1. SUR 111 LAB #3 Establishing the Sterile Field

2. Skill Assessments 12-2 Opening Back Table Opening small wrapped item on clean surface Opening small wrapped item onto the sterile field Opening peel packs Opening instrument container system 12-1 Surgical Hand Scrub

3. Textbook Reading Assignment Please review pages 315-321

4. Commonalities in Opening Sterile Items OR attire Have performed basic hand wash OR furniture positioned correctly in room All supplies readily available Visual inspection of dust cover Visual inspection of external chemical indicators Visual inspection of packaging after removing dust cover Surface placing item on is dry and clean Avoid contamination when opening items! If in doubt discard and get another item Maintain 12-18” distance at all times Touch only up to 1” of edges of any packaging!

5. Opening the Back Table Back table always opened first Center and orient custom pack properly on a dry, clean back table Visual inspection of dust cover Open seal Inspection of inner package integrity, external chemical indicator Position properly (may be an arrow pointing towards front of table and you Maintain distance/do not lean over table as opening/only handle up to one inch of package edges as opening Open right or left (look at packaging and how it is wrapped as you open) Pull towards you by inserting hands under the cuff and grasping the 1” edge Go around the table facing as you move about and pull open other side in same manner Be vigilant about awareness of where packaging touches as you open/avoid contamination

6. Opening Basin Set Center and orient custom pack properly on a dry, clean ring stand Visual inspection of dust cover Open seal Inspection of inner package integrity, external chemical indicator Maintain distance/do not lean over as opening/only handle up to one inch of package edges as opening Open right or left (look at packaging and how it is wrapped as you open) Pull towards you by inserting hands under the cuff and grasping the 1” edge Spin around the ring stand and open the other side in the same manner (wrap may be in the envelope style-turn stand to open each side towards you) Be vigilant about awareness of where packaging touches as you open/avoid contamination/DO NOT lean over (squat to open) Move close to back table (squat and position by only touching the metal part of the ring stand below packaging)

7. Opening Small Wrapped Package Center and orient surgical gown properly on a dry, clean mayo stand or other small table such as prep stand Do not open sterile gown for yourself on the back table! Visual inspection of dust cover Open seal Inspection of inner package integrity, external chemical indicator Position properly Maintain distance/do not lean over as opening/only handle up to one inch of package edges as opening Open away, right, left, (pull from both sides to get memory of wrap out), towards you Do not allow edges to bounce back into package (contaminated if it does) Do not touch beyond 1” edge Be vigilant about awareness of where packaging touches as you open/avoid contamination Do not reach over inner contents as opening or after!

8. Opening Small Wrapped Package Onto Sterile Field Sterile field MUST be established (back table is open) Visual inspection of dust cover Open seal Inspection of inner package integrity, external chemical indicator Position properly in hand (grasp firmly with dominant hand) Face sterile field/maintain 18” distance from sterile field/do not reach over as opening/only handle up to one inch of package edges as opening With non-dominant hand: Open away and secure, right and secure, left and secure, towards you and hold with non-dominant hand Gently toss in a small arc the sterile contents onto sterile field Do not allow edges to bounce back into package (contaminated if it does) Do not touch beyond 1” edge Be vigilant about awareness of where packaging touches as you open/avoid contamination Do not reach over inner contents as opening or after! Discard wrapper

9. Opening Small Wrapped Package Onto Sterile Field Bulky, heavy, or long awkward items should be opened by the circulator once the surgical technologists has entered the OR and is sterile The item can be slowly opened by the nonsterile team member and retrieved by the sterile team member to avoid unnecessary contamination risk therefore unnecessary cost to the patient or institution Heavy items may be opened by the nonsterile person on a separate table to be retrieved by the sterile team member once scrubbed in in the manner described for opening your sterile gown

10. Opening Peel Packs Sterile field MUST be established (back table is open) Visual inspection of package integrity Inspection of inner package integrity, external chemical indicator Position properly in hand Face sterile field and maintain 18” distance from sterile field Open seal using both hands to peel apart edges to about ¾ of the way Turn and move package towards sterile field as you finish opening package remainder of the way creating a SLOW gentle arc with package contents Will end with hands behind and below (but back) the package contents Do not allow edges to bounce back into package (contaminated if it does) Do not touch beyond package sealed edge (will not have an inch here) Be vigilant about awareness of where packaging touches as you open to avoid contamination (If you can’t see it, you can’t guarantee it) Discard wrapper

11. Opening Instrument Container System Place instrument container on a sturdy dry, clean surface (prep stand or single ring stand) Do not place on a mayo stand or back table! Visually inspect container exterior including filters, container dryness, lock mechanisms and external chemical indicators If either lock is broken, a filter is missing or visibly wet, container must be returned to SPD and another tray should be obtained

12. Opening Instrument Container System Continued Make sure as opening locks do not become airborne! Break locks, hold lid edges, lift lid up and back towards you, stepping away as you do this Check/inspect lid filters and then discard them in trash Place lid in case cart Look inside container at instrument tray to visualize internal chemical indicator and that container is dry DO NOT lean over your instrument tray Do not drag lid off of container If a filter and its securing mechanism falls into the tray of instruments, the instruments are contaminated

13. Surgical Hand Scrub You must scrub your hands and arms up to inches above the elbow rendering them surgically clean Transient microorganisms are removed and resident flora are reduced –Occurs by two actions: –Mechanical friction brings microorganisms to the surface –Chemical action of antimicrobial soap which also provides a film that lasts several hours after the scrub See Technique, pg. 317-321

14. Equipment Scrub sink Scrub brush with nail cleaner Antiseptic solution PPE Proper OR attire

15. Scrub Techniques Brush Stroke –Each surface is scrubbed a designated number of times – We will use this Timed Method –Scrub for a designated time (5 Min) –Not used here

16. Counted Brush Stroke OR attire and PPE OR prepared for you to enter and set up called (we’ve opened) Refers to opening those supplies/establishing the sterile field You should have opened your own gown and gloves Some circulators will tell you to go on and wash your hands that they have got it ALWAYS offer to help open your room ONLY go scrub if circulator tells you to TEAM EFFORT!

17. Counted Brush Stroke Inspect your hands and cuticles No nail polish/nails short-NOT over fingertips Nonintact skin puts you at risk of acquiring disease You CANNOT cover cuts with a Band-Aid! Remove and secure all jewelry Roll up sleeves! Turn on the water Retrieve scrub brush and open securing top under the scrub brush packaging

18. Counted Brush Stroke Wash your hands and arms to two inches above your elbows using regular soap Rinse beginning at finger tips and working your way up towards your elbows Step away Remove scrub brush and nail cleaner Clean nails/subungual under running water with nail cleaner, discard Wet and squeeze/rotating scrub brush to lather well! Space feet apart a little over a foot, relax shoulders, elbows out, hands in front of your face

19. Counted Brush Stroke Each stroke consists of one back and forth motion You will perform 30 strokes to your nails You will perform 10 strokes to each plane of your fingers (4 planes) You will perform 10 strokes to each of your web spaces as you progress to each finger You will perform 10 strokes to each of the four planes of your hand Your arm is divided into three sections Each section has four planes or more You will perform 10 strokes to each plane of your arm beginning at your lower forearm, proceeding to your upper forearm and ending with your lower upper arm STOP at 2”above your elbows Please measure at home so you know how far this is Not as far as you think

21. If You Can’t See it, You Can’t Guarantee It! Total Self-Awareness

22. Counted Brush Stroke Bunch up your nails and apply 30 counted strokes to your nail tips with bristle side of brush Switch hands and apply 30 strokes to the other hand Begin with thumb, apply ten strokes to lateral side and progress to each of the four planes, web space between index finger and thumb, moving to index finger, etc. Ten strokes to hand’s four planes Move to lower forearm, apply ten strokes to each of the four planes Move to upper forearm, apply ten strokes to each of the four planes Move to lower upper arm, apply ten strokes to each of the four or more planes Stop at 2” above elbow DO NOT TOUCH your scrub sleeves KEEP YOUR fingers up, arms away from your body and hands in front of your face AVOID touching spigot or sink Proceed to other hand beginning with fingers and progress in same manner described

23. Counted Brush Stroke Keeping your hands up in front of yourself and away from your body, turn to the side you intend to rinse first Beginning with your fingertips, place them under the water, wiggle them and rotate hand to thoroughly rinse, progress up your arm KEEP your arm in an arc (U), finger pointed at the ceiling DO NOT GO BACK Once you have rinsed an area, you can’t go back down Once you have reached your elbow, step away from the water, turn body to other side and rinse using same technique Turn off water with your hip or leg DO NOT SHAKE your hands, can drip a minute KEEP HANDS up in front of you! Putting them out to the side endangers you being run into by someone and having to start over! Progress to OR suite door and open with your hip or buttocks (BACK IN!)