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

2. The Technician’s Role in the Surgery Room
Important assistant to the surgeon:
Retract tissue
Lavage surgical field with sterile fluid
Manage instrument table

3. Nutrition, Hygiene, and Appearance
Eat a meal of substance before surgery
Complex carbs and protein
Groom fingernails
Avoid cologne and perfume
some people are sensitive
May mask important odors

4. Types of Contamination
Endogenous
From the patient itself
Exogenous
From surgical team or environment

5. Proper Attire in Surgical Area
Microbial shedding of microorganisms from humans can be prevented by:
Freshly laundered scrub suits
Head covers
Masks
Perhaps shoe covers
Follow written and posted dress code

6. 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

7. Proper Attire Scrub top tucked snuggly into the pants This prevents
body scurf
from being
shed

8. (im-)Proper attire This skull cap head cover This bouffant is a proper
does not fit snugly
and leaves hair
exposed.
This bouffant is a proper
head cover for this
technician

9. 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
Foot attire has no proven significance in reducing the incidence of post-op wound infections
Shoe covers used to reduce floor contamination

10. Jewelry and Fingernails
Jewelry: all should be removed
Can harbor microorganisms that routine hand washing cannot remove
Earrings, necklaces, bracelets, and body piercings could fall into the surgical field
Fingernails: clipped to below fingertips; no nail polish

11. 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
Skin is never made “sterile” but rather surgically clean

12. Surgical Hand Scrub and Hand Rub
Timed vs. stroke method: 5 min minimum
For both methods follow an anatomical pattern
Fingers, fingertips, hands and arms; each have four sides
Subsequent scrubs of the day can be 2-3 min
Antimicrobial scrub agents:
FDA-approved hand scrubs or
alcohol-based rubs
Brushless technique
Standardized protocol in scrub room

13. 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

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

15. 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.

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

17. Scrubbing Guidelines
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

18. scrubbing Guidelines

19. Prescrubbing Guidelines

20. Prescrubbing Guidelines

21. Prescrubbing Guidelines

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

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

24. Dry Hands

25. Gowning

26. Gowning

27. Gowning

28. Gloving
Methods:
Closed
Open
Assisted

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

30. Closed Gloving

31. Closed Gloving

32. Cuff of glove completely covers cuff of gown
Closed Gloving
Cuff of glove completely covers cuff of gown

33. Closed Gloving

34. Closed Gloving

35. Closed Gloving

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

37. Only folded cuff of first glove can be touched
Open Gloving
Only folded cuff of first glove can be touched

38. Open Gloving

39. Open Gloving

40. Open Gloving

41. Open Gloving

42. Open Gloving

43. Open Gloving

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

45. 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.

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