Gowning

Scrubbing, Gowning and Gloving-Universal precaution

-Disinfections and sterilization-Physical Lay-out

Scrubbing

Scrubbing

• DEFINITION:–Surgical scrub is the removal of as

many bacteria as possible from the hands and arms by mechanical washing and chemical disinfection before participating in an operation.

Scrubbing

•PURPOSE:–To help prevent the possibility of contamination of the operative wound by bacteria on the hands and arms.

Scrubbing• PREPARATION PRIOR TO SCRUB– Skin and nails should be kept clean and in good

condition and cuticles uncut.– Fingernails should not reach beyond the fingertip to

avoid glove puncture.– No fingernail polish.– No skin abrasion from hands to forearms– No jewelleries.– Wear cap and mask properly– Adjust eyeglasses comfortably in relation to mask.– Adjust water to a comfortable temperature.

Scrubbing

•LENGTH OF SCRUBBING–The length of scrub varies from institution to another.

Scrubbing

TWO TYPES OF SURGICAL SCRUBA.TIME METHOD–COMPLETE SCRUB- 5-7 minutes–SHORT SCRUB- 3minutes

B.BRUSH STROKE METHOD

Scrubbing

A.TIME METHOD• Fingers, hands, and arms are

scrubbed by allotting a prescribed amount of time to each anatomical area or each step of the procedure.

Scrubbing• COMPLETE SCRUB- 5-7 minutes• INDICATIONS:– In the morning before the first gowning and gloving.– Following a clean case if the gloves have been removed

before the gown.– Following a clean case if glove have had punctured.– Following a clean case if hands have been

contaminated in any other way.– Before an emergency case at anytime.

Scrubbing

• SHORT SCRUB- 3minutes• INDICATIONS:–Following a clean case, if the hands ands

arms have not been contaminated.–To remove bacteria that have emerged

from the pores and multiplied while the gloves were on.

ScrubbingB. BRUSH STROKE METHOD–A prescribed number of brush strokes, applied

lengthwise of the brush or sponge, for the fingers, hands, arms to 3 inches above the elbow.

• NAILS-30• SIDE OF FINGERS-20• BACK OF THE HAND-20• ARMS-20

Scrubbing• PROCEDURE:1. Turn on the water faucet and get an antiseptic solution.2. Wash hands prior to scrub.3. Clean the fingernails under running water.4. Scrub the left hand.5. Close-up scrubbing left fingertips.6. Scrub the left arm.7. Scrub the left elbow area.8. Rinse the brush and transfer to other hands.9. Scrub the right hand. 10. Close-up scrubbing right fingertips.11. Scrub the right arm.12. Scrub the right elbow area.13. Rinse the left hand and brush.14. Rinse the left arm and elbow area.15. Rinse the right hand.16. Rinse the right arms and elbow area.17. Complete the scrub as indicated with anatomical timed or stoke count method.18. Turn the water faucet with brush if water faucet is hand control.19. Walk in the operating room.

DRYING HAND AFTER SURGICAL SCRUB• Purpose:

– to prepare hand prior to gloving to prevent soiling of sterile drape DRYING HAND AFTER SURGICAL SCRUB

• Pick up sterile towel to dry hands from gown pack• Unfold towel• Place a third over right hand; two third will be hanging toward left hand• Dry left hand• Dry left arm• Transfer dry end of towel to left hand, a third over left hand, two thirds toward

right hand.• Dry right hand• Dry right arm• Fold towel into thirds• Dry right elbow area• Transfer towel, keeping hands on underside of towel• Dry elbow area

Parts of the Gown:

Cuffs

Neckband

Belt

Sleeves

Body

Gowning

Definition:• Donning a sterile gown immediately

after the surgical scrubPurpose:• To permit the wearer to come within the

sterile field and carry out sterile technique during an operative procedure.

Gowning

Parts of the Gown: • right side• wrong side• body• sleeves• cuffs• neckband• belt• him line• back ties

Gowning: Procedure• UNASSITED (SELF-SERVICE)– Grasp the gown at the center or you may receive it

from the circulating nurse.– Step one or two feet away from the sterile field– Unfold the gown and expose the hemline portion– Continue unfolding the gown and locate for the

armhole– Slip your hands into each arm hole and hold your hands

and arms straight and obliquely upward. The circulating nurse will fix it.

– Stoop and swing your body to the right and to the left.

Gowning: Procedure• ASSISTED (SERVING OTHERS)– Pick-up the gown directly from the table– unfold the gown slowly and serve the hemline portion to

the surgeon– Continue unfolding the gown while the surgeon is drying

his hands and arms.– When serving the gown, your gloved hands should come

in contact with the right side portion of the gown under the protecting cuff made.

– Show the opening and armholes to the surgeon.– As soon as the surgeon inserted his hands through the

armholes, leave it.

Gowning: Procedure• REMOVING THE GOWN–With the gloves till on, ask the circulating nurse

to loosen the ties and the belt.–Grasp the right shoulder of the gown and slip off

the arm allowing the sleeves to turn inside out.–Repeat the same procedure for the opposite

shoulder–discard the gown in the hamper

GLOVING

Definition:• This is the method of donning a sterile

glove. It is done after the gowning technique

Purpose: • To complete the sterile attire in order

that the one who wears may handle sterile equipment.

GLOVING

Parts of a Glove:•palmar surface•dorsal surface•finger holes•wrist• everted cuff

GLOVINGTypes1. Open method• This method of gloving uses a skin to skin, glove to

glove technique.• The hand, although scrubbed, is not sterile and

must not contact the exterior of sterile gloves. The everted cuff exposes the inner surfaces. The first glove is put on with skin to skin technique, bare hand to inside cuff. The sterile fingers of that glove hand may touch sterile exterior of the second glove. Glove to glove technique.

GLOVING

2. Closed method• The most preferred method, except

when changing glove during the operation or when donning for procedures not requiring gowns.

• This afford assurance against contamination when gloving oneself, since no bare skin is exposed during the process

GLOVING: ProcedureUNASSISTED (SELF-SERVICE)• Get the powder pack, taking care not to contaminate the outside part of the

glove• Powder both hands over the bucket away from the sterile field• Get the right hand glove with the left hand by holding it at the edge of everted

cuff. Step back from the sterile field• Explore the fingerholes before inserting the whole hand completely. Leave the

everted cuff as is• Slip the gloved right hand under the fold of the everted cuff. Insert the left hand

by exploring the fingerholes before inserting the whole hand completely. Leave the everted cuff as is.

• Make a pleat at the left cuff of the gown and secure this in place with your thumb.

• Slip the four fingers of the right hand under the fold of the glove and pull it up over the pleated cuff of the sleeves. Fix the glove firmly

• Repeat the same procedure for the right hand

Serving of Gloves

GLOVING: ProcedureASSISTED (SERVING OTHERS)• Open the powder pack and serve it to the surgeon over the bucket.

Take care that the wrapper will not touch the hands of the one being served.

• Get the right hand glove and inflate it• In serving the gloves, the palmer surface or the thumb portion

should be facing the one who is being served• Evert the cuff one inch wide. Slip four fingers inside the everted cuff• Stretch the glove wee outward. Put your thumbs out.• Allow the surgeon to explore the fingerholes• When the surgeon jerks his hand downwards, release your hold

upward so that the cuff of the glove covers the cuff of the gown.• Repeat the same procedure for the left hand.

GLOVING: Procedure

REMOVING THE GLOVES• With the gloved right hand, remove the glove

by holding it at its outer and pull off. This is the glove to glove technique

• To remove the right glove, insert your thumb or 3 fingers between the skin and the glove and pull off. This is the skin to skin technique.

• “universal precautions”• applied to all clients• performed whenever there is a possibility of

contact with:» blood» body fluids (except sweat)» secretions» mucus membrane» breaks in skin

Sterilization– Consists of physical and

chemical techniques that destroy all microorganism including spores.

1. Saturated Steam under Pressure (3-10’)e.g. autoclave

2. Gas Chemical Sterilization (3-7⁰)

e.g. Sterrad, Ethylene oxide3. Liquid Chemical Sterilization - 2% activated aqueous

glutaraldehyde solution (10⁰)( e.g. cidex).

Physical Lay-out

•prevent wound infection

Construction or Renovation Planning

•Multidisciplinary team

approach

Criteria for Designs, construction or Renovation

1. Number, type, and length of the surgical procedure to be performed

2. Type and distribution by specialties of the surgical staff and equipment for each

3. Proportion of elective inpatient and emergency surgical procedures to ambulatory patient and minimally invasive procedures.

Criteria for Designs, construction or Renovation

4. Scheduling policies r/t the number of hours per days per week the suite will be in use and staffing needs.

5. Systems and procedures established for the efficient flow of patients, personnel, and supplies.

Criteria for Designs, construction or Renovation

6. Consideration of volume changes and need for future expansion capabilities.

7. Technology to be implemented and plan for potential technology to be develop.

8. Safety of staff, patients, and other personnel during construction or renovation.

Principles in Construction or Renovation Planning

1. Strategic planning2. Plans for emergencies3. Exclusion of contamination from outside the

suite with sensible traffic patterns to and from the suite

4. Separation of clean areas from contaminated areas within the suites during the building phase

5. Noise control

Type of Physical Plant Design

4 basic Design:1. Central Corridor, or hotel plan2. Central core, or clean core plan with

peripheral corridor3. Combination central core and peripheral

corridor, or racetrack plan4. Grouping, or cluster plan with peripheral

and central corridor