SURGICAL GOWN TECHNIQUE

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 is used, dry one hand and arm on one end of the towel and use the opposite end to dry the other hand and arm.
• In serving the gown, do not turn your back on the sterile field to prevent contamination.
• In picking the gown from a sterile line pack, be careful not to touch any other articles in the pack with the bare hands.

Gowning (unassisted) :

•  Lifts the folded gown directly upward from the sterile package.
•  Steps back from the table into an unobstructed area
• Carefully locates the neckband and holds the inside front of the gown just below the neckband with both hands.
•  Lets the gown unfold while keeping the inside of the gown toward the body without touching the sterile exterior of the gown with bare hands.
•  Holds the hands at shoulder level and slips both arms into the armhole simultaneously. 

Gowning (assisted) :

• This is done by the scrub nurse when she is already completely sterile.
• When serving the gown, the gloved hands should come in contact with the right side portion of the gown under the protecting cuff made.
•  Show the opening and armholes to the surgeon.
•  As soon as the surgeon inserted his hands through the armholes, leave it. The circulating nurse will fix it.
•  Nurse will grasps ends of the gown’s belt without touching the upper part of sleeves of the gown.
• Nurse will ties the belt at the back of the gown, keeping belt ends away from the sterile part of the gown.

GLOVING TECHNIQUE

Gloving Procedure - Open

1. Avoid contact of sterile gloves with ungloved hands during closed-glove procedure.
2. For closed-glove method, never let the fingers extend beyond the stockinette cuff during the procedure. Contact with ungloved fingers constitutes contamination of the glove.
3. For open-glove method, touch only the cuff of the glove with ungloved hand, and then only glove to glove for other hand.
4. If contamination occurs during either procedure, both gown and gloves must be discarded and new gown and gloves must be added.
5. When removing gloves after a procedure is finished, the gloves are removed after the gown is removed inside out, using glove-to-glove, then skin-to-skin technique.

Gloving Procedure - Closed

1. With your right hands inside the gown’s sleeves, lift the glove by the cuff.
2.  Put thumb down or your upturned left palm, fingers of glove pointed toward your elbow.
3. At this time, move your left hand so that your fingers are halfway down the cuff of your gown. Do not let them protrude from our gown cuff or touch the end of the cuff.
4. With your right hand still inside the sleeve, take hold of the folded cuff of the left glove and pull it out and over the left hand and well over the cuff of the left sleeve.
5.  Take the right hand, still inside the sleeve, and grasp the left glove and gown cuff at the wrist and pull glove unto the hand.
6. Proceed to the right hand the same way.

For more information : http://www.utmb.edu/surgery/clerks/ormanual.htm
http://www.scribd.com/doc/8961229/Scrubbing-Gowning-And-Gloving

SURGICAL HANDS SCRUB

The purpose of surgical hand scrub is to:

• Remove debris and transient microorganisms from the nails, hands, and forearms
• Reduce the resident microbial count to a minimum, and
• Inhibit rapid rebound growth of microorganisms.

Characteristics of a Surgical Scrub :

1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work rapidly. An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed off.

2. Persistent Activity--an agent offering persistent activity keeps the bacterial count low under the gloves. Studies have shown the rate of glove failures increases with the duration of surgery. In addition, studies show bacteria grow faster under gloved than ungloved hands.

3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.

4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. 

1. 

• Regulate the flow and temperature of the water
•  Lay  the  brush  on  the  back  of the scrub sink

2. 

Wet hands and arms, for an intitial prescrub wash. Use several drops of surgical detergent ,
work up a heavy lather, then wash the hands and arms to a point about two inches above the elbow.

3. 

Rinse hands and arms thoroughly, allowing the water to run from the hands to the elbows.
Do not retrace or shake the hands and arms, let the water drip from them.

4. 

Take a brush package, moisten brush and work up a lather. Soap fingertips and clean
 the spaces under the fingernails of both hands under running water.

5. 

Lather fingertips with sponge side of brush, then using bristle side of brush, scrub the spaces
under the fingernails of the right or left hand 30 circular strokes. When scrubbing, slightly bend
forward, hold hands and arms above the elbow, and keep arms away from the body.

6. 

Lather digits scrub 20 circular strokes on all four sides of each finger.

7. 

You may begin with the thumb or little finger or the right or left hand.
Scrub one hand and arm completely before moving on to the other hand and  arm.

8. 

• Slightly bend forward, pick up the hand towel from the top of the gown pack and step back from the table.
• Grasp the towel and open it is folded to double thickness lengthwise
• do not allow the towel to touch any unsterile parts of your body.
• Hold your hands and arms above your elbow, and keep your arms away from your body.

9. 

Holding one end of the towel with one of your hands, dry your other hand and
arm with a blotting, rotating motion.

10. 

Holding one end of the work from your fingertips to the elbow.
Do not retrace any area. Dry all sides of the fingers, the forearm, and the arms thoroughly.

11. 

Grasp the other end of the towel and dry your other hand and arm in the same manner.
Discard the towel into a linen receptable.

For more information : http://www.brooksidepress.org/Products/Scrub_Gown_and_Glove_Procedures/lesson_1_Section_4.htm

PROPER HAND WASHING

How to wash your hands :

1.    Wet your hands with running water

2.    Apply liquid, bar or powder soap

3.    Lather well and rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including   the backs of your hands, wrists, between your fingers and under your fingernails.

4.    Rinse well for at least 10 seconds.

5.    Dry your hands with a clean or disposable towel or air dryer.

6.    If possible, use your towel to turn off the tap.

               When to wash your hands :

§     Before and after eating

§    Before, during and after you prepare food

§    After you use the bathroom or change diapers

§    After you blow your nose, sneeze or cough

§    Before and after taking care of someone who is sick

§     After touching animals, their toys, leashes, or waste (poop)

§    After touching something that could be dirty

§    Before and after you clean a wound, give medicine or insert contact lenses

§    Whenever your hands look dirty

VIDEO

Asepsis

Definition

Asepsis is a freedom from infection or infectious material and the absence of viable pathogenic organisms. Medical asepsis the use of practices aimed at destroying pathological organisms after they leave the body,employed in the care of patients with infectious diseases to prevent reinfection of the patient and to avoid the spread of infection from one person to another. This is achieved by isolation precautions, in which the objects in the patient's environment are protected from contamination or disinfected as soon as possible after contamination. Surgical asepsis the exclusion of all microorganisms before they can enter an open surgical wound or contaminate a sterile field during surgery. See accompanying table. Measures taken include sterilization of all instruments, drapes, and all other inanimate objects that may come in contact with the surgical wound. All personnel coming in contact with the sterile field perform a surgical hand scrub with an antimicrobial agent and put on a surgical gown and gloves.

Purpose

Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms, in the clinical setting. The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens. Often, practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe levels), or disinfect (remove most microorganisms but not highly resistant ones) are not sufficient to prevent infection.