Gowning, Gloving (Open and

Closed techniques-unassisted)
 
 
 
OPERATING ROOM CONCEPTS
Outline:

 Terminologies
 Types of surgery
 Phases of surgery
 OR attire
 OR team/ Duties and responsibilities
 Principles of OR technique
 Surgical Incisions
 Different positions
 Skin preparation
 Anesthesia – Types; stages
 Basic instruments – Functions

Return Demonstration

 Surgical scrub
 Gowning
 Gloving – open/ closed technique
 Serving the gown & gloves

Surgery
Is a unique experience of a planned physical alteration.
Terminology

 Excision surgery names often start with a name for the organ to be excised
(cut out) and end in -ectomy.
 Hysterectomy
 

 Procedures involving cutting into an organ or tissue end in -otomy.

o A surgical procedure cutting through the abdominal wall to gain
access to the abdominal cavity is a laparotomy.

 Reparation of damaged or congenital abnormal structure ends in -rraphy.

Herniorraphy is the reparation of a hernia, while perineorraphy is the
reparation of perineum.

 Reconstruction, plastic or cosmetic surgery of a body part starts with a name

for the body part to be reconstructed and ends in -oplasty.
 Rhino is used as a prefix for “nose”, so rhinoplasty is basically reconstructive
or cosmetic surgery for the nose.

 Minimally invasive procedures involving small incisions through which an

endoscope is inserted end in -oscopy. For example, colonoscopy.

 Procedures for formation of a permanent or semi-permanent opening called a

stoma in the body end in -ostomy.

3 Phases:
1. Pre-operative phase - begins when the client decides to have surgery and ends
when the client is transferred to the OR bed.
Nursing Activity

 Assessment of the client, evaluate medical history

 Identification of potential or actual health problems.
 Planning specific care based on individual needs
o preoperative skin preparation as appropriate
 o provide GI preparation as prescribed NPO (restricting solid food
and fluid for 8 to 10 hours before surgery, administering enema)
 Pre-operative teaching including client and family.
o deep breathing and coughing exercises
o relaxation techniques
o postoperative exercises of extremities
o turning and moving techniques
o pain-control techniques
o incentive spirometer use
 Perform standard preoperative procedure (complete pre-op checklist)
o Take and record Vital signs, weight
o verify allergy, identification bands
o Validate NPO status
o remove jewelry, nail polish and hair pins, dentures, eyeglasses
o have the client void and don a clean hospital gown and turban
o administer pre anesthetic medication and instruct the client to stay
in bed.

2. Intraoperative Phase – begins with the admission of the client to the operative bed
and ends when the client is admitted to the post anesthesia care unit (PACU) or
recovery room (RR).
Nursing Activity

 To provide the client with comprehensive, safe, and effective care during the
surgical procedure.
 Assess the client’s physiologic and psychologic status
 Reviewing the results or the dx test and lab studies
 Positioning the client for surgery
 Performing the surgical skin prep.
 Assisting in preparing the sterile field.
 Opening and dispensing sterile supplies during surgery.
 Monitoring and maintaining a safe, aseptic environment.
 Managing catheters, tubes, drains and specimens.
 Performing sponge, sharps, and instrument counts.
 Administering medications and solutions to the sterile field.
 Documenting the nursing care provided and the client’s response to the nsg.
Interventions.

3. Postoperative Phase- begins with the admission to the post anesthesia care unit
and ends with the discharge from the hospital or facility providing the continuing care.
3 segments of Postoperative phase
a. Immediate post-op period- care given to the client in the RR and in the 1st few hours
in the surgical floor.
b. Intermediate period- care given during the course of surgical convalescence to the
time of discharge.
c. Postoperative stage- discharge planning, teaching, referral
Nursing Activities

 Monitor client’s response to the surgery

 Teaching and providing support to client & support persons.
 Main goal is to assist client to achieve the most optimal health status by:
o client free from infection
o client’s F/E balance will be maintained
o Client’s skin integrity will be maintained.

TYPES OF SURGERY
A. Degree of Urgency
1. Elective Surgery – planned weeks or months ahead and is based on the client’s
choice. It is performed for the client’s and the surgeon’s convenience.
Example: circumcision, hemorrhoidectomy, thyroidectomy, cosmetic surgery.
2. Urgent Surgery – frank attention within 24-48 hours Example: Appendicitis, kidney
stones, amputation 3. Emergency Surgery – performed to preserve client’s life, body
parts, or body functions. Example: Gunshot wounds or stab wounds, control of
hemorrhage
B. Degree of Risk Major - it involves a high degree of risk for a variety of reasons, it
maybe complicated or prolonged. (large losses of blood, vital organs may be involved.
Examples: open heart surgery removal of kidney
2. Minor - it involves little risk; produces few complications. Examples: Breast biopsy
Removal of tonsils
C. Purpose 1. Diagnostic - to confirm a diagnosis e.g. Excision Biopsy

2. Exploratory – e.g. Exploratory Laparotomy - To estimate the extent of a disease &

Confirm diagnosis As well.

a. Ablative – removal of a diseased organ e.g.Hysterectomy

b. Constructive –repair of congenital defects e.g. Cheiloplasty

c. Reconstructive –restoration of a damaged organ organ or cosmetic revision e.g.
Rhinoplasty

4. Palliative – relieves symptom but does not cure the disease e.g. myringotomy (otitis
media)

INFORMED CONSENT

 Operative permit/ Surgical Consent

 An agreement by a client to accept a course of treatment or a procedure after
complete information, including the risk of treatment and facts relating to it
has been provided by the physician.
 The client signs the form and the nurse acts as a witness.

Operative permit/ Surgical Consent

INFORMED CONSENT
3 ELEMENTS:
1. It must be given voluntarily
2. It must be given by an individual with the capacity and competence to understand.

 18 years and above, conscious & oriented.’

 Are not considered functionally competent:
 Confused, disoriented, sedated, minors, unconscious, mentally ill

3. The client must be given enough info to be the ultimate decision maker.
CIRCUMSTANCES REQUIRING A CONSENT:

1. Any surgical procedure where a scalpel, scissors, sutures, hemostats maybe used.
2. Entrance into a body cavity.
3. General anesthesia, local infiltration, regional block.


o In a life-saving emergency, the surgeon may operate without consent.
o Every effort must be made to contact the family.

12 Principles of OR technique
Surgical Conscience

 is one’s inner voice for the conscientious practice of asepsis and sterile technique at
all times.
 Is the foundation for the practice of strict aseptic and sterile techniques.
 It is self-regulation in practice according to a deep personal commitment to the
highest values.

1. All articles in the OR are previously sterilized.

2. Persons who are sterile touch only sterile articles; persons who are unsterile touch only
unsterile articles.

3. If in doubt of the sterility of something consider it unsterile.

4. Non-sterile persons avoid reaching over the sterile field; sterile persons avoid leaning over
unsterile field.

5. Tables are sterile only at table level.

6. Gowns are considered sterile only from the waist to shoulder in front level, and on the sleeves.

7. Edges of anything that encloses sterile articles is considered unsterile.

8. Sterile persons keep well within the sterile area.
9. Non-sterile persons keep away from sterile area.
10. Sterile persons keep in contact with sterile areas in a minimum.
11. Moisture may cause contamination.
12. When bacteria cannot be eliminated from a field, they must be kept to irreversible minimum.
 

Serving gown and gloves

(assisted)
 
 
 

I. GOWNING AND GLOVING TECHNIQUE

1. Gowning: To don the gown, the scrub person:
a. Lifts the folded gown directly upward from the sterile package.
b. Steps back from the table into an unobstructed area;
c. Carefully locates the neckband and holds the inside front of the gown just
d. below the neckband with both hands;
e. Lets the gown unfold while keeping the inside of the gown toward the body without
touching the sterile exterior of the gown with bare hands. (NOTE: IF the gown does not
unfold completely, then the circulating nurse may assist by pulling down the unfolded
bottom inside the gown);
f. Holds the hands shoulder level and slips both arms into the armhole simultaneously.
2. Gloving:
A. Closed Glove Technique- In the closed-glove technique, the scrub person's hands
remain inside the sleeves and should not touch the cuffs. In the open-glove technique,
the scrub person's hands slide all the way through the sleeves out beyond the cuffs.
a. Keeps both hands within the cuff so that the hands do not touch the cuff edges;
b. Grasps the folded cuff of the left glove with the right hand;
c. Holds the top edge of the cuff in the left hand above the palm;
d. Places the palm of the glove against the palm of the left hand-the glove fingers point
up the forearm;
e. Grasps the back of the cuff in the right hand and turn it over the open end of the left
sleeve and hand while holding the top of the left glove and underlying gown sleeve with
the covered right hand;
f. Pulls the glove over the extended left finger onto the wrist by pushing the hand
through the glove until it completely covers the cuff of the glove;
g. Gloves the right hand in the same manner by reversing the above steps
h. lnspects the gloves for integrity after denning; and
i. Hands the tie end to the circulator and secures the wraparound glove (when used.)
B. Open Glove Technique- The closed glove technique should not be used when
changing one or both gloves because once the hand has been passed through the
cuffs, they are contaminated. When a glove must be changed without assistance during
a surgical procedure, the open-glove technique is used.
a. To change one glove during the procedure using the open-glove technique, the
scrub Person:

o


1. Steps away from the sterile field;
2. Extends the contaminated glove
away from the sterile field so that
the circulator, using exam gloves to
protect his/her hands, can remove it;
3. Lifts the new sterile glove under the
cuff with the uncontaminated gloved
hand;
4. Inserts the hand into the glove and
pulls it on, leaving the cuff turned
well down over the hand and
avoiding inward rolling of the cuff.
The bare hand does not touch the
outside of the glove; and
5. Rotates the arm and pulls the cuff of
the glove up and over the sleeve
cuff, letting the gloved fingers touch
only the outside of the other glove.
b. To change both gloves during a procedure using an open-glove technique, the scrub
Person:

1.
1.
1.
1.
1. Follows instructions I and 2 above;
2. Picks up the left glove cuff, touching
only the edge of the cuff with his or
her right thumb and index finger;
3. Pulls the glove onto the left hand
and leaves the glove cuff turned
down;
4. Picks up the right glove with the
gloved left hand, keeping the gloved
fingers under the folded cuff;
5. Slides the right hand fingers inside
the right glove cuff and pulls the
glove onto the right hand while
avoiding inward rolling of the cuff;
6. Pulls the right glove cuff over the
sleeve cuff by rotating the arm;
7. Places the gloved right-hand fingers
under the folded left glove cuff,
rotates the arm, and pulls the left
glove cuff over the sleeve cuff.

II. Assisted Gowning and Gloving

1. Assisting gowning- The scrub person may assist another member in drying,
gowning, and gloving by:
a. Opening the towel that the other member will use to dry his/her hands
b. Laying the towel on the team member's hand without touching his/her hands;
c. Holding the gown at the neckband and carefully unfolding it
d. Keeping the hands on the outside of the gown, forming a protective cuff of the neck
and shoulder area as the person being gowned holds both arms outstretched;
e. Offering the inside of the gown to the other member so he or she can slip his or her
hands into the sleeves; and
f. Releasing the gown when the team members' hands are in the sleeves.
2. Assisted gloving- To glove another team member, the scrub person always
gloves the other person's right hand first. The scrub person:
a. Picks up the glove with his or her fingers under the cuff
b. Holds the palm of the glove toward the person being gloved
c. Stretches the cuff to open the glove and holds his or her thumbs out to keep them
from touching the other team member's bare hands
d. As the other person inserts his or her hands into the glove, exerts upward firm
pressure making sure the hand does not go below the waist
e. Unfolds the inverted glove cuff over the cuff of the sleeve
f. Gloves the left hand with the assistance of a team member by repeating the steps
g. Hold the tie as the other team member turns to secure wraparound sterile gown when
it is used.
3. Assisted re-gloving- When a team member other than the scrub nurse
contaminates a glove during the surgical procedure, the circulator, using exam
gloves so that his or her hands are protected, will grasp the outside of the glove
and pull it off inside out. the scrub person then re-gloves the team member as
describe above in assisted gloving.
The options for the scrub nurse who needs to change gloves are to: remove both
gown and gloves, have another team member assist in re-gloving, or use the
open-glove technique.
The closed-glove technique cannot be used to re-glove. In closed gloving, the
hand passes through the cuff of the gown, contaminating the edge of the cuff.
This would cause the outside of the new glove to be contaminated.

III. Removing Gown and Gloves

At the end of the procedure, the gown is always removed before the gloves to
prevent cross contamination of the wearer's scrub attire. The circulator can assist
by unfastening the neck and back closures of the gown. The scrub person:

1. grasps the shoulders of the gown, pulls it downward from the shoulder and off
the arms, and turns the sleeves inside out;
2. folds the contaminates surface of the gown on the inside and rolls it away
from the body; and
3. Discards the rolled gown in the appropriate receptacle.

As the gown comes off, it usually turns the cuffs of the gloves down. To removes
the gloves the wearer uses a glove-to-glove and then a skin-to-skin technique.
This approach protects hands from the contaminated glove. The scrub person:
 1. grasps the under cuff of the left glove with the gloved fingers on the right and
pulls it off inside out;
2. slips the ungloved fingers of the left hand inside the right glove and slips it off
inside out;
3. discards the gloves in the appropriate receptacle; and
4. Washes hands and arms with soap and water.

Removing the gloves after removing the gown prevents the bare hands from
contamination that would usually occur from handling the soiled gown.

IV. Maintaining a Sterile Field:

The surgical team should take precautions to avoid contamination and maintain
the sterile field. The hands should be kept above the waist and insight at all
times.
The sterile areas are:

1. The front of the gown from the table level or sterile field to two inches below
the neck
2. The sleeves from two inches above the elbow to the cuff
3. The surgical gloves

The underarms are considered nonsterile. The back of the gown is not
considered sterile even if it is the wraparound style. If any part of the sterile attire
becomes contaminated, immediate corrective steps must be taken (e.g. if a glove
becomes contaminated, it must be changed immediately). Once the original
gloves are donned, the gown cuffs should be considered contaminated because
the scrubbed hand passed through them.