OR NURSING - Shoe Covers/ Scrub Shoes: to prevent spread of

- identification of physiological, psychological and microorganisms.

sociological needs of the patient - Mask – must be worn in restricted area to contain
- implementation of an individualized program of or filter microorganisms expelled from the moth
nursing care in order to restore or maintain the and nasopharynx by coughing.
health and welfare of the patient before, and after - Gloves – a pair of sterile gloves completes the
surgical intervention attire for sterile team members
- Sterile gown: worn over the scrub suit to permit
GOALS the wearer to come within the sterile field
- provide a safe, supportive, comprehensive care.
- assist surgeon by functioning effectively as a ATTIRE CRITERIA
member of the surgical team - Effective barrier for microorganisms
- create & maintain as aseptic/sterile environm - Resistant to blood and aqueous fluid abrasion to
prevent penetration by microorganism.
AREAS - Designed for maximal skin coverage.
Unrestricted/ Semi-restricted/ Restricted/ - Hypoallergenic, cool, comfortable.
Unsterile Semi-sterile Sterile Area - Pliable material to permit freedom to movement.
Area Easy to don and remove.

isolated by doors OR attire is marks are SURGICAL SCRUBBING

from main required. required to - process of removing as many as microorganisms as
hospital corridor supplement OR possible from the hand and arms by mechanical
includes attire. washing and chemical antisepsis before
peripheral
participating in an operation
support areas Sterile
PURPOSE
and access procedures are
corridors to the carried out in - To decrease the number of microorganism on the
OR this room skin.
- To keep the population of microorganism minimal
Dressing Rooms and Lounges during the operative procedure by suppression of
- Clothes changing areas must be provided for both growth.
men and women. - To reduce the hazard of microbial contamination of
- Access is from an unrestricted area to change from the operative wound by skin flora.
street clothes to OR attire before entering the semi PREPARATION FOR SURGICAL SCRUBBING
restricted areas or vice versa - Skin integrity of hands and arms must be intact.
OR ATTIRE - Remove all finger jewelry because it harbors
- Consists of body covers: scrub suit, head cover, microorganism
mask and scrub shoes. - Be sure that all hairs are covered by headgear
- Purpose: To provide effective barriers that prevents because they are potential foreign body inside the
the dissemination of microorganism to the patient operative wound
TO REMEMBER - Adjust mask snugly and comfortably on the nose
- Only approved, clean OR attire must be worn and mouth
within restricted area of OR. - Adjust eyeglasses comfortably in relation to mask.
- OR attire is not worn outside the OR suite. - Adjust water to comfortable temperature.
- Eyeglasses should be wiped with the tissue wet TIME METHOD BRUSH STROKE
with antiseptic solution to prevent cross - allotting a - allotting
contamination. prescribed length prescribed
of time. number of strokes
- Personal hygiene must be emphasized.
to each sides of
- No unauthorized person should be permitted in
the hands
OR.
PRINCIPLES
- Personnel with skin diseases or wounds must
- Surgical scrubbing starts from the cleanest area →
never be allowed to scrub.
dirtiest area. (fingers, hands, arms and elbows 3
- Jewelry and nail polished should not be worn
inches above)
inside the OR
PREREQUISITES
COMPONENTS
- Wear scrub suit, put on mask cover all hair with a
- Body Cover: be done before entering a restricted
cap.
or semi restricted areas
- Remove jewelries Fingernails must be short and no
- Head Covers: cap protects the garment/ body
nail polish.
cover from contamination by hair.
 - Hands must be free from wounds. Procedure: Brush stroke method
- Eyeglasses must be washed and secured. - Follow the procedure of time method from nos. 1-
SCRUB ROOM 5 except that instead of allotting time, you’re going
- area wherein surgical scrubbing is done to allot prescribed no. of strokes for each part
- for surgical scrubbing and must be provided L NAILS 20 strokes
adjacent to each OR. L FINGERS 10 strokes
EQUIPMENTS L HANDS 10 strokes
- Antimicrobial Solution – contained in a liquid soap L ARMS 6 strokes
dispenser near the sink often operated by foot L ELBOWS 6 strokes
pedal. RINSE BRUSH
- Deep sink with foot or knee controls for water R NAILS 20 strokes
- Nail cleaning tool-file or orange stick. R FINGERS 10 strokes
- Surgical scrub brushes R HANDS 10 strokes
R ARMS 6 strokes
Procedure: Time scrub method R ELBOWS 6 strokes
1. Wet hands & forearms under running water, RINSE HANDS, ARMS AND BRUSH
L NAILS 10
holding the hands above the level of the elbows so
L FINGERS 5
that the water runs from the fingertips to the
L HANDS 5
elbows.
L ARMS 3
2. Apply 2-4 mL of antiseptic solution to the hands.
RINSE BRUSH
Use firm rubbing circular motion to wash
L NAILS 10
➔ the palms and the back of the hands
L FINGERS 5
➔ wrists and forearms L HANDS 5
➔ interlace the fingers and thumbs L ARMS 3
➔ move the hands back and forth. RINSE HANDS, ARMS AND BRUSH
3. Clean the nails with a file or an orange stick. Rinse R NAILS 10
hands and arms under running water while R FINGERS 5
keeping the hands higher than the elbows. R HANDS 5
4. Get a sterile brush and rinse it under running R ARMS 3
water. Apply antiseptic on the brush. Start RINSE HANDS, ARMS AND BRUSH
brushing the L NAILS 5
➔ fingernails L FINGERS 3
➔ back and the palm of the hand L HANDS 3
➔ forearm and the elbow while allotting a RINSE BRUSH
prescribed time of brushing for each part. R NAILS 5
5. At the end of the scrub dry your hands with a R FINGERS 3
sterile towel beginning at the tip of the fingers to R HANDS 3
the elbow. Rotate the towel and repeat the
procedure on the other hand. Proceed to put on a RINSE HANDS, ARMS
sterile gown ➔ Discard brush
➔ rinse hands, arms.
➔ Turn off the faucet then proceed to OR
L HAND 1 min
L ARM 1 min
GOWNING & GLOVING
L ELBOW 30 secs
- The sterile gown is put on after the surgical
RINSE BRUSH
scrubbing.
R HAND 1 min
R ARM 1 min - The sterile gloves are put on immediately after
R ELBOW 30 secs gowning.
RINSE HANDS, ARMS AND BRUSH When Surgeon Arrives After Scrubbing
L HAND 1 min - Gown and glove the surgeon and his assistants as
L HAND 1 min soon as they arrive.
RINSE BRUSH - Assist in draping the patient according to routine
R HAND 1 min procedure
R ARM 1 min PURPOSE
RINSE HANDS, ARMS AND BRUSH - Sterile gowns and gloves are worn exclude skin as
L HAND 3o secs possible contaminant and to create a barrier
R HAND 30 secs between sterile and unsterile areas.
RINSE HANDS, ARMS AND BRUSH
AND PROCEED TO OR

Closed Gloving Technique
- Using the left hand, while keeping it within the cuff
of the left sleeve, pick up the right glove.
- Place the palm of the right glove against the palm
of the right hand. Glove fingers must be pointing
toward the wearer
- Secure hold the lower portion of the cuff of the
right glove with right hand that is still hidden inside
the sleeves. Secure upper portion of cuff of the
glove with your left
- Slip/slide your right hand into the right glove.
Arrange sleeve and glove with your left hand.
- Do the same procedure in donning the left glove.
STERILE FIELD
- any area covered with a sterile drape.
DURING OPERATION
- Step away from sterile field of contaminated.
- Change gloves when pricked by needles.
- Do not turn your back from sterile field.
- Keep sterile field as dry as possible
- Discard soiled sponges from a sterile field.
- Keep talking to a minimum.
- Provide 2 sponges on the operative site prior to
skin incision.
- Pass the first knife for the skin to the surgeon's
needs.
- Pass instruments in a decisive and positive manner.
- watch out for signals and keep instruments as
clean as possible
STERILITY PRINCIPLES
- Only sterile items are used within the sterile field.
- If you are in doubt about the sterility of anything,
consider it unsterile.
- Gowns are considered sterile ONLY from the waist
to shoulder level in front and themselves.
- Sterile persons keep hands in sight and at or above
waist level
- Hands are kept from the face and never held under
the axillaries region.
- Changing table levels are avoided.
- Items dropped below waist level are considered
unsterile
- Tables are considered sterile only at table level.
- Anything that extends below the table level is
considered unsterile.
- In unfolding sterile drape, the part that drops
below the table level is considered unsterile
- Sterile persons touch only sterile items or areas,
unsterile persons touch only unsterile items or
areas.
- Unsterile persons should not directly get in contact
with the sterile field. Use sterile transfer forceps.
- Unsterile persons a void reaching over a sterile
field and sterile persons avoid leaning over an
unsterile field.
- In pouring into a sterile field and sterile persons
avoid leaning over the basin to avoid over
reaching.
- The scrub nurse should set the basin or glasses to
be filled at the edge of the sterile table.
- Surgeons turn away from the sterile field and to
have perspiration removed from the brow
- Sterile persons keep well within the sterile area.
- Sterile persons pass each other back to back.
- Sterile persons turn back to non-sterile person or
area when passing
- Unsterile persons avoid sterile areas.
- Unsterile person should maintain at least 1 foot
distance from any sterile area.
- Unsterile persons never walk between 2 sterile
areas
- Sterile field is created as close as possible to the
time of use.
- Sterile areas are continuously kept in view.
- Destruction of integrity of the microbial barriers
results in contamination.
- Microorganisms must be kept to a minimum