Assisting Another Sterile Team Member SUR 111 Lecture 7

Topics Assisting another sterile team member: Toweling Gowning Gloving Turning Removing gown and gloves for replacement Removing gown and gloves end of case

Concepts STSR already scrubbed and donned sterile OR attire assists with drying, gowning, and gloving other sterile team members who have performed the surgical hand scrub and will enter the sterile field Typically reserved for surgeon and surgeon assist, but not limited to them NEVER pass a surgeon a paper towel, but always a cloth one There are currently waterless surgical hand scrub solutions being used, so a towel may not be necessary You as a student will not use waterless hand scrub solutions until you have demonstrated proficiency of both for Midterm semester clinical exam

Toweling/Drying Upon scrubbed person entering the OR, the STST approaches them but not compromising sterility of the sterile field or yourself Maintaining an 18” distance Facing them Avoiding turning your back to your field The towel is passed by unfolding it long way, rolling the towel over your hands and passing the towel to the person’s outstretched hand Hold towel firmly and drop one end on their hand Do not touch the person’s hand with your glove! Step away and retrieve the sterile gown of correct size

Gowning Unfold gown so that the outside of the gown is facing you Reverse it from how you grab it normally Holding the shoulder seam of the gown with your fingers spread, form a cuff over your hands Approach the person gown out in front of you, arms outstretched and allow the person to put their hands through the sleeves You will release the gown on top of the person’s upper arms Step away hands straight back towards you and retrieve right glove

Gloving Expose the team member’s hand if necessary Avoid touching their hand with your sterile glove Only handle the sleeve if you pull the cuff over the person’s hands Secure the right glove, unfold it so that the glove thumb is towards the person, roll the cuff over your fingers and open in a circle or square ensuring that your gloved hand is not in the way This will require the use of all of 8-10 fingers to retract the cuff open enough to form the circle/square and protect yourself from contamination You are opening the inside of the glove for the person to put their hand in it without compromising the outside of the glove or you!

Gloving Hold securely while person inserts their hand through the glove Their cuff should be covered by the glove cuff Retrieve the left glove and repeat The left glove will be easier as the person now has a sterile hand to grasp the cuff and pull towards them, making it easier to apply the left glove

Turning To turn the sterile person, grasp or wait for them to pass you the gown tag Grasp tag and remove tie holding it away (18”) and firmly and form a half C around the person until they have grasped the tie from your hand Should the person turn with a non-sterile team member, you will not participate as this will occur the same as for you when you gowned

Remaining Steps Will cover this in detail soon! Next steps: Prepare to pass the prep solution to surgeon Prepare the drapes and assist with draping prn Prepare your mayo stand, being ready to pass up light gloves to surgeon, pass off bovie cord, and suction tubing Surgery begins Secure back table MAINTAIN asepsis at all times! Constant VIGILANCE!

Gown and Glove Removal For Replacement Step away from the sterile field and request a new gown and gloves as soon as contamination is recognized Let surgeon know what you need to do Remain still so that circulator can unfasten you and face you to remove your gown Extend arms so circulator may remove and contain the gown Hold hands out palms up so that circulator can grasp cuff without touching your exposed skin (should that occur you must rescrub) Take the sterile gown the circulator gives you and gown and glove in the usual fashion with the closed glove technique Return to sterile field

Glove Replacement Should your one of your sterile gloves become contaminated: You may request and retrieve a new sterile glove for your contaminated hand only touching it with your sterile gloved hand Hold your now contaminated hand out to circulator who will remove it only touching the cuff of the glove Ask another sterile team member to glove you

Glove Replacement If you are double gloved and contaminate a gloved hand: Have circulator remove outer glove if you do not see where the contamination was If you observed on distal end of fingers, you can remove the out glove by grasping at the cuff of that glove and pulling off inverting as you pull Replace the second pair of gloves by requesting another pair from the circulator

Glove Replacement OPEN GLOVING IS NEVER okay to replace sterile gloves when you are a sterile team member! You may see “old school scrubs” do it in clinical YOU ARE NOT TO DO THIS! Poor technique Not a recommended practice of AORN or AST

Gown and Glove Removal End of Procedure Finish all clean up duties (breaking down case) Allow circulator to unfasten the back of the gown if it is non-disposable Disposable gowns may be grasped firmly by the anterior shoulders and pull Roll and pull the gown away from you Only touch the gown with your gloves hands Grasp cuff of one glove with the opposite gloved hand and invert (glove to glove) Holding on to the removed glove, place an exposed finger under the cuff of the remaining soiled glove and remove inverting to contain both gloves (skin to skin) Dispose of and wash hands as soon as possible May use clean gloves (from box on wall) to assist with the patient