Perioperative nursing is a specialty that involves invasive procedures or operations.

The
perioperative team includes the surgeon who is the captain of the team the, Anesthesiologist.
Assistant surgeon, the OR nurses such as the scrub or sterile nurse and circulating or non-sterile
nurse and any aid needed depending on the procedure. The Operating room is a sterile field and
the team members specifically the OR nurses use a comprehensive, multidisciplinary approach to
patient care, they assist the surgeon and all the members of the perioperative team on the
preoperative period, intraoperative phase, and post-operative phase. 
The rules and responsibilities of the scrub nurse include the preparation of the instruments
and equipment needed in the operation. He or she uses the sterile technique for scrubbing,
gowning, and gloving. He or she receives sterile equipment via circulating nurse using sterile
technique. And he or she performs initial sponges, instruments, and needle count, checks with
the circulating nurse.
On the other hand, the circulating nurse makes preparations for an operation and
continually monitors the patient and staff during its course, who works in the operating room
outside the sterile field in which the operation takes place, and who records the progress of the
operation, accounts for the instruments, and handles specimens.

In the operating room, we wear personal protective equipment or PPE from head to toe which
include scrubs, gloves, OR gown, shoe covers, head covers, masks, eye protection, face shields, and OR
shoes.  This prepares us for any health and safety risks and gives us extra protection to the prevention of
an pathogens or accidents and when directly handling potentially infectious materials or contaminated
surfaces. All things considered, we use PPEs to protect basically everyone.

13 Principles of Asepsis

1. All Articles used in an operation have been sterilized previously.

2. Only sterile personnel are allowed to touch the sterile areas. Whereas unsterile personnel are
only allowed to touch unsterile areas.
3. If in doubt about the sterility of anything, consider it unsterile.
4. Unsterile persons, avoid reaching over sterile area while sterile persons avoid leaning over
unsterile area.
5. Tables are only sterile at table levels.
6. Gowns are considered sterile only from the waist to shoulder level and the sleeves.
7. The edge of anything that encloses the sterile contents are considered unsterile.
8. Sterile persons keep within the sterile area.
9. Non-sterile persons keep away from the sterile area.
10. Sterile persons keep contact with sterile area to a minimum.
11. Moisture may cause contamination.
12. When bacteria cannot be eliminated from the field, they must be kept to an irreducible
minimum.
13. Destruction of integrity of microbial barriers result in contamination.

When in doubt consider it unsterile.

No compromise in sterility.
Prepare for the OR:

1. Wear scrubs and shoes.

2. Make sure that all hair strands are covered by the cap.
3. Wear masks snugly and comfortably over the nose and mouth.

Surgical Hand Scrub

- The process of removing as many microorganisms as possible from the hands and arms
through mechanical washing and asepsis.
1. Make sure that hands are free from breaks cracks and cuts.
2. Remove all pieces of jewelry from fingers, wrist and neck.
3. No finger nail polish and artificial nails.
4. Wet the hands and arms with hands downwards.
5. Dispense a few drops of antiseptic agent on hands.
6. Lather well until 2 inches above the elbows.
7. Rinse the hands and arms thoroughly under running water holding the hands upward and
allowing water to drip to the flexed elbow.
8. Take a sterile brush.
9. Apply antiseptic solution.
10. Using the abrasive part of the brush, scrub the nails of one hand in a circular motion
(30strokes).
11. Using the non-abrasive side of the brush, scrub all sides of the fingers (10 strokes each)
12. The back of the hand (20 strokes)
13. The palm (20 strokes)
14. And 10 strokes for each plane of the anterior, posterior, and lateral part of the wrist, arm
and going up until 2 inches above the elbow.
15. Rinse the brush
16. Apply an antiseptic again
17. Repeat the procedure on the other hand and arm
18. Drop the brush afterwards
19. Rinse hands and arms thoroughly. (holding the hands upward and allowing water to drip to
the flexed elbow.)

Sterile Gowning and Donning of Gloves

1. After the surgical hands scrub enter the operating room with hands up using your back.
2. The circulating nurse serves the gown to the scrub nurse.
3. Grab the hem of the gown
4. Dry both hands thoroughly but independently.
5. To dry one arm, hold the hem of the gown on the opposite hand and using an oscillating motion
of the arm throw it up to the elbow.
6. Dry the opposite arm using the unused side of the hem.
7. Find the center fold of the gown.
8. Grab the neck band.
9. Locate the holes of the sleeves.
10. The left and the right and slip both arms into the arm holes simultaneously.
 11. Keep both hands inside the sleeves.
12. The circulating nurse securely fastens the gown.

Closed glove technique

Sterile Gown and gloves are worn to prevent the skin from being a possible contaminant and to create a
barrier between the sterile and unsterile areas.

1. Using the left hand pick up the right glove by grasping its folded cuff.
2. Place the cuff of the glove against the palm of the right hand grasping in the right hand the top
end of the cuff above the palm.
3. Grasp the back of the cuff and the right hand and flip it over the end of the right sleeve and
hand.
4. Grasp the cuff of the right glove and the underlying gown sleeve with the covered left hand.
5. Make sure that the fingers are in place.
6. Pull the sleeves until the right hand is fully gloved.
7. Glove the left hand in the same manner reversing the hands.
8. Use the gloved right hand to pull the left glove.

Sterilization

 Sterilization is a process of complete elimination or destruction of all microorganisms which is

carried out by various physical and chemical methods. For physical method, includes Dry heat,
moist heat, radiation, filtration. While for the chemical method include phenols, alcohols,
halogens, aldehydes, and ethylene oxide.

Basic Surgical Instruments

Clamps (grasping instruments)

Mosquitoes (3 curves and 3 straights)

Kelly clamps (for deeper structures)

Allis (2)
Bobcocks (2)

Blade (1)

Mayo scissors (1)

Metzenbaum (1)

Pick up forceps - Tissue forceps (with & ((thumb) without teeth) (2)

Needle holder (2)

Sutures

Army navy and Richardson retractors