Operating Room Personnel Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Learning Objectives Discuss personal preparation for duties as a surgical nurse. Describe proper attire in the surgical area. Define endogenous and exogenous threats to asepsis. Explain the general guidelines for personal hygiene of veterinary surgical personnel. Describe and perform a surgical hand scrub. Explain and perform a surgical hand rub.

Learning Objectives  Describe the types of surgical hand preparation solutions.  Explain and demonstrate the process to aseptically dry the hands and arms after performing a surgical hand scrub or rub.  Describe and demonstrate the procedure for donning a surgical gown.  Describe and perform open and closed gloving and assisted surgical gloving.

The Technician’s Role in the Surgery Room Important assistant to the surgeon: – Retract tissue, immobilization of body parts – Lavage surgical field with sterile fluid – Manage instrument table – Maintain aseptic techinique – Anticipate instruments needed

Nutrition, Hygiene, and Appearance Eat a meal of substance before surgery Groom fingernails Avoid cologne and perfume

Types of Contamination Endogenous Exogenous

Proper Attire in Surgical Area Microbial shedding of microorganisms from humans: – Freshly laundered scrub suits – Head covers – Masks – Perhaps shoe covers Follow written and posted dress code

Scrub Suit No street clothes Don’t wear scrubs from home into work Freshly laundered in clinic Fit snug to body; shirt tucked into pants Clean lab coat over scrubs if stepping out of surgery area

Proper Attire

(im-)Proper attire This head cover does not fit snugly and leaves hair exposed.

Masks and Shoes Mask: over mouth and nose – If about to sneeze, don’t turn head; step out of sterile field Shoes: comfortable and clean; can use shoe covers

Jewelry and Fingernails Jewelry: all should be removed Fingernails: clipped to below fingertips; no nail polish

Surgical Hand Scrub and Hand Rub Hand scrub: remove as many microorganisms as possible from the nails, hands, and arms using mechanical and chemical antisepsis

Surgical Hand Scrub and Hand Rub Timed vs. stroke method: 5 min minimum Fingers, fingertips, hands and arms; each have four sides Antimicrobial scrub agents: FDA-approved hand scrubs or alcohol-based rubs Brushless technique Standardized protocol in scrub room

Scrub Solutions Ideal characteristics: – FDA compliant – Broad spectrum of activity – Fast acting and effective – Non-irritating – Persistent effects and cumulative activity Follow manufacturer’s written directions for use

Chlorhexidine gluconate (4%) Iodophor (7.5%) Alcohol (60%–90%) Parachlorometaxylenol (PCMX) Brushless rub Scrub Solutions

Prescrubbing Guidelines  Remove rings, watches, jewelry, name tags, pens from top pockets, and so on.  Wash hands and forearms with antimicrobial scrub and running water.  Clean subungual areas using disposable nail-cleaning pick.  Keep hands above elbows to allow water to run off.

Prescrubbing Guidelines Don’t touch anything. Apply antimicrobial agent to wet hands and forearms.

Brush each fingertip 10 times; go under fingernails. Sides of fingers, beginning with the lateral side of each. Webbing between the fingers Lateral side of the hand Palm Outside of the thumb Base of the fingers to the wrist Forearms to elbow Then rinse Scrubbing Guidelines

scrubbing Guidelines

Prescrubbing Guidelines

Antimicrobial Rub Agents Fingers Hands Forearms To elbow Use amount of hand rub recommended by the manufacturer

Dry Hands After hand scrub (or rub), dry with a sterile towel.

Dry Hands

Gowning

Gloving Methods: 1. Closed 2. Open 3. Assisted

Closed Gloving No bare skin is exposed Palm to palm, thumb to thumb, fingers of glove facing the elbow

Closed Gloving

Cuff of glove completely covers cuff of gown

Closed Gloving

When one glove becomes contaminated When no gown is needed (e.g., minor surgical procedures, bone marrow biopsies, catheterizations) Open Gloving

Only folded cuff of first glove can be touched

Open Gloving

Assisted Gloving  When a sterile team member helps another scrubbed-in team member glove  Cuff of gown should not be pulled over the hand

Contaminated Gown Circulating nurse unfastens it and pulls it off (inside out) from the team member who was contaminated. Contaminated person removes gloves and pulls them off inside out. Sterile sleeves can be used.

Remain Alert Avoid locking knees when standing for long periods of time. Eat before scrubbing in. Slowly shift weight from leg to leg.