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R1 OCHWA Surgical Scrubbing

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Surgical Scrubbing, Gowning, and Gloving Procedure

This document outlines the standard procedures for surgical hand washing, scrubbing, and the donning of sterile gowns and gloves. These protocols are essential for transitioning from a non-sterile to a sterile state in preparation for participating in surgery within a sterile field.

Introduction to the Scrub Room

The scrub room is a designated transitional area where surgical personnel perform the necessary hand and arm decontamination before entering the operating theatre. While the layout and appearance of scrub rooms may vary, their fundamental purpose remains the same: to provide the facilities for achieving surgical sterility.

Initial Hand Washing Procedure

A thorough hand wash is required for the first scrub of the day or any time hands are visibly soiled. This process differs from a routine surgical scrub and involves a deeper clean using soap and a brush.

Step-by-Step Guide

  1. Preparation: Obtain a sterile scrubbing brush pack. Open the pack, remove the nail pick, and separate the sponge from the brush backing.
  2. Activate Water: Start the taps using your elbows to avoid contaminating your hands.
  3. Nail Cleaning: Use the provided nail pick to clean thoroughly under each fingernail, removing any trapped dirt. Ensure nails are well-trimmed for this to be effective. Dispose of the nail pick in the bin after use.
  4. Lathering: Apply a neutral hand soap to the sponge side of the brush and create a lather.
  5. Systematic Washing: Methodically scrub all surfaces of the hands, fingers, wrists, and forearms. Ensure no area is missed. Once complete, dispose of the brush/sponge.
  6. Rinsing: Rinse hands and forearms thoroughly under running water. Crucially, keep hands elevated above the elbows at all times, allowing the contaminated water to run off the elbows and away from the hands.
  7. Final Wash: Apply more soap and complete a final hand wash, again keeping hands elevated during the rinse.
  8. Drying: Once rinsing is complete, turn off the taps using your elbows. Take paper towels and pat the skin dry. Use one side of the towel to dry from the hands down to the elbow on one arm, then use the other side to repeat the process on the other arm.

Pre-Scrub Preparations

Before beginning the surgical scrub, all personal attire and hygiene requirements must be met. Once the scrub begins, you will not be able to touch your hair or face.

Personal Attire

  • Cap: A surgical cap must be worn. Both elasticated and tie-back styles are available.
  • Mask: A Level 3 surgical mask is required. These may come with or without an integrated visor.
  • Eyewear: If your mask does not have a visor, separate protective eyewear should be worn.

Personal Hygiene

  • Nails: Must be kept short and free of any nail polish, gels, or artificial enhancements.
  • Jewelry: All jewelry, including rings and watches, must be removed from the hands and wrists.

Preparing the Sterile Field

Before scrubbing, the sterile gown and glove packs must be opened on a clean, dry surface, such as a metal trolley.

Opening a Sterile Gown Pack

Sterile packs must be opened in a specific manner to avoid contaminating the contents.

  1. Open the first corner of the outer wrapping away from your body.
  2. Open the second and third corners to the sides.
  3. Open the final corner towards your body, taking care not to cross your arm over the sterile field.
  4. Make minor adjustments by touching only the outer 1-inch border of the sterile paper to ensure the underlying trolley is fully covered.

Opening Sterile Glove Packs

Both inner (under) and outer sterile gloves are required. Open the outer packaging for both sets of gloves and place them onto the sterile field created by the gown pack, following the same principles to maintain sterility.

The Surgical Scrub (Alcohol-Based Method)

This section details the modern, alcohol-based surgical scrub technique. An alternative method exists for individuals with sensitivities to alcohol-based products, but it is not covered here.

The product used in this demonstration is Bactol 90 (by Whiteley). Always refer to the manufacturer’s specific instructions for use.

Procedure

  1. Dispense the alcohol-based surgical rub into your hands.
  2. Systematically rub the product over all surfaces of the hands, wrists, and forearms, following the manufacturer’s guidelines.
  3. It is critical that the hands and forearms remain visibly wet with the product for a minimum of 60 seconds for the decontamination to be effective.
  4. Once the scrub duration is complete, allow the alcohol to evaporate completely, which will dry the hands. Do not use a towel.
  5. Throughout this process and until the procedure is over, keep hands elevated above the elbows.

Donning Sterile Attire

Gowning Procedure

  1. Approach the sterile gown. Identify the neck and armholes and grasp the gown by its inner material only.
  2. Step away from the trolley and any other non-sterile objects to allow the gown to unfold without contamination.
  3. Slide both arms into the sleeves.
  4. A non-sterile assistant will help secure the gown by fastening the top Velcro tab at the neck and tying the middle tie at the back.
  5. Note that the back of the surgical gown is considered non-sterile.

Gloving Procedure (Closed Donning Method)

This method is used to don gloves without the bare hands ever leaving the confines of the gown’s sleeves, ensuring sterility.

  1. Under Gloves:
    • Open the inner packet for the under gloves and orient it so the gloves are facing away from you (reversing their left/right direction).
    • Keeping your hand inside the gown’s cuff to form a “mitten,” use one hand to grasp the opposite glove.
    • Place the glove palm-down onto the cuffed forearm, with the glove’s fingers pointing towards your elbow.
    • Grasp the top edge of the glove’s cuff and pull it over and around the gown’s cuff, enclosing it completely as you slide your hand into the glove.
    • Repeat the process for the other hand.
  2. Outer Gloves:
    • The process for donning the outer gloves is identical to the under gloves.
  3. Once gloving is complete, do not let your hands drop below your waist.

Securing the Gown

The final step is to secure the outer waist tie to create a sterile front.

  1. Firmly hold the short end of the tie in one hand.
  2. Pass the cardboard tab attached to the long end of the tie to another person (this person can be sterile or non-sterile).
  3. Turn in a circle while the other person holds the tab stationary.
  4. Retrieve the long tie from the cardboard tab and tie it to the short end at your side in a simple knot.

Entering the Sterile Environment

With scrubbing, gowning, and gloving complete, you are ready to enter the sterile field. Use your back to push open any doors to avoid contaminating your sterile hands and the front of your gown.

Analysis of Key Components in Surgical Procedures

This document outlines the essential elements and procedures identified as critical during surgical transitions. The focus is on hand hygiene, specific products used, and the roles of personnel involved in maintaining a sterile environment.

Hand Hygiene Protocols

Proper hand hygiene is a foundational requirement for all surgical procedures to prevent infection. The process involves specific techniques and products.

  • Surgical Scrub: A formal, rigorous hand and arm cleaning procedure performed by sterile personnel before donning gowns and gloves. This was identified as a significant component of the overall process.
  • Hand Wash: Refers to the general act of hand washing, which may be performed by all personnel in the surgical environment.
  • Neutral Hand Soap: The use of a specific type of soap, likely pH-neutral, is indicated to minimize skin irritation from frequent and thorough washing.

Required Products and Materials

The successful execution of surgical procedures relies on the correct use of specific sterile and non-sterile products.

  • Under Glove Packet: This specific item contains the first pair of gloves used in a double-gloving technique, a common practice to reduce the risk of contamination from glove perforation.
  • General Products: The term “product” was frequently noted, underscoring the importance of having all necessary supplies, both sterile and non-sterile, readily available.

Personnel and Procedural Context

The coordination between different team members and the management of procedural phases are crucial for efficiency and safety.

  • Non-Sterile Person: This individual, often a circulator nurse, plays a vital role. They can handle non-sterile items, assist sterile team members (e.g., by opening the outer packaging of sterile supplies), and manage the operating room environment without compromising the sterile field.
  • Surgery Transitions: This term highlights the critical phases within and between surgeries, such as patient entry, preparation, and the turnover of the operating room. Strict adherence to protocols during these transitions is essential to maintain sterility and ensure patient safety.

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