while adequately A neat work area promotes proper techniques
covering other areas.
4. Assist surgeon to clean the site with
bacteriocidal solution
5. Offer sterile, towels and towel clips to Sterile field is maintained.
surgeon and assist in draping operative site.
6. Drape patient according to nature, type of Ensures that the sterile towels remains in
surgery and incision. place
7. Secure towel clips at each corner, viz Sterile field is maintained.
above, below and sides of operative site.
8. Assist surgeon to apply “Opsite” evenly Preparation provides for an organised
without air pockets, soon after cleaning and approach to task.
drying operative site.