1.

GATHERING PACKS
2. MEDICAL HANDWASHING
3. OPENING THE PACKS
A sterile field is a work surface area prepared to hold sterile equipment during a sterile technique procedure. It
provides an area in which sterility is continually maintained.

Do medical handwashing To deter the spread of microorganism.

The first flap of the big pack should be facing the sink.
To ensure placement of the gowns and drapes after
opening the pack.
Open and remove the sterile pick-up forceps from its
wrapper
With the use of the sterile pick-up forceps, position the
drapes and gowns on opposite upper corners of the
table by grasping the bottom parts.
Content:
- 5 OR gowns
The gowns are usually positioned near the scrub room/
sink to avoid overreaching.
The sterile pick-up forceps will be used to manipulate
anything that is within the sterile field.
Allows enough space at the center of the table where
all necessary instruments will be placed.
- 1 mayo cover
- 5 OR towels
- 1 foot drape, head drape, lapsheet
Unwrap the following using the banana peel technique, c. Cutting instruments
while checking the integrity and exp. date d. Accessory instruments
a. Big and heavy individually packed instruments e. Suture basin- inline w/ towels then sparate
b. Abdominal set f. Suture book
Open the pack of MS (medium sponge) and place it Counting each sponge as you place it in the round
one by one in the big round basin using the sterile basin ensures completeness before the start of the
pick-up forceps. surgery.
Open and drop the surgical blades in the small round Open and drop the needles and sutures in the small
basin round basin
Open the outer wrapping of the sterile gloves and Ensures sterility of the gloves.
discard. Hold then fold the inner wrapping inside out.
Using the sterile pick-up forceps, remove the gloves Promotes organization.
and place it inline w/ the gowns.
Always keep close watch on the open sterile items Ensures sterility of all the items.

4. SURGICAL HAND SCRUB

Check for completeness of supply. Anti-microbial
soap, surgical brush
Remove all pieces of jewelry, including the wedding
ring.
Trim nails if needed. No nail polish or artificial nails
should be worn.
Wear a surgical cap and a disposable mask. Fold the
sleeves 2 inches above the elbow BECAUSE IT MAY
WET THE SLEEVES AND CONSIDERED IT
CONTAMINATED
Stand before the sink keeping the body away from it.
Turn on the faucet and adjust the pressure using the
foot, knee or elbow control.
Wet and apply approximately 1 tsp of antimicrobial
soap on the palm and work up a lather.
Using the bristles of brush, make 20 circular strokes
on the nails or fingertips (starting with the less
dominant hand).
Prevents having to stop to obtain those materials
needed.
Jewelry harbors microorganism.
Microorganisms collect in chipped nail polish and
under artificial or long fingernails.
Provides a barrier to reduce the spread of
microorganisms from the hair or respiratory tract.
The sink is considered to be contaminated.
Holding your hands above your elbow, wet the skin
from the fingertips down to the elbow.
Soap emulsifies skin oils and contaminants and
facilitates their removal
The scrubbing action loosens resident bacteria and
contaminants, thus facilitating their removal. Circular
motion mechanically removes microorganisms.
Scrub all skin surfaces using circular strokes:
a. each finger (10) +web space
b. palm (10)
c. back of the hand (10)
d. forearms (divide into 2 then 10 strokes on each of
the 4 quadrants) (10)
After scrubbing the less dominant hand, rinse the
brush then dispense anti-microbial soap then lather it.
Brush the dominant hand
When the scrub is finished on the dominant hand, drop
the brush on the sink.
With the use of foot, knee or elbow control, turn on the
faucet and rinse the arms starting from the fingertips
to the elbow. Then turn off water
Position the hands and elbow above the waist without
touching any part of the scrub uniform.
Enter the operating room using the back or the
buttocks.
The scrubbing action loosens resident bacteria and
contaminants, thus facilitating their removal. Circular
motion mechanically removes microorganisms.
Dispense more soap if its not enough.
Wrist to mid-forearm
The brush contains lather that may contain
microorganisms. Rinsing will remove the lather from
the brush.
To avoid contamination of your hands.
Water should flow from the area of least contamination
to the area of most contamination.
After surgical hand scrubbing, the hands are
considered to be surgically clean. Keeping it in your
line of vision will prevent contamination.
Using this manner when entering the
Operating room will prevent contamination of the
surgically clean hands.
 5. DONNING A STERILE GOWN AND CLOSE GLOVING - If a sterile OR towel is not available, the foot part
of the gown can be used in wiping the hands

Stand on the side of the table where the sterile gowns Contact of outer surface of gown with a dirty or
are positioned. Grasp the center of top sterile gown with clean surface would result in contamination of the
the dominant hand and stand in an area where the gown gown. No choose = contaminate rest of gown
may be opened without risk of contamination. Then
dangle half of gown
Using non dominant hand, grab the foot part of gown and making sure that it will not swing or come in contact
dangle the rest with a portion of your body, thus, causing it to be
contaminated.
Then bend a little, maintain a distance of one arms-length from body to gown, to avoid contamination to gown.
Start pat drying from each of the fingers of dominant Raise up the gown a little higher to locate the
hand to the palm, towards the elbow, making sure the armholes. With the non-dominant facing up, the
swinging gown will not touch the scrub suit. Then do the thumb will locate one armhole and the 4 fingers will
same with the other hand with the same manner. locate the other armhole securely. Then flip, and
release the lower portion of gown
Then start inserting your arms in each of the armholes,
then spread your arm sideways. Do not let hands to slip
Out of cuff, then Rationale
Call for the circulating nurse to tie the ties of the gown
working from behind.
Lift the first glove (for dominant hand) and place it over
your hand anatomically. (Palm to palm Thumb to thumb
Edge to edge) then flip the glove, making sure that the edges lip.
of the cuff is parallel to the edge of your fingers.
Then slowly insert your dominant hand by forming a
closed fist inside the glove, after, pull down the folded
cuff
Then lower the sleeves in order to adjust the gloves and
hands, then at the same time you can maneuver the
gloves to your hands
Extension of arms straight ahead keeps sterile outer
surface of the gown in view and reduces risk of
contamination.
Working from behind the scrub nurse prevents
contamination by the circulating nurse.
Using non-dominant, hold the upper lip if opening of
cuff of glove, then dominant hand holds the lower
Prevents the hands from contaminating the sterile
gloves.
Use the gloved hand to position remaining glove to
your non dominant hand with the same manner
(anatomically) (palm2–thumb2- edge2)
Then flip the glove, and with the same steps as the
dominant hand, don your non-dominant hand
Gloved hands are held above the waist or at the level of
the sterile table to prevent it from becoming unsterile.
6. ARRANGING/ SETTING UP THE MAYO TABLE
Pick up the sterile mayo cover, unfold it, with opening
portion is away from you, hold the close end of mayo
cover and insert it in the cuff
Step the base of mayo table. Then slip the mayo cover
slowly while unfolding the cuff. Move it a little forward
until the end portion of mayo cover is parallel to the
end of mayo table
Get one towel and spread the top of the mayo table,
make sure the end of towel is parallel to end of mayo
tray
After donning of the sterile gown and gloves,
position or place the gloved hands at the chest or on
the sterile top of the back table.
Then it is time to arrange the MAYO TABLE
To prevent dangling while covering mayo table and
avoid contamination
To make the table neat, pull one side pf the cover, then
tuck it under the mayo tray by making a triangle
Then get the abdominal set and place the on top of
mayo tray.
Remove the indicator tape and stick it on anterior
portion of gown since it will be used later. While
unwrapping the pack slowly roll it to prevent from
dangling. Then remove the instruments and set aside.
Use the wrapper as roll towel (no specific way)
Arrange the loose instruments like knife handles,
retractors and tissue forceps in its proper place.
Place the ovum forceps at the back table while the
towel clip is positioned with the rest of the instruments
on the rolled towel
The scrub nurse informs the circulating nurse that
he/she is ready to count. (Initial counting).
Name of ins – count – total
Roll the wrapper neatly and secure with the tape. Place
the rolled wrapper on the left side the mayo table and
position the instruments’ handles over the roll
Unlock the towel clip and pulls out the ovum forceps
from the handles of the instruments.
Mount the blades on the knife handles with the use of
the needle holder
To reduce the incidence of retained sponges and
instruments during surg
Picks up one of the tissue forceps and uses the tip of 3 allis
the handle in counting the instruments. Start the 3 babcocks
2 needle holders
counting by stating the name of the instrument and its 2 army navy
quantity. 1 long thumb 2 thumb forceps
2 knives 2 tissue forceps
1 metz 1 adson w/ teeth
1 mayo scissor 1 adson w/o teeth
1 suture scissor
7 towel clip BACKUP TABLE
12 fine curves 12 non ATR
6 straight clamps NEEDLES
6 big curves SPONGES

Separate 4 towel clips and position it diagonally on

one side or opposite side of the scalpels
Place the 3 towels at the back table. Attach the suction Then 1 towel clip above to facilitate organization
tip to the tubing as well as the tip of the cautery to the throughout the draping of the patient
cautery tip. Then roll tubings properly and place it on
the mayo table.
Bring the drapes to the mayo table and place it over Wait for the surgeon to signal the start of the
the instruments and accessory items. procedure by draping the patient
Take the remaining 4 towels and unfold each towel
with folded portion facing up. Arrange the towels in a
cascading manner.
(4 OR TOWEL, FOOT DRAPE, HEAD DRAPE, LAP
DRAPE)
Then continue the initial counting. INS
7. SERVING THE GOWN AND GLOVE TO THE SURGEON
The scrub nurse will offer OR towel if available, if not the OR Making sure that hand is in the middle of gown, to
gown is used to dry his/her hands. Grab gown with both
hands and offer foot part by unfolding gown.
Once surgeon is drying, locate the anterior part of gown,
place hands inside shoulder portion to expose the armhole
then serve the gown to surgeon, halfway R
The scrub nurse grasps the glove and unfold the cuff.
Checks for holes by inflating the gloves.
While waiting for the surgeon ISULAT SA BOARD
(SURGEON, PROCEDURE, NAME OF THE PT, ANESTH,
TIME IN, BP PRE ANES, SPO2, CARDIAC RATE)
INCLUDING THE ACCOUNTABLE INSTRUMENT
avoid contact with the hands of surgeon.
Then ask the circulating nurse to tie the ties of
the gown, start preparing the gloves, serving
right glove first.
Checking for holes will ensure that the gloves to
be used by the surgeon is sterile. Inflating will
also facilitate easier insertion.
By making smaller cuff using four fingers of each hand,
making sure thumb is facing surgeon/ abducted.
Stretches the cuff of the glove with the four fingers and
thumbs abducted. And inform surgeon “right glove doc”
Exerts a slight upward pressure on the cuff while the
surgeon inserts his/her hand into the glove using firm
downward thrust.
Then release the stretch slowly
8. COUNTING OF THE SIN
9. SURGICAL PAUSE
Face surgon, keep feet apart (or one forward) to
provide support later when gloving
Stretching the gloves will allow the surgeon to
insert his/her hand without touching the scrub
person's gloves. The scrub person protects own
gloved fingers by holding them beneath the cuff
of the glove, and their thumbs by holding them
away from the partly gloved hand.
Pulls the cuff over the wristlet of the gown while
the surgeon slips his/her hand well into the glove.
The procedure is repeated to don the other glove.
 1. INITIATED BY THE CIRCULATING NURSE, IT IS THE TIME THAT ALL PERSON IN THE OR ROOM WILL
INTRODUCED THEIR PART OF THE SURGICALTEAM, MENTION THE NAME OF THE PATIENT AND THE
PROCEDURE BEFORE THE CUTTING TIME

10. SERVING INSTRUMENTS

1. SERVING DRAPES

EXCUSE ME D1, D2, D3 AND FOR THE REST OF THE SURGICAL TEAM, THE third and final COUTING OF INS IS
COMPLETE

11. AFTERCARE
1. Counting for soiled lines is the ovum forceps, after magamit ihatag sa circulating nurse for counting AP,
MS AND OS in the kick bucket, and for the cherry balls, peanuts balls and cottonoids
2. SHARPS PUT ON THE ORANGE TRASHBIN
3. YELLOW TRASH BIN FOR SOILED
4. BLACK FOR THE NON-SOILED LIKE WRAPPER

12. REMOVAL OF GOWN AND GLOVES – anterior contaminated (inside)

 1. THE CIRCULATING NURSE MUST UNTIE THE STRINGS
2. GRASP THE CHEST PART OF GOWN WITH BOTH GLOVED (GLOVES CONSIDERED CONTAMINTED) AND
PULL IT AWAY FROM YOU AND MAKE SURE THAT THE GLOVES WILL NOT BE REMOVED TOGETHER
WITH THE GOWN (contaminated side inside)
3. GLOVE TO GLOVE, SKIN TO SKIN TECHNIQUE OF REMOVING GLOVES
13. Copy the case from the accounting clearance from circulating nurse/ OR staff nurse, meron ding
pagsulatan sa exhibit form booklet, THE CONTENT OF THE EFB (date, what time nagstart ang surgery,
initials ng patient, case number, procedure, staff nurse, signature of the CI)

14. JOTDOWN NB – COPY THE CASE (DATE, WHAT TIME TO START THE SURGERY, FULL NAME SA PT.,
CASE NUMBER, NAME: SURGEON, ANES, PROCEDURE, AND THE POST OPERATIVE DIAGNOSIS)