Operation Room Attire

OPERATION ROOM ATTIRE
Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

By:- Ame Mehadi (BSc, MSc) Department of Emergency and Critical Care Nursing
OR Attire/PPE
 Purpose:– To provide effective barriers that prevent the dissemination of
MOs to the pt and/or from the pt.
 General Principles:
►Each operating room department should have a specific complete
written policy.
►Only approved clean OR attire worn with in restricted area of OR suites.
►The OR attire is not worn outside of OR suite.
►Eye glasses should be wiped with tissue wet with antiseptic solution.
►Comfort table supportive shoes should be worn to relieve fatigue.
►Personal hygiene must be re-emphasized.
►No, person with acute infection allowed to visit OR.
By:- Ame Mehadi (BSc, MSc-EMCCN) Department of Emergency and Critical Care Nursing
Components of OR Attire and PPE
 Body cover
 Mask
► muslin – 40%
► Muffin – 99%
 Head cover/caps
 Foot cover/shoes
 Goggles
 Gloves
 Mackintosh/plastic apron
 PPE should include

► Hair cover
► Eye protection
► Fluid-resistant facemask
► Fluid-resistant gown
► Gloves
► Shoe covers or Boots
Gloves
 Types of Gloves
►Sterile/HLD surgical glove
►Clean examination glove
►Utility/heavy duty gloves
►Elbow length gloves
 When to Double Gloves

►The procedure that involves contact with large amounts of blood/body
fluids.
►Orthopedic procedure in sharp bone fragments, wire sutures and other
sharps.
►Surgical gloves when re-used.
►Surgical procedures lasting more than 45 minutes.
By Ame M.
Gloves
 Elbow Length Gloves
►Are Used During:-
 Vaginal deliveries.
 Cesarean section.
 Manual removal of placenta.
 Large volume of blood/body fluids contact.
 Cut the four fingers of gloves completely off.
 sterilize or disinfect 2-3 pairs of cut off (finger less) gloves.

By Ame M.
Gloves
 Some Do’s and Don’ts about gloves
►Do – wear the correct size gloves
►Do – change s- gloves every 45 minutes ’
►Do – keep finger nails trimmed moderately short.
►Do – pull the gloves up over cuffs of gown
►Do – use water soluble hand lotions
►Don’t – oil based hand lotions or creams.

►Don’t – use latex gloves if you have allergy.
►Don’t – store gloves that are cracked.
►Don’t -reprocess gloves that are cracked.
►Don’t –reprocess exam gloves for reuse.
Surgical Scrubbing
 Definition:-
►It is the process of removing as many MOs as possible from the
hands and arms by mechanical washing and chemical antisepsis
before participating in an operative procedure.
 Purpose
►To remove soil, debris natural skin oil, MOs from the hands and fore arms
of the surgical team/sterile team.
►To decrease the no of MOs on skin to an irreducible minimum.
►To reduce the hazards of microbial contamination of the operative wound
by skin flora.
►To keep the population of the MOs minimal during the operative
procedure by suppression of growth.

Surgical Scrubbing
 Before a surgical operation
►Alcohol hand rub
►Routine hand wash 10-15 seconds
►Aseptic procedures 1 minute
►Surgical wash 3-5 minutes

Surgical Scrubbing…………cont’d
General preparations
►The skin and nails should be kept clean.
►Finger nails should not reach beyond the finger tip.
►Finger nail polishing avoided.
►Artificial devices should not cover natural finger nails.

By Ame M.
Before You Wash
Bad
Jewelry and Watch

 It is hard to clean under your jewelry or watch
 Bacteria and dirt can sit under your jewelry or watch
 Remove jewelry to ensure a complete clean
Good

Nail Polish and False Nails Nail Length
Bad Bad
Good
If it is less than 4 days old
you can keep it on
Introduction to OR Technique
Good July, 2021 © Haramaya University, CHMS,
Skin Integrity (condition)
Bad Result
Cuts, breaks and weeping No jewelry

can spread infection No watch
No nail polish
Good No false nails
No open wounds, No long nails
bleeding or weeping No cracked skin
You are now ready to
wash

Surgical Scrubbing…………cont’d
 Procedures  Methods
►The pre-operative surgical antisepsis ►Two methods:
consists of three processes.  The counted brush-stroke method
 Hand hygiene  The time scrub method
 Gloving of the surgical team  Note: The Surgical Scrub is Prior to
 Applying antiseptic agent to the surgical Gowning.
site
 The length of surgical scrubbing
depends on:
►The frequency of scrubbing.
►The agent used.
►The method used.

Procedures of Surgical Scrubbing
 Do not scrub if you have an infection.
 Make sure all hair is covered and that you are
protected from splashes.
 Remove jewelery (rings, watches, and bracelets)
 Wash hands thoroughly around nails, b/n fingers
and forearms to the elbow with soap,
brush/sponges, running water.
 Clean nails with nail cleaner.
 Scrub hands, arms up to elbows.

By Ame M.
Procedures of Surgical Scrubbing
 Rinse hands and fore arms with water.
 After scrubbing, hold up arms to allow water to drip off elbows.
 Apply antiseptic agent to all surface of hands and forearm.

 Rinse hands and fore arms with clean water.
 Turn off tap with elbow.

 Hold hands, forearms away from body and higher than elbows and
don’t touch any surface until putting on sterile gown and gloves.
 Dry hands from distal to proximal with sterile towel, make sure
towel does not become contaminated.
 Put sterile surgical gown, then gloves on both hands after drying
hands.
Gowning & gloving
 The sterile gown is put on immediately after the surgical scrub.
 General consideration
► The scrub person gowns and gloves himself.
► Gown packages opened on separate table.
► Avoid splashing water on scrub attire.
 Place arms through sleeves.
 Have a non-scrubbed assistant pull gown over shoulders so

hands go through sleeves
 Assistant will tie back of gown
 The circulator assists gowning.

Gowning

By Ame M.
Surgical Gloving
 don immediately after gowning.
 Easiest to have someone who is already gowned

and gloved to assist.
 Techniques - two types

►Closed Vs Open

GLOVING without Assistance
 Open sealed package of sterile gloves before scrubbing, gowning;
place inner package on sterile surface.
 Once gowned, take cuff of left glove with rt hand (1);

► make sure thumb in correct position
 Slide glove onto left hand, wriggle fingers slightly to help
 Only touch inside of glove, cuff with bare hands
 Slide fingers of gloved left hand into cuff of rt glove (2)
 Pull glove onto rt hand in similar fashion to placing left glove (3)
 Ensure that cuffs cover ends of both gown sleeves (4)

Precautions when Gloving/Degloving
 Do not allow your skin to touch the outer surface of
the glove.
 Keep your fingers inside the sleeve of the gown

until the glove is on.
 If contamination occurs, both gown and gloves

must be replaced.
 Gloves are removed after the gown using a glove-

to-glove, then skin-to-skin technique.
Skin Preparation and Draping of Surgical Site
 SKIN PREPARATION
► Before operation, wash surgical site, surrounding area with
soap, water; particularly wash debris from injuries.
► Prepare skin with antiseptic solution; start in centre, move

to periphery.
► This area should be large enough to include entire incision,

adjacent working area.
► Solution should remain wet on skin for at least two minutes.
► Chlorhexidine gluconate and iodine preferable to alcohol

as less irritating to skin.
Skin Preparation
Procedure
1. Expose only the skin area to be prepared.
2. Wear sterile gloves.
3. Place towels above and below to protect gloved hand from
touching the blanket.
4. Wet the sponge with antiseptic agent but squeezed out.
5. Scrub the skin.
6. Discard the sponge after reaching the periphery.

DRAPING
 is" the procedure of covering pt and surrounding areas with a sterile barriers to create and maintain
sterile field during operation.“
 done after scrubbing, gowning, gloving
 only operative field (prepped area) and areas necessary for anesthesia left uncovered.
 Drapes secured with towel clips at each corner.
 Proper draping exposes only the surgical site, which decreases the risk for infection.
 Types of Drapes:
1. Towels
2. Laparotomy sheet
3. Stockinet
4. Ortho pack sheet
DRAPING

Summary

Summary……

References
 Berry & Kohn: Introduction to Operating Room Techniques, 3 rd Edition (The Blakiston Division,
McGraw-Hill Book Company, 1966)
 Abebaw Eredie: Operating Room Technique LECTURE NOTES For Nursing Students, Ethiopia
Public Health Training Initiative, USAID, 2008.
 A Guide to Operating Room Technique by Irene Gregory, June 1969.
 Introduction to the Operating Room U.S. Army Medical Department Center and School Fort Sam
Houston, Texas 78234-6100, 100th Edition.
 Emergency and Essential Surgical Care (EESC) programme www.who.int/surgery
 Internet sources


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OPERATION ROOM ATTIRE

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 PPE should include

 When to Double Gloves

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

►Don’t – oil based hand lotions or creams.

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Jewelry and Watch

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Cuts, breaks and weeping No jewelry

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 Apply antiseptic agent to all surface of hands and forearm.

 Turn off tap with elbow.

 Have a non-scrubbed assistant pull gown over shoulders so

 Assistant will tie back of gown

 The circulator assists gowning.

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 Easiest to have someone who is already gowned

 Techniques - two types

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 Once gowned, take cuff of left glove with rt hand (1);

 Slide glove onto left hand, wriggle fingers slightly to help

 Only touch inside of glove, cuff with bare hands

 Slide fingers of gloved left hand into cuff of rt glove (2)

 Ensure that cuffs cover ends of both gown sleeves (4)

 Keep your fingers inside the sleeve of the gown

 If contamination occurs, both gown and gloves

 Gloves are removed after the gown using a glove-

► Prepare skin with antiseptic solution; start in centre, move

► This area should be large enough to include entire incision,

► Solution should remain wet on skin for at least two minutes.

► Chlorhexidine gluconate and iodine preferable to alcohol

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 done after scrubbing, gowning, gloving

 Drapes secured with towel clips at each corner.

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

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