Transcript Surgical Case Management

Entering the Sterile Field:
Scrubbing, Gowning, and
Gloving
ST220
Concorde Career College
Entering the Sterile Field
Objectives:
 State the purpose of performing the surgical scrub, list
the steps of the surgical scrub utilizing the counted brush
stroke method, and explain the related sterile concepts.
 Describe the technique utilized when drying and
gowning oneself and explain the related sterile concepts.
 Describe the technique utilized when closed gloving and
explain the related sterile concepts.
Entering the Sterile Field
Objectives:
 Describe the technique utilized when assisting a team
member with gowning and gloving and explain the
related sterile concepts.
 Describe the technique utilized when removing and
replacing the gown and gloves intraoperatively and
explain the rationale.
 Describe the technique utilized when removing the
gown and gloves postoperatively and explain the
rationale.
Practices in Sterile Technique
Surgical Scrub
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Method
 Traditionally, both timed and counted brush stroke methods
have been used
 The method demonstrated is the counted brush stroke
method
Please Note the Following
Recent studies suggest that the use of
alcohol solutions may be as or
more effective than traditional
scrub solutions.
More studies are warranted.
Preparation for the Surgical Scrub
 Attend to personal needs
 Don all personal protective equipment
 Tear open the packet containing the scrub brush
 Adjust water temperature if necessary
Scrubbing: Step 1
 Hands and arms should
be visually inspected for
wounds or infections of
any type
Scrubbing: Step 2
 Nails and cuticles, also,
should be carefully
inspected
Scrubbing: Step 3
Apply water to the arms for
the pre-scrub
hand-wash
Scrubbing: Step 4
Apply antimicrobial
solution
Scrubbing: Step 5
 Perform a 30 second
standard handwash
 Rinse from finger tips to
elbows
Scrubbing: Step 6
 Secure the previously opened
scrub brush
 Reapply antimicrobial
solution
 Remove the nail cleaner
Scrubbing: Step 7
 Clean each nail thoroughly
under running water
Note:You will need to hold the
brush at the same time you
are cleaning the nails
Scrubbing: Step 8
Rinse the end of the nail
cleaner after each nail
Scrubbing: Step 9
 Discard the nail cleaner into
the waste receptacle
 Add an antimicrobial solution
to the brush if necessary or
wet and squeeze brush if it is
soap impregnated
Scrubbing: Step 10
 Begin with scrubbing the nails
 Use 30 strokes
 1 stroke is the combined
movement in both directions
Scrubbing: Step 11
 Scrub all fingers
 10 strokes per plane per digit
 (Planes = superior, medial,
lateral, inferior)
 Scrub web between fingers
Scrubbing: Step 12
 Continue to scrub the hand
covering all planes
 Continue proximally along the
arm, scrubbing 1/3 the arm at
a time
 Keep arms away from scrub top
and other objects
Note
While several different practices are used, we recommend
scrubbing one hand and arm completely, changing the brush
to the other hand, and repeating the process with the second
hand and arm.
Scrubbing: Step 13
 When scrub of both arms is
completed, drop brush into
waste receptacle
 Keep arms away from the body
 Rinse from finger tips toward
elbow
 Note blue path of water run-off
Scrubbing: Step 14
 Rinse arms thoroughly using a
dipping maneuver
 Note all the environmental
dangers
 Keep arms out
 Note the blue path of water
run-off
Practices in Sterile Technique
Drying the Hands and Arms
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Step 1
 Watch the sterile field and
verify that no water drops
fall onto the sterile field
from wet hands
 Reach directly to the center
of the towel and grasp it
firmly
Step 2
 Lift the towel directly
from the Mayo stand
 Step back as the towel is
lifted
Step 3
 Bend at the waist
 Unfold the towel
 Maintain distance from
sterile fields
 Use one end of the towel
Step 4
 Be aware of the lower
ends of the towel
 Begin to dry the hand at
the fingers working
toward the elbow
Step 5
 Rotate the hand and arm
being dried to ensure that all
surfaces are contacted
 Use a squeezing and/or
patting motion with the
towel hand
 Watch the lower end of the
towel
Step 6
 Stop drying the first arm
at the elbow
 Place the dry hand on the
sterile end of the towel
(unused part)
Step 7
 Reverse the ends so that
the contaminated / wet
end is now the lower end
Step 8
 Repeat the process on the
second hand
 When finished drying, do not
regrasp or refold the towel
 Drop the towel into the linen
hamper without changing
hand positions on the towel
Practices in Sterile Technique
Putting on a Gown
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Gowning: Step 1
 Observe the placement of
various sterile fields
 Approach the Mayo stand
with gown and gloves opened
upon it
 Keep your body away from
the sterile field
 Reach from above down to
the gown
Gowning: Step 2
 Reach directly onto the
gown
 Avoid touching the glove
package or gown
wrapping
 “Pinch” the gown,
controlling all layers
Gowning: Step 3
 Lift the gown vertically
from the Mayo stand
 Keep your body away
from the Mayo stand
Gowning: Step 4
 Once the gown is lifted
from the sterile field, step
back from the Mayo stand
 Beware other sterile fields
and do not back into
them
Gowning: Step 5
 Identify the collar of the
gown
 Confirm that the gown is
oriented properly - inside of
gown facing toward you
 Grasping the gown at the
collar and sleeves, release
the lower portion
Gowning: Step 6
 Identify the arm openings
 Place one hand inside each
opening
 Move hand into the sleeve
 Remain conscious of all items
around you
Gowning: Step 7
 Slip the first arm into the
sleeve
 Stop before the hand reaches
the edge of the cuff
 Flexing the arm slightly will
help hold the gown in place
 Repeat on other side
Gowning: Step 8
 Stop the second arm
movement before the hand
reaches the edge of the cuff
 Flex both arms to hold the
gown in place
 Prepare to put on gloves
Donning a Surgical Gown
Donning a surgical gown requires some
“big” movements; therefore the
surgical technologist must have a
heightened awareness of the total
environment around her/him.
Gloving Oneself
Closed Glove Technique
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Step 1
 After gowning, approach the
Mayo stand
 Hands should be contained
within the gown sleeve and
distal to linen cuff
 Keep distance between body
and Mayo stand
Step 2
 Be aware of the gown front and
do not allow it touch the gown
wrapper
 Open the glove package with
covered hands
 Stop as soon as one glove is
exposed
Step 3
 Lift first glove from glove
package by the cuff of the glove
 Place it on the hand to be gloved
so that the edge of the glove cuff
is at the union of gown and cuff
 Palm to palm; thumb to thumb
Close-up View
 Cuff to cuff
 Palm to palm
 Thumb to thumb
Step 4
 Grasp lower edge of glove cuff with
fingers on the hand being covered
 Grasper upper edge of glove cuff with
fingers of other hand
 Stretch and extend the glove cuff
 Roll wrist of hand being covered so
glove cuff covers the linen cuff of the
gown
Step 5
 Be sure glove covers all of
the gown cuff
 Do not touch gown cuff
with other hand
 Extend fingers into glove
fingers
 Pull glove onto hand
Step 6
 Repeat for the other hand
Step 7
 Note: always step back from
the Mayo stand in order to
perform gowning and
gloving tasks
 Complete gloving process
Practices in Sterile Technique
Turning a Wrap-around Gown
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Turning a wrap-around gown
Most gowns are designed to wrap around the person
working in the sterile field. The practices described
should be used for all gowns turned. No one should turn
their back to the sterile field while the gown is being
turned.
Turning: Step 1
 Grasp the tab in the right hand
and the tie in the left hand
 Separate the two
 Hand the distal end of the tab
to the circulator
 To avoid contamination watch
the circulator’s hand as you
make the exchange
Turning: Step 2
 The circulator moves the tab
behind the gowned person,
keeping the “tie” extended
 The gowned person rotates the
shoulders to the left in order to
receive the “tie”
 Beware of other sterile items
Turning: Step 3
 While rotating the
shoulders to the left,
transfer the tie held in the
left hand to the right hand
Turning: Step 4
 Circulator continues
circling the gowned
person, keeping the tie
extended
 Both parties observe areas
of potential
contamination
Turning: Step 5
 Gowned person takes the
tie, NOT the TAB, from
the circulator
 Circulator keeps and
discards the tab
Turning: Step 6
 The ties are secured
 The gowned person
should maintain
appropriate distance from
the other sterile areas
until the gown is
completely secured
Assisting Other Team Members
Gowning and Gloving Another
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Handing a Towel to an Unsterile Team
Member
 Maintain safe distance
 Allow the unsterile team
member to reach out into
neutral zone
 Keep towel close to body
until ready to hand
Handing a Towel to an Unsterile Team
Member
 Open the towel
 Keep hands spread and towel
taut at the top
 Keep hands away from
unsterile team member’s
hands
Handing a Towel to an Unsterile Team
Member
 Keeping your hands spread, place the
towel across the unsterile team
member’s hands
 Apply slight pressure so the unsterile
team member can feel the towel in
his/her hand
 Unsterile team members dries hands
and arms and discards towel into linen
hamper
Gowning the unsterile team member
 Maintain a safe distance
 Be aware of the position
of the unsterile team
member’s hands
Gowning the unsterile team member
 Allow the bottom of the
gown to unfold toward
the floor
 Hold the gown near the
neck line
Gowning the unsterile team member
 Spread the gown so the unsterile
team member can identify the
sleeve entrances
 Cuff the neck of the gown over
your hands to protect them from
contamination
Gowning the unsterile team member
 Allow the unsterile team
member to place both
arms in the sleeve
entrances
Gowning the unsterile team member
 Once the unsterile team
member’s arms are well
started in the sleeve, step
back and remove your hands
from the gown
Gloving the unsterile team member
 Maintain a safe distance
 Unfold the cuff of the
first glove
Gloving the unsterile team member
 Orient the glove so the palm
faces the team member to be
gloved
 Unfold the cuff of the glove
 Refold the cuff over your
fingers to protect your hand
Gloving the unsterile team member
 With the fingers of both
hands protected under the
cuff, pull laterally opening
the glove for the other team
member
Gloving the unsterile team member
 Repeat steps for the
other hand
 Allow the team member
to help open the glove
with his/her sterile hand
Gloving the unsterile team member
 Release the glove after
the cuff of the gown is
completely covered
Practices of Sterile Technique
Disrobing with a contaminated gown
(Technique used when re-gowning and gloving during a
procedure)
Asepsis and Sterile Technique is the third publication in the educational library of the Association
of Surgical Technologists. Visit www.ast.org for more information about AST and their educational
resources.
Disrobing: Step 1
 The sterile person stands with
her/his back to the circulator
 The circulator wears nonsterile gloves
 Keeping appropriate distance
from the gown, the circulator
unfastens top of the gown
Disrobing: Step 2
 Continuing to maintain a
safe distance, the
circulator unties the
inside back tie
Disrobing: Step 3
 The gowned team member
turns to face the circulator
 Care is taken not to touch the
circulator with the hands or
front of the gown
 The circulator grasps the
contaminated gown at the
shoulders
Disrobing: Step 4
 The circulator pulls the gown
forward and down over the
arms
 Both team members watch
the gown carefully
 Gloves will normally role
slightly at the cuff
Disrobing: Step 5
 The gloves are presented to
the circulator with the
palms turned up
 Circulator grasps gloves by
pinching the palmar surface
of the gloves
Disrobing: Step 6
 The gloves are pulled
forward slowly over the
hands
 Care is taken not to snap the
gloves and produce airborne
debris or contaminates
Disrobing: Step 7
 As the gloves are removed,
the hands are moved away
from the circulator
 Gloves are placed in the
proper contaminated
receptacle
Scrubbing Video
 http://www.youtube.com/watch?v=O1sS0ahb4MA