Perioperative Nursing Skills and Procedure
To prevent hands and forearm from
Surgical Handwashing or Scrub
• Definition: Type of hand washing
used in the operating room
Protocol that is done before any
surgical procedures.
Very Sensitive handwashing because
it will really protect our pt. to prevent
infections associated during
operation (open wounds, incisions)
• Purpose: To remove soil and
transient microorganism.
• Equipment:
- Brush
- Sink with faucet and running
water
- Liquid soap
- Sterile towel
Hands considered clean, if clean
towel is used, possible
contamination of hands.
- Nail cleaner
1. Asses the hand for visible soiling, breaks
or cuts in the skin and cuticles. Do no
scrub if there are open lesions or breaks
in the skin.
Breaks in the skin facilitate development
of infection.
Kakalat
2. Assemble Equipment.
To facilitate easy performance of the skill
and prevent contamination.
3. Remove rings, chipped nail polish and
watch and push long sleeves above
elbow.
To decrease resident and transient
microorganisms.
4. Put on cap or hood, shoes cover and
mask.
To prevent introduction of contaminants
into environment.
5. Use a deep sink with side foot pedal.
touching a soiled surface.
6. Turn on water using foot or knee control
and adjust temperature.
To be comfortable warm.
7. Wet hands starting from the tips of the
finger to the forearms keeping hands
higher than elbows.
Water will drain off your elbows, flowing
from the cleanest area to less clean area.
8. Apply soap to a scrub brush or open a
pre-packed scrub brush if available.
To remove resident bacteria from the
skin surface.
9. With brush in your dominant hand, using
a circular motion, scrub nails, and all skin
areas of non-dominant hand and arm
(twenty strokes of each areas).
The circular motion mechanically
removes microorganisms, scrubbing the
non-dominant hands first sets a routine
you can remember to prevent
contamination.
10. Take a second scrub brush and repeat
actions in no. 8 on your dominant hand
and arm.
Same as above
11. Keep the hands and arms above elbow
level, place the fingertips under running
water and thoroughly rinse the fingers,
hands and arms.
Allow flow of water from the area of least
hand contaminated (hand) to the area of
most contamination (elbow)
12. Keeps arms flexed and proceed to the
operating room.
Prevents water from flowing from the
least clean area (elbows) to most clean
area (hands).
Usually at the level of our head, if binaba
above chest it is contaminated, repeat
surgical handwashing.
13. Secure sterile towel by grasping it on one
edge, opening it at full length, making
sure it does not touch your uniform.
Maintain sterility of the towel.
Uniform not yet sterile.
14. Dry each hand and arm separately,
extend one side of the towel around
fingers and hands and dry in a rotating
motion up to the elbow.
Prevents contamination by drying from
cleanest to less clean area.
15. Reverse towel and repeat same action on
the other hand and arm, thoroughly
drying the skin. Discard the towel into
linen hamper.
To prevent contamination of gown.
Kapag idiscard ang towel dapat naka
taas parin kamay.
16. Inspect hands and nails for cleanliness.
To make it sure the hands are clean.
17. Record time of hand washing was done.
For proper documentation.
Things not documented considered not
done.
Gowning and Gloving
1. Asses client care situations that require
gowning and closed gloving.
2. Locate the gown.
3. Grasp the gown inside the neckline, step
back, and allow the gown to open.
4. Keep the inside of the gown toward you
and do not allow it to touch anything.
5. Put your hands at shoulder level and slip
your arms inside the sleeves of the gown
6. Wait for the circulating nurse to secure
the ties of the gown at the neck and waist
7. Keep hands inside the sleeves of sterile
gown and open the inner wrapper of the
gloves on the sterile field.
8. Use your non-dominant sleeved hand to
grasp the cuff of the gloves for the
dominant hand.
9. Lay the glove for the dominant hand on
the forearm with the palm up.
10. Place the palm of the glove against the
sleeved palm of hand with the fingers of
the glove pointing toward the elbow.
11. Manipulate the glove so that the sleeved
thumb of the dominant hand and the
gown’s cuff.
12. Use the sleeved non-dominant hand to
grasp the cuff of the glove and the
sleeves of the dominant hand and extend
the fingers into the glove.
13. Use the sleeved non-dominant hand to
grasp the cuff of the glove and sleeves of
the dominant hand and extend the
fingers into the glove.
14. With the gloves dominant, repeat steps
11 thorough 13 to apply the glove to the
non-dominant hand.
15. Interlock your fingers to secure the fit
16. Check that the gloves completely cover
the cuffs of the gown.
Performing Open Gloving and Removal of
Soiled Gloves
Performing Open Gloving
1. Asses gloves available and select
required size.
Also, asses if gloves are moistened
(contaminated), Check expiration date
and if already open (exposed).
2. Wash hands.
3. Gather equipment.
4. Identify client
Able to know what kind of gloving
technique to be performed (close or
open)
5. Remove gloves from the outer wrapper
6. Place inner wrapper on a clean, dry
surface.
7. Open the inner wrapper without
touching the gloves and identify the right
and left hand.
8. Apply gloves to dominant hand first.
9. Grasp 2 inch (5cm) wide cuff with the
thumb and first two fingers of the non-
dominant hand (index and thumb –
movable, manipulate), touching only the
inside of the cuff.
10. Gently pull the glove over the dominant
hand, making sure the thumb and fingers
fit into the proper spaces of the glove.
11. With the gloved dominant, slip your
fingers under the cuff of the other glove,
gloved thumb abducted, making sure it
does not touch any part on your non-
dominant hand.
12. Gently slip the glove onto your non-
dominant hand, making sure the fingers
slip into the proper spaces.
13. Interlock fingers to fit the gloves well on
all fingers.
Similarities of Open and Close Gloving
- Sterile gloves are used
- Prevent infection
- Perform using aseptic technique
Difference of Open and Close Gloving
- Depends on situation/ scenario
Operation:
If performing surgery (scrub
nurse) use close gloving.
If only assisting scrub nurse
(circulating nurse) use open
gloving.
Wound Care: Open Gloving
Removal of Soiled Gloves
14. With the gloved fingers of the dominant
hand, grasp the outer part of the glove at
the wrist on the nondominant hand.
15. Pull the glove off the fingers, turning it
inside out as you do so. Hold the glove in
the gloved dominant hand.
16. Slip the uncovered non-dominant thumb
under the opposite gloves at the wrist.
17. Pull the gloves off the fingers, turning it
inside out as you do so.
18. Discard the gloves.
We can lower our hands for we already
performed what we need to do. Yellow
(infectious)
19. Wash hands.
20. Evaluate need for sterile gloves during
client care.
After operation we can perform medical
handwashing.
Preparation of Sterile Field
• Definition: sterile field is a
microorganism free are that can
receive sterile supplies.
• Purpose: to create a non-
contaminated are prior to sterile or
invasive procedure.
• Equipment:
- Packaging containing sterile
drape.
- Sterile equipment as needed
- Wrapped sterile gauze
- Antiseptic solution
1. Confirm the sterility of the package.
To ensure that the package is clean and
dry. Moist indicates contamination and
package must be discarded.
2. Select clean work surface above waist
level.
Below waist level is contaminated.
3. Wash hands.
To prevent transmission of
microorganisms.
4. Assemble the supplies in the work area.
To promote efficiency.
First 4 steps of different methods of
preparation of sterile field.
To Open a wrapped Package on a Surface
5. Place the package at the center of the
work area so that the top flap of the
wrapper opens away from you.
To prevent subsequent reaching over the
exposed sterile contents, this could
contaminate them.
6. Pinch the wrappers top flap between
your thumb and index finger.
Touching only the outside of the wrapper
maintains the sterility of the inside
wrapper.
7. Repeat for the side flaps, opening the top
one first. Use the right hand for the right
flap, and the left hand for the left flap.
By using the two hands you avoid
reaching over the sterile field.
8. Pull the fourth flap or the innermost flap
toward you, allowing it to fall flat on the
surface. Make sure that the flap does not
touch your uniform.
If the inner surface touches any unsterile
article like uniform, it is considered
contaminated.
To Add Sterile Item on Sterile Field
5. Open the sterile item while outside
wrapper in non-dominant hand.
To free dominant hand for unwrapping
the outer package.
6. Carefully peel wrapper onto dominant
hand.
Items remains sterile, inner surface of
the wrapper cover the hands, making it
sterile.
7. Place items well within the sterile field.
Small items such as gauze dressing may
be dropped 6-8 inches above the sterile
field. Large items should be put down
carefully.
To prevent accidental contamination of
the sterile field.
8. Dispose outer wrapper.
To prevent contamination of the sterile
field.
To Add Solution to a Sterile field
5. Read the solution Label and sterile side
up onto clean surface.
To ensure giving the right medication.
6. Remove the lid and place sterile side up
onto clean surface.
To prevent contamination of the field.
7. Holding the bottle, pour the liquid from
6-8 inches above the sterile container in
the sterile field.
To avoid the possibility of the two
containers touching each other.
8. Pour slowly to prevent splashing.
If liquid is spilled in sterile field the spot
is considered contaminated.
9. Keep your arms as far as possible from
the sterile field. Avoid reaching over the
sterile field.
To prevent contamination of the sterile
area.