SURGICAL HAND SCRUB Preparation: 1. approaches scrub sink in proper OR attire 2.

recognize proper time limit for procedure 3. sets water timer and wet arms and hands 4. if soap dispenser available, prelathers with soap 5. open sponge and discards wrapper Scrubbing Procedure: 1. follows prescribed method for surgical scrub technique 2. keeps hands and arms at correct level 3. keeps front of scrub suit dry by avoiding splash back 4. avoid going over prescrubbed areas 5. does not touch unsterile areas while scrubbing 6. avoids unnecessary talking or moving away from sink during scrub 7. rinses hands and arms while avoiding raising hands or arms above shoulder level 8. approaches door to OR room correctly 9. if contaminated, starts from beginning of scrub procedure

APPLICATION OF STERILE GLOVES CLOSED AND OPEN METHOD Closed glove method 1. recognizes proper usage of this method 2. opens glove packet using mitten hands (gown covering hands) 3. lift gloves out of package and places glove thumb to thumb and palm to palm with fingers pointing toward below 4. grasps cuff of glove and glove with mitten-hand and extends glove cuff over gown cuff and hand 5. extends individual fingers into correct slots 6. repeats same procedure for other hand 7. adjusts gloves; wipes off with damp towel open glove method 1. recognizes proper usage for this method 2. open glove packet using outside flaps 3. grasps cuff of one glove and slides glove over hand 4. adjust fingers into proper slots 5. releases cuffs 6. using gloved hand, lifts second glove off package using finger to finger touch 7. slides glove over ungloved hand 8. avoids touching gloved fingers with ungloved hand 9. adjusts gloves 10. avoids contact of gloved hands with nonsterile items or persons.

DRYING, GOWNING AND GLOVING ANOTHER TEAM MEMBER Presentation of towel: 1. opens towel, laying it across the hand of the team member 2. avoids contact with nonsterile areas Gowning procedure: 1. unfolds gown in proper manner 2. presents gown to wearer with inside of gown facing wearer 3. protects sterile hands while presenting gown 4. adjusts sleeves of gown 5. avoids contact with nonsterile hands while gowning Gloving procedure 1. opens gloves, announces hand to be gloved first 2. presents glove so that thumb is facing wearer and sterile hand is protected 3. applies resistance while glove is being applied 4. gloves other hand, pulling cuff away to ease insertion 5. offers damp towel to wipe off gloves 6. avoids contamination of self during procedure

CHANGING CONTAMINATED GLOVES DURING A PROCEDURE Self: 1. 2. 3. 4. 5. holds contaminated glove away from field maintains cuff at wrist while glove is removed by nonsterile person uses open glove technique when reapplying sterile replacement glove wipes off glove with damp towel returns to sterile field when task is complete

Tea Member: 1. asks nonsterile person to remove soiled gloves 2. presents gloves to team member, thumb facing the wearer 3. supplies resistance during gloving 4. offers damp towel to wipe off new gloves 5. avoids contamination with self and sterile field during removal and reapplication

REMOVING SOILED GOWN AND GLOVES Gown and gloves are removed contaminant to contaminant and clean to clean REMOVING GOWN 1. with one hand grasps opposite shoulder of gown 2. pulls down and inward, taking care outside of gown does not touch scrub attire 3. repeat step 1 for other shoulder 4. disposes of gown in appropriate receptacle, touching inside only REMOVING GLOVES 1. removes first glove using glove to glove technique 2. removes other glove using skin to skin technique 3. disposes of gloves (touching inside of gloves only) in appropriate receptacle 4. performs general hand washing after leaving procedure room