Tips in the operation room techniques

1. OPERATING
ROOM
TECHNIQUES
Nurs
e
BSN LEVEL 3

2. OBJECTIVES
 To understand the importance and
principles of surgical hand
antisepsis. Techniques.
 To understand the principle of
surgical gown and glove
 To reinforce techniques of donning
sterile gowns and gloves.

3. SURGICAL HAND
AND
SKIN CLEANSING

4. Also called the
Surgical Scrub.
The process of removing as many
microorganisms as possible
from the skin of the hands
and arms by mechanical
washing and chemical antisepsis
before participating in a surgical
procedure.

5. Done before gowning
and gloving.
!Skin is never
rendered sterile. The
process of scrubbing
is not a sterile
procedure.

6. ? ? ? ? ? ? ? ?...
Purpose: is to remove or
deactivate soil, debris,
natural skin oils, hand
lotions, and transient
microorganisms from the
hands and forearms of the
sterile team members.

7. QUESTIONS?

8. SURGICAL
GOWNING AND
GLOVING
TECHNIQUES

9. OBJECTIVE:
TO PREVENT
CONTAMINATION TO THE
SURGICAL WOUND AND
HELP CONTROL
INFECTION VIA ASEPTIC
PRINCIPLES.

10. Gowning and
gloving is part of
the daily routine
in the OR.

11. Sterile gowns and
gloves are worn to
prevent the migration
of microbes from the
skin and scrub attire of
the sterile team
member to the sterile

12. Sterile attire
prevents blood and
body fluids from
contaminating the
team member.

13. Sterile attire aids in
preventing surgical
site infections by
allowing team
members to work
within the sterile

14. STERILE
SURGIC
AL
GOWN

15. A
NECKLINE/
NECKBAND
SLEEVE
SEAM
STOCKINETTE
AXILLA
PART OF
THE
GOWN
WAIST
TIE
HEMLINE

16. Without
STOCKINETTE
BEADED CUFF

17. STERILE
SURGIC
AL
GLOVES

18. CUFF
PALM
PART
OF THE
GLOVE
FINGER
PART OF
GLOVE

19. OUTSIDE
part of
the glove
Everted
CUFF
(Inside)
Opening of
the Everted
ROLLED
CUFF

21. SURGICA
L ATTIRE

22. CAP
GOWN
MASK
GLOVES
SCRUB
SUIT
BOOTIES

23. GOGGLES

24. EYE
SHIELD
Or
MASK
with
VISOR

25. PRINCIPLES
Touch only the inside of
the gown.
Touching the
outside of the gown while
donning it, the gown is
considered
contaminated.

26. OUTSIDE
PORTION
OF THE
GOWN

27. Scrubbed hands and arms
are contaminated if they fall
below waist level or touch
the body.
Keep hands and arms above the
waist and away from the body
and at an angle of about 20 to 30
degrees above the elbows

28. NON-STERILE
NON-STERILE
STERILE

29. After donning the surgical
gown, the only parts of the
gown that are considered
sterile are the;
 sleeves and from the
front from waist level to a
few inches the neck
opening.

30. NON-STERILE
NON-STERILE
STERILE

31. SHOULDERS
BACK
NECKLINE
AXILLARY
AREA
NON-STERILE

32. QUESTIONS?

33. STEPS...
SURGICAL
GOWNING
and
CLOSED-

34. SURGICAL
GOWNING
1. Prepare necessary
materials:
Sterile gown, proper-
sized sterile surgical
gloves and sterile
towel.

35. 2. After surgical
hand scrubbing.
Pick up the sterile
towel and pat dry
the hands.

36. 3. With one hand, pick up the
entire folded gown from the
sterile table wrapper by
grasping the gown through
all layers and step back
from the table.
!Being careful to touch only the
inside top layer, which is exposed.

37. 4. Hold the gown with both
hands away from the body
and allow it to unfold with
the inside toward the
wearer.
!Being careful that it does not
touch either your body or other

38. 5. Grasp the inside
shoulder seams and
open the gown with
the armholes facing
the wearer.

39. 6. Slip both hands into
the open armholes,
keeping the wearer
hands at shoulder
level away from the
body.

40. 7. Push the hands and
forearms into the sleeves
of the gown, advancing
the hands onto to the
proximal edge of the cuff
for closed gloving
technique.

41.  Position the gown over your shoulders by
grasping the inside surface of the gown at
the shoulder seams.
 The Circulator adjusts the gown over the
Scrub's shoulders and side seams.
 Note that the Circulator's hands are in
contact with only the inside aspect of the
gown.

42. CLOSED-GLOVING
TECHNIQUE
1. Pick up a glove by its folded
cuff edge with a sleeve-
covered hand.
!Note that gloves are packaged with a
wide folded cuff so the nurse can don
the gloves without touching the
outside surfaces with bare fingers.

43. 2. Place the glove on the
opposite gown sleeve, palm
down, with the glove fingers
pointing toward your
shoulder.
!The palm of your hand inside the gown
sleeve must be facing upward toward the
palm of the glove.

44. 3. Place the glove’s
rolled cuff edge at
the seam that
connects the sleeve
to the gown cuff.

45. 4. Grasp the bottom
rolled edge of the
glove with your
thumb and index
finger.

46. 5. While holding the glove’s
cuff edge with one hand,
grasp the uppermost edge
of the glove’s cuff with the
opposite hand.
!Take care not to expose the bare
fingers while doing this.

47. 6. Continuing to
grasp the glove;
stretch the cuff of
the glove over the
hand.

48. 7. Using the opposite sleeve-
covered hand, grasp both the
glove cuff and sleeve seam
and pull the glove onto the
hand.
!Pull any excessive amount of gown
and sleeve from underneath the cuff of
the glove.

49. 8. Repeat the procedure
to the other hand.
(Steps 4, 5, 6, and 7)
!Check to make sure that each gown
cuff is secured and covered
completely by the cuff of the glove.

50. 4. Grasp the bottom
rolled edge of the
glove with your
thumb and index
finger.

51. 5. While holding the glove’s
cuff edge with one hand,
grasp the uppermost edge
of the glove’s cuff with the
opposite hand.
!Take care not to expose the bare
fingers while doing this.

52. 6. Continuing to
grasp the glove;
stretch the cuff of
the glove over the
hand.

53. 7. Using the opposite sleeve-
covered hand, grasp both the
glove cuff and sleeve seam
and pull the glove onto the
hand.
!Pull any excessive amount of gown
and sleeve from underneath the cuff of
the glove.

54. REMOVING OF GOWN
1. Grasp the shoulders
of the gown, pulls it
downward from the
shoulder and off the
arms, and turns the
sleeves inside out;

55. 2. Fold the
contaminated
surface of the gown
on the inside and
rolls it away from the
body;

56. 3. Discard the
rolled gown in the
appropriate
receptacle.

57. REMOVING OF
GLOVES
1. Grasp the under cuff
of the left glove with
the gloved fingers on
the right and pulls it off
inside out;

58. 2. Slip the ungloved
fingers of the left
hand inside the right
glove and slips it off
inside out;

59. 3. Discard the gloves
in the appropriate
receptacle; and
washes hands and
arms with soap and
water.

60. YOU GOT
IT?

61. SURGICAL
GOWNING AND
OPEN-GLOVING
TECHNIQUE

62. STEPS...
GOWNING
1. Prepare necessary
materials:
Sterile gown, proper-
sized sterile surgical
gloves and sterile
towel.

63. 2. After surgical hand
scrubbing.
Pick up the sterile
towel and pat dry the
hands.

64. 3. With one hand, pick up the
entire folded gown from the
sterile table/ wrapper by
grasping the gown through
all layers and step back from
the table.
!Being careful to touch only the
inside top layer, which is exposed.

65. 4. Hold the gown with both
hands away from the body
and allow it to unfold with
the inside toward the
wearer.
!Being careful that it does not touch
either your body or other unsterile
objects.

66. 5. Grasp the inside
shoulder seams
and open the gown
with the armholes
facing the wearer.

67. 6. Slip both hands into
the open armholes,
keeping the wearer
hands at shoulder
level away from the
body.

68. 7. Push the hands and
forearms into the sleeves
of the gown, advancing
the hands completely
through the cuffs of the
gown, for open gloving
technique.

69. The circulator must continue to
assist at this point.
 Positions the gown over your shoulders by
grasping the inside surface of the gown at
the shoulder seams.
 The Circulator adjusts the gown over the
Scrub's shoulders and side seams.
 Note that the Circulator's hands are in
contact with only the inside aspect of the
gown.
 Tie the neckline, back waist ties of the
gown.

70. OPEN-GLOVING
TECHNIQUE
1. Take one glove from inner
glove wrapper by placing
thumb and index finger of
opposite hand on fold of
everted cuff at a point in line
with glove’s palm and pulls
glove over hand, leaving
cuff turned back.

71. 2. Take second glove
from the inner glove
wrapper by placing
gloved fingers under
everted cuff.

72. 3. Introduce free hand into
glove and draws it over
cuff of gown and upper
part of wristlet by slightly
rotating arm externally
and internally.

73. 4. Bring turned-back cuff
on other hand over
wristlet of gown and
draws it over cuff of
gown and upper part of
wristlet by slightly
rotating arm externally

74. REMOVING OF
GOWN
1. Grasp the shoulders
of the gown, pulls it
downward from the
shoulder and off the
arms, and turns the
sleeves inside out

75. 2. Fold the
contaminated
surface of the gown
on the inside and
rolls it away from the
body;

76. 3. Discard the
rolled gown in the
appropriate
receptacle.

77. REMOVING OF
GLOVES
1. Grasp the under
cuff of the left
glove with the
gloved fingers on
the right and pulls
it off inside out

78. 2. Slip the ungloved
fingers of the left
hand inside the
right glove and
slips it off inside
out;

79. 3. Discard the gloves
in the appropriate
receptacle; and
washes hands and
arms with soap and
water.

80. YOU GOT
IT?
GOOD!

81.  Assisted gowning- The scrub
person may assist another
member in drying, gowning, and
gloving.
 Assisted gloving- To glove
another team member, the scrub
person always gloves the other
person's right hand first

82. ASSISTED GOWNING
1. Prepare
necessary
materials such as:
sterile gown and
sterile towel.

83. 2. Open the towel
that the other
member will use
to dry his/her
hands.

84. 3. Lay the towel on
the team member's
hand without
touching his/ her
hands;

85. 4. Hold the gown
at the neckband
and carefully
unfolding it.

86. 5. Keep the hands on the
outside of the gown,
forming a protective cuff
of the neck and shoulder
area as the person being
gowned holds both arms
outstretched.

87. 6. Offer the inside of
the gown to the other
member so he or
she can slip his or
her hands into the
sleeves;

88. 7. Release the
gown when the
team members'
hands are in the
sleeves.

89. The circulator must continue
to assist at this point.
 Positions the gown over your shoulders by
grasping the inside surface of the gown at
the shoulder seams.
 The Circulator adjusts the gown over the
Scrub's shoulders and side seams.
 Note that the Circulator's hands are in
contact with only the inside aspect of the
gown.
 Tie the neckline, back waist ties of the
gown.

90. ASSISTED GLOVING
Material
needed: Proper-
sided sterile
gloves.

91. 1. Picks up the
glove with his or
her fingers
under the cuff.

92. 2. Holds the palm
of the glove
toward the person
being gloved.

93. 3. Stretches the cuff to
open the glove and
holds his or her thumbs
out to keep them from
touching the other team
member's bare hands.

94. 4. As the other person
inserts his or her hands
into the glove, exerts
upward firm pressure
making sure the hand
does not go below the
waist.

95. 5. Unfolds the
inverted glove
cuff over the cuff
of the sleeve.

96. 6. Gloves the left
hand with the
assistance of a
team member by
repeating the
steps.

97. END
OF THE
PROCEDURE

98. YOU GOT
IT?
PERFECTO!

99. QUESTIONS?

101. REQUIREMENT/S
 What is Perioperative and
Perianesthesia Nursing
 What are the following:
 PHASE of Perioperative Nursing
 SURGICAL Classifications
 Categories of Surgery Based on
Urgency

102.  Surgical Team
 Surgical Environment
 Types of Anesthesia and
the Method of Anesthesia
Administration

103. Principles of
Sterile/ Aseptic
Technique.

104. Types of Sutures
Different types of
Needles
Different Methods of
Sterilization

105. THANK YOU
HAVE A
GLORIOUS DAY!