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ST220 Concorde Career College Entering the Sterile Field: Scrubbing, Gowning, and Gloving.

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Presentation on theme: "ST220 Concorde Career College Entering the Sterile Field: Scrubbing, Gowning, and Gloving."— Presentation transcript:

1 ST220 Concorde Career College Entering the Sterile Field: Scrubbing, Gowning, and Gloving

2 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.

3 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.

4 Surgical Scrub Practices in Sterile 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.

5 Method Traditionally, both timed and counted brush stroke methods have been used The method demonstrated is the counted brush stroke method

6 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.

7 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

8 Scrubbing: Step 1 Hands and arms should be visually inspected for wounds or infections of any type

9 Scrubbing: Step 2 Nails and cuticles, also, should be carefully inspected

10 Scrubbing: Step 3 Apply water to the arms for the pre-scrub hand-wash

11 Scrubbing: Step 4 Apply antimicrobial solution

12 Scrubbing: Step 5 Perform a 30 second standard handwash Rinse from finger tips to elbows

13 Scrubbing: Step 6 Secure the previously opened scrub brush Reapply antimicrobial solution Remove the nail cleaner

14 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

15 Scrubbing: Step 8 Rinse the end of the nail cleaner after each nail

16 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

17 Scrubbing: Step 10 Begin with scrubbing the nails Use 30 strokes 1 stroke is the combined movement in both directions

18 Scrubbing: Step 11 Scrub all fingers 10 strokes per plane per digit (Planes = superior, medial, lateral, inferior) Scrub web between fingers

19 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

20 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.

21 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

22 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

23 Drying the Hands and Arms Practices in Sterile 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.

24 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

25 Step 2 Lift the towel directly from the Mayo stand Step back as the towel is lifted

26 Step 3 Bend at the waist Unfold the towel Maintain distance from sterile fields Use one end of the towel

27 Step 4 Be aware of the lower ends of the towel Begin to dry the hand at the fingers working toward the elbow

28 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

29 Step 6 Stop drying the first arm at the elbow Place the dry hand on the sterile end of the towel (unused part)

30 Step 7 Reverse the ends so that the contaminated / wet end is now the lower end

31 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

32 Putting on a Gown Practices in Sterile 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.

33 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

34 Gowning: Step 2 Reach directly onto the gown Avoid touching the glove package or gown wrapping “Pinch” the gown, controlling all layers

35 Gowning: Step 3 Lift the gown vertically from the Mayo stand Keep your body away from the Mayo stand

36 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

37 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

38 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

39 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

40 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

41 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.

42 Closed Glove Technique Gloving Oneself 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.

43 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

44 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

45 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

46 Close-up View Cuff to cuff Palm to palm Thumb to thumb

47 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

48 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

49 Step 6 Repeat for the other hand

50 Step 7 Note: always step back from the Mayo stand in order to perform gowning and gloving tasks Complete gloving process

51 Turning a Wrap-around Gown Practices in Sterile 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.

52 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.

53 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

54 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

55 Turning: Step 3 While rotating the shoulders to the left, transfer the tie held in the left hand to the right hand

56 Turning: Step 4 Circulator continues circling the gowned person, keeping the tie extended Both parties observe areas of potential contamination

57 Turning: Step 5 Gowned person takes the tie, NOT the TAB, from the circulator Circulator keeps and discards the tab

58 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

59 Gowning and Gloving Another Assisting Other Team Members 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.

60 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

61 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

62 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

63 Gowning the unsterile team member Maintain a safe distance Be aware of the position of the unsterile team member’s hands

64 Gowning the unsterile team member Allow the bottom of the gown to unfold toward the floor Hold the gown near the neck line

65 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

66 Gowning the unsterile team member Allow the unsterile team member to place both arms in the sleeve entrances

67 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

68 Gloving the unsterile team member Maintain a safe distance Unfold the cuff of the first glove

69 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

70 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

71 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

72 Gloving the unsterile team member Release the glove after the cuff of the gown is completely covered

73 Disrobing with a contaminated gown (Technique used when re-gowning and gloving during a procedure) Practices of Sterile 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.

74 Disrobing: Step 1 The sterile person stands with her/his back to the circulator The circulator wears non- sterile gloves Keeping appropriate distance from the gown, the circulator unfastens top of the gown

75 Disrobing: Step 2 Continuing to maintain a safe distance, the circulator unties the inside back tie

76 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

77 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

78 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

79 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

80 Disrobing: Step 7 As the gloves are removed, the hands are moved away from the circulator Gloves are placed in the proper contaminated receptacle

81 Scrubbing Video http://www.youtube.com/watch?v=O1sS0ahb4MA


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