Scrubbing, Gowning

and Gloving

Universal precaution

Disinfections and

sterilization

Physical Lay-out

Resident

natural habitat is the skin

gram-positive and gram-

negative bacteria

fingernails and in the

deeper layers of the skin

(such as the hair follicles,

the sweat glands, the

sebaceous glands).

Transient

CONTACTS

PREVENT

WOUND

INFECTION

Dry Scrub Brush

Pre-pac

Antimicrobial

Action

Safety

Acceptance

Persistent Activity

CHG (chlorhexidine gluconate)

iodophor

PCMX (parachlorometaxylenol)

PREPARATION PRIOR TO SCRUB

▪ Skin and nails

▪ Fingernails

▪ No fingernail polish.

▪ No skin abrasion

▪ No jewelleries.

▪ Wear cap and mask

▪ eyeglasses

▪ Water sink

LENGTH OF

SCRUBBING

The length

of scrub

varies from

institution

to another.

TWO TYPES OF SURGICAL

SCRUB

A.TIME METHOD

▪COMPLETE SCRUB- 5-7

minutes

▪SHORT SCRUB- 3minutes

B.BRUSH STROKE METHOD

A.TIME METHOD

Fingers, hands, and

arms are scrubbed by

allotting a prescribed

amount of time to each

anatomical area or each

step of the procedure.

INDICATIONS of

short Scrub

▪ In the morning before the first

gowning and gloving.

▪ Following a clean case if the

gloves have been removed before

the gown.

▪ Following a clean case if glove

have had punctured.

▪ Following a clean case if hands

have been contaminated in any

other way.

▪ Before an emergency case at

anytime.

B. BRUSH STROKE METHOD

NAILS-30

SIDE OF FINGERS-20

BACK OF THE HAND-20

ARMS-20

PROCEDURE:

1. Turn on the water faucet and get an antiseptic solution.

2. Wash hands prior to scrub.

3. Clean the fingernails under running water.

4. Scrub/lather the left hand.

5. Close-up scrubbing left fingertips.

6. Scrub the left arm.

7. Scrub the left elbow area.

8. Rinse the brush and transfer to other hands.

9. Scrub/lather the right hand.

10. Close-up scrubbing right fingertips.

11. Scrub the right arm.

12. Scrub the right elbow area.

13. Rinse the left hand and brush.

14. Rinse the left arm and elbow area.

15. Rinse the right hand.

16. Rinse the right arms and elbow area.

17. Turn the water faucet with brush if water faucet is hand

control.

19. Walk in the operating room.

Purpose:

▪to prepare hand

prior to gloving to

prevent soiling of

sterile drape

PROCEDURE:

Pick up sterile towel to dry hands from gown

pack

Unfold towel

Place a third over right hand; two third will be

hanging toward left hand

Dry left hand

Dry left arm

Transfer dry end of towel to left hand, a third

over left hand, two thirds toward right hand.

Dry right hand

Dry right arm

Fold towel into thirds

Dry right elbow area

Transfer towel, keeping hands on underside of

towel

Dry elbow area

Cuffs

Neckband

Belt

Sleeves

Body

Types

1. Open

method

2.Closed

Method

“universal precautions”

applied to all clients

performed whenever there is a

possibility of contact with:

blood

body fluids (except sweat)

secretions

mucus membrane

breaks in skin

Sterilization

▪ Consists of physical

and chemical

techniques that

destroy all

microorganism

including spores.

free of living

microorganis

ms, including

spores

absence of

disease

producing

microorganisms

Medical Asepsis –

procedures used to

reduce the number of

microbes and prevent

spread

Surgical Asepsis –

procedures use to

eliminate any

microorganisms

(sterile technique)

The process of

killing the

pathogenic

microorganism

1. Physical

1. Autoclave

2. Chemical

1. ETO:Gas

2. Cold (chemical)

3. Radiation

1. autoclave

a. Machines that sterilizes with

steam under pressure.

b. Sterilization is achieved by the

high temperature.

c. High pressure also ensures

saturation of wrapped surgical

packs

Autoclave

Settings

Temperature

˚F

Pressure

(Psi)

Time (min)

General

Wrapped

Items

250 20 30’

Bottled

Solutions

250 20 30’

“Flashing” 270 30 4-7’

Double wrapped in a

linen or special

paper

Metal box equipped

with a filter

a.Autoclave tape indicator

b.Place on the inside and

outside of equipment

pack

c.Expiration dates is

printed on all equipment

packs.

Indicators contain spores

that are supplied in closed

containers and are

included with instruments

being autoclaved

ETHYLENE OXIDE STERILIZATION: ETO

Gas

a. Colorless gas, very toxic and

flammable

b. Used for heat sensitive instruments:

plastics, suture material, lenses and

finely sharpened instruments.

c. Materials must be well aerated after

sterilization.

a. Instruments must be dry before

immersion

b. Glutaraldehyde (Cidex) is the

most common disinfectant

c. Ten hours exposure time is

needed to destroy spores.

a. High energy ionizing radiation

destroys microorganisms and is

used to sterilize prepacked

surgical equipment.

b. Used for instruments that can’t

be sterilized by heat or

chemicals.

c. Common sources of radiation

include electron beam and

cobalt-60

a surgical suite

designed to promote

safe therapeutic

environment for the

patient.

a collection of rooms that

are used interactively

during surgical procedure

wherein each room has a

specific purpose. (e.g. OR,

substerile, scrub sink,

sterile storage.)

A specialized

room where the

actual surgery

takes place

a room with a double sink

that is separated from the

OR by a door and where

select clean case and

contaminated activities

take place during the

process of surgery

prevent

wound

infection

MULTI

DICIPLINARY

TEAM

APPROACH

1.Number, type,

and length of the

surgical

procedure to be

performed

2. Type and

distribution by

specialties of the

surgical staff and

equipment for each

3. Proportion of elective

inpatient and

emergency surgical

procedures to

ambulatory patient and

minimally invasive

procedures.

4.Scheduling policies

r/t the number of

hours per days per

week the suite will be

in use and staffing

needs.

5. Systems and

procedures

established for the

efficient flow of

patients, personnel,

and supplies.

6.Consideration of

volume changes

and need for future

expansion

capabilities.

7. Technology to be

implemented and

plan for potential

technology to be

develop.

8. Safety of staff,

patients, and other

personnel during

construction or

renovation.

1.Strategic

planning

2. Plans for emergencies

▪ Power

▪ Communications

▪ Medical gases

▪ Vacuum system

▪ Waste gas scavenger

▪ Air handlers

▪ Water

3.Exclusion of

contamination

from outside

the suite with

sensible traffic

patterns to and

from the suite

4.Noise

control

4 basic Design:

1. Central Corridor, or hotel plan

2. Central core, or clean core plan

with peripheral corridor

3. Combination central core and

peripheral corridor, or racetrack

plan

4. Grouping, or cluster plan with

peripheral and central corridor

Unrestricted

street clothes

Semi-

restricted

scrub suit and

cap

Restricted

scrub suit, cap,

shoe covers,

gloves

ss

SCRUB

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SCRUB

SEMI