Scrubbing, Gowning And Gloving

SURGICAL SCRUB, GOWNING AND GLOVING Surgical Scrub  Surgical scrub is the removal of as many bacteria as possible from the hands and arms by mechanical washing and chemical disinfection before taking part in a surgical procedure. Purpose  Surgical Scrub helps prevent the possibility of contamination and infection of the operative wound by bacteria on the hands and arms. Types Complete Scrub – it usually takes 10-15 minutes. This time may vary in different hospitals, depending upon the frequency of the scrubs. This is done: 1. Before the first gowning and gloving. 2. Following a clean case if the gloves have holes in them. 3. Following a clean case if the gloves have been removed inadvertently before the gown. 4. Following a clean case if hands been contaminated in ay other way. 5. Following a contaminated case, before starting the next case. Short Scrub – it is usually takes 5-10 minutes. This scrub is done following a clean case if the hands and arms have not been contaminated. It is done to remove bacteria that have emerged from the pores and multiplied while the gloves were worn. PREPARATION BEFORE DOING SURGICAL SCRUB:  Attend to your personal needs.  Adjusts your cap and mask properly. The hair should be confined inside the cap. The mask should cover the nose, mouth, cheek and chin.  Roll up sleeves of the uniform 3 inches above the elbow if sleeves are long  Check on the liquid soap and brush dispenser.  Remove your jewelry.  Check on your fingernails. They must be kept clean and short to reduce the bacteria count and to prevent the puncturing or tearing of gloves. SCRUB-UP TECHNIQUE  Take note of the time you started scrubbing  Wash hands and arms with soap and water to remove superficial dirt and bacteria.  Get the sterile brush with the right hand in such a way that it faces up.  Saturate the brush with soap and water and start scrubbing from the fingertip, to the four corners of each finger, to the dorsum, palm and wrist. Do this for 2 1/2 minutes, rinse.  Transfer the brush to your left hand. Saturate it again with soap and water and do the same as in no 3 (5 minute for both hands).  Transfer the brush to your right hand. Saturate it again with soap and water and brush the left arm from the wrist up to 2 inches above the elbow. Rinse, Do this for 2 ½ minutes.  Transfer the brush to your left hand and do the same as in no. 6 (5 minutes for both arms) hence a total of ten (10) minutes, from the tip of the fingers up to 2 inches above the elbow.  Drop the brush in a pail provided for used brushes. Rinse both hands and arms well taking care the flow of water is from the hands down the elbows. POINTS TO REMEMBER IN SURGICAL SCRUB:  Rinse as often as possible using one direction only. Start from the hand going to the arm taking care not to touch the faucet and the sink.  A person with cut or burn should not scrub because of the high bacterial count.  The hands and arms can never be rendered sterile no matter how long or how strong the antiseptics.

 Surgical scrub is most effective when firm motion is applied. Short horizontal or circular stroke could be used.  Use an ample supply of antiseptics  Since the hands are to be cleaner than any other area, after the initial hand wash, they are held higher than the elbows during the rest of the procedure to prevent water from running back the scrubbed hands. Gowning  The sterile gown is put on immediately following the surgical scrub. Purpose  The sterile gown is worn in order to permit the wearer to come within the sterile field and carry out sterile technique during an operative procedure. Parts of a Gown 1. Right Side 6. Neckband 2. Wrong Side 7. Belt 3. Body 8. Hemline 4. Sleeves 9. Back ties 5. Cuffs PREPARATION FOR STERILIZATION The gown is folded lengthwise with the wrong side out and facing the wearer A. Unassisted (Self-service) • Grasp the gown at the center or you may receive it from the circulating nurse • Step one or two feet away from the sterile field to have an adequate working space. • Unfold the gown and expose the hemline portion. Dry your hands and arms with this small portion. Use each side of the folded gown in drying each hand and arm. • Continue unfolding the gown and locate for the armhole. • Slip your hands into each armhole and hold your hands and arms straight and obliquely upward. The circulating nurse will fix it. • Stop and swing your body to the right, then to the left. The circulating nurse will catch the belt of its ends as you swing. B. Assisted • This is done by the scrub nurse when she is already completely sterile, i.e. she has donned the gown and the gloves. • Pick up the gown directly from the table or receive it from the circulating nurse. • Unfold the gown slowly and serve the hemline portion to the surgeon. • Continue unfolding the gown while the surgeon is drying his hands and arms • When serving the gown, your gloved hands should come in contact with the right side portion of the gown under the protecting cuff made. • Show the opening and armholes to the surgeon. • As soon as the surgeon inserted his hands through the armholes, leave it. The circulating nurse will fix it. RESPONSIBILITY OF THE CIRCULATING NURSE IN THE APPLICATION OF STERILIZATION  She places hands inside of the gown near the shoulder of scrub nurse and aids her in putting on the gown.  She grasps ends of the gown’s belt without touching the upper part of sleeves of the gown.

 She ties the belt at the back of the gown, keeping belt ends away from the sterile part of the gown. She ties the back ties after trying the belt.

POINTS TO REMEMBER IN GOWNING:  This is done after the surgical scrub.  Use an oscillating motion pat dry in drying the hands and arms. Start from the hand going to the arms  Do not dry hand then arms and return to the same hand  In drying the hand and arms, the hemline portion of the gown or a towel could be used. If a towel is used, dry one hand and arm on one end of the towel and use the opposite end to dry the other hand and arm.  In serving the gown, do not turn your back on the sterile field to prevent contamination.  In picking the gown from a sterile line pack, be careful not to touch any other articles in the pack with the bare hands. GLOVING TECHNIQUE: This is done after the gowning technique. PURPOSE:  Gloves are worn to complete the sterile dress in order that the one who wears them may handle sterile equipment. PART OF A GLOVE: 1. Palmar Surface 2. Dorsal Surface 3. Finger Holes 4. Cuff 5. Wrist TYPE OF A GLOVE TECHNIQUE: OPEN METHOD OF GLOVE TECHNIQUE Unassisted (Self-service)  Get the right hand gloves with the left hand by holding it at the edge of everted cuff. Step back from the sterile field.  Explore the finger holes before inserting the whole hand completely. Leave the everted cuff as is.  Slip the gloved right hand under the fold of the everted cuff. Insert the left hand by exploring the fingerholes before inserting the whole hand completely. Leave the folded cuff.  Make a pleat at the cuff of the gown and secure this is place with your right thumb.  Slip the four fingers of the right hand under the fold of the glove and pull it up over the pleated cuff of the sleeves. Fix the glove firmly.  Repeat for the right hand. Assisted (Serving Others)  Get the right hand glove and inflate it first for easy insertion and to detect for holes.  In serving the gloves, the palmar surface or the thumb portion should be facing the one who is being served/ facing the surgeon.  Evert the cuff one inch wide. Insert four fingers inside the everted cuff.  Stretch the glove well outward. Put your thumbs out.  Allow the surgeon to explore the fingerholes

 When the surgeon jerks his hand downward, release and pull upward so that the cuff of the glove covers the cuff of the gown.  Repeat the same procedure for the left hand.

Closed Method This is the method with the least possibility of contamination. PROCEDURE  With your right hands inside the gown’s sleeves, lift the glove by the cuff.  Put thumb down or your upturned left palm, fingers of glove pointed toward your elbow.  At this time, move your left hand so that your fingers are halfway down the cuff of your gown. Do not let them protrude from our gown cuff or touch the end of the cuff.  With your right hand still inside the sleeve, take hold of the folded cuff of the left glove and pull it out and over the left hand and well over the cuff of the left sleeve.  Take the right hand, still inside the sleeve, and grasp the left glove and gown cuff at the wrist and pull glove unto the hand.  Proceed to the right hand the same way. POINTS TO REMEMBER IN GLOVING:  Take care not to contaminate the outside surface of the glove  In serving the gloves, the nurse must have a wide base of support by putting her foot apart.  Always serve the right hand glove first.  In serving, get the right glove with the left and the left hand glove with the right hand.  Always keep gloved hands at waist level or above.  Keep gloved hands away from your mask. REMOVING THE GOWN AND THE GLOVES  Regardless of whether the scrub nurse assists in a case or contaminated case remove first the gown and then the gloves. Wash the gloved hands if they are grossly contaminated before removing the gown. Removing the Gown:  With the gloves still in, ask the circulating nurse to loosen the ties and the belt.  Grasp the right shoulder of the gown and slip off the arm allowing use sleeves to turn inside out.  Repeat the same procedure for the opposite shoulder.  Discard the gown in the hamper. Removing the Gloves:  With the gloved right hand, remove the left glove by holding it at its outer surface and pull off. (This is the glove to glove technique).  To remove the right glove, insert your thumb or three fingers between the skin and the glove and pull off. (This is the skin to skin technique).