LEARNING OBJECTIVE: Recall sterile article handling and surgical hand scrubbing techniques, donning procedure for gowning and gloving, and the steps to clean an operating/treatment room.
When you are changing a dressing, removing sutures, or preparing the patient for a surgical procedure, it will be necessary to establish a sterile field from which to work. The field should be established on a stable, clean, flat, dry surface. Wrappers from sterile articles may be used as a sterile field as long as the inside of the wrapper remains sterile. If the size of the wrapper does not provide a sufficient working space for the sterile field, use a sterile towel. Once established, only those persons who have donned sterile gloves should touch the sterile field. Additionally, the following basic rules must be adhered to:
Surgical Hand Scrub
The purpose of the surgical hand scrub is to reduce resident and transient skin flora (bacteria) to a minimum. Resident bacteria are often the result of organisms present in the hospital environment. Because these bacteria are firmly attached to the skin, they are difficult to remove. However, their growth is inhibited by the antiseptic action ofthe scrub detergent used. Transient bacteria are usually acquired by direct contact and are loosely attached to the skin. These are easily removed by the friction created by the scrubbing procedure.
Proper hand scrubbing and the wearing of sterile gloves and a sterile gown provide the patient with the best possible barrier against pathogenic bacteria in the environment and against bacteria from the surgical team. The following steps comprise the generally accepted method for the surgical hand scrub.
- Before beginning the hand scrub, don a surgical cap or hood that covers all hair, both head and facial, and a disposable mask covering your nose and mouth.
- Using approximately 6 ml of antiseptic detergent and running water, lather your hands and arms to 2 inches above the elbow. Leave detergent on your arms and do not rinse.
- Under running water, clean your fingernails and cuticles, using a nail cleaner.
- Starting with your fingertips, rinse each hand and arm by passing them through the running water. Always keep your hands above the level of your elbows.
- From a sterile container, take a sterile brush and dispense approximately 6 ml of antiseptic detergent onto the brush and begin scrubbing your hands and arms.
- Begin with the fingertips. Bring your thumb and fingertips together and, using the brush, scrub across the fingertips using 30 strokes.
- Now scrub all four surface planes of the thumb and all surfaces of each finger, including the webbed space between the fingers, using 20 strokes for each surface area.
- Scrub the palm and back of the hand in a circular motion, using 20 strokes each.
- Visually divide your forearm into two parts, lower and upper. Scrub all surfaces of each division 20 strokes each, beginning at the wrist and progressing to the elbow.
- Scrub the elbow in a circular motion using 20 strokes.
- Scrub in a circular motion all surfaces to approximately 2 inches above the elbow.
- Do not rinse this arm when you have finished scrubbing. Rinse only the brush.
- Pass the rinsed brush to the scrubbed hand and begin scrubbing your other hand and arm, using the same procedure outlined above.
- Drop the brush into the sink when you are finished.
- Rinse both hands and arms, keeping your hands above the level of your elbows, and allow water to drain off the elbows.
- When rinsing, do not touch anything with your scrubbed hands and arms.
- The total scrub procedure must include all anatomical surfaces from the fingertips to approximately 2 inches above the elbow.
- Dry your hands with a sterile towel. Do not allow the towel to touch anything other than your scrubbed hands and arms.
- Between operations, follow the same hand-scrub procedure.
Gowning and Gloving
If you are the scrub medical technician, you will have opened your sterile gown and glove packages in the operating room before beginning your hand scrub. Having completed the hand scrub, back through the door holding your hands up to avoid touching anything with your hands and arms. Gowning technique is shown in the steps of figure 2–4.
Pick up the sterile towel that has been wrapped with your gown (touching only the towel) and proceed as follows:
Continue the process by opening the inner glove packet on the same sterile surface on which you opened the gown.
The entire gloving process is shown in the steps of figure 2–5.
To gown and glove the surgeon, follow these steps:
Cleaning the Operating/ Treatment Room
Cleanliness in the operating room is an absolute must. Cleaning routines must be clearly understood and carefully followed. The cause of postoperative wound infections have, on occasion, been traced to the operating room. Since no two patients are alike and all patients have their own “resident” bacteria, every surgical case must be considered to be contaminated.
At the beginning of each day, all the fixtures, equipment, and furniture in each operating room will be damp-dusted with an antiseptic germicide solution. During the operation, keep the room clean and orderly at all times. Should sponges be dropped on the floor, or if blood or other body fluids spill, clean the area immediately using a disinfectant germicide solution and a clean cloth. Between operations, clean all used items. The area of the floor occupied by the surgical team must be cleaned using the wet vacuum method. If a wet vacuum is not available, mops may be used, but a clean mop head must be used following each operation. Gowns and gloves must be removed before leaving the room. All linens and surgical drapes must be bagged and removed from the room. All trash and disposable items must be bagged and taken from the room. All instruments must be washed by gloved hands or placed in perforated trays and put through a washer/sterilizer.
At the completion of the day’s operations, each operating room should be terminally cleaned using an antiseptic germicide solution and the following tasks accomplished.