SCRUB, GOWN AND GLOVE PROCEDURES

Irene Fernando RN CNORPCC/OR EDUCATOR

Janice Kay RN

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:

THANK YOU.Enjoyed being with you. Thank you.