lecture 4: surgical hand scrub, gowning and gloving Flashcards
The technologists role in the surgery room
Maintaining sterility and assisting the surgeon are the primary concerns
Retraction of tissue
Lavage surgical field with sterile fluid
Manage instrument table
Running suture
A skilled and qualified technologist can significantly affect the duration and outcome of the surgical procedure
What are the sources of contamination
Endogenous: front eh patient itself
Exogenous: from the surgical team and/or the surgical environment
What should the tech do before going into surgery
Eat a meal of substance
Consume fluids
Visit the restroom
Groom fingernails
Avoid cologne and perfume
How to avoid weakness or nausea for surgery
Avoid locking the knee joint while assisting
Slowly shift weight from leg to leg
Eat before scrubbing in
What are the proper attire in the surgical area
To reduce shedding of microorganisms
Freshly laundered scrub suits
Head covers
Masks
Perhaps shoe covers or designated shoes for surgery
Follow written and posted dress code
Follow provided guidelines for general personal cleanliness
What scrubs should you wear in the surgery suit
Never wear street clothes in surgery
Launder scrubs in hospital laundry
Don’t wear scrubs from work to home
Scrub top should be short sleeved, fit snug to body, and be tucked into pants
Clean lab coat over scrubs of stepping out of surgery area
What is unique about the mask and shoes worn in the surgery suit
Masks
- Worn over mouth and nose
- Changed frequently
- Conform to face
- If about to sneeze, don’t turn head
-Step out of sterile field, keep facing forward
Shoes: should be comfortable and clean; can use shoe covers
What does the surgical hand scrub do
The surgical hand scrub is the process of removing microorganisms from the nails, hands, and arms using mechanical and antiseptic cleaning
Mechanical cleaning: removal of bacteria, dirt, oils, and debris that are loosely attached to the skin using friction
The use of an antiseptic in activates or inhibits the growth of microorganisms on skin, in hair follicles, sebaceous glands and sweat glands
Ensure that you are cleaning all four sides of your fingers, hands, and arms
Antimicrobial scrub agents are FDA approved hand scrubs or alcohol based rubs
Brushless technique (alcohol rub)
What is the ideal characteristics of a hand scrub solution
FDA compliant
Broad spectrum of activity
Fast acting and effective
Non irritating
Persistent effects and cumulative activity
Follow manufacturer written directions for use
What are the types of scrub solution
Chlorhexidine gluconate (4%)
Iodophor (7.5%)
Alcohol (60-90%)
Parachlorometaxylenol (PCMX)
Brushless rub
What should you do before even masking for surgery
Clean and thoroughly dry eyeglasses
Apply cap and mask
Open your gown and glove pack
Remove rings, watches, jewellery, name tags, pens from scrub top pockets
Nails should be short and clean
Artificial nails and nail polish should not be worn
Wash hands and forearms up to 2 inches above the elbows with antimicrobial scrub and running water – dry with a paper towel
What should you do to your nails for a hand scrub
Clean under your nails on both hands under running water using a disposable nail cleaning pick
How do you scrub your hands for surgical scrubs
Take 1 minute to wash each hand
Brush eat fingertip going under fingernails
Scrub all four sides sides of fingers, include the base of the fingers and the webbing between the fingers
Scrub lateral sides of the hand, palm, and the back of your hand to your wrist
How do you scrub your arms for surgical scrubs
1 minute per arm
Scrub forearms from wrist to halfway up to elbow – this should take 30 sec per arm
Scrub from your mid forearm up to your elbow– this should take 30 sec per arm
How do you rinse your hands after scrubbing
Rinse soap from tip of finger to elbow
Remember → always keep hands above elbow to allow water to run away from hands while rinsing
how do you dry your hands after a surgical hand scrub
After you have finished your surgical scrub, you will use the hand towel from your gown to dry your hands and arms before gowning up
Start at your hands and move down to your elbows
Do not allow the towel to touch your body
Flip your towel after drying your first arm to prevent contamination when you are drying your second hand
What are the basic steps of surgical hand scrub
Follow manufacturer written instructions
Dispense the recommended amount of the antimicrobial agent into the palm of your hand
Start with fingers
Proceed to hands
Move up forearms to elbows
Dry with a sterile towel or air dry
Use amount of hand rub recommended by the manufacturer
Why and how do we gown and glove
To create a barrier b/w sterile and nonsterile areas
Open on a dry, flat surface from other sterile supplies
Specific procedures for donning gowns, performing open, closed, assisted surgical gloving
What are the types of gloving and when is each type used
Closed
- Used when surgical gown is worn
Open
- Used when surgical gown is NOT worn
Assisted
- Requires assistance of another team member
How do you closed glove
No skin exposed
Hands are within the cuffs of the gown
Palm of your hand to palm of the glove, thumb to thumb, fingers of glove face your elbow
When do you open glove
When no gown is needed
Minor surgical procedures
Bone marrow biopsies
Catheterization
Only folded cuff of the first gloves can be touched
How do you do assisted gloving
Sterile member helps another scrubbed in team member
Cuff of gown not pulled over hand
Best method to re glove if contamination occurs
What do you do if a gown is contaminated and the surgeon is NOT scrubbing out
Team member who was contaminated steps away from the sterile field
A circulating nurse unfastens the contaminated gown and pulls it off from the shoulders towards the hands so that it is inside out once it is removed
Circulating nurse carefully removes gloves so that they are also inside out
What do you do if a gown is contaminated and the surgeon is scrubbing out
Team member who was contaminated steps away from the sterile field
A circulating nurse unfastens the contaminated gown
Contaminated team member pulls the gown off from the shoulders towards the hands so that it is inside out
Contaminated team member removes gloves so that they are also inside out
