(GNUR 301)

(PERI-OPERATIVE NURSING)
Lesson 3 – THEATRE TECHNIQUES

Lecturers: DR GLADYS DZANSI

gdzansi@ug.edu.gh
DAVID TENKORANG-TWUM
dtenkorang-twum@ug.edu.gh

Department of Adult Health

School of Nursing and Midwifery
College of Health Science
 LESSON OVERVIEW
• There are major techniques that are employed by the
operating staff or the surgical team to minimize
infection and ensure patient safety in the theatre
environment Before surgery. Staffs must scrub up
and gown before operation. The sterility of the
operation area must be maintained at all times.
• This session is designed to introduce the student to
techniques such as scrubbing, gowning, and gloving.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 2

 Goals and Objectives

At the end of the session, the student will be able to:

• Describe and perform a component theatre
technique of surgical scrubbing of the hands.

• Describe and perform the technique of surgical

gloving.

• Conduct the technique of surgical gowning.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 3

 SESSION OUTLINE
The key topics to be covered in the session are as
follows:
• Topic 1- Surgical scrubbing of the hands.

• Topic 2 –Techniques in gowning

• Topic 3 –Donning and doffing of surgical gloves

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 4

 READING LIST
• Annamma, J., Rekha, R. & Jadhav, T. (2007) Clinical
Nursing Procedures: The Art of Nursing Practice
Jaypee Brothers, New Delhi 
• Kozier, B., Erb, G.B., Synder, S. (2004) Fundamentals
of Nursing: Concepts, Process, and Practice, 7th Ed,
Pearson Education Inc. New Jersey 
• LeMone, P. & Burke, K. (2008) Medical and Surgical
Nursing-critical thinking in client care fourth edition
Pearson Prentice Hall, New Jersey

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 5

 Topic one (1)

SURGICAL HAND SCRUB

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 6
 DEFINING SURGICAL HAND SCRUB
• This is performed by all surgical team members
before donning a sterile gown and gloves to assist at
the operative site.
• Surgical hand scrub does reduce the number of
microbes, if performed well preventing wound
infection in the surgical patient.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 7

 DEFINING SURGICAL HAND SCRUB
(cont.)
• It also provides an
antiseptic cover on the
skin surface to prevent
microbial growth for a
number of hours.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 8

 FACTORS TO CONSIDER BEFORE A
SURGICAL HAND SCRUB (SHS)
• The skin and nails should be kept clean and in good
condition.
• Inspect hands and arms to be sure there are not cuts,
or abrasions or lesions since these serve as good
medium for microbes.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 9

 FACTORS TO CONSIDER BEFORE A
SURGICAL HAND SCRUB (cont.)
• Nails must be kept short since long nails serves as
reservoirs for microbes.
• Fingernails should not reach beyond the finger tip to
avoid glove puncture.
• Avoid artificial or acrylic nails.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 10

 FACTORS TO CONSIDER BEFORE A
SURGICAL HAND SCRUB (cont.)
• All jewelry should be removed from the fingers,
wrists and neck as jewelry harbours microorganisms.
• Be sure all hair is covered by headgear.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 11

 FACTORS TO CONSIDER BEFORE A
SURGICAL HAND SCRUB (cont.)
• Mask must be worn ensuring that it is tied securely
to prevent venting at the sides.
• Adjust the disposable mask snugly and comfortably
over the nose and mouth.
• Clean eyeglasses if worn, is adjusted comfortably in
relation to the mask.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 12

 FACTORS TO CONSIDER BEFORE A
SURGICAL HAND SCRUB (cont.)
• To reduce the risk of scrubbed hands and arms
brushing against loose garments and becoming
contaminated, scrub shirts must be well tucked into
the trousers.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 13

 TYPES OF SURGICAL HAND SCRUB
(cont)
• Timed scrub method

• Stroke count method

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 14

 TYPES OF SURGICAL HAND SCRUB
(cont)
Timed Scrub Method
• Here the fingers, hands and arms are scrubbed for a
prescribed time that is consistent with the scrub
agent manufacture’s written recommendations.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 15

 TYPES OF SURGICAL HAND SCRUB
(cont)
Stroke Method
• The stroke method ensures that all skin surfaces are
exposed to the same amount of mechanical
scrubbing and germicidal solution.
• In this method a prescribed number of strokes are
expected on each surface of the fingers, hands and
arms.
• To the nails, 30 strokes are applied.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 16

 TYPES OF SURGICAL HAND SCRUB
(cont)
• Stroke Count Method (cont).
• On other areas of the hands and arms up to 5cm
above the elbow, 20 strokes are applied.
• The arm is divided into thirds; using circular strokes,
each one is scrubbed up to 5cm above the elbow.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 17

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Scrub sinks with running Water
• Sterile brushes
• Dispensable Soap
• Sterile towels.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 18

 VIDEO (Surgical scrub)

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 19

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Change into approved scrub attire.
• Remove all ornaments and nail polish
• Get ready all requirements
• Put on rubber apron and boots
• Turn on the tap, regulate its flow and adjust to a
comfortable temperature.
• Wet hands and forearms.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 20

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Using an antimicrobial soap or detergent, lather the
hands and arms to two inches (5 cm) above the
elbows to loosen surface debris and remove the
gross contamination.
• Adopt a position with hands slightly higher than the
elbow by flexing the arms.
• Rinse Soap off hands and arms so that the water
flows off at the elbows.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 21

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Traditional Hand Scrub
• Dispenses soap into palms and applies same from tip
of finders to elbow joints
• Receives sterile brush, and removes nail pick, cleans
under finger nails and discards nail pick
• Wets brush and dispenses soap unto it aseptically

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 22

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Starts scrubbing the contra lateral hand from the
finger tips, the palm, back of the fingers, in-between
the fingers, back of the hand, the wrist in a circular
movement to the elbow joint
• Rinses brush and the scrubbed hand
• Dispenses soap unto brush and systematically scrub
the opposite hand; repeating steps three times for
each hand and scrubbing for 3-5 mins.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 23

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Drops brush, soaps hands and rinses each arm from
finger tips to elbow joints
• Closes tap aseptically and allows excess water to
drain from elbows into the sink
• Holds hands at chest level and walks to gowns trolley

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 24

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
Surgical Hand Scrub (Brushless Technique)
• Changes into approved theatre attire
• Removes all ornaments from neck, hands and fingers.
• Gets scrub area ready with antiseptic soap (e.g. 50-
95% alcohol combined with chlorhexidine gluconate),
and running water

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 25

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Surgical Hand Scrub (Brushless Technique cont.)
• Puts on rubber apron and boots
• Turns on tap, and regulates flow and temperature
• Adopts a position with hands slightly higher than the
elbows
• Rinses hands and arms to elbow joint
• Dispenses soap into palms and wash both arms
sequentially in the following manner

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 26

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Surgical Hand Scrub (Brushless Technique cont.)
• Palm to palm
• Right palm over left dorsum
• Left palm over right dorsum
• Palm to palm, fingers interlocked
• Back of fingers to opposing palms with fingers
interlocked

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 27

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Surgical Hand Scrub (Brushless Technique cont.)
• Rotational rubbing of right thumb clasped in left
hand and vice versa
• Rotational rubbing backwards and forwards with
clasped fingers of right hand in left palm and vice
versa

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 28

 REQUIREMENTS AND PROCEDURE
FOR SURGICAL HAND SCRUB
• Surgical Hand Scrub
(Brushless Technique cont.)
• Rinses both arms
• Closes tap aseptically and
allows excess water to
drain from elbows into the
sink
• Holds hands at chest level
and walks to gowns trolley

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 29

 DRYING HANDS AND ARMS AFTER
HAND SCRUB
• Hands and arms must be thoroughly dried with a
sterile towel to prevent contamination of the sterile
gown by organisms on the skin.
• A reusable or disposable towel for drying the hands
is normally placed on top of the gown during
packaging.
• Reach down to the opened sterile package and pick
up the towel. Be careful not to drop water onto the
pack.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 30

 DRYING HANDS AND ARMS AFTER
HAND SCRUB
• The nurse bends slightly forward to prevent the
towel as it is unfolded, from touching the scrub
clothes.
• If two towels are used, one towel is used for each
hand and arm.
• To dry one arm hold the towel in the opposite hand
then using a rotating motion the forearm and the
elbow are dried and the towel discarded.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 31

 DRYING HANDS AND ARMS AFTER
HAND SCRUB
• If one towel is used one half is used for each hand
and arm- with the dried hand grasp the dry unused
end of the towel and repeat the process on the
second hand and arm.
• Discard the towel.
• In both these techniques once the towel has been
moved from the hands to the elbows, the towel is
considered contaminated and must not come in
contact with the dried portion of the hand or arm.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 32

 VIDEO (Hand drying)

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 33

 Topic Two (2)

GOWNING OF THE THEATRE GOWN

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 34
 GOWNING
• Gowns are folded with the inside front neckline
visible to make it possible for team members to wear
them without touching the outer side with their bare
hands.
• Purpose- to enable the nurse to work close to a
sterile field and to handle sterile objects freely.
• To protect patients from becoming contaminated
with microorganisms on the nurses hands, arms and
clothing.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 35

 GOWNING cont.
PROCEDURE:
• Grasp the gown by the
neckline
• Step back from the
trolley and allow the
gown to unfold with the
inside of the gown
towards the wearer.
• Identify the arm holes

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 36

 GOWNING cont.
• Slip arms in simultaneously, holding the hand at
shoulder level and away from the body.
• The circulatory nurse may assist by reaching inside
the gown and pulling the inside seam.
• The circulatory nurse ties tapes at the back.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 37

 GOWNING cont.
• If the closed – gloving technique will be required, the
gown is pulled on leaving the sleeves extended
beyond the hands approximately 1 inch (2.5cm).
• If open glowing technique is used, then the hands
are extended through the cuffs/stockinette of the
gown.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 38

 Topic Three (3)

GLOVING
Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 39
 GLOVING
There are two main methods of gloving
namely:

• Open

• Closed

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 40

 GLOVING cont.

Open Gloving
The open-gloving technique is used before
performing sterile procedures such as bladder
catheterization or insertion of an intravenous
cut down or when both gloves must be
changed without assistance during a surgical
procedure.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 41

 GLOVING cont.
Procedure
• Pick up the cuff of the left glove using the
thumb and the index finger of the right hand.
• Pull the glove onto the left hand, leaving the
cuff of the glove turned down.
• With the gloved left hand, slide the fingers
inside the cuff of the right glove, being careful
to keep the gloved fingers under the folded cuff.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 42

 GLOVING cont.
• Pull the glove unto the right hand avoiding
inward rolling of the cuff. Then by rotating the
arm, the cuff of the glove is pulled over the
gown.
• Place the fingers of the gloved right hand
under the folded cuff of the left glove, rotate
the arm and pull the cuff of the glove over the
gown.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 43

 GLOVING cont.
• Do same for the other hand.
• Then hold hands together at the chest
level and enter the operating room.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 44

 GLOVING (cont.)
Closed gloving
• For the scrub nurse the closed method of
gloving is preferred because it is not possible
for the bare hand to touch the outside of the
gloves.
• Slide the hands into the sleeves of the gown
until the cuff seam is reached ensuring that
the hands do not touch the edges of the cuff.
Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 45
 GLOVING cont.
• With the right hand covered by the cuff,
pick up the left glove.
• Place the glove on the upward-turned
left hand, palm side down, thumb to
thumb with fingers extending along the
forearm pointing towards the elbow.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 46

 GLOVING cont.
• The glove cuff and the sleeve cuff are
held together with the thumb of the left
hand.
• The sleeve-covered right hand stretches
the cuff of the glove and the gown as the
fingers are worked into the glove and the
cuff is pulled up onto the wrist.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 47

 GLOVING cont.
• The right glove is donned the same
manner in which the left is donned
with the help of the left gloved hand.

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 48

 VIDEO (Closed gloving)

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 49

 The End

Thank you

Dr Dzansi and Mr Tenkorang-Twum 04/29/2023 Slide 50