This should be reperated on the other hand and arm in an identical fashion. While a timed scrub, which includes specific time minimums for each scrub area, is most common, the Association of Operating Room Nurses AORN also endorses a counted stroke method. The use of a sponge or brush is often recommended in hospital guidelines, but reviews of recent studies by the World Health Organization WHO and the CDC have shown that scrubbing without a sponge or brush also reduces bacterial levels to an appropriate level.
The timing of the surgical scrub is an important part of the protocol. Historically, a longer scrub has been thought to be more effective, but a number of studies question the minimum scrub time for an effective outcome. They found 5-minute scrub is equally sufficient as a minute scrub and 2- to 3-minute scrubs proves as effective in lowering bacterial counts. An antiseptic must meet several qualifications including: decreasing microbial counts; be fast-acting; and prevent regrowth of organisms, particularly in a gloved hand where a warm, moist environment can easily foster growth.
Other traits are the bacteriocidal nature of antiseptic, a broad spectrum of activity and timing of scrub. Antiseptics include alcohols, chlorhexidine, chloroxylenol, hexachlorophene, iodine and iodophors, quaternary ammonium compounds and triclosan.
A recent change in surgical hand hygiene has been the addition of waterless alcohol-based hand rubs that often include long-acting compounds like chlorhexidine gluconate. Even though studies comparing alcohol rubs with scrubs are inconclusive, alcohol-based rubs are considered an acceptable alternative to a scrub.
While it is not necessary to wash hands before using an alcohol-based hand rub, hands should be washed if they are visibly soiled to eliminate risk of bacterial spores which are not affected by alcohol. Sterile gloves limit contamination of the surgical field and decrease the risk of pathogen transmission to the patient and the surgical team. However, in orthopedic surgery, gloves are at great risk for puncture. One particular study found Thus, hand washing continues to be a necessary line of defense against the ultimate orthopedic failure: infection.
With a proper regimented surgical scrub protocol and the proper use of various antiseptics, we as surgeons can help minimize surgical-site infections. Boyce JM, Pittet D, et al. Guideline for hand hygiene in health-care settings.
With one hand, pick up the entire folded gown from the wrapper by grasping the gown through all layers, being careful to touch only the inside top layer which is exposed. Once your hands are securely pinching the gown in these slots , step back from the shelf and allow the gown to drop.
Make sure the gown does not touch any surrounding unsterile objects. Grasp the inside shoulder seams and open the gown with the armholes facing you. Carefully insert your arms partway into the gown one at a time, keeping hands at shoulder level away from the body.
Slide the arms further into the gown sleeves and when the fingertips are level with the proximal edge of the cuff, grasp the inside seam at the cuff hem using thumb and index finger. Be careful that no part of the hand protrudes from the sleeve cuff. A theatre assistant will fasten the gown behind you, positioning it over the shoulders by grasping the inside surface of the gown at the shoulder seam.
The theatre assistant then prepares to secure the gown at the neck and upper back. Gowns differ in how they are secured, but most with have either ties , buttons or velcro tabs. Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing towards you. The palm of the hand inside the gown sleeve must be facing upward toward the palm of the glove. Grasp the bottom rolled cuff edge of the glove with the thumb and index finger of the hand the glove is on top of.
Using the opposite sleeve covered hand, grasp both the glove cuff and sleeve cuff seam and pull the glove onto the hand. Pull any excessive amount of glove sleeve from underneath the cuff of the glove. Using the hand that is now gloved put on the second glove in the same manner.
Check to make sure that each gown cuff is secured and covered completely by the cuff of the glove. There is a cardboard slip holding two ties together across the front of the gown. Detach the cardboard slip from the short tie , ensuring you keep hold of the short tie in your left hand.
Now pass the cardboard slip to the theatre assistant , ensuring not to make direct contact with their hand. They will pass the tie around your back — now take the tie , and let them pull the cardboard off the tie so that you can tie a bow at your waist. Clinical Examination. An Introduction to the Arclight. Eye Drops Overview. Statin Counselling.
Prescribing in Renal Impairment. Interpreting Hepatitis B Serology. Medicine Flashcard Collection. A collection of surgery revision notes covering key surgical topics. Aortic Dissection. Surgery Flashcard Collection. Anatomical Planes. Anatomy Flashcard Collection. The Inguinal Canal. A man with penile swelling. Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time.
However, because cold water prevents soap from lathering properly, soil and germs may not be washed away. Clean subungual areas with a nail file. Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes. Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
Wash each side of the arm to three inches above the elbow for one minute. Repeat the process on the other hand and arm, keeping hands above elbows at all times.
If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated. Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
Proceed to the operating room suite holding hands above elbows. However, vigorous scrubbing that causes the skin to become abraded should be avoided. At all times during the scrub procedure care should be taken not to splash water onto surgical attire. You are now ready to don your gown and sterile gloves.
Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff. The surgeon will thrust his or her hand into the glove. Do not release the glove yet. Gently release the cuff do not allow the cuff to snap sharply while unrolling it over the wrist. Proceed with the left glove, using the same technique.
In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons: Staff time constraints.
Desire to reduce poor hand health. Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate. Characteristics of a Surgical Scrub Performance characteristics for a surgical scrub agent generally fall into four categories: 1.
Surgical scrub agents come in many forms. Not all forms meet all characteristics. Conclusion No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. For a complete list of references visit www.
To describe correct scrub technique. To list the different characteristics of products used for surgical scrub. To be able to demonstrate the correct aseptic technique when gloving and gowning. True or false questions Surgical site infections contribute to nosocomial infections.
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