SCRUBBING GOWNING AND GLOVING

Surgical Technology Program
Anatomically and Biologically

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1. Skin • Layers — Epidermis Outer layer of skin, which varies in thickness — Dermis

Deep layer of skin, containing sebaceous and sweat glands, blood vessels, nerves, and hair roots Characteristics — Skin cannot be sterilized, but it can be made surgically clean by reducing the number of microbes. — The number of bacteria on the epidermis are constantly replenished by the continuous secretory activity of the skin glands. — The subungual area under the fingernails is very difficult to clean and particularly prone to contamination. • Relevant personal hygiene — Fingernails should not reach beyond the fingertip to avoid glove puncture. — Fingernail polish and artificial devices must not cover the natural fingernail. 2. Flora • Types — Normal flora

Bacterial population peculiar to a particular body location; made up of transient and resident flora — Transient (contaminating) flora Organisms present on the epidermis which have been picked up through contact with other objects 2. Flora • Types — Resident (colonizing) flora Bacteria which are normally present below the skin surface in sebaceous glands and hair Characteristics — The number of transient flora is reduced by frequent scrubs.

follicles

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— Conversely, there is a sharp increase in the number of these organisms when the surgical scrub is carried out only occasionally.

Keeps the population of microorganisms minimal during the operative procedure by suppression of growth 4. Removes soil. though resident flora is not affected Purposes of the Surgical Scrub • • • • • • • • • • 1. • Scrub sinks are deep and wide enough to prevent splash-back. and microorganisms from the dermis of the hands and forearms of sterile team members 2. debris. rather than hand-operated. Reduces the hazard of microbial contamination of the operative wound by skin flora Processes used to remove microbes from the skin 1. • • • • • • • • • • • Scrub sinks should be knee. • Scrub sinks are designated as single-use for scrubbing and hand-washing and are not to be used for cleaning or rinsing contaminated instruments or equipment. soap or detergent 2. 2. Mechanical brushes Designed for effectively removing microbes Reusable (not commonly used) — When taken from the dispenser where they were sterilized. remove each brush without contaminating the others — Packaged with or without nail files (cleaners) — Should not cause skin abrasion • Single-use (disposable) . hand lotion. Decreases the number of microorganisms on the skin to an irreducible minimum (near zero) 3. natural skin oils. to reduce contamination risks.or foot-operated. Scrub sinks Used by all operate room members for scrubbing and hand-washing • Scrub sinks are generally located adjacent to OR for convenience and safety reasons.• • • • Surgical scrub Process of reducing the number of microorganisms from the hands and arms to a safe level before participating in an operative procedure Surgically clean Condition of skin immediately after a surgical scrub in which the transient bacterial flora has been reduced within safe limits. Chemical disinfection Causes removal of microbes via antimicrobial or antiseptic solution Surgical Scrub Materials 1. Mechanical cleansing Uses friction of a brush in combination with water.

but is a neurotoxin that can be absorbed through the skin. but loses its potency when exposed to organic matter — Povidone-iodine Causes skin irritation. so routine use is discouraged — Idophors Less irritating than iodines. each finger. — Alcohols Used for hand antisepsis and surgical site prop — Chlorhexidine gluconate (Hibiclens®) Good for both hand antisepsis and surgical prep. Forearm . Chemical antisepsis agents—Antimicrobial or antiseptic detergents Requirements • • • • • • • • • • • • • • • • • • • • • — Broad-spectrum antimicrobial agents — Fast-acting and effective — Non-irritating and non-sensitizing — Prolonged action that leaves antimicrobial residue on skin to temporarily prevent growth of microorganisms or transient bacteria — Independent of cumulative action Popular brands Most hospitals have more than one agent available for those allergic to a particular agent. arm. Numbered stroke method Designated number of brush strokes for the nails. best used for surgical site prep Mechanical Surgical Scrub 1. back of hand. forearm and elbow Sequential Order • • • • 1. Timed method Prescribed amount of time for scrubbing each hand. Fingers 3.• • • — Can be brush-sponge Combination — Individually packaged — Impregnated with antiseptic-detergent agents 3. and elbow area and elbow 2. but keep away from mucous membranes — Hexachlorophene Used for hand antisepsis. Hand 4. palm. Fingernails 2.

General scrub guidelines • Perform a surgical scrub before each operative procedure. Use a circular brush stroke. 2. Drying guidelines Thoroughly dry hands and arms with a sterile towel after scrubbing to avoid strikethrough contamination of the gown. • Wear proper operating room attire when scrubbing in the restricted area. circular. • Take care to avoid dripping water on the pack while reaching for towel. holding the towel away from the body to prevent scrub suit contamination with towel. • Bend slightly at the waist. Reasons for Gowning and Gloving 1. Hold hands higher than the elbows during and after scrubbing to prevent water from running down the upper arms to the lower arms and hands. 5. • Initial scrub Generally 5 minutes • Subsequent scrubs Generally 3 to 5 minutes 3. Allows personnel to create and work within the sterile field 2. and from fingertips to elbow without returning to any area. 4. 2. Prevents contamination of surgical supplies and equipment 3. front and center. Devote equal attention to each scrubbed surface.• • • • • • • • • • • • • • • • • • • • • • • • 5. Duration guidelines Hospitals have different policies concerning the length of time to scrub. rather than a straight stroke. 3. it covers a larger area and is more effective in loosening bacteria and dead skin. since conditions under surgical gloves are ideal for bacterial growth. • Take towel from pack by reaching down and lifting it straight up and away from the sterile field. Protects the wearer and other personnel from contaminants Gowning and Gloving Methods . to prevent touching other people or objects. • Dry using a rotating motion by moving the arms. Elbow Mechanical Surgical Scrub Characteristics 1. Hold scrubbed hands above the waist. Use firm and brisk brush strokes with short. friction motions. Aseptic Guidelines 1. not towel.

most often is the first sterile team member for a procedure — Gowning for closed glove technique — Gowning for open glove technique • Assisted-gowning Gowning by or for other personnel 2. based on usage • • . Gown composition Material must establish an effective barrier. Gown design Varies. most often is the first sterile team member for a procedure — Closed technique (preferred method) Most common technique in preparing for a procedure.• • • • • • • • • • • • • • • • • 1. prevents outside of sleeve or gloves from touching the skin or hands. when reusable 3. • Self-gloving Gloving performed alone. which are covered with the sleeves of the gown when gloves are put on — Open technique Generally used during a procedure or when no gown is required. Gowning Gowning method is determined by two factors: type of gloving technique and whether it is being performed before or during the procedure. Gown types • Single-use (disposable) • Reusable 2. which are uncovered or "open" when gloves are put on • Assisted-gloving Gloving by or for other personnel Gown Characteristics • • • • • • • • • 1. Gloving Gloving method is determined by two factors: level of asepsis (gowned or un-gowned) and time of gloving (prior to or during a procedure). Self-gowning Gowning performed alone. allows wearer to touch inside of glove with bare hands. eliminating the passage of microorganisms between sterile and non-sterile areas • A lint-free material that is sufficiently porous to eliminate heat build-up and meets the National Fire Protection Association requirements • A memory-free material • A material that possesses a high degree of drapability • A material that allows complete steam penetration for sterilization.

• Inside and outside surfaces may be pre-lubricated with an absorbable dry starch powder before sterilization to prevent sides from sticking together and to ease gloving process.• • • • • Sleeves end at the wrist with a tightly fitted cuff. including sleeves to 2" above the elbow. Glove types • Disposable and packaged in peel-packs • Manufactured in standard sizes in half-size increments from 5 1/2 to 9 2. General gowning and gloving guidelines • Inspect package integrity for damage or wetness that would indicate contamination before opening gowns or gloves. 4. — Consider gown backs contaminated. ties. ensuring that no part of gown or glove has contacted the wrapper edge. 4. — Prevent contamination of the sterile field by changing punctured. Glove design Gloves should fit snugly with no wrinkling. • Some have fronts and forearms made of double thickness material or water repellent material for extra protection during long procedures. 2. Gown presentation • Folded inside out to prevent contamination of the exterior when picking up the gown to put it on • • • • • • • • • • • Fastened at the neck by snaps. Glove composition—Latex or other synthetic material 3. which is completely covered by sterile gloves. but without restricting circulation or movement. . or Velcro and at the waist by inner pull-ties and outer wrap-around ties Glove Characteristics 1. torn or wet gowns . Gowning Guidelines • General gowning guidelines — Remember gowns are sterile only from waist (table) level to chest level in front. Glove presentation Packaged in pairs with an everted 2-3" cuff on each glove to protect its sterility when Key Term Everted Turned inside out gloving • • • • • • • • • • • Aseptic Guidelines 1. • Lift gowns and gloves straight up and away from the wrapper when gowning and/or gloving.

Do not allow gown sleeves to touch below waist level before handing the gown to the scrubbed team member. — Discard gloves and obtain new ones from the circulator if glove sides adhere together. • • • • • • • • • • • • Roll the gown forward on the arms. • Gown removal — During an operation (assisted)— Removed after stepping away from the sterile field Have the circulator step up from behind. — Dispose of the contaminated gown in an appropriate container.• • • • Self-gowning — Face the sterile field and step away from unsterile objects or people to avoid hitting • Assisted gowning — Open gown packages on a separate table from the back table and away from other packages to avoid contamination from dripping water. leaving sleeves extended over the hands. — Bring gown over the shoulders by reaching inside to shoulder and arm seams and pulling the gown on. Secure ties or fasteners without touching the sides or front of the gown. circulators perform gown tying duties. making gloving impossible. Normally. — Always keep gloved hands above waist level. — Wipe off excess powder from external glove surfaces immediately after gloving if packaged with dry starch. keeping hands on the outside of the gown under a protective cuff. Pushes the gown forward onto the arms Comes to the front to pull the gown off inside-out so that the gown exterior is rolled up Then the gloves are removed using glove-to-glove and skin-to-skin technique. them. then roll up until the gown exterior is enclosed within the gown interior. . • • • • • • • • • • — Unfold gown carefully by holding at the neckband. Gloving guidelines • General gloving guidelines — Only open the number required for a case. — After an operation (self-removal)—REMOVE GOWN PRIOR TO GLOVE REMOVAL inside. Unties the gown. A rescrub is not necessary if the procedure is executed properly. lubricant can cause peritonitis or granuloma formation if introduced into a wound. • — Change a sterile glove immediately if punctured or torn to prevent any microbial exchange through escape of microorganisms from the wearer on seepage of blood and body fluids from patient into glove. below chest level. — Wipe external side of gloves with a sterile damp towel. since gloves are expensive. and in sight at all times. 3. then watch the gown gently unfold.

— Closed technique Used after surgical scrub and after surgical gown is in place.After gown removal and disposal. who then assists all other team members. if double gloved. contaminated gloves contain wet and often bloody materials. Do not allow the skin of the hands to touch gloves or exterior of gown cuffs.• • • • • • — Inter-operatively. . Glove removal — During an operation (assisted) . — Re-glove other sterile team members during an operative procedure as required. Do not flick or allow quick movements to avoid splash contamination. palm up.Dispose of gloves by dropping into an appropriate container. . Assisted gloving • • • • • • • • • • • • • • • — Start with the right glove. .Circulator will draw glove off inside-out without touching any sterile area including gown or skin. .Extend glove away from sterile field. — Unfold everted cuff over the cuff of gown sleeve. — Hold a contaminated glove away from the sterile field until it can be removed.Grasp the outer cuff of both gloves with the opposite hand's thumb and middle finger and simultaneously pull outward.Another member of the sterile team will assist in re-gloving or. Repeat for second layer. . Hold the palm of the glove toward the person. selfgloving is possible or use the open glove technique. this technique is only used by the first scrubbed team member. After an operation (self-removed) . if double-gloved. . leaving gloves inside out. avoiding any chance of splash outside of the container. Generally. remove gloves one layer at a time unless there is an overriding reason to remove both layers at once. allow circulator to remove a contaminated glove by grasping the outside of the cuff about 2 inches below the top of the glove and pulling the glove inside out. Glove removal .Post-surgery. Self-gloving — Open technique Used for any procedure that does not require a surgical scrub or sterile gown or when changing a contaminated glove during the operation.Circulator will glove for protection. stretch the cuff and cover fingers to avoid touching the hand. then pinch the glove in the palm of the hand in question.