Comprehensive Guide to Surgical Scrubbing, Gowning, Gloving, Draping, and Sterilization Procedures

Comprehensive Guide to Surgical Scrubbing, Gowning, Gloving, Draping, and Sterilization Procedures

• 1.
  SCRUBBING - HANDWASHING Surgical scrubbing is process to remove or nearby area by the action of fiction with the destroy the microorganism from hands and it's soap and water. Procedure of Hand Washing Good technique of hand washing covers the all areas of hands involves in surgical procedure. Preparation • Remove wrist watches • Do not wearing any rings • Remove long sleeved clothing • Nails should be short • Weak chemical can be used for hand washing • Skin cuts or abrasion should not be on the hand Common Agents for Hand Washing • Iodine containing compounds • Ammonium compounds (having bacteriostatic or bactericidal actions • Hexachlorophene (having bacterio-static action). Requirements for Procedure • Sterile towel • Antiseptic soap • Sterile nail brush • Running water. Procedure • Turn on the water • Ensure that it is flowing moderate • Wet the hands under running water • Lather the hand and arms with selected antiseptic soap or solution • Wash the hand for at least 10-15 minutes without adding water • Held the hand above the level of elbow • Scrub the hand with brush • Rinse off the lather • Rinse the hands under running water • Dry hands with sterile towel. • Rinse the hands from finger to elbows • Keep the hands up and away from clothing. GOWN TECHNIQUE Gown Isolation gown is used in operation theatre should be used at one time only. After surgical procedure the used gown is discarded. Preparation • Remove watch and jewellery because these items interfere during procedure and leads the infection • Wash the hands • Do not touch anything by washed hands • Put on mask first.
• 2.
  Procedure • Wash thehands • Dry one hand with one end of sterile towel from hands to elbow • Dry other hand with another end of same towel from hands to elbow • Drop the used towel • Pick up the gown with hand in a manner that only inner surface touches the hands. Do not touch the outer surface • Hold the gown above the floor and front of own body • Open the gown • Locate the arm holes in gown • Put the arms in arm holes with keeping arm s infront • Hold the arms out and slightly up • Slip the hand • Call the another nurse to help • Another nurse holds the inner sides of gown at each shoulder • She will pull them on shoulder • She will tie the gown tape at the back. GLOVES TECHNIQUE Gloves are used in both medical and surgical procedures: Purposes • To prevent nosocomial infections • To protect the clients with poor resistance • To prevent the direct contact with patient's body parts, fluids and fomites and articles • To protect the hands from infection during care in isolation unit. Procedure There are two methods of gloves technique: 1. Closed method: In closed method the scrub personnel's hands remains inside. It should be reminded that cuff should not be touch. • Collect the glove pack with the help of forefinger and thumb • Put the gloves pack of the sterile towel • Grasp the right glove with left hand through the gown • Turn the right hand in such manner that the palm of hand should be upward • Place the glove on the palm of hand • Grasp the glove with forefinger and thumb • Push the fingers and thumb into gloves • Pull on the glove. 2.Open method: • Collect the glove packet • Place the gloves on the sterile towel • Remove the packet of power from glove pack • Powdered the hands (not always) • Pick up the left glove with the help of right hand by inside turned • Push the fingers and thumb of left hand in glove • Pick up the right glove by gloved left hand under the cough • Push the fingers of the right hand in the glove • Pull the glove cuff • Completely pull the cuff on the left glove over the gown cuff • Adjust the gloves.
• 3.
  DRAPPING OF PATIENTS SurgicalDraping is a procedure which is perform to cover the patient with a sterile covering barrier. Purposes • To maintain sterile field • To provide on outline for surgical team • To expose only operative area • To maintain the sterility of areas on which gloved hand equipment placed during surgical procedure Characteristics and Properties of Drape • Use only sterile drapes: • Drapes act as a barrier between micro-organism and surgical area • Sterile drapes protect the surgical team and environment from infection • Drapes should be sterilized • Sterilized drapes should not handled by contaminated hands Fluid penetrative drape should not be used: • Drape should be fluid resistant • The irrigating solutions, body fluids and blood should be sponged as early as possible by the drape • Use flame resistant drape • Use lint free drapes reduce the chance of airborne transmission of microbes • Drapes should be use with proper precautions Type of Drape Material 1.Synthetic and paper: There are presterilized packages of absorbent and non-absorbent. Synthetic and paper drapes are used. Characteristics: • Non-irritative • Lint free • Light-weighted Disadvantage: Easily penetrate by liquids, solvents and sharp instrument. Impermeable Plastic: These are available in different size and types. It act as a barrier to prevent infection on surgical area, e.g., Vi-drape Linen drapes: • Stockinette (used for limbs draping) • Sheets These are used to cover the sterile area • Hand towel - Provide a outline of incisional area • Perineal Sheet - Used when patient is lies in lithotomy position Instructions • Sterile drape should be place only in sterile area • Two person should place the drape if it is large • Drape should not be given to unsterile handed person • Allow the enough or sufficient time for draping • Contaminated drape should be discarded • Do not move the drape after placement • During opening of drape it should be above waist level
• 4.
  Types of Drapes 1.Sheets: •Breast sheet • Thyroid sheet • Perineal sheet • Laparotomy sheet • Hip sheet • Kidney sheet 2.Combined sheets: • Minor sheet • Medium sheet • Leg pocket drape • Split sheet • Separate sheet 3.Towel: Principles: • Sterile Surface: Use an incised drape to create a sterile field draping) • Sterile field: Use aseptic technique to maintain sterile field • Isolation: Isolate the sterile field from contamination by using an impervious drape. 4.Covering of equipment- cover the non sterile field as well as non sterile instruments. It prevents patient contact with non-sterile field and instruments. Procedure • Steps of Draping • Select the drape sheet • Place this drape sheet from foot of patient to knees • Place the drape sheet below the site of incision • Place the four sterile tower around the incisional site • Unfolded the first folded towel drape • Pass this unfolded towel drape to surgeon • Placing of drape in scrubbed part in incisional line • Expose the skin for essential surgical incision • Place the second towel in the manner of placing first towel. But in this step the towel is place towards the feet • Place the third towel in same manner but the placing is done towards head of patient in incisional line • The fourth towel is place far but in incisional line. Role of Nurse in Draping Keep the drape high to avoid chances to get infected Discard and change the drape sheet if it became infected Assist the surgeon during drape of patient expose the area which is require to surgery. Avoid expose the area unnecessary
• 5.
  PREPARATION OF THEATRE,EQUIPMENT AND SUPPLIES CLEANING OF OT The success of every surgery is depends on the cleaning of OT because clean OT reduce the chances of post operative complications. Each morning (beginning of the day): • Clean the OT with vacuum cleaner • After cleaning moping of OT with plain clean water mixing with bleaching powder (10 gm/litre) wait for drying of OT floor • Clean the OT table and instrument with 70% alcohol solution • Moping of OT table, operation table, procedure table, sitting stool, boyle's apparatus and trolly tops • Keep the instrument ready for the use During the surgery: • Contaminate the body fluids with chlorine or bleaching solution • Discard all the waste material in plastic bags • At the end of Surgery: • Carefully handling of body fluids • Discard all the waste material according to colour coding of biomedical waste management • Collect all the soiled linen and send to dirty utility room • Collect all the used equipments and send for disinfection and sterilization. • Clean the OT table, floor, doors, table tops Each evening: • Clean the OT table, procedure table, doors and table tops • Clean the OT floor with water and detergents • Allow to dry the OT • Disinfect the toilets and bathrooms with bleaching powders (100 gm/litre) STERLIZATION AND DISINFECTION INTRODUCTION Sterilization is essential for operating room and instrument. During various procedures the instruments become infected. Before starting next procedure by same instrument they should be sterilized. DEFINITIONS • Sterilization: It is a process by which an article, surface or medium is freed of all living micro-organisms either in vegetative or spore state. • Disinfection: It is a process of killing and inhibition of pathogenic organism which are capable to infection. GOALS AND AIMS • To prevent nosocomial infections • To bring positive outcome in all procedures • To prevent the infection during pre operative, intra operative and post operative period. • To prevent post operative complica-tions • To reduce the chance of further multiplication of micro-organism.
• 6.
  METHODS Physical Agents 1.Sun light:Sun light is spontaneous sterilization which occurs by sunlight. It having germicidal effects due to presence of ultraviolet rays. Sunlight sterlize the river, water in ranks, and lakes. 2. Drying: Drying in air has many deleterious effects on bacteria’s but spores are unaffected. 3.Filtration: This method is usually used in laboratories for antibiotic solutions, sera, sugar solutions. Types of Filters: ➢ Earthware filters: Usually this type of filter is made up in hollow candles form. The liquid (to be filtered) is passed through the candle, e.g., chamber land, berkefeld. ➢ Sintered glass filters: These filters are available in different many different pore sizes. They prepare by fusing finely powdered glass particles. ➢ Asbestos disc filters: These filter made up from magnesium silicate (asbestos). Filter disc is discarded after use, e.g., sietz. ➢ Membranous filter or collodion: Membranous filter consist of polymeric materials (such as cellulose diacetate). They come in wide range but 0.22 W pore size is most commonly used. ➢ Pressure filtration ➢ Syringe filters ➢ Air filters ➢ Vacuum and in-line filters Uses: • To sterilize antibiotic solution • Sterilization of serum • Separation of bacterial growth soluble product • Water purification • To isolate the organisms which are scanty in fluid • To sterilize blood products • Sterilization of sera and sugar solutions. 4.Heat: Heat is most common and reliable method of sterilization 1. Dry Heat : Factors influencing sterilization by heat: • Total number of organism present • Temperate and time • Nature of heat (dry or moist) • Nature and type of contaminated material. (a) Hot air sterilizer/hot air oven: It is the most common method of dry heat sterilization. This is electric oven and a fan is fitted for distribution of hot air in chamber. A thermostat is also fitted to maintain desired temperature. Precaution in use of hot air oven: • Hot air oven should not be overloaded • Allow the oven to cool for about 2 hours before opening • Ensure that all glassware should be perfect dry before placing in hot air oven • Any inflammatory material should not be kept inside oven. • Temperature and time require-ment: 160°C temperature for two hours or 170°C for 1
• 7.
  hour or 180°Cfor 1/2 hour. (b) Red heat: In this method the sterilization is done by holding the metallic objects in flame till become red hot. Uses: • Needles sterilization • To sterilize inoculating wires and forceps. (c) Incineration: This is an excellent and efficient method of steriliza-tion. This method involves dis-posal of contaminated waste ma-terial at high temperature. Waste and contaminated material surgi-cal dressing and other waste prod-ucts are reduced to ashes. Uses: Sterilization and disposal of contaminated dressing, material and other waste products. (d) Flamming: Glass slides scalpel blades and mouth of culture tubes are passess through flame without becoming red hot. 2.Moist heat Temperature below 100°C: (a) Pasteurization of milk: There are two methods of milk pasteurization: • Holder method: 63°C for 30 minutes. • Flash method: 72°C for 15-20 seconds. The heating is followed by sudden or instant cooling at 13°C or lower temperature. (b) Inspissation: Serum or eggs are sterile by heating at 80°C for at least 30 minutes in inspis-sator for three consecutive days. (c) Vaccine bath: Vaccine are sterilized by this method by killing non-sporing bacteria’s (present in vaccine) at 60°C for one hour. (d) Water bath: Utensils, washing laundry, or rinsing laundry water bath for few minutes at 80°C kill the non-sporing microbes. Temperature at 100°C: a) Boiling: Bacterias, viruses and fungi are killed in vegetative form at 50 to 70°C for a few time. 10 to 13 minutes are enough to sterilize the instruments boiling in water. This procedure is not used to sterilize the surgical instruments. b) Tyndallization: The process in which medium is placed at 100°C for 20-30 minutes on three successive days. The mechanism of this method vegetative cells become destroyed and spore into vegetative form which get destroy on subsequent heating. Uses: Sterilization of serum or sugar containing media. c) Steam at atmospheric pressure (100°): It used to sterile culture media by free steam.
• 8.
  Temperature above 100°C(Steam under pressure) Autoclave Autoclaving is process of sterilization in which sterilization is done by autoclave device. Sterilization is carried out by steam above 100°C or saturated steam. Principles: When the water boils its vapor pressure equal that of surrounding atmosphere. When pressure increase in closed vessel, the temperature also increase (at which water boils). Saturated steam has a power to penetrate porous material. Types: • Simple iron jacketed • Simple laboratory autoclave • Large simple autoclave • Multipurpose laboratory autoclave • Transportable bench top autoclave • Porous load sterilizer • High security autoclave. Components of autoclave: Auto-clave is a device like as a modified pressure cooker. Which con-sist of a cylinder (vertical or horizontal) of gunmetal or stainless steel in a supporting iron case. Conditions for autoclaving: (a) Temperature: 121°C Holding time: 15 minutes Chamber pressure: 15 pounds per square inch (b) On higher temperature Temperature: 126 deg * C (20 ibs/square) Holding time: 10 minutes Temperature 133 deg * C (30 ibs/square) Holding time: 3 minutes Uses of Autoclaving: • Sterilization of culture media • To sterilize syringes, rubber goods, gown and dressing. • Useful to sterilize the instruments and material which can-not withstand at higher temperature. Sterilization control: • Bacillus stearothermophilus • Autoclave tapes • Browne's tubes (chemical indicator) • Thermocouples. Chemical Methods 1. Acids and alkalis • Having a antibacterial activity through free H+ and OH- ions. • They inhibit the growth of bacteria. 2. Alcohol: • Ethyl alcohol (ethanol) and isopropyl alcohol: They destroy the bacteria by bacteriocidal action but spore are not affected. Except HIV viruses are not killed by these type of alcohol. • Isopropyl alcohol: These are less volatile and more bactericidal.
• 9.
  • Methyl alcohol:It is effective on spores of fungi. The vapour of methyl alcohol is toxic and inflammable. 3. Phenol: Chloroxylerrol, cresol are com-mon phenol used as antiseptics. Phenol is usually used in 3 percent solution • Chlorhexidine and cetrimide: Salvon is used in disinfection of skin and wounds. • Cresols: Lysol is used in (a) sterilization of glass wares, (b) disinfection of excreta and (c) cleaning of floors. 4. Formaldehyde: It has bacteriocidal and spirocidal activity. Uses: • Sterilize wards and operation theatre • Disinfection of woolen blancket • Disinfection of atheletic foot. 5. Soap and Detergent: Detergents disrupt the normal function by concentrations on cell membrane. Soap and detergents have bacteriocidal or bacteriostatic action. 6. Dyes: Aniline dyes and aciridine are used as antiseptic for skin and wounds. Due to poor penetration dyes have bacteriostatic action. 7. Halogens: Iodine and chlorine: In the al-cohol and aqueous solution iodine used as a disinfectant for skin. Chlorine is used in water tank and swimming pools. 8. Gases: (a) Ethylene oxide (ETO): The vapours of ETO are high permeable. This method is used to sterilize medical and pharmaceutical production such as plastic and rubber articles, heart lung machine, dental equipments, sutures and clothing. Stages: Pre-conditioning stage: • Glassware and test tubes: Test tubes, petridishes and bottels are sterilized by hot air oven. 160°C temperature should be adjusted for 50-60 minutes. Do not remove these articles immediately. The progressive cooling is require after completion of process. • Formaldehyde gas: Formaldehyde gas is used for fumigation of operation theatre. This gas is bactericidal and sporicidal. BACILLOCID STERILIZATION It is a new and effective sterilization method of environmental decontamination. This procedure has many excellent properties. In this procedure a Formaldehyde-free disinfectant is used in low concentration. Ingredients • Glutaral (100 mg/g) • Didecyldimethylammonium chloride (60 mg/g) • Benzyl-C12-18 alkyldimethylammo-nium chlorides (60 mg/g) Advantages • It provides quick asepsis and takes about ½ to 1 hours. • No requirement of formerly fumigation • No requirement of carbolic acid clean-ing. • No need of OT shut down.
• 10.
  STERILIZATION OF COMMONOT MATERIALS Sterilization 1. Gloves • These are sterilized by autoclave. • 15 IbS pressure for 10 minutes is enough in autoclave to sterilize gloves. • Use corn starch powder • After sterilization packed the gloves in small paper envelopes. 2. Surgical dressing and linen drapes: The gauze, bandage are sterilize by autoclave in drums. The linen drapes which are used for drape the patient to maintain sterile field. Packing should be lose in drums. 3. Rubber goods: Autoclave and boiling are two methods which are used to sterilize rubber goods. 5 minutes boiling is enough for sterilization. First expel the air bubble after boiling. (a) Attach to tubing to a pressure nozzle (b) Force by cold water. Then clean wash to tubing in warm soapy water. (c) After washing rise the tubes (d) Tubing is boiled in water at least for 5 minutes. (e) Hang up the tubes for drying. 4. Plastic and Gum elastic materials: If the material is sensitive, it should not be boiled. These material should be disin-fected or sterilize by chemical disinfec-tants. 5. Instruments • Boilable: The boilable instruments are sterilized by boiling method or. autoclaving such as scissors. After sterilization precaution should be taken to separate them. Scrub all the instruments under running water before boiling. • Non boilable instruments: For the non boilable instruments chemicals are used to sterilize 6. Intravenous Fluids and Sterile Water: Ster-ilization of Intravenous Fluid and Sterile Water is done in screw capped bottles by autoclaving. After the opening of screw cap the solution is names as sterile. 7. Suture needles: Usually suture needles are sterilized by chemicals or autoclaving with other equipments. THANK YOU