Lesson 3: Sterile Technique: Scrubbing, Gowning/Gloving and Urinary Bladder Catheterization

Question 1

What is sterile technique?

Answer 1

Method by which asepsis is maintained by throughout the duration of an invasive procedure thereby minimizing the introduction of microorganisms into a sterile field.

Question 2

Principles of sterile technique?

Answer 2

• All items used within a sterile field must be sterile.
• A sterile barrier that has been permeated must be considered contaminated.
• The edges of a sterile container are considered contaminated once the package is opened.
• Gowns are considered sterile in front from shoulder to waist level, and the sleeves are considered sterile to 2 inches above the elbow.
• Tables are sterile at table level only.
• Sterile persons and items touch only sterile areas; unsterile persons and items touch only unsterile areas.
• Movement within or around a sterile field must not contaminate the field.
• All items and areas of doubtful sterility are considered contaminated.

Question 3

For what procedures is just sterile gloves sufficient?

Answer 3

Joint aspiration, suturing a minor laceration, and performing a lumbar puncture.

Question 4

When is a sterile gown required?

Answer 4

Repairing large wounds, for cardiac catheterization, or for any procedure that requires it by protocol.

Question 5

What is the result of an effective surgical hand scrub technique?

Answer 5

An immediate reduction in the surface microbial count that is sustained, cumulative, and persistent.

Question 6

What is the duration of a surgical hand scrub?

Answer 6

Now 3-5 minutes (was 10).

Question 7

Why do some want to eliminate scrubbing?

Answer 7

To reduce hand dryness/dermatitis.

Question 8

CDC Guidelines for surgical hand scrub?

Answer 8

1. Remove rings, watches, jewelry
2. Remove debris from underneath fingernails using a nail cleaner under running water.
3. Use antimicrobial soap/or an alcohol-based hand rub with persistent activity. (before placing sterile gloves for sterile procedures).
4. For surgical hand antisepsis, use an antimicrobial soap, scrub hands and forearms for length of time recommended by manufacturer. (usually 2-6 minutes)
5. When using an alcohol based surgical hand scrub product, first prewash hands/forearms with a non-antimicrobial soap and dry hands/forearms completely. Then apply alcohol-based product, allow to dry completely, then put on sterile gloves.

Question 9

What “soap” is used during surgical hand scrub and what are they and what are they effective against?

Answer 9

Chlorhexidine gluconate or povidone-iodine solutions, which are rapid-acting, broad-spectrum antimicrobials effective against gram-positive and gram-negative microorganisms.

Question 10

What is the sterile disposable scrub brushes impregnated with?

Answer 10

Chlorhexidine gluconate, povidone-iodine, or other CDC approved products.

Question 11

Two method of scrubbing?

Answer 11

1. Timed Method

2. Counted Stroke Method

Question 12

How long does timed method take?

Answer 12

3-5 minutes.

Question 13

What does the counted stroke entail?

Answer 13

30 strokes fingernails, 20 strokes to each surface of fingers, hands, wrists, and arms.

Question 14

Procedure for scrubbing?

Answer 14

1. Organize supplies and adjust water to a comfortable temperature.
2. Wet hands and arms, prewash with soap from a dispenser, and rinse.
3. Remove the scrub brush from the package and use the nail cleaner to clean fingernails.
4. Squeeze the scrub brush under water to release soap from sponge.
5. With the scrub brush perpendicular to the fingers, begin to scrub all four sides of each finger with a back-and-forth motion.
6. Scrub dorsal and palmar surfaces of hand and wrist with a circular motion.
7. Starting at the wrist, scrub all four sides of the arm to the elbow.
8. Transfer the scrub brush to the other hand and repeat steps 5 through 7.
9. Discard the scrub brush and rinse hands and arms, starting with the fingertips and working toward the elbows.
10. Allow contaminated water to drip off the elbows by keeping hands above the waist.

Question 15

Procedure for surgical mask?

Answer 15

1. Fit the mask snugly over both the nose and the mouth and tie securely.
2. When wearing a mask, keep conversation to a minimum to prevent excessive moisture buildup.
3. Change surgical masks routinely between procedures or during a procedure if they become moist or wet.

Question 16

Why are surgical caps used?

Answer 16

Prevent underlie material from the hair from entering the sterile field.

Question 17

What is required during lengthy procedures or when it is necessary to put the forearms into the sterile field?

Answer 17

Sterile surgical gown.

Question 18

Disposing of materials during scrubbing?

Answer 18

1. Care should be taken to dispose of contaminated supplies and materials to avoid the transmission of infectious organisms to others.
2. Sharp objects should be disposed in appropriately marked containers.
3. Body fluids, human tissue, disposable gowns, gloves, caps, and drapes should be placed in containers marked with the appropriate biohazard warnings.
4. All receptacles containing biohazardous waste should be properly labeled, identified, and processed according to institutional procedures.

Question 19

Why should you perform a urinary bladder catheterization?

Answer 19

To obtain a sterile urine sample.
To monitor urinary output closely in critically ill patients.
To facilitate urinary drainage in patients who are incapacitated.
To bypass obstructive processes in the urethra, prostate, or bladder neck caused by disease or trauma until surgical repair can be performed.
To hold urethral skin grafts in place after urethral stricture repair.
To act as a traction device for the purpose of controlling bleeding after prostate surgery.

Question 20

Contraindications to urinary bladder catheterization?

Answer 20

1. The appearance of blood at the urethral meatus in a patient who has sustained pelvic trauma.
   This finding can be an indication that the urethra has been partially or totally transected.
   If partially transected – it can cause total transection.
   If blood is present at urethral meatus, consult urologist.

2.Allergy to any of materials used in procedure.

Question 21

Complications of urinary catheterization?

Answer 21

Complications occur more commonly in males.
Urethral dilation (from long-term indwelling Foley).
Urinary structural trauma (from catheterization).
Urinary tract infection (UTI).
Inflammation of tract.
May be difficult to catheterize male patients w/ urethral stricture dx, bladder neck contracture, or an enlarged prostate.
False passage may occur when inserting catheter forcefully (in attempt to bypass blockage): catheter can also tear completely through wall of urethra, causing bleeding into surrounding tissue.
Having the catheter double back or make a U-turn at the site of obstruction.
Patient-caused trauma. Patients who are confused can pull out a fully inflated Foley catheter.

Question 22

How long is the female urethra?

Answer 22

In females, the distance from the distal end of the urethra to the bladder is relatively short (1.5 to 2 inches).

Question 23

How long is the male urethra?

Answer 23

In males, the distance from the distal tip of the urethra to the bladder is longer (typically 6 to 7 inches).

Question 24

Preparation for urinary catheterization?

Answer 24

Explain procedure to patient.
Patient comfort should be primary consideration.
Explain importance of patient remaining still, and refraining from touching sterile area/gloves.
Draping patient.

Question 25

Robinson?

Answer 25

“straight cath”, “in and out cath” – (Fig A)
To obtain a sterile urine sample or to decompress a distended bladder caused by an acute obstructive process.
As a protocol of intermittent catheterization in persons with neurogenic bladder.

Question 26

Three way catheter?

Answer 26

For continuous irrigation after bladder/prostate surgery.

Question 27

Coude’ Catheter?

Answer 27

Has a bend at the distal tip that causes the catheter to follow the anterior surface of the male urethra.

Question 28

Foley catheter?

Answer 28

(common type of indwelling catheter), can be left in place for a period of time.
Has balloon to stay in place. Balloon size can be 5 or 30ml. 5ml is more commonly used, and it is typically inflated with 10ml sterile water.
At the distal end is an elbow with a Luer-Lok cap attached. The Luer-Lok cap allows the balloon to be inflated once the catheter is in place and deflated once the catheter must be removed.

Question 29

Catheter size is measuring according to?

Answer 29

Charriere French scale.

Question 30

How many mm in diameterr is a 3 Fr catheter?

Answer 30

1 mm.

Question 31

What should adults typically be catheterized?

Answer 31

16 or 18 Fr catheter.

Question 32

Procedure of female catheterization?

Answer 32

Obtain the Foley catheter and open the kit in a sterile manner.
Place first drape (in kit) under patient, plastic side down. (only touching corners of non-sterile side)
Put on sterile gloves.
Prepare patient by draping her in sterile drapes (found in the kit) and exposing the genital area, making sure to allow for the patient’s privacy and comfort.
Open the catheter, prepare the lubricant, and open the package of povidone-iodine.
Check the balloon for any breakage. (inflate and deflate)
Inform the patient that you are going to swab the urethral opening to cleanse the area.
Using the non-dominant hand, spread the patient’s labia. Wipe the urethral opening with the cotton swabs from an anterior to a posterior direction.
Grasp the catheter with your dominant hand. Lubricate the catheter well, about 1/3 of the way from the tip of the catheter up.
Grasp the catheter with your dominant hand, making sure that the catheter is still well lubricated, and gentlyinsert the tip of the catheterinto the urethral opening until urine starts to flow or approximately one third of the catheter has been inserted into the bladder.
Once catheter is in place, inflate balloon.
Pull back gently on Foley until it stops.
Secure the Foley catheter to the inner thigh.
Hang drainage back on side of bed, below level of patient.

Question 33

Things to Know for male catheterization?

Answer 33

In an uncircumcised male, the foreskin is drawn back prior to cleaning.
When using iodine swabs to sterilize, making sure to clean the meatal opening first and wiping out to the glans.
To minimize discomfort, some insert a sterile anesthetic jelly (lidocaine jelly), into the urethra, prior to the catheterization.
When inserting lidocaine, lubricant, or Foley, the penis should be positioned at a 90◦.
When inserting a Foley in a male patient, Foley is inserted almost to the hub.
Do not leave foreskin retracted, put back to original position.

Question 34

Follow up care instructions for urinary catheterization?

Answer 34

In short-term catheterization or in-and-out catheterizations:
The most common complications include irritation of the urinary tract and infection.
Patients will most likely experience a burning sensation the first few times they urinate after catheterization. Reassurance is usually all that is needed.
Instruct the patient to monitor urination for continuous dysuria, urinary frequency, hematuria, and pyuria, as well as for systemic signs of urinary tract infection such as fever or back pain.