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Principle in Scrubbing

1. The document provides procedures for surgical hand scrubbing and donning sterile gowns and gloves. It describes scrubbing the hands and arms using either an anatomical or counted brush stroke method. 2. The gowning procedure involves drying hands with a sterile towel and then opening a sterile gown and pushing the arms into the sleeves. 3. The gloving procedure can be open or closed. For closed gloving, a sterile glove is pulled over the stockinette cuff and hand. For open gloving, each finger is inserted one by one.

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1K views6 pages

Principle in Scrubbing

1. The document provides procedures for surgical hand scrubbing and donning sterile gowns and gloves. It describes scrubbing the hands and arms using either an anatomical or counted brush stroke method. 2. The gowning procedure involves drying hands with a sterile towel and then opening a sterile gown and pushing the arms into the sleeves. 3. The gloving procedure can be open or closed. For closed gloving, a sterile glove is pulled over the stockinette cuff and hand. For open gloving, each finger is inserted one by one.

Uploaded by

Jenny Ajoc
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Principle in Scrubbing

1. Skin and nails should be kept clean and in good condition.


2. Finger nails should be short (not reaching beyond the finger tips) and polish free. Artificial nails
are not recommended because it may harbor bacteria and may develop fungal under the nails. 3.
Jewelry including watches and rings and bracelet should not be worn.
4. Hands should be inspected for break in the skin, which could become an entry of
microorganism.
5. A clean scrub suit, a mask and a cap covering the hair should be worn.

Procedure for Surgical Hand Scrub

Rationale

To remove microbial organisms from hands and arms by both mechanical friction and chemical
antisepsis.

Prerequisite

Proper scrub attire, including mask and cap.

Materials;

Liquid soap or chlorohexidine gluconates

Brush and nail file

Procedural Steps

A. ANATOMIC METHOD
1. Assemble equipment and adjust water to a comfortable setting.
2. Wet hands and arms. If prewashing with detergent from soap dispenser, lather hands and
arms with soap and rinse.
3. Remove scrub brush from package, and using the nail cleaner provided, clean subungual
spaces.
4. Squeeze brush under the water to dispense soap from the sponge.
5. Holding sponge perpendicular to finger tips, begin to scrub, using a back and forth motion.
Scrub all four sides of each finger, including spaces in between.
6. Maintaining lather, scrub palm of hand and back of the hand to the wrist, using a circular
motion.
7. Starting at the wrist, scrub to 2 inches above the elbow on all sides of the arm and wrist,
rotating the arm from back to front.
8. Transfer sponge to the other hand and repeat steps 6 through 8, maintaining aseptic
technique.
NOTE: NEVER GO BACK OVER AREA ALREADY SCRUBBED.
9. Discard brush, and rinse hands and arms under the running water starting at finger tips and
working toward elbows, keeping hand upright and elbows down.
10. Allow water to drip off elbows, maintaining proper position before entering the procedure
room.

B. COUNTED BRUSH STROKE METHOD

The counted-brush-stroke is a prescribed number of brush strokes for each surface of the
fingers, hands, and arms.

1. Follow Steps 1 through 4 of anatomic scrub procedure, then


5. Scrub the nails of one hand 30 strokes, all sides of each finger 20 strokes and the back of the
hand 20 strokes.
6. Maintaining the lather, scrub the palm of the hand 20 strokes and the arm 20 strokes for
each third of the arm, to 2 inches above the elbow.
7. Repeat Steps 5 and 6 for the other hand and arm.
8. Rinse hands and arms thoroughly under running water starting at finger tips and working
toward the elbows, keeping hands upright and elbows down.
9. Allow water to drip off elbows, maintaining proper position before entering the procedure
room.

POINTS TO REMEMBER

1. A “splash back” of water (scrub agent) on scrub suit.


2. Time interval 5-minute scrub = 2 ½ minutes for extremity.
3. Avoid unnecessary movement and talking during the scrub procedure.
4. All persons entering the scrub area must have masks in pace during the scrub procedure.
5. If contact is made with unsterile surfaces during the scrub procedure, the entire scrub
procedure must be started from beginning.
6. Only recommended antimicrobial solutions should be used during the surgical scrub.

Procedure for Donning Sterile Gown

Purpose

To provide assurance of maintaining a sterile field by covering areas of the body and clothing with a
sterile bacterial barrier.

Materials;

Pack of sterile gown


Prerequisite
Surgical hand scrub.Opening the sterile gown and glove package on designated flat surface in prescribed
manner

Procedural Steps

A. DRYING HANDS
1. Enter procedure room holding hands and arms away from the body at the appropriate
height.
2. Approach the table where gown and gloves have been prepared, and pick up the sterile
towel, touching only the sterile tower, and step back. Allow the towel to fall open. 3.
Starting with one end of the towel, dry one hand and arm, stopping 2 inches above the
elbow.
4. Invert the towel, and with the other end, dry the other hand and arm.

NOTE: AS YOU ARE DRYING THE HAND AND ARM, BEND FORWARD SLIGHTLY TO PREVENT ANY
PART OF THE TOWEL FROM COMING IN CONTACT WITH YOUR CLOTHING.

5. When both hands and arms are dry, discard the towel.

B. UNASSISTED GOWNING
1. Grasp the pre folded sterile gown by the neckline with both hands and step back from the
table into an unobstructed area.
2. Holding the folded gown with the inside toward you, locate the neckline of the gown, and
holding the gown with both hands allow the gown to unfold in front of you.
3. Holing the unfolded gown at shoulder level, push both hands and arms into the sleeve
simultaneously.

NOTE: THE CIRCULATING NURSE WILL ASSIST BY BRINGING THE GOWN OVER THE SHOULDERS
BY REACHING INSIDE THE GOWN, AND CLOSING AND SECURING THE GOWN AT THE WAIST AND
NECKLINE. THE HANDS SHOULD NOT BE EXTENDEED BEYOND THE STOCKINETTE CUFF.

Procedure for Applying Sterile Gloves

Purpose

To provide bacterial barrier over the hands, thus allowing contact with sterile items and protection from
contaminates during procedure.
Prerequisite

A. Closed gloved method: surgical scrub and sterile gown.


B. Open method: none if sterile gown is not worn.

Material;

gloves

Procedural Steps

A. CLOSED GLOVE METHOD


1. Using the stockinette cuff of the gown as a “mitten”, open the inside wrappers of the glove
package, and with the left hand, lift the right glove off the wrapper by the cuff. 2. Extend the
right forearm with palm upward. Place the palm of the glove against the palm of the protected
hand thumb to thumb with fingers pointing toward the elbow.
3. Hold securely the cuff of the glove, and with other protected hand, stretch the glove cuff
over the end of the right sleeve and hand. (The cuff of the glove is now over the stockinette
cuff of the gown, with the hand still inside the sleeve).
4. Pull the glove on over extended fingers until it completely covers the stockinette cuff.
5. Using the gloved hand, pick up the other glove from the package, and repeat Steps 2
through 4.

B. OPEN GLOVE METHOD


1. Open glove package by grasping the two center folds of the wrapper and spreading them
apart.
2. Lift the left glove up from the wrapper by the edge of the cuff, using thumb and index finger
of the right hand.
3. Slide the glove over the left hand, holding the cuff, and adjust each finger into its own slot. 4.
Invert the gloved hand so that gloved fingers are touching the sterile glove and lift it off the
wrapper.
5. Slide ungloved hands into glove and adjust fingers.
6. Adjust both gloves for comfort and covering of wrists.

POINTS TO REMEMBER

A. Gowning
1. When drying hands, do not go over areas already dried.
2. Avoid contact of towel with scrub suit by bending slightly at the waist during the drying
procedure.
3. Use one end of the towel foreach hand/arm.
4. When placing arms into gown, maintain proper level of arms and hands (no higher than
shoulders or lower than waist).
5. For initial gowning gloving, do not let hands go beyond cuff of gown.
6. When removing a gown at the end of the procedure, care must be taken to avoid touching
contaminates on the gown. Therefore, it is removed inside out, pulling downward from the
shoulders toward the middle.
B. Gloving
1. Avoid contact of sterile gloves with ungloved hands during closed glove procedure. 2. For
closed glove method, never let the fingers extend beyond the stockinette cuff during the
procedure, contact with ungloved fingers constitutes contamination of the glove. 3. For open
glove method, touch only the cuff of the glove with ungloved hands, and then only glove to
glove for the other hand.
4. If contamination occurs during either procedure, both gown and gloves must be disregarded
and new gown and gloves must be used.
5. When removing gloves after a procedure is finished, the gloves are removed after the gown
is removed inside out, using glove to glove, then skin to skin technique

Procedure for Gowning and Gloving Another Team Member (Assisted Gowning/Gloving)

Purpose

Assist another member of the sterile team don sterile gown and gloves prior to the start of a procedure.

Prerequisite

Surgical hand scrub by team member.

Procedural Steps

A. GOWNING ANOTHER MEMBER


1. Open the sterile towel and lay it across the palm of the team member being gowned. 2.
Unfold the gown carefully, holding at the neckband so that the inside of the gown faces the
wearer.
3. Keeping gloved hands covered by the outside gown shoulders, place the gown on the arms
of the wearer, as he or she slips into the sleeves of the gown, and push up toward the
shoulders.
4. Release the gown at shoulder height, and adjust the sleeves in preparation for assisted open
gloving.

NOTE: THE CIRCULATOR WILL ASSIST WITH THE GOWNING PROCEDURE BY PULLING THE GOWN
ONTO THE SHOULDERS FROM THE INSIDE OF THE GOWN AND SECURING THE BACK OF THE
GOWN BY FASTENERS AT THE NECK AND WAIST FROM THE INSIDE.

B. GLOVING ANOTHER MEMBER (open glove method)


1. Pick up the right glove, grasping if firmly, with fingers under the everted cuff, and present it
so that the thumb and palm are facing the wearer. Announce the hand to be gloved. 2. Stretch
the cuff sufficiently to allow hand access while protecting your gloved hand, and apply
resistance while the wearer pushes hand into the glove.
3. Release the cuff.
4. Present the left glove in the same manner. The wearer will assist by stretching the cuff with
the index finger of his or her gloved hand.
5. Apply resistance as needed; then release the cuff.
6. Offer a damp towel to remove powder from gloves, and discard towel after use.

POINTS TO REMEMBER

1. Protect your sterile gown and gloves during the gowning and gloving of another team
member.
2. During gloving, do not let your hands fall below your waist when applying resistance. 3. If
contamination occurs during either procedure, ask the circulator to assist in removing the gown
and gloves, and repeat the gown and glove procedure.

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