All operating room (OR) personnel will wear scrub clothing, caps, masks and either shoe covers

or shoes designated to be worn only in the OR area.

• Caps completely cover hair.

YES -- Hair Covered NO -- Hair Exposed

• Masks are worn so that they securely cover nose and mouth.

YES -- Nose and mouth covered NO -- Nose exposed

• When shoes that are dedicated to the OR area are worn outside of the OR area, shoe covers are
used until they return to the OR area.

• When personnel leave the OR area, lab coats or such cover gowns are worn to protect scrub
clothing from contaminates; if such covers are not available then the scrub clothing is changed prior
to re-entering the OR area.

• Gown and gloves should be changed with a re-scrub between cases. It is the practice in many
operating rooms, particularly in developing countries, to simply change gloves between cases. This
is theoretically supportable but is not ideal, especially if the gown has been contaminated by the
patient's fluids including, but not limited to, blood. Ideally, the surgeon should put on a new sterile
gown for each case. If the gown is removed first and then the gloves, some consider it acceptable
to re-gown and glove without repeating the surgical scrub.
All scrubbed personnel will make their fingernails, hands, and forearms as clean as possible prior
to donning scrub attire.

• Jewelry is removed.

• Fingernails are cleaned with a nail cleaner under running water prior to scrubbing hands and
forearms.

• Hands and forearms are cleaned via a surgical hand scrub which reduces the number of
microorganisms on skin.

• Alcohol-based products are shown to have superior antimicrobial activity over detergent-
based preparations.

The team at the sterile field will put on sterile gowns and sterile gloves prior to setting up the
sterile table, mayo stand, and draping the patient. (1)

• Closed-glove technique is used initially to prevent contamination of the sterile gown and gloves.
This takes some practice, but it can be mastered.

• Sterile area is deemed to be from fingertips to elbows, circumferentially, and two inches above
the elbows; from scrubbed person's chest to horizontal surface of draped table or draped patient.
 • The neckline, shoulders, underarms, sleeve cuffs, and gown back are not considered part of the
sterile area.

• The use of intact sterile gloves and gowns establishes a barrier that minimizes the passage
of microorganisms between nonsterile and sterile areas. (2)

The operative site and the surrounding surgical area (e.g. globe, eyelids, eyelashes, periorbital
area and surrounding skin) is prepped with an antiseptic agent. (3)

• Providone-Iodine preparations of 5% to the surface of

the eye and in the fornix and the same solution
at 10% to the lashes, lids, periorbital area and
surrounding skin.

• It should be noted that the 5% Providone-Iodine solution is somewhat painful to the patient and the
local anesthetic preparation, if used, should be administered prior to the eye prep.

• If only one eye is to be prepped, the non-prepped eye should at the least be taped closed prior
to beginning the operative eye prep.
 • Care must be taken to avoid corneal exposure so prep sponges are used in a
downward and out motion which closes the upper eyelid and protects the
cornea.

• At the end of the prep the 5% Providone-Iodine is rinsed from the cul de sac
with normal saline or balanced salt solution (BSS) which prevents having the
5% solution in the eye longer than three or four minutes.

• Providone-Iodine solution has been shown to have optimal antimicrobial activity for eyeball prep. If
such is not available, the use of normal saline or BSS rinse is acceptable.

Solutions will be poured onto the sterile field in a controlled manner which prevents
contamination of the sterile field.

• Pour the full amount needed in a continuous flow; do not stop then start
pouring from the same container again.

• Sterility of the solution in the container cannot be ensured after drops contacting the edge of the
opening run back inside the container.

• Solutions in previously opened containers are considered not sterile and should not be used on
the sterile field. (4)

Only scrubbed persons and sterile items should touch sterile surfaces at the sterile field.

• The sterile field should be prepared as close as possible to the time of use which reduces the chance
of dust and other air particulates settling on horizontal surfaces.

• Scrubbed personnel should keep their arms and hands within the sterile field at all times.

• Contaminated gloves should be changed immediately. (5)

The OR setting will be clean and will be maintained in order to prevent cross-contamination and
infection in the patient population.

• A clean environment in the OR setting reduces the number of microorganisms present. (6)
• Surgical procedure rooms and scrub/utility areas should be terminally cleaned daily with disinfectant
and mechanical friction.

• Refillable liquid soap containers, if they are used, should be disassembled and cleaned before being
filled with fresh soap solutions. Liquid soap containers can become contaminated and serve as
reserviors for microorganisms. (7)