PREPARATION FOR SCRUBBING
Personal cleanliness is extremely importantFingernails not visible over the finger tipsFingernails if kept smooth will not puncture
glovesNails should be free of polish
SCRUB-CONT.Remove all jewelry from hands and armsMay pin these items to your scrub suitBacteria and dead skin cells accumulate
beneath watches, bracelets and rings.
SCRUB-CONTDon a clean, short-sleeved cotton suit each
day before entering the surgical suiteNo street clothes or hospital uniformsThe scrub suit cover all undergarmentsScrub shirt be tucked into the trousersTrouser legs should not touch the floorSleeves of the suit at least four inches above
the elbow
SCRUB-CONT
Ideally should keep a pair of shoes for wear in the surgical suite only
Street shoes if worn should use shoe coversShoe covers must be removed on leaving the
surgical suiteWear a clean head cover each day to cover
the hair completely
SCRUB- CONTSurgical mask is worn all the time in the
restricted/semi restricted areasThe mask must fit snugly around the nose
and mouth to filter airDon a fresh mask immediately before every
scrub procedureThe mask is worn primarily to protect the
patient. Mask is not sterile, do not touch the inside of the mask, handle it by the ties.
THE SURGICAL SCRUB
A surgical scrub brush/sponge with a nail cleaner are prepackaged, presterilized and may be impregnated with a surgical soap
The surgical scrub should be performed according to local standard policy
At uhs perform complete scrub before the first case in the morning
SCRUBBINGFollow an anatomical pattern of scrubThink of the fingers, hands and arms as
having four sides or surfaces.Regulate the flow and temp. of the waterPretear brush package( it is sterile) lay the
brush on the back of the scrub sink.Wet hands and arms for an initial prescrub
wash. Use several drops of surgical detergent.
SCRUBBING CONT.Work up a heavy lather, then wash the hands
and arms to a point about two inches above the elbow.
Rinse hands and arms thoroughly, allowing the water to run from the hands to the elbows
Do not retrace or shake the hands and arms; let the water drip from them.
SCRUBBING CONT.Remove the sterile brush and file, moisten
brush and work up a lather.Soap fingertips and clean the spaces under
the fingernails of both hands under running water; discard file.
Lather fingertips with sponge-side of brush; then using bristle side of brush, scrub the spaces under the fingernails of the right or left hand about 30 circular strokes.
SCRUBBING CONT.When scrubbing slightly bend forward, hold
hands and arms above the elbow, and keep arms away from the body.
Lather digits ; scrub 20 circular strokes on all four sides of each finger.
Scrub one hand and arm completely before moving on to the other hand and arm.
SCRUBBING CONT.Lather palm, back of hand, heel of hand and
space between thumb and index finger.Choosing either of the surfaces, scrub 20
circular strokes on each surface.After soaping digits, scrub, beginning with
the thumb or little finger of the right or left hand.
SCRUBBING CONT.
You are now ready to scrub the forearmDivide your arm in three inch increments.Use the sponge side of the brush lengthwise
to apply soap around wrist. Scrub 20 circular strokes on all four sides.
Move up the forearm-lather, then scrub, ending two inches above the elbow.
SCRUBBING CONT.Soap and /or water may be added to the
brush at any time.Repeat the procedure above for the other
armDiscard brushRinse hands and arms without retracing
and/or contaminating.Allow the water to drip from your elbows
before entering the operating room.
DRYING THE HANDSNow you are entering the OR from the scrub
area to the sterile back tableSlightly bend forward, pick up the hand
towel from the top of the gown pack and step back from the table
Grasp the towel and open it so that it is folded to double thickness lengthwise.
Do not allow the towel the to touch any unsterile object, keep your arms away/body
DRYING THE HANDS CONT.Holding one end of the towel with one of your
hands, dry your other hand and arm with a blotting, rotating motion
Work from your fingertips to the elbowDo not retrace any areaDry all sides of the fingers, the forearm and
the arms thoroughlyGrasp the other end of the towel, dry your
other hand and arm in the same manner as above.
GOWNINGSurgical gowns are folded with the inside
facing the scrub person.This facilitates picking up and donning the
gown without touching the outside surface If you touch the outside surface the gown
while donning it, the gown is contaminated.Remember your hands are not sterile they
are but just clean
GOWNING CONT.Your scrubbed hands and arms are
contaminated if you allow them to fall below waist level or to touch your body
With one hand, pick up the entire folded gown from the wrapper by grasping through all layers, being careful to touch only the inside top layer which is exposed
GOWNING CONT.
Unfold the gown. Hold the gown away from you, at chest level to facilitate safe handling without break in asepsis
Grasp the inside shoulder seams and open the gown with the armholes facing you.
Slide your arms part way in to the sleeves of the gown, keeping your hands at shoulder level away from the body
GOWNING CONT.Hold your hands high so gown does not touch
the floorWith the assistance of your circulator slide
your arms further in to the gown sleevesWhen the fingertips are even with the
proximal edge of the cuff, grasp the inside seam at the juncture of gown sleeve and cuff using your thumb and index finger.
Be careful that no part of your hand protrudes from the sleeve cuff.
GOWNING CONT.The circulator must continue to assist at this
point. She/he positions the gown over your shoulders by grasping the inside surface of the gown at the shoulder seams.
The circulator then prepares to secure the gown, the neck and back may be secured with a Velcro tab or ties.
The circulator ties the gown at waist level at the back. This technique prevents the contaminated surfaces at the back of the gown from into contact with the front of the gown.
GOWNING- OPEN CUFFThe procedure is same as above except you
do not grasp the inside seam of the sleeve but you allow your hands to protrude from the cuffs of the gown.
Both you and the circulator must be careful that the gown cuffs are not pulled too high on the wrists
The edge of the cuff should be at the distal end of the wrist.
GLOVINGClosed Cuff methodOpen cuff method Closed Cuff method of gloving is preferable
to the open cuff methodClosed cuff method eliminates potential
hazards in the glove procedure.Demonstration of both.
FINAL TIE OF GOWNGloves are on, you are ready to complete
gown tie with the assistance of the circulatorHold the paper tab- do not pull, Undo gently the knot so that you have the
other belt into your other handHand it over the paper tab to the circulator
while holding the belt, you spin, circulator will pull the paper tab, now you tie the knot
CHANGE OF GLOVE In between cases, hold outer surface of the
first glove rubber to rubber and pull off.To remove the next glove, place your finger
inside of the cuff of the glove skin to skin and pull off
REMOVE GOWN & GLOVEThe outer part of the gown and gloves are
contaminated by bacteria from the procedure.Remove them, careful to avoid contamination
of forearms, clothing and handsRemove the gloves after removing the gown.Demonstration: