Copyright © 2012 by Mosby, an imprint of Elsevier Inc

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

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 2

Important assistant to the surgeon:Retract tissueLavage surgical field with sterile fluidManage instrument table


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


Endogenous From the patient itself

Exogenous From surgical team or environment


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


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


•Scrub toptucked snuggly into the pants

•This preventsbody scurffrom being shed


This skull cap head coverdoes not fit snuglyand leaves hairexposed.

This bouffant is a proper head cover for this technician


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


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


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


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


Ideal characteristics:FDA compliantBroad spectrum of activityFast acting and effectiveNon-irritatingPersistent effects and cumulative

activity Follow manufacturer’s written

directions for use


Chlorhexidine gluconate (4%) Iodophor (7.5%) Alcohol (60%–90%) Parachlorometaxylenol (PCMX) Brushless rub

Scrub Solutions


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.


Don’t touch anything.

Apply antimicrobial agent to wet hands and forearms.


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



Prescrubbing Guidelines




Fingers Hands Forearms To elbow

Use amount of hand rub recommended by the manufacturer


After hand scrub (or rub), dry with a sterile towel.






Methods: 1. Closed

2. Open

3. Assisted


No bare skin is exposed

Palm to palm, thumb to thumb, fingers of glove facing the elbow




Cuff of glove completely covers cuff of gown



Closed Gloving



When one glove becomes contaminated

When no gown is needed (e.g., minor surgical procedures, bone marrow biopsies, catheterizations)

Open GlovingOpen Gloving


Only folded cuff of first glove can be touched








When a sterile team member helps another scrubbed-in team member glove

Cuff of gown should not be pulled over the hand


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.


Avoid locking knees when standing for long periods of time.

Eat before scrubbing in.

Slowly shift weight from leg to leg.

Documents

Copyright © 2012 by Mosby, an imprint of Elsevier Inc