Surgical Scrubbing,Downing and Gloving


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Surgical Scrubbing,Downing and Gloving

  1. 1. Foundations of NursingSurgical TechniquesPrepared by: Mark Fredderick R. Abejo R.N, M.A.N  Get the sterile brush with the right hand in such a way that it faces up.  Saturate the brush with soap and water and start scrubbing from the fingertip, to the four corners of each finger, to the dorsum, palm and wrist. Do this for 2 1/2 minutes, rinse.  Transfer the brush to your left hand. Saturate it FOUNDATIONS OF NURSING again with soap and water and do the same as in no 3 (5 minute for both hands). Surgical Techniques  Transfer the brush to your right hand. Saturate it Lecturer: Mark Fredderick R. Abejo R.N, M.A.N again with soap and water and brush the left arm from the wrist up to 2 inches above the elbow. SURGICAL SRUB and HANDWASHING Rinse, Do this for 2 ½ minutes.  Transfer the brush to your left hand and do the same as in no. 6 (5 minutes for both arms) henceSurgical Scrub a total of ten (10) minutes, from the tip of the  Surgical scrub is the removal of as many bacteria fingers up to 2 inches above the elbow. as possible from the hands and arms by  Drop the brush in a pail provided for used mechanical washing and chemical disinfection brushes. Rinse both hands and arms well taking before taking part in a surgical procedure. care the flow of water is from the hands downPurpose the elbows.  Surgical Scrub helps prevent the possibility of contamination and infection of the operative POINTS TO REMEMBER IN SURGICAL SCRUB: wound by bacteria on the hands and arms.  Rinse as often as possible using one direction only. Start from the hand going to the arm takingTypes care not to touch the faucet and the sink.  A person with cut or burn should not scrubComplete Scrub – it usually takes 10-15 minutes. Thistime may vary in different hospitals, depending upon the because of the high bacterial count.frequency of the scrubs. This is done:  The hands and arms can never be rendered sterile1. Before the first gowning and gloving. no matter how long or how strong the2. Following a clean case if the gloves have holes in them. antiseptics.3. Following a clean case if the gloves have been removed  Surgical scrub is most effective when firminadvertently before the gown. motion is applied. Short horizontal or circular4. Following a clean case if hands been contaminated in stroke could be used.ay other way.5. Following a contaminated case, before starting the next  Use an ample supply of antisepticscase.  Since the hands are to be cleaner than any other area, after the initial hand wash, they are heldShort Scrub – it is usually takes 5-10 minutes. This scrub higher than the elbows during the rest of theis done following a clean case if the hands and arms have procedure to prevent water from running backnot been contaminated. It is done to remove bacteria that the scrubbed hands.have emerged from the pores and multiplied while thegloves were worn. How to perform surgical scrubPREPARATION BEFORE DOING SURGICALSCRUB: Step 1 :Remove all jewelry on your hands and wrists.  Attend to your personal needs. Step 2 : Adjust the water to a warm temperature and wet your hands and forearms thoroughly.  Adjusts your cap and mask properly. The hair Step 3 : Clean under each fingernail with a stick or brush. should be confined inside the cap. The mask It is important for all surgical staff to keep their should cover the nose, mouth, cheek and chin. fingernails short.  Roll up sleeves of the uniform 3 inches above Step 4 : Holding your hands up above the level of your the elbow if sleeves are long elbow, apply the antiseptic. Using a circular motion,  Check on the liquid soap and brush dispenser. begin at the fingertips of one hand and lather and wash  Remove your jewelry. between the fingers, continuing from fingertip to elbow. Repeat this for the second hand and arm. Continue  Check on your fingernails. They must be kept washing in this way for 3-5 minutes. clean and short to reduce the bacteria count and Step 5 : Rinse each arm separately, fingertips first, to prevent the puncturing or tearing of gloves. holding your hands above the level of your elbow. Step 6 : Using a sterile towel, dry your arms--fromSCRUB-UP TECHNIQUE fingertips to elbow--using a different side of the towel on  Take note of the time you started scrubbing each arm.  Wash hands and arms with soap and water to Step 7 : Keep your hands above the level of your waist remove superficial dirt and bacteria. and do not touch anything before putting on sterile surgical gloves.Foundations of Nursing Abejo
  2. 2. Foundations of NursingSurgical TechniquesPrepared by: Mark Fredderick R. Abejo R.N, M.A.N PREPARATION FOR STERILIZATION The gown is folded lengthwise with the wrong side out and facing the wearer A. Unassisted (Self-service) Grasp the gown at the center or you may receive it from the circulating nurse Step one or two feet away from the sterile field to have an adequate working space. Unfold the gown and expose the hemline portion. Dry your hands and arms with this small portion. Use each side of the folded gown in drying each hand and arm. Continue unfolding the gown and locate for the armhole. Slip your hands into each armhole and hold your hands and arms straight and obliquely upward. The circulating nurse will fix it. Stop and swing your body to the right, then to the left. The circulating nurse will catch the belt of its ends as you swing. B. Assisted This is done by the scrub nurse when she is already completely sterile, i.e. she has donned the gown and the gloves. Pick up the gown directly from the table or receive it from the circulating nurse. Unfold the gown slowly and serve the hemline portion to the surgeon. Continue unfolding the gown while the GOWNING surgeon is drying his hands and arms When serving the gown, your glovedGowning hands should come in contact with the The sterile gown is put on immediately following right side portion of the gown under the the surgical scrub. protecting cuff made. Show the opening and armholes to thePurpose surgeon. The sterile gown is worn in order to permit the As soon as the surgeon inserted his hands wearer to come within the sterile field and carry out through the armholes, leave it. The sterile technique during an operative procedure circulating nurse will fix it. RESPONSIBILITY OF THE CIRCULATING NURSE IN THE APPLICATION OF STERILIZATION  She places hands inside of the gown near the shoulder of scrub nurse and aids her in putting on the gown.  She grasps ends of the gown’s belt without touching the upper part of sleeves of the gown.  She ties the belt at the back of the gown, keeping belt ends away from the sterile part of the gown. She ties the back ties after trying the belt. POINTS TO REMEMBER IN GOWNING:  This is done after the surgical scrub.  Use an oscillating motion pat dry in drying the hands and arms. Start from the hand going to the arms  Do not dry hand then arms and return to the same hand  In drying the hand and arms, the hemline portion of the gown or a towel could be used. If a towel isFoundations of Nursing Abejo
  3. 3. Foundations of NursingSurgical TechniquesPrepared by: Mark Fredderick R. Abejo R.N, M.A.N used, dry one hand and arm on one end of the towel and use the opposite end to dry the other hand and arm. CLOSED METHOD OF GLOVE TECHNIQUE This is the method with the least possibility of  In serving the gown, do not turn your back on the contamination. sterile field to prevent contamination.  In picking the gown from a sterile line pack, be  With your right hands inside the gown’s sleeves, careful not to touch any other articles in the pack lift the glove by the cuff. with the bare hands.  Put thumb down or your upturned left palm, fingers of glove pointed toward your elbow.  At this time, move your left hand so that your fingers are halfway down the cuff of your gown. GLOVING Do not let them protrude from our gown cuff or touch the end of the cuff.Gloving This is done after the gowning technique.  With your right hand still inside the sleeve, take hold of the folded cuff of the left glove and pull itPurpose: out and over the left hand and well over the cuff of  Gloves are worn to complete the sterile dress in the left sleeve. order that the one who wears them may handle  Take the right hand, still inside the sleeve, and sterile equipment. grasp the left glove and gown cuff at the wrist and pull glove unto the hand.PART OF A GLOVE:  Proceed to the right hand the same way.1. Palmar Surface2. Dorsal Surface POINTS TO REMEMBER IN GLOVING:3. Finger Holes  Take care not to contaminate the outside surface of4. Cuff the glove5. Wrist  In serving the gloves, the nurse must have a wideTYPE OF A GLOVE TECHNIQUE: base of support by putting her foot apart.  Always serve the right hand glove first.OPEN METHOD OF GLOVE TECHNIQUE  In serving, get the right glove with the left and theUnassisted (Self-service) left hand glove with the right hand.  Get the right hand gloves with the left hand by  Always keep gloved hands at waist level or above. holding it at the edge of everted cuff. Step back  Keep gloved hands away from your mask. from the sterile field.  Explore the finger holes before inserting the whole REMOVING THE GOWN AND THE GLOVES hand completely. Leave the everted cuff as is.  Regardless of whether the scrub nurse assists in a  Slip the gloved right hand under the fold of the case or contaminated case remove first the gown everted cuff. Insert the left hand by exploring the and then the gloves. Wash the gloved hands if they fingerholes before inserting the whole hand are grossly contaminated before removing the completely. Leave the folded cuff. gown.  Make a pleat at the cuff of the gown and secure this is place with your right thumb. Removing the Gown:  Slip the four fingers of the right hand under the fold  With the gloves still in, ask the circulating nurse to of the glove and pull it up over the pleated cuff of loosen the ties and the belt. the sleeves. Fix the glove firmly.  Grasp the right shoulder of the gown and slip off  Repeat for the right hand. the arm allowing use sleeves to turn inside out.  Repeat the same procedure for the oppositeAssisted (Serving Others) shoulder.  Get the right hand glove and inflate it first for easy  Discard the gown in the hamper. insertion and to detect for holes.  In serving the gloves, the palmar surface or the Removing the Gloves: thumb portion should be facing the one who is  With the gloved right hand, remove the left glove being served/ facing the surgeon. by holding it at its outer surface and pull off.  Evert the cuff one inch wide. Insert four fingers (This is the glove to glove technique). inside the everted cuff.  To remove the right glove, insert your thumb or  Stretch the glove well outward. Put your thumbs three fingers between the skin and the glove and out. pull off. (This is the skin to skin technique).  Allow the surgeon to explore the fingerholes  When the surgeon jerks his hand downward, release and pull upward so that the cuff of the glove covers the cuff of the gown.  Repeat the same procedure for the left hand.Foundations of Nursing Abejo
  4. 4. Foundations of NursingSurgical TechniquesPrepared by: Mark Fredderick R. Abejo R.N, M.A.NFoundations of Nursing Abejo