1. Irene Fernando RN CNOR PCC/OR EDUCATOR Janice Kay RN

2. PREPARATION FOR SCRUBBING  Personal cleanliness is extremely important  Fingernails not visible over the finger tips  Fingernails if kept smooth will not puncture gloves  Nails should be free of polish

3. SCRUB-CONT.  Remove all jewelry from hands and arms  May pin these items to your scrub suit  Bacteria and dead skin cells accumulate beneath watches, bracelets and rings.

4. SCRUB-CONT  Don a clean, short-sleeved cotton suit each day before entering the surgical suite  No street clothes or hospital uniforms  The scrub suit cover all undergarments  Scrub shirt be tucked into the trousers  Trouser legs should not touch the floor  Sleeves of the suit at least four inches above the elbow

5. SCRUB-CONT  Ideally should keep a pair of shoes for wear in the surgical suite only  Street shoes if worn should use shoe covers  Shoe covers must be removed on leaving the surgical suite  Wear a clean head cover each day to cover the hair completely

6. SCRUB- CONT  Surgical mask is worn all the time in the restricted/semi restricted areas  The mask must fit snugly around the nose and mouth to filter air  Don a fresh mask immediately before every scrub procedure  The mask is worn primarily to protect the patient. Mask is not sterile, do not touch the inside of the mask, handle it by the ties.

7. THE SURGICAL SCRUB  A surgical scrub brush/sponge with a nail cleaner are prepackaged, presterilized and may be impregnated with a surgical soap  The surgical scrub should be performed according to local standard policy  At uhs perform complete scrub before the first case in the morning

8. SCRUBBING  Follow an anatomical pattern of scrub  Think of the fingers, hands and arms as having four sides or surfaces.  Regulate the flow and temp. of the water  Pretear brush package( it is sterile) lay the brush on the back of the scrub sink.  Wet hands and arms for an initial prescrub wash. Use several drops of surgical detergent.

9. SCRUBBING CONT.  Work up a heavy lather, then wash the hands and arms to a point about two inches above the elbow.  Rinse hands and arms thoroughly, allowing the water to run from the hands to the elbows  Do not retrace or shake the hands and arms; let the water drip from them.

10. SCRUBBING CONT.  Remove the sterile brush and file, moisten brush and work up a lather.  Soap fingertips and clean the spaces under the fingernails of both hands under running water; discard file.  Lather fingertips with sponge-side of brush; then using bristle side of brush, scrub the spaces under the fingernails of the right or left hand about 30 circular strokes.

11. SCRUBBING CONT.  When scrubbing slightly bend forward, hold hands and arms above the elbow, and keep arms away from the body.  Lather digits ; scrub 20 circular strokes on all four sides of each finger.  Scrub one hand and arm completely before moving on to the other hand and arm.

12. SCRUBBING CONT.  Lather palm, back of hand, heel of hand and space between thumb and index finger.  Choosing either of the surfaces, scrub 20 circular strokes on each surface.  After soaping digits, scrub, beginning with the thumb or little finger of the right or left hand.

13. SCRUBBING CONT.  You are now ready to scrub the forearm  Divide your arm in three inch increments.  Use the sponge side of the brush lengthwise to apply soap around wrist. Scrub 20 circular strokes on all four sides.  Move up the forearm-lather, then scrub, ending two inches above the elbow.

14. SCRUBBING CONT.  Soap and /or water may be added to the brush at any time.  Repeat the procedure above for the other arm  Discard brush  Rinse hands and arms without retracing and/or contaminating.  Allow the water to drip from your elbows before entering the operating room.

15. DRYING THE HANDS  Now you are entering the OR from the scrub area to the sterile back table  Slightly bend forward, pick up the hand towel from the top of the gown pack and step back from the table  Grasp the towel and open it so that it is folded to double thickness lengthwise.  Do not allow the towel the to touch any unsterile object, keep your arms away/body

16. DRYING THE HANDS CONT.  Holding one end of the towel with one of your hands, dry your other hand and arm with a blotting, rotating motion  Work from your fingertips to the elbow  Do not retrace any area  Dry all sides of the fingers, the forearm and the arms thoroughly  Grasp the other end of the towel, dry your other hand and arm in the same manner as above.

17. GOWNING  Surgical gowns are folded with the inside facing the scrub person.  This facilitates picking up and donning the gown without touching the outside surface  If you touch the outside surface the gown while donning it, the gown is contaminated.  Remember your hands are not sterile they are but just clean

18. GOWNING CONT.  Your scrubbed hands and arms are contaminated if you allow them to fall below waist level or to touch your body  With one hand, pick up the entire folded gown from the wrapper by grasping through all layers, being careful to touch only the inside top layer which is exposed

19. GOWNING CONT.  Unfold the gown. Hold the gown away from you, at chest level to facilitate safe handling without break in asepsis  Grasp the inside shoulder seams and open the gown with the armholes facing you.  Slide your arms part way in to the sleeves of the gown, keeping your hands at shoulder level away from the body

20. GOWNING CONT.  Hold your hands high so gown does not touch the floor  With the assistance of your circulator slide your arms further in to the gown sleeves  When the fingertips are even with the proximal edge of the cuff, grasp the inside seam at the juncture of gown sleeve and cuff using your thumb and index finger.  Be careful that no part of your hand protrudes from the sleeve cuff.

21. GOWNING CONT.  The circulator must continue to assist at this point. She/he positions the gown over your shoulders by grasping the inside surface of the gown at the shoulder seams.  The circulator then prepares to secure the gown, the neck and back may be secured with a Velcro tab or ties.  The circulator ties the gown at waist level at the back. This technique prevents the contaminated surfaces at the back of the gown from into contact with the front of the gown.

22. GOWNING- OPEN CUFF  The procedure is same as above except you do not grasp the inside seam of the sleeve but you allow your hands to protrude from the cuffs of the gown.  Both you and the circulator must be careful that the gown cuffs are not pulled too high on the wrists  The edge of the cuff should be at the distal end of the wrist.

23. GLOVING  Closed Cuff method  Open cuff method  Closed Cuff method of gloving is preferable to the open cuff method  Closed cuff method eliminates potential hazards in the glove procedure.  Demonstration of both.

24. FINAL TIE OF GOWN  Gloves are on, you are ready to complete gown tie with the assistance of the circulator  Hold the paper tab- do not pull,  Undo gently the knot so that you have the other belt into your other hand  Hand it over the paper tab to the circulator while holding the belt, you spin, circulator will pull the paper tab, now you tie the knot

25. CHANGE OF GLOVE  In between cases, hold outer surface of the first glove rubber to rubber and pull off.  To remove the next glove, place your finger inside of the cuff of the glove skin to skin and pull off

26. REMOVE GOWN & GLOVE  The outer part of the gown and gloves are contaminated by bacteria from the procedure.  Remove them, careful to avoid contamination of forearms, clothing and hands  Remove the gloves after removing the gown.  Demonstration:

27. THANK YOU. Enjoyed being with you. Thank you.