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SGG notes - Surgical Scrubbing and Gloving as a study guide for medical students.
nursing (NCM116)
De La Salle Lipa
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NCM-
Care of Clients with Problems in Oxygen, Fluid, Electrolytes, Infectious, Inflammatory,
Immuno (RLE)
(Surgical Scrubbing, Gloving, Gowning) | SEM 1 2022
Definition of Terms
● Asepsis
● Sepsis
● Disinfection
● Aseptic Technique
● Antiseptic
- freedom from infection or absence of microorganism
- general reaction from the action of bacteria or their products
- process of destroying all pathogenic microorganisms except spore bearing ones
- methods by which contamination of microorganism is prevented
- substance which combat sepsis and cause bacteriostasis
TRANSIENT MICROORGANISMS - Microorganisms that are introduced onto the skin surface by contact. Mechanical scrubbing and surgical cleansing agents will remove most of the bacteria.
RESIDENT MICROORGANISMS
- Natural habitat is the skin
- Exist in large numbers under the fingernails and deep layers of the skin
- Removed by scrubbing from the surface and just beneath the surface of the skin
- Sterile gloves are worn to prevent contamination from this source
SURGICAL HAND ANTISEPSIS
● A systematic washing and scrubbing of the hands and forearms using especially developed techniques ● A process to destroy transient microorganisms and inhibit the growth of resident microorganisms
SURGICAL HAND SCRUB
● Purpose: reduce resident and transient skin flora (bacteria) to 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 of the 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 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:
SURGICAL HAND SCRUBBING - STEPS
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. Remove all the jewelries (watch, rings, earrings).
Regulate the flow and temperature of the water.
Pre tear package containing brush; lay the brush on the back of the scrub sink.
Wet hands and arms for an initial pre scrub wash.
- Use several drops of surgical detergent, work up a heavy lather, then wash the hands and arms to a point about 2 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.
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 the sponge-side of the brush; then, using the bristle side of the brush, scrub the spaces under the fingernails of the right or left hand 30 circular strokes.
- When scrubbing, 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. You may begin with the thumb or little finger or the right or left hand.
- Scrub one hand and arm completely before moving on to the other hand and arm.
Lather palm, back of hand, heel of hand, and space between thumb and index finger. Choosing either of the surfaces, scrub 20 strokes.
You are now ready to scrub the forearm. Divide your arm in 3- inch increments. The brush should be approximately 3 inches lengthwise. Use the sponge-side of the brush lengthwise to apply
soap around the wrist. Scrub 20 circular strokes on all four sides; move up the forearm--lather, then scrub, ending 2 inches above the elbow.
Soap and/or water may be added to the brush at any time
Repeat steps #6 through #9 above for the other arm.
Discard brush.
Rinse hands and arms without retracing and/or contaminating.
Allow the water to drip from your elbows before entering the operating room
Slightly bend forward, pick up the hand towel from the top of the gown pack or the hem line of the gown 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 to touch any unsterile object or unsterile parts of your body. ➔ Hold your hands and arms above your elbow and keep your arms away from your body. ➔ 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 elbow; DO NOT retrace any area. Dry all sides of the fingers, the forearm, and the arms thoroughly. ➔ If moisture is left on your fingers and hands, donning the surgical gloves will be difficult. Moisture left on the arms may seep through surgical cloth gowns, thus contaminating them.
Grasp the other end of the towel and dry your other hand and arm in the same manner as #16.
Discard the towel into a linen receptacle (the circulator may take it from the distal end.
SURGICAL GOWNING - STEPS
GOWNING: The Scrub Person
Lifts the folded gown directly upward from the sterile package.
Steps back from the table into an unobstructed area.
Let the gown unfold while keeping the inside of the gown toward the body without touching the sterile exterior of the gown with bare hand .(If the gown does not unfold completely, then the circulating nurse may assist by pulling down the unfolded bottom inside the gown)
Maintain the hands at shoulder level and slips both arms into the arm hole simultaneously. And let the circulator do the rest.
SURGICAL GLOVING- STEPS
CLOSED GLOVING TECHNIQUE
- scrub person's hands remains inside the sleeves and should not touch the cuffs.
surface touching your arm.
Leaving the cuff over your thumb, pick up the second glove by sliding your gloved fingers underneath the cuff as shown.
Grasp the left- hand cuff with your right hand and, in one movement, pull the glove over your hand and cuff of the gown
Ensure the cuff of the glove completely covers the cuff of the gown all the way around.
Now, with your gloved hand, lift the cuff of the right glove up and over the cuff of the gown. Don’t grasp the glove cuff because you have already touched the inner surface of the glove with your bare hand, therefore it is not sterile.
Work your fingers into the glove.
Adjust the gloves as necessary to ensure they are comfortable.
ASSISTED GOWNING - STEPS
Keeping the hands on the outside of the gown, donning a protective cuff of the neck and shoulder area as the person being gowned holds both arms outstretched;
Offering the inside of the gown to the other member so he or she can slip his or her hands into the sleeves;
Releasing the gown when the team members' hands are in the sleeves.
ASSISTED GLOVING- STEPS
To glove another team member, the scrub person always gloves the other person's right hand first: the scrub person
Picks up the glove with his or her fingers under the cuff
Holds the palm of the glove toward the person being gloved
Stretches the cuff to open the glove and holds his or her thumbs out to keep them from touching the other team member’s bare hands.
As the other person inserts his or her hands into the glove, exerts upward firm pressure making sure the hand does not go below the waist.
Unfolds the inverted glove cuff over the cuff of the sleeve.
Gloves the left hand with the assistance of a team member by repeating the steps
How to stand hands up and clasped. Ensure the cuff of the glove completely covers the cuff of the gown all the way around.
REMOVING GOWN AND GLOVES - STEPS
At the end of the procedure, the gown is always removed before the gloves to prevent cross contamination of the wearer's scrub attire. The circulator can assist by unfastening the neck and back closures of the gown.
Grasps the shoulders of the gown, pulls it downward from the shoulder and off the seams, and turns the sleeves inside out;
Fold the contaminated surface of the gown on the inside and rolls it away from the body;
Discard the rolled gown in the appropriate receptacle.
As the gown comes off it usually turns the cuffs of the gloves down. To remove the gloves, Wearer uses a glove-to-glove and then a skin-to-skin technique. This approach protects hands from the contaminated gloves.
Grasps the under cuff of the left glove with the gloved fingers on the right and pulls it off inside out.
Slip the ungloved fingers of the left hand inside the right glove and slips it off inside out;
Discard the gloves in the appropriate receptacle
Wash hands and arms with soap and water.
Removing the gloves after removing the gown prevents the bare hands from contamination that would usually occur from handling the soiled gown
MAINTAINING A STERILE FIELD
● The surgical team should take precautions to avoid contamination and maintain the sterile field. ● The hands should be kept above the waist and insight at all times. ● The sterile areas are: - front of the gown from the table level or sterile field to 2 inches below the neck - sleeves from 2 inches above the elbow to the cuff - Surgical gloves ● The non-sterile areas are: - Underarms - back of the gown even if it is the wrap around style. ● If any part of the sterile attire becomes contaminated, immediate corrective steps must be taken (e. If a glove becomes contaminated, it must be changed immediately). ● Once the original gloves are donned, the gown cuffs should be considered contaminated because the scrubbed hand passed through them.
SGG notes - Surgical Scrubbing and Gloving as a study guide for medical students.
Course: nursing (NCM116)
University: De La Salle Lipa
