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Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

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Presentation on theme: "Copyright © 2012 by Mosby, an imprint of Elsevier Inc."— Presentation transcript:

1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

2 2  Important assistant to the surgeon:  Retract tissue  Lavage surgical field with sterile fluid  Manage instrument table

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 3  Eat a meal of substance before surgery  Complex carbs and protein  Groom fingernails  Avoid cologne and perfume  some people are sensitive  May mask important odors

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 4  Endogenous  From the patient itself  Exogenous  From surgical team or environment

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 5  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

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 6  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

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 7 Scrub top tucked snuggly into the pants This prevents body scurf from being shed

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 8 This skull cap head cover does not fit snugly and leaves hair exposed. This bouffant is a proper head cover for this technician

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 9  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

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 10  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

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 11  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

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 12  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

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 13  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

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 14  Chlorhexidine gluconate (4%)  Iodophor (7.5%)  Alcohol (60%–90%)  Parachlorometaxylenol (PCMX)  Brushless rub Scrub Solutions

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 15  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.

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 16  Don’t touch anything.  Apply antimicrobial agent to wet hands and forearms.

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 17  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 Scrubbing Guidelines

18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 18

19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 19 Prescrubbing Guidelines

20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 20

21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 21

22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 22  Fingers  Hands  Forearms  To elbow  Use amount of hand rub recommended by the manufacturer

23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 23 After hand scrub (or rub), dry with a sterile towel.

24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 24

25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 25

26 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 26

27 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 27

28 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 28 Methods: 1. Closed 2. Open 3. Assisted

29 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 29  No bare skin is exposed  Palm to palm, thumb to thumb, fingers of glove facing the elbow

30 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 30

31 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 31

32 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 32 Cuff of glove completely covers cuff of gown

33 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 33

34 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 34 Closed Gloving

35 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 35

36 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 36  When one glove becomes contaminated  When no gown is needed (e.g., minor surgical procedures, bone marrow biopsies, catheterizations) Open Gloving

37 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 37 Only folded cuff of first glove can be touched

38 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 38

39 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 39

40 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 40

41 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 41

42 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 42

43 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 43

44 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 44  When a sterile team member helps another scrubbed-in team member glove  Cuff of gown should not be pulled over the hand

45 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 45  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.

46 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 46  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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