OPERATING ROOM PROCEDURE

Procedure for Gowning and Closed Gloving

>After you have scrubbed and dried your hands,

you are ready to put on a sterile gown. Remember
to always keep your hands above your wrist and
higher than your elbows to make sure they do not
touch anything nonsterile.

>Gowning is a two-person procedure. You will

need an assistant to put on a sterile gown safely,
and your assistant will need sterile forceps.

>The closed glove technique is in widespread use

because it provides a way to put on gloves without
the possibility that they will be touched on the
outside by the bare hand. You will put on the right
glove first, and then the left glove.

1.Facing the sterile field, hold gown by the The inside surface of the gown will contact the
inside top neckline, lift folded gown directly skin’s surface and is thus considered
upward, and step back, away from the table. contaminated.
Allow it to unfold.

SURGICAL SCRUB, DONNING A STERILE GOWN AND CLOSED

GLOVING
Hand washing alone does not eliminate normal flora on the hands. This normal flora can produce
infection when introduced into an open wound. During surgical procedure, deliveries, and
invasive diagnostic procedures, sterile gloves are worn. However, gloves can tear during a
procedure, so it is important that the hands be rendered as nearly free of microorganisms as
possible. A gown, too, can become moist, allowing microorganisms to move from the arms to the
surface of the gown.
Purposes:

1 Surgical hand washing, or scrub, is used to remove soil and microorganisms from the
skin.
2. Nurses working in the operating room perform surgical hand washing to decrease

Gowning Another person.

1.Facing the sterile field, hold gown by the The inside surface of the gown will contact
inside top neckline, lift folded gown directly the skin’s surface and is thus considered
upward, and step back, away from the table. contaminated.
Allow it to unfold.
Gowning Another person.
A team member in sterile gown and gloves may
assist another team member in gowning by
taking the following steps.
1. Give the towel to the surgeon, being careful
not to touch the hand.
Unfold the gown, holding it at the neckband.
Keep the hands on the outside part of the gown
under the protective cuff and shoulder area.
Offer the inside of the gown to the surgeon. The
surgeon slips into the sleeves.
Release the gown. The surgeon holds arms
outstretched while the circulating nurse pulls
the gown onto the shoulders and adjusts the
sleeves and cuffs.
Gloving another Person.
1. Pick up the right glove, grasp it firmly, with
fingers under the everted cuff. Hold the palm of
glove toward the surgeon.
2. Stretch the cuff sufficiently for the surgeon to
insert the hand. Avoid touching the hand by
holding your thumbs out.
3. Exert upward pressure as the surgeon
plunges the hand into the glove. Unfold the
everted glove cuff over the cuff of the sleeves.
4. Repeat for the left hand.
Changing Gown During Operation.
1. Circulating nurse unfastens neck and waist.
By grasping it at shoulders, the gown is pulled
off inside out. The gown is always removed first
before the gloves. If only the sleeves is
contaminated, a sterile sleeve may be put on
over the contaminated one.
Removing Gown
1. The gown is always removed before the
gloves. It is pulled downward from shoulders,
turning the sleeves inside out as it is pulled of
the arms.
SEQUENCE OF SCRUB NURSE REMOVING
SOILED GOWN AT THE END OF OPERATION.
Clean arms and scrub dress are protected from
contaminated outside part of gown.
With gloves on, loosen cuffs of gown and shake
them down over wrists. Then grasps right
shoulder of gown with left hand.
In pulling the gown, of arms, turn arm of gown
away from body with flexed elbow.
Then grasp the other shoulder with the other
hand and remove gown entirely, pulling it off
inside out; thus, arms are kept clean.
Changing Glove during operation.
If a glove becomes contaminated for any reason
during operative procedure, it must be changed
immediately. If you cannot step away at the
moment. Hold the contaminated hand away
from the sterile area. To change the glove:
1. Turn away from the sterile field.
Extend contaminated hand to the circulating
nurse who grasp the outside of the glove about
2 inches below the top of the glove and pulls the
glove off, inside out.
Preferably a sterile team member glove another.
If this is not possible step aside and glove the
hand using the open glove technique.
NOTE: The closed glove technique cannot be
used for glove change during an operation
without contamination of their new glove by the
sleeve of the gown or without contamination of
the hand by the cuff of the gown. The cuff must
be pulled down over hand. If this method is
used, gloves and gown must be removed and
another sterile gown donned before gloves.
Removing Gloves
Glove is removed after the gown. Gloves are
turned inside out, using glove-to-glove then
skin-to-skin technique.
SEQUENCE OF SCRUB NURSE REMOVING
SOILED GLOVES AT END OF THE OPERATION.
a. Use glove- to- glove, then skin-to-skin
technique to protect “clean “hands from the
contaminated outside of gloves, which bear cells
of the patient. Turn gloves inside out when
removing them, keeping hands “clean”.

1.Facing the sterile field, hold gown by the The inside surface of the gown will contact
inside top the skin’s surface and is thus considered
neckline, lift folded gown directly upward, contaminated.
and step
back, away from the table. Allow it to unfold.
GOWNING AND CLOSED GLOVING

All gowns are folded and packaged for sterilization with the inside exposed so that the surgeon
may handle the gown without contaminating the outside of the gown. Grasp the exposed inside
of the gown and lift the gown away from the table.
Unfold the gown by placing hands into the white arm holes. Continue placing hands and arms
through the sleeves. If you are planning on closed gloving, do not thrust hands through the cuff

CLOSED GLOVING

Step 2: Left hand (within the gown) lifts the

right glove by its cuff.

Step 3: Right glove is laid on the palm of the right hand (cuff to cuff with the gown sleeve) with
fingers of the glove pointing toward the elbow and the thumb of the glove positioned on top of
the surgeon's covered right thumb.
Step 4: The inside of the cuff of the glove is grasped by the right hand (still within the gown) and the
left hand folds the cuff of the glove over the back of the right hand.
Step 5: The left had then pulled the cuff of the right glove and sleeve of the right gown towards
the elbow as the right-hand slides into the glove. Wait to adjust the glove until both gloves are on
and sterility is ensured (left fingers may slip out of the gown while trying to adjust the right glove
prematurely).

Step 6: With the gloved right-hand lift left glove by its cuff and place on palm of left hand
(aligned with the cuff of the gown), with glove fingers pointing toward the elbow and the left
thumb of the glove over the covered left thumb of surgeon.
Step 7: Left fingers (still within the gown) grasp the inside of the glove and the right hand pulls
left glove cuff over the back of the hand.
Step 8: Pull the glove cuff and gown sleeve toward elbow as left-hand slides into the glove
Step 9: Now that both gloves are on, pull glove cuffs over gown sleeves and adjust gloves for
comfort.
Source: Nursing Manuals
XUCON
Ateneo de Cagayan