8 - Sterile Technique Flashcards
Preparing to scrub includes:
Disposable hair net / skull cap
Mask
Eye pro
Scrubs tucked in
Shoe covers on
Sleeves rolled
Chains, rings, watches - off and stored
Name tag
Scrub instrutions
- Wet brush, work up lather, and lather hand with sponge
- Scrub fingertips 30 circular strokes with the brush
- Start at either little finger or thumb side of hand; scrub 4 sides of each digit 20 strokes with the sponge
- Scrub palm, sides of the hand, back of the hand, web space between thumb and index finger 20 strokes each
- Wet the brush any time you need more lather
- Apply soap to circumference of the wrist with a sponge
- Scrub 4 sides of wrist 20 times using circular strokes
- In this manner, continue up the forearm past the elbow
Additional scrub instructions
Keep elbows down
Re-scrub if you touch a non-sterile surface
Let water drip off elbows
Rinse in one motion, no see-sawing
Place trash in kick bucket, not in sink
Do you have to be sterile to go past the red line?
No, but you do need proper OR attire
What do you do with your hands once in the OR?
Keep hands above the waist and at the xyphoid
Keep your hands and arms away from clothing
Where do you dry your hands?
In the OR with the help of a scrub tech / nurse
Who will normally “gown” you?
A gloved tech
Once you are gowned:
Tech will present a glove - slide your hand in, and adjust only after the second gloves is placed
The white of the gown cuff should be completely covered by the glove
Proper conduct in the OR
Know your role!
Be helpful but stay in your fucking lane (aka out of the way)
Unscrubbed members do NOT reach over sterile surfaces
If you are not gowned and gloved, do NOT go between 2 sterile members, or between a sterile member and a sterile field
Which areas of the member are considered unsterile?
Below the waist
Above the shoulders
Back of the gown
Who usually prepares the patient?
Unsterile team member
Positions, shaves, paints the site
Places indwelling urinary catheter
Positions monitors
Ensures IV access is available
Who usually does the draping of the patient?
Sterile team member (usually surgeon and first assist)
Ensure only prepped area visible through fenestration
Ensure operative field is well-lit
What is the “blood brain barrier”? (In surgery slang)
The drape between the anesthesiologist (unsterile) and the operative field)
What must be done before surgery?
Perioperative checklist
TEAM steps
Introduce crew
Instrumentation, special packs discussed
Time-out performed - lead by surgeon
Final step before starting surgery?
Surgeon asks anesthesia if patient is ready to start
Any time a package is opened:
A count is performed and all must be 100% by the end of the case
What is the Mayo stand?
The scrub tech’ area
If you want something, ask the scrub tech for it
Pass everything off to them unless otherwise instructed
What is usually kept on the back table?
Instruments for the case not on the Mayo stand
Setting up cautery:
Monopolar
Scalpel, grounding pad plugged in
Place grounding pad
Ensure proper (low voltage) settings on cut/coag
Setting up suction
Secure on drape
Follow cautery with suction to suck up smoke
If using suction with irrigation, filter through sponge to avoid clogging with fat/tissue
If someone says you contaminated yourself:
You DID. Don’t argue.
Glove:
Circulator will remove contaminated glove, scrub tech will re-glove you.
Sleeve:
Scrub tech can place paper sleeve over your contaminated gown
Gown:
Circulator removes gown / gloves
Scrub tech will re-gown/glove you
Moving the patient:
Strongest person takes the torso; weaker at the feet
Anesthesia moves the head and counts
Where does the pt usually go after surgery?
The morgue………well, hopefully not
The PACU, and then back to their respective unit (ICU, tele, med-surg, etc)
What is Avogard?
Presurgical scrub which may be done in lieu of full surgical scrub IF:
- full surgical scrub was done for the first case
- you have not left the operating area
- not gone to the latrine, eaten, or smoked
Process:
- one pumpful in palm and work in over hand
- additional pumpful from wrists to elbows
- rub into hands/arms until dry
What does an annoying pepper do?
It gets jalopeno face
