Transcript Behavioral Emergencies

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 Important
assistant to the surgeon:
 Retract
tissue
 Lavage surgical field with sterile fluid
 Manage instrument table
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 Eat
a meal of substance before
surgery

Complex carbs and protein
 Groom
 Avoid


fingernails
cologne and perfume
some people are sensitive
May mask important odors
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
Endogenous


From the patient itself
Exogenous

From surgical team or environment
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
Microbial shedding of microorganisms from
humans can be prevented by:





Freshly laundered scrub suits
Head covers
Masks
Perhaps shoe covers
Follow written and posted dress code
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 No
street clothes
 Don’t wear scrubs from home into work
 Freshly laundered in clinic
 Fit snug to body; shirt tucked into
pants
 Clean lab coat over scrubs if stepping
out of surgery area
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•Scrub top
tucked
snuggly into
the pants
•This prevents
body scurf
from being
shed
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This skull cap head cover
This bouffant is a proper
does not fit snugly
head cover for this
and leaves hair
technician
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 Mask:

over mouth and nose
If about to sneeze, don’t turn head; step
out of sterile field
 Shoes:
comfortable and clean; can use
shoe covers


Foot attire has no proven significance in
reducing the incidence of post-op wound
infections
Shoe covers used to reduce floor
contamination
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 Jewelry:


all should be removed
Can harbor microorganisms that routine
hand washing cannot remove
Earrings, necklaces, bracelets, and body
piercings could fall into the surgical field
 Fingernails:
clipped to below
fingertips; no nail polish
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 Hand
scrub: remove as many
microorganisms as possible from the
nails, hands, and arms using
mechanical and chemical antisepsis

Skin is never made “sterile” but rather
surgically clean
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Timed vs. stroke method: 5 min minimum
 For both methods follow an anatomical
pattern
 Fingers, fingertips, hands and arms; each
have four sides
 Subsequent scrubs of the day can be 2-3 min
 Antimicrobial scrub agents:
 FDA-approved hand scrubs or
 alcohol-based rubs



Brushless technique
Standardized protocol in scrub room
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
Ideal characteristics:
 FDA
compliant
 Broad spectrum of activity
 Fast acting and effective
 Non-irritating
 Persistent effects and cumulative activity

Follow manufacturer’s written
directions for use
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Scrub Solutions





Chlorhexidine gluconate (4%)
Iodophor (7.5%)
Alcohol (60%–90%)
Parachlorometaxylenol (PCMX)
Brushless rub
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 Remove
rings, watches, jewelry, name
tags, pens from top pockets, and so
on.
 Wash hands and forearms with
antimicrobial scrub and running water.
 Clean subungual areas using disposable
nail-cleaning pick.
 Keep hands above elbows to allow
water to run off.
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 Don’t
touch anything.
 Apply
antimicrobial agent to wet hands
and forearms.
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Scrubbing Guidelines
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Brush each fingertip 10 times; go under fingernails.
Sides of fingers, beginning with the lateral side of
each.
Webbing between the fingers
Lateral side of the hand
Palm
Outside of the thumb
Base of the fingers to the wrist
Forearms to elbow
Then rinse
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Prescrubbing Guidelines
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 Fingers
 Hands
 Forearms
 To
elbow
 Use
amount of hand rub recommended
by the manufacturer
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After hand scrub (or rub), dry with a sterile towel.
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Methods:
1. Closed
2. Open
3. Assisted
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No
bare skin is
exposed
Palm to palm,
thumb to thumb,
fingers of glove
facing the elbow
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Cuff of glove completely covers cuff of gown
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Closed Gloving
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Open Gloving

When one glove becomes contaminated

When no gown is needed (e.g., minor surgical
procedures, bone marrow biopsies,
catheterizations)
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Only folded cuff of first glove can be touched
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 When
a sterile
team member
helps another
scrubbed-in team
member glove
 Cuff of gown
should not be
pulled over the
hand
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 Circulating
nurse unfastens it and pulls
it off (inside out) from the team
member who was contaminated.
 Contaminated
person removes gloves
and pulls them off inside out.
 Sterile
sleeves can be used.
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 Avoid
locking knees when standing for
long periods of time.
 Eat
before scrubbing in.
 Slowly
shift weight from leg to leg.
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