Scrubbing, Gowning & Gloving

Peri-Operative Nursing
 Is the identification of the physiological,
psychological and sociological needs of the
patient, and the implementation of an
individualized program of nursing care in order
to restore or maintain the health and welfare of
the patient before, during and after surgical
intervention.
Definition of terms:
Surgery- branch of medicine
concerned with diseases and
trauma requiring operative
procedures.
Phases in Surgery
1) Pre-operative- It begins when
decision to proceed with
surgical intervention is made
and ends with the transfer into
the operating table.
 Definition of terms:
2) Intra-operative- It starts form
the transfer of patient to the
operating table and ends with
the admission of the patient to
the PACU.

3) Post-operative- It begins with

admission to the PACU and
ends with follow-up evaluation
in the clinical setting or home.
GOALS
 to provide a safe, supportive and comprehensive
care.
 to assist the surgeon by functioning effectively as a
member of the surgical team.
 to create and maintain as aseptic/sterile
environment.
Suffixes

-ectomy – removal of a part from the body.

-otomy – making of an opening

-rrhaphy – repair of a part of the body

CONDITIONS TREATED BY SURGERY

Congenital
– inborn deformities

Acquired
– conditions resulting
from trauma or
injury.
4 Basic Pathologic Conditions that
require surgery
1. Obstruction – blockage in obstructions that are
dangerous because they block the flow of blood, air,
CSF, urine and bile through the body.
CHOLEDOCHOLITHIASIS
2. Perforation – is the rupture of an organ,
artery or bleb.
3. Erosion – break in the continuity of tissue
surface it can be caused by irritation, infection,
ulceration or inflammation. It may damage the
walls of the blood vessels resulting in serious
bleeding.
4. Tumors – abnormal growth of tissue that serves no
physiologic function in the body.
CLASSIFICATIONS OF SURGERY
 Location
Internal External
– inside the body. – outside the body.
HYSTERECTOMY SKIN
GRAFTING
Degree of risk to the person
 Major  Minor
- life threatening when major – non-life threatening,
or vital organs are involved less serious.
and those surgeries that Lip
may involve serious Suturing
bleeding.

Cesarean
Section
Surgery According to Purpose
 Diagnostic – verifies
a suspected diagnosis.

Exploratory Laparotomy

 Exploratory –
estimates the
extent of the
diseases or injury.
 Surgery According to Purpose
 Curative – removes or repairs damaged tissues,
diseased or congenitally malformed organs or
tissues.
Cheiloplasty
Surgery According to Purpose

Ablative
– removing diseased organs.

Appendectomy
Surgery According to Purpose

 Palliative – relieves
symptoms but does
not cure the
underlying disease
process.

Tracheotomy
Surgery According to Purpose

 Reconstructive – a partial or complete

restoration of a damaged organ or tissue to
its original appearance and function.
Surgery According to Purpose

 Constructive – repair of a congenitally

defective organ, improving its function or
appearance.
Surgery According to Purpose

 Transplant- The transfer of

an organ from one person
to another.
Categories of Surgeries According to
Urgency
 Emergency Surgery – done
immediately to save life, limb or a
part of the body.
Ex. Explore Lap, CS

 Urgent Surgery – must be done

within 24-48 hours. Ex. relief of
intestinal obstruction.
Categories of Surgeries According to
Urgency

 Required/Planned – needs to be
done in order to retain quality
of life. Do not need to be
performed immediately.
Examples of required
surgery are kidney stone or
tumor removal.
Categories of Surgeries According to
Urgency

 Elective surgery – done at the

patient's or surgeon's
convenience. It can be
completed within days or
months.
 Common elective surgical
procedure were bariatric
surgery, colectomy, ventral
hernia repair , appendectomy
, cholecystectomy, and rectal
resection.
Categories of Surgeries According to
Urgency

 Optional surgeries -
performed for non-medical
reasons. This includes
cosmetic surgery, such as
facelifts, breast implants,
liposuction, and breast
reduction, which aim to
subjectively improve a
patient's physical
appearance.
AT RISK PATIENTS Hypertensive and ALCOHOLIC
Hypotensive

Young and Elderly

DIABETIC PATIENT

UNDER WEIGHT

overweight

dehydrated
 Stages of Operating Room
(PERIOPERATIVE)

Preoperative Intra- Postoperative

Phase operative Phase
Phase
Pre-operative
- The giving of nursing care to surgical patient as
soon as he is admitted and the decision to
undergo surgery is made. It ends on the time the
patient is transferred to OR.

Pre-operative Phase
Intra-operative

- Giving nursing care to patient undergoing

surgery. It starts from the time he was admitted
to OR, during operation until it ends.
Post-operative
- Starts from the end of the operation until the patient
is transferred into the recovery room or surgical
intensive care unit for immediate post op nursing
care. It also extends from the time the patient was
returned to his room until discharge.
Operating Room team
 Sterile Team
- scrubbed, gowned and gloved
personnel.
- Operating Surgeon
- Assistant to the surgeon
- Scrub person
 Unsterile team
- In scrub suit, mask and cap
attire only.
- Anesthesiologist or
Anesthetist
- Circulating nurse
Functions of Sterile personnel
 Operating Surgeon
- Pre-op diagnosis and care
- Performance of operation
- Post-op management and care
- Assumes full responsibility
- For all medical acts of judgment and
- management.
 Assistant to the surgeon
- Holds retractors in the wound to expose operative site.
- Clamp bleeding blood vessels.
- Assist in suturing during operation or closing the
wound/operative site.
- Suction body fluid/blood to provide clear view of the
operative site.
Scrub Person
- Maintain integrity of, safety, and efficiency of the
sterile field.
- Prepare and arrange instruments and supplies.
- Assist the surgeon and assistants surgeon and assistants
throughout the operation by providing sterile
instruments and supplies.
Functions of Unsterile Personnel
 Anesthesiologist or Anesthetist
- Administers and maintain anesthesia and manages untoward
reaction to anesthesia.
Circulating Nurse
- Application of the nursing process in directing and
coordinating all nursing activities related to the care
and support of the patient.
- Creation and maintenance of a safe and comfortable
environment for the patient through implementing the
principles of asepsis.
Circulating Nurse
 Provision of assistance to any member of the OR team in
any manner in which the CN is qualified. Identification of
any potential environment dangers or stressful situations.
 Maintenance of communication link between events and
team members as the sterile field and persons not in the OR
but concerned with the outcome of the operation.
Circulating Nurse
 Direction of the activities of the learners.
 Communication links inside and outside the OR.
 Charting/Organizing.
Division of Duties of Scrub and
Circulating Nurse
 Duties Circulating Nurse
Preliminary Preparations of the OR
Done before First Operation of the day.
Housekeeping duties that must be done at least
1 hour before scheduled incision time.
Duties Circulating Nurse
Remove unnecessary equipments and tables from the
OR.
Perform dusting using a damp cloth wet with
disinfectant.
OR light furniture, etc.
Disinfect the floor.
Turn on aircon.
Before each operation and
After the room is cleaned
Secondary Preparations of the OR
Place a clean sheet, arm straps and a pillow on the
OR table.
Position OR light, tables and check for proper
functioning.
Assemble and check
suction machine.
Provide a clean kick bucket.
Before each operation after the
room is cleaned
Arrange furniture according to use.
Obtain sterile instruments, sets, drapes and sterile
supplies that will be needed during operation.
Refer to surgeon's preference card for additional
supplies.
When Patient Arrives

Greet and identify the patient.

Check the patient's chart for consent and if
Preoperative preparations are carried out.
Be sure to cover the patient's hair with the cap.
Transfer the patient to OR table.
Make the patient comfortable.
During Induction of Anesthesia:

Help/ assist the anesthesiologist in positioning

the patient.
Assist the patient in assuming the position for
anesthesia.
Anticipate the anesthesiologist's needs.
 If spinal anesthesia
Place the patient in quasi fetal position, provide
pillows.
Perform lumbar prep aseptically.
Anticipate anesthesiologist's needs.
After the Patient is Anesthetized

Reposition the patient per anesthesiologist's

instruction
attach anesthesia screen and arm boards.
apply restraints on the patient.
Expose the area for skin preparation.
Catheterize the patient.
Turn on OR light.
Perform skin prep.
 During Operation

Be alert to anticipate the

needs of both sterile
and unsterile team
members.
Collect soiled sponges for
counting.
Monitor blood loss
Charting Watch out for any
break in aseptic technique.
During Closure

Assist in counting sponges, needles and instruments.

Report count as to complete or incomplete.
After Operation
Assist the surgeon and assistants
in removing their gowns.
Assist with dressing.
Clean the patient.
Transport the patient to Recovery Room (RR),
Intensive Care Unit (ICU) or ward.
Endorse the patient properly.
 Duties of the Scrub Nurse
Check instruments and supplies.
Do a complete scrub
Gown and Glove
Drape and Mayo Stand – mayo cover first then mayo
towel.
Count sponges, surgical needles and instruments as the
C.N stands to countercheck the counting.
Duties of the Scrub Nurse
Arrange the instruments on the mayo table and on the back
table.
ex. Mayo Table – scissors, knife/ scalpel
clamps, graspers, and army – navy.
Place blade on the knife handle. Assemble suction tip and
suction tube.
assemble the drapes according to use and ready the towel
clips.
Prepare sutures and needles according to use.
 When Surgeon Arrives After
Scrubbing
Gown and glove the surgeon and his assistants as
soon as they arrive.
Assist in draping the patient according to routine
procedure.
 When Surgeon Arrives After
Scrubbing
Bring mayo stand and back table in position after
draping is completed.
Drop the end of the suction tube and cautery cord for the
circulating nurse to connect to their proper attachment.
Check suction machine.
 During Operation

Provide 2 sponges on the operative site prior to skin incision.

Pass the first knife for the skin to the surgeon's needs.
Pass instruments in a decisive and positive manner.
watch out for signals and keep instruments as clean as
possible.
During Operation
Notify C.N. if you need additional instruments as clean
as possible.
Keep two clean sponges on the field.
Save and care for tissue specimen according to hospital
policy.
Maintain sterile technique and
watch for any breaks.
 During Operation
Step away from sterile field of contaminated.
Change gloves when pricked by needles.
Do not turn your back from sterile field.
Keep sterile field as dry as possible
Discard soiled sponges from a sterile field.
Keep talking to a minimum.
 During closure
Count sponges, needles and instruments with C.N.
Always ready your sutures, clamp, forceps, and
straight scissors.
Have a clean damp sponge ready to clean the
incision site.
Have a dressing and
antiseptic ready.
Assist in application of
pressure dressing.
 After Scrub Person Scrubs
Fasten the back of the scrub person's gown.
Open package of the sterile supplies.
Assist the scrub nurse in counting the sponges,
needles and instruments. write the figure on the
white board.
After Surgeon and Assistants'
Scrub
Assist with gowning.
Observe for sterile technique during draping.
Assist the scrub nurse in moving the mayo stand and
back table
Focus OR light
Position kick buckets on
the operating side.
Connect suction tube
to suction machine.
Informed Consent/Operative Permit/Surgical
Consent: LEGAL document required for certain
diagnostic procedures or therapeutic measures
including surgery
PURPOSE: Protection
Major Elements of Informed Consent
• Given voluntarily
• Given to individual who have the capacity to
understand.
• Given information to be the ultimate decision maker.
Requisites for Validity of Informed
Consent
• Written consent made by the client.
• No signs of pressure
• No Sedation
• 24 hours before elective surgery
• emancipated minor
• Legal age and mentally capable
• 2 surgeons signed the consent in emergency.
• Authorized representative-minor,
unconscious, psychologically incapacitated.
Exemptions for consent:
 Emergency cases
 Life threatening conditions
Unconscious

Nursing Consideration:
 No sedation
 the surgeon explains the consent
 The role of nurse is ADVOCATOR
 Types of Consent
 General Consent
- Signed upon admission
- Authorizes the physician in
charge and hospital staff to
render such treatment or
perform such procedures, as
the physician deems
advisable.
- Applicable only to routine
duties carried out.
 Informed Consent/
Operative Permit
- Signed before the
procedure is performed.
- For specific procedures,
that can possibly injure the
patient.
3 Division of OR Suite

Unrestricted
area

Semi-restricted
area

Restricted area
 Unrestricted/ Unsterile Area
 this area is isolated by doors from the main
hospital corridor.
Semi-restricted/ Semi-sterile
Area
 OR attire is required. This area includes peripheral
support areas and access corridors to the OR.
Restricted/ Sterile Area
 marks are required to supplement OR attire. Sterile
procedures are carried out in this room.
Dressing Rooms and Lounges
 Clothes changing areas must be provided for both
men and women. Access is from an unrestricted area
to change from street clothes to OR attire before
entering the semi restricted areas or vice versa.
Scrub Room
 for surgical scrubbing and must be provided adjacent
to each OR.
Furniture and other equipments

 OR Table/ Operating Table – divided into bed, body

and leg sections.
Instrument Tables
Mayo Stand/Table Small tables

placed just above and for patient’s preparation

across the patient serves equipments.
to bring near the Ex. Skin Prep
operative field.
Other Equipments
 Anesthesia machine and tables for anesthesiologist’s
equipments.
Other Equipments
 Sitting stools and standing flat forms or foot stools.
 IV stands
Other Equipments
 Suction Machine, bottles and tubing.
 Linen bumper
 Kick buckets in wheeled bases
 Operating Room Attire
 Consists of body covers such as
scrub suit, head cover, mask
and scrub shoes.
Purpose:
To provide effective barriers
that prevents the dissemination
of microorganism to the
patient.
 Points to Remember:
 Only approved, clean OR attire must be worn within the
restricted area of the OR.
 OR attire is not worn outside the OR suite.
 Eyeglasses should be wiped with the tissue wet with antiseptic
solution to prevent cross contamination.
 Personal hygiene must be emphasized.
 Points to Remember:
 No unauthorized person should be permitted in the OR.
 Personnel with skin diseases or wounds must never be
allowed to scrub.
 Jewelry and nail polished should not be worn inside the OR.
 Components of attire:
 Body Cover – must be done
before entering a restricted or
semi restricted areas.

 Head Covers – cap protects the

garment/ body cover from
contamination by hair.
 Shoe Covers/ Scrub  Mask – must be worn in
Shoes – must be worn to restricted area to contain or
prevent spread of filter microorganisms
microorganisms. expelled from the moth and
nasopharynx by coughing.
  Gloves – a pair of
sterile gloves completes
the attire for sterile
team members.

 Gown
– a sterile gown is worn over the
scrub suit to permit the wearer
to come within the sterile field.
Criteria for Attire:
Effective barrier for microorganisms
Resistant to blood and aqueous fluid abrasion to prevent
penetration by microorganism.
Designed for maximal skin coverage.
Hypoallergenic, cool and comfortable.
Pliable material to permit freedom to movement.
Easy to don and remove.
Surgical Scrubbing
The process of removing as many as microorganisms as
possible from the hand and arms by mechanical washing
and chemical antisepsis before participating in an
operation.
 Purpose:
To decrease the number of microorganism on the skin.
To keep the population of microorganism minimal during the
operative procedure by suppression of growth.
To reduce the hazard of microbial contamination of the operative
wound by skin flora.
Preparation for Surgical Scrubbing:
Skin integrity of hands and arms must be
intact.
Remove all finger jewelry because it
harbors microorganism
Be sure that all hairs are covered by
headgear because they are potential
foreign body inside the operative
wound
Preparation for Surgical Scrubbing:

Adjust mask snugly and comfortably on

the nose and mouth

Adjust eyeglasses comfortably in relation

to mask.

Adjust water to comfortable

temperature.
Method of Surgical Scrubbing
Time Method
allotting a prescribed length
of time.
Brush Stroke Method
allotting prescribed number of
strokes to each sides of the
hands.
Principle involved
 Surgical scrubbing starts from the cleanest area to the
dirtiest area. (fingers, hands, arms and elbows 3 inches
above)
Prerequisites to Surgical Scrubbing

Wear scrub suit, put on mask cover all hair with a cap.
Remove jewelries
Fingernails must be short and no nail polish.
Hands must be free from wounds.
Eyeglasses must be washed and secured.
 Scrub Room
– area wherein surgical scrubbing is done.
Equipments for Surgical Scrubbing
Antimicrobial Solution – contained in a liquid soap
dispenser near the sink often operated by foot pedal.
Deep sink with foot or knee controls for water
Nail cleaning tool-file or orange stick.
Surgical scrub brushes
 Procedure: Time scrub method

Wet hands and forearms under running water, holding

the hands above the level of the elbows so that the
water runs from the fingertips to the elbows.
Apply 2-4 mL of antiseptic solution to the hands. Use firm
rubbing circular motion to wash the palms and the back
of the hands, wrists and forearms, interlace the fingers
and thumbs and move the hands back and forth.
Clean the nails with a file or an orange stick. Rinse hands and
arms under running water while keeping the hands higher than
the elbows.
Get a sterile brush and rinse it under running water. Apply
antiseptic on the brush. Start brushing the fingernails, back
and the palm of the hand, forearm and the elbow while
allotting a prescribed time of brushing for each part.
At the end of the scrub dry your hands with a sterile towel
beginning at the tip of the fingers to the elbow. Rotate the
towel and repeat the procedure on the other hand. Proceed to
put on a sterile gown.
 Time allotted:
 Left hand – 1 minute  Left hand – 1 minute
 Left arm – 1 minute  Right arm - 1 minute
 Left elbow – ½ minute  RINSE BRUSH
 RINSE BRUSH  Right hand - 1 minute
 Right hand - 1 minute  Right arm - 1 minute
 Right arm - 1 minute  RINSE HANDS, ARMS AND
 Right elbow – ½ minute BRUSH
 RINSE HANDS, ARMS  Left hand – ½ minute
AND BRUSH  Right hand – ½ minute
 RINSE HANDS, ARMS AND
BRUSH AND PROCEED TO
OR
BRUSH STROKE METHOD
 Follow the procedure of time method from nos. – 1-5 except
that instead of allotting time, you’re going to allot prescribed
no. of strokes for each part.
Prescribed no. of Strokes
 Left hand: Nails – 20 stroke across nails.
 Fingers – 10 strokes to each side
 Hand – 10 strokes to each side
 Left arm – 6 strokes to each side
 Left elbow – 6 strokes
 RINSE BRUSH
 Repeat the above procedure to your right hand.
 RINSE HANDS, ARMS AND BRUSH
Prescribed no. of Strokes
 Left hand – nails – 10 strokes, fingers – 5 and hand - 5
Left arm – 3 strokes to each side.
 RINSE BRUSH
 Repeat above for right hand then rinse hands, arms and
brush.
 Left hand – nails – 5 strokes, fingers – 3 and hand – 3 then
brush then rinse
 Repeat above for right hand then rinse hands, arms and
then discard brush, rinse hands, arms. Turn off the faucet
then proceed to OR.
Gowning and Gloving
The sterile gown is put on after the surgical scrubbing.
The sterile gloves are put on immediately after
gowning.
Purpose:
Sterile gowns and gloves are worn exclude skin as
possible contaminant and to create a barrier between
sterile and unsterile areas.
Gowning
 Reach down to the sterile package and lift the folded
gown upward.
 Move one step backward for safety margin while
gowning.
Gowning
 Holding the folded gown, carefully locate the neck
band.
 Unfold the gown and be careful not to touch the
outside portion of the gown.
Gowning
 Slip both hands into the arm holds simultaneously.
Gowning
 The circulating nurse brings gown shoulders by
reaching inside the shoulder and arm seams. The
gown is pulled out the lowering the sleeves extended
to both hands. The back of the gown is securely tied or
fastened at the neck and waist.
Closed Gloving Technique
 Using the left hand, while keeping it within the
cuff of the left sleeve, pick up the right glove.
 Place the palm of the right glove against the

palm of the right hand. Glove fingers must be

pointing toward the wearer.
Closed Gloving Technique
 Secure hold the lower portion of the cuff of the
right glove with right hand that is still hidden
inside the sleeves. Secure upper portion of
cuff of the glove with your left hand.
Closed Gloving Technique
 Slip/slide your right hand into the right glove.
Arrange sleeve and glove with your left hand.
 Do the same procedure in donning the left

glove.
Removing gowns and gloves:
 the gown is removed first before the gloves.
Sterile Field
– any area covered with a sterile drape.
Principle of Sterile Technique
 Only sterile items are used within the sterile field.
 If you are in doubt about the sterility of anything,
consider it unsterile.
Principle of Sterile Technique

 Gowns are considered sterile ONLY from the

waist to shoulder level in front and themselves.
 Sterile persons keep hands in sight and at or
above waist level.
Principle of Sterile Technique

 Hands are kept from the face and never held

under the axillaries region.
 Changing table levels are avoided.
 Items dropped below waist level are considered
unsterile.
Principle of Sterile Technique
 Tables are considered sterile only at table level.
 Anything that extends below the table level is
considered unsterile.
 In unfolding sterile drape, the part that drops
below the table level is considered unsterile.
Principle of Sterile Technique

 Sterile persons touch only sterile items or areas,

unsterile persons touch only unsterile items or areas.
 Unsterile persons should not directly get in contact
with the sterile field. Use sterile transfer forceps.
Principle of Sterile Technique

 Unsterile persons a void reaching over a sterile field

and sterile persons avoid leaning over an unsterile
field.
 In pouring into a sterile field and sterile persons
avoid leaning over the basin to avoid over reaching.
Principle of Sterile Technique
 The scrub nurse should set the basin or glasses to be
filled at the edge of the sterile table.
 Surgeons turn away from the sterile field and to
have perspiration removed from the brow.
 Principle of Sterile Technique
 Sterile persons keep well within the sterile area.
 Sterile persons pass each other back to back.
 Sterile persons turn back to non-sterile person or
area when passing.
Principle of Sterile Technique
 Unsterile persons avoid sterile areas.
 Unsterile person should maintain at least 1 foot
distance from any sterile area.
 Unsterile persons never walk between 2 sterile
areas.
Principle of Sterile Technique
 Sterile field is created
as close as possible to
the time of use.
 Sterile areas are
continuously kept in
view.
 Destruction of integrity
of the microbial barriers
results in contamination.
 Microorganisms must be
kept to a minimum.