SURGICAL HAND ANTISEPSIS

GOWNING AND GLOVING

SUTURING
Flora Agustina
Sterile area

■ Zona 0 = sterile zone/aseptic zone

■ Zona 1 = ultra clean zone
■ Zona 2 = super clean zone
■ Zona 3 = Clean zone (semirestricted
area)
■ Zona 4 = General zone (unrestricted
area)
NB : Zona 0, 1, 2 : (restricted area)
 Scrubbing
■ The removal of finger rings / jewelry,
nail polish and and artificial nail.
■ „Finger rings and jewelry can harbor
microorganism and dead skin.
■ „Dark nail polish obscures the
subungual
■ space and the likelihood of careful
cleansing is reduced.
■ „Artificial nail increases the microbial
load on hands and interferes bacteria
removal during cleansing.
Categories of antiseptics for scrubs
■ Alcohols
■ Cholorhexidine Gluconate (CHG)
■ Iodophors

[i]
Denton GW. Chlorhexidine. In: SS Block. Disinfection, sterilization, and preservation. 4 th ed. Philadelphia: Lea and Febiger, 1991:274-89.
[ii]
Bernstein D, Schiff G, Echler G et al. “In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate mouthrinse. J Dent Res 1990;69:874-6.
Step One: Water based hand scrub

Step One
Wet hands and arms up to the elbows.
Use nail pick to clean nails under
running water.
Step Two: Water based hand scrub

Wet sponge and squeeze to work up lather.

Wash each finger, hand, and arm to two inches
above the elbows using the non abrasive sponge for a
total scrub time of three minutes.
Note: Use brush side only on nails and cuticles or
on areas of visible soil.
Step Three: Water based hand scrub

Rinse hands and arms from finger tips to

elbows. Dry hands and arms with a sterile
towel.
Avagard: Pump 1

Dispense one pump (2ml) into

the palm of one hand. Dip
fingertips of the opposite hand
into the hand prep and work
under fingernails. Spread
remaining hand prep from wrist
to 2” above the elbow.
Avagard: Pump 2

Dispense one
pump (2ml) and
repeat procedure
with opposite
hand/arm.
Avagard: Pump 3

Dispense final pump

(2ml) of hand prep into
either hand and
reapply to all aspects
of both hands up to the
wrists. Allow to dry-
Do not use towels!
Reference sheets for scrub sinks
GOWNING
 Surgical gowns are folded with the inside facing the scrub person.
 If you touch the outside surface the gown while donning it, the gown is contaminated.
 Remember your hands are not sterile they are but just clean
 Your scrubbed hands and arms are contaminated if you allow them to fall below waist
level or to touch your body
 With one hand, pick up the entire folded gown from the wrapper by grasping through all
layers, being careful to touch only the inside top layer which is exposed
 Unfold the gown. Hold the gown away from you, at chest level to facilitate safe
handling without break in asepsis
GOWNING CONT.
 Grasp the inside shoulder seams and open the gown with the armholes facing you.
 Slide your arms part way in to the sleeves of the gown, keeping your hands at shoulder
level away from the body
 Hold your hands high so gown does not touch the floor
 With the assistance of your circulator slide your arms further in to the gown sleeves
 When the fingertips are even with the proximal edge of the cuff, grasp the inside seam
at the juncture of gown sleeve and cuff using your thumb and index finger.
 Be careful that no part of your hand protrudes from the sleeve cuff.
 The circulator must continue to assist at this point
GLOVING

 Closed Cuff method

 Open cuff method
SUTURING
Preparing the Wound

■ First, trim or shave the area surrounding the wound to avoid contamination and to
ensure proper airflow.

■ The wound edges should be exposed and clearly visible.

■ Ideally, there should be a half-inch diameter of hair-free skin surrounding the wound.
■ Irrigating and washing the wound will remove bacteria and debris. Use soap to gently
wash the skin wound and surrounding tissue.
■ Allow warm water to flow over and into the wound for a period of two full minutes.
Preparing the tools

Betadine Scrub & Solution (dilute

iodine) Gauze Pad
Materials Needed for
Suturing
 Needle Holders
■ A needle holder is a surgical instrument
used to hold a suturing needle for
closing wounds during suturing and
surgical procedures

■ It has both a serrated portion and a

cutting portion (for holding the needle
and cutting the stitching material.
Needle Holding Techniques
■ There are several techniques for holding
the needle holder.

■ The most common method is to place the

thumb and ring finger slightly into the
instrument’s rings.

■ Avoid inserting your fingers far into the

rings of the instrument, since this will tie
up your fingers and impede your mobility.

■ Some surgeons do not put their fingers

into the rings at all and simply grasp the
rings and body of the needle holder in the
palm of their hand.
 Source: Boston University Medical Campus
Suture Materials
■ Suture materials can be divided into two categories: absorbable and non-
absorbable.

■ Absorbable materials have the advantage in that they are less likely to cause
an immune response by the body

■ Non-absorbable materials can be left in the body permanently if needed.

Absorbable Suture Materials
■ Absorbable suture materials are broken
down by the patient’s body.
■ The original absorbable material was
chromic catgut (still used today).
■ This is made from animal intestines and
breaks down after 7 days.
■ Because it breaks down, there is less of
a likelihood of an immune reaction.
Non-absorbable Suture Materials

■ Non-absorbable sutures are made of

materials that are not readily broken
down by the body’s enzymes or by
hydrolysis.
■ Non-absorbable materials can be
removed or left in place permanently
 Source: Boston University Medical Campus
Forceps
■ Forceps allow you to control the
position of the skin to make it
easier to pass the needle and
suture material through the skin.

■ For skin closure use a fine-

toothed forceps
■ Source: Boston
University Medical
Campus
Skin hooks

■ Instead of using forceps, the skin

edges can also be controlled using
skin hooks

■ These have the advantage that they

do not crush the skin edge. 
TYPES OF SUTURES
Continuous Sutures
Non-continuous Sutures
Purse-String Suture
Continuous Suture

■ A continuous suture, Also called

uninterrupted suture is made from
an uninterrupted series of stitches that
are fastened at each end by a knot.
■ A.k.a. Running Stitch
Non-Continuous Suture/ Simple Suture/
Interrupted
■ Also called an Interrupted
Stitch.
■ Each stitch is tied separately.
■ It be used in skin or underlying
tissue layers.
■ This stitch has the benefit of
creating a more accurate fit for
the edges of the wound.
Pro’s and Con’s

■ Continuous ■ Non-continuous
+ faster + allows adjustment of tension
+ less foreign material in wound + one knot failure, not a big deal
+ potentially better airtight/watertight
- More time needed
- Knot failure, big deal - Costs more
- Less control over tension - Increased amount of foreign material in
wound

Courtesy of J. James
SIMPLE SUTURING
TECHNIQUES
Remember to create right angles

■ The ideal skin suture should form a

rectangle.
■ It should penetrate the epidermis and
dermis perpendicular to the skin
surface
■ After penetration, turn at a right
angle, at the depth of the wound,
move parallel to the skin surface, and
then move straight to the surface.
Coordinated Use of the Forceps and
Needle Holder
■ The tip of the needle holder
should grasp the needle about 2/3
of the way back from the point.
■ The needle holder and needle
should be perpendicular to each
other.
■ The tip of the needle should
penetrate the skin perpendicularly
about 5-10 mm from the wound
edge. 90*
■ Elevate the skin with the forceps
while penetrating the skin.
 Forceps & Needle (Cont)
■ The tip of the needle should now be
seen protruding into the wound
■ At this point, continue to hold the
skin w/ the forceps.
■ A common error here is to release
the forceps from the skin edge
– This would cause the skin to
retract, and the needle may
move and retract beneath the
skin edge
Forceps and Needle (cont)

■ The key is to hold the position of the

skin edge while releasing the needle
from the needle holder.
■ Pull the needle from the other side of
the elevated skin.
■ Elevate the other skin edge and
penetrate it with the needle.
Suture Removal

■ Sutures should be removed from the…

– Face: 3-4 days

– Scalp: 5 days

– Trunk: 7 days

– Arm or leg: 7-10 days

– Foot 10-14 days

Suture Removal Steps
■ The skin should be cleansed.
– Hydrogen peroxide is a good choice
for gently removing dried blood and
exudate (seepage). 
■ Grasp one of the “ears” of the suture with
a forceps to elevate the suture just enough
to slip the tip of a small scissor under the
suture in order to cut it.

Source: Boston University

Medical Campus
Thank You