Scrubbing, Gowning, and Gloving
Before you scrub, you have to set up your gown and gloves on a separate table. The first thing you do is check the integrity of the package. Make sure that it's intact, and then you can open it onto your separate Mayo before you scrub. It's away, to the side, to side, towards. And usually the gowns are wrapped so that the sides present themselves in the order that they're to be opened. So to the side, to side, towards.
Now you're going to bring your gloves, and we double glove every time we scrub. Checking the integrity of the package, making sure that the expiration date is okay. Open the gloves separately, onto the sterile field. Now the second set of gloves is going to be opened. Checking integrity of the package. And now we're ready to scrub.
So you wet your hands and you get some soap and you wash your hands like you would wash your hands at home or at a medical office. You do the medical hand wash by making sure get in the webbed spaces, and you can even go like that to do your nails. And once you finish your medical hand wash, it take- the medical hand wash is like your "Happy Birthday" hand wash. When you wash your hands at home, "Happy Birthday To You" or "The ABCs", so, it's the same thing.
And then you rinse your hands off, and what we try to do is to go from clean to dirty, your fingertips being clean and your wrist being the dirty part, and up further than that. So clean to dirty, not dirty to clean, always clean to dirty.
Same thing when you dry your hands, you start at your fingertips, and you go to up your arm. And you make sure that you don't touch anything because you just did the medical hand wash before you're doing your scrub.
Again. Getting the paper towels out without touching anything. Drying your hands from the fingertips to the wrist to the elbow. So that when you scrub and you rinse your hands and arms you do the exact same thing: clean to dirty.
So, now we're going to grab our scrub brush. We're going to check the integrity of the package. Make sure it's okay. Then you're going to dispose of the paper. The first thing you're going to do is take the pick we call it, our fingernail file, and do underneath your fingernails under the running water. So, each finger nail is done under the running water. And we usually do either a timed scrub or a brush strokes scrub. And we're going to do the brush strokes scrub here.
Now you're going to do fingernails again with the bristle brush, and then you're going to do 30 times on each hand.
Then you're going to go to your fingers and you'll start either at your thumb or your little finger so you know where you started and where you end. And there's four surfaces on each finger, so you do 10 strokes back and forth, one stroke is back and forth, on each surface. And you do that each finger.
So here we do one hand, one arm, one hand, one arm. Some places are a little different, depends on the institution you're at.
Once you're finished with all your fingers, you break your hand up into four spots: palm, side, side, top. Same thing, 10 strokes, one stroke being back and forth.
Then once your palm- once your hand is all done, you break your arm up into three- three areas, four surfaces. 1, 2, 3, 4. To about two inches above your elbow.
Then rinse, and repeat on the second hand.
Again fingertips to elbow, clean to dirty, clean to dirty, clean to dirty, can't emphasize that enough. Now you're going to repeat on the- the same thing on the second hand and arm.
You proceed to your gown and gloves. Exaggerate your stance. Grab the corner of the towel without dripping onto the sterile field. Take the towel open it up. Use one side for one hand. Again fingertips to elbow without going back. Clean to dirty, clean to dirty. If you go back, you're bringing the dirty to the clean. So then you'll flip the towel, and do the same thing on the other hand. Dry your hand from clean to dirty. Fingertips to elbow.
So, when you do the surgical scrub, you're not sterile, you're surgically clean. You're not sterile until you put the gown and gloves on.
So then you're going to grab your gown without touching the paper. Put the writing in the gown towards you. The gown should-the sleeves should be there, the gown should open right up. Just let it drop, don't try to shake it. No shaking in the OR.
Then the circulator will come and tie the back of your gown. And you're going to put your gloves on, making sure that your fingertips do not come through the white cuff of the gown. The white cuff of the gown is the only part of the gown that is compromised, so, because it's not fluid resistant like the rest of the gown.
Then putting the gloves on, you flip the glove up with the fingertips of the glove towards your elbow, and the thumb down towards the thumb. This is closed gloving.
So this helps you maintain the sterility of the gown. And remember your hands are only surgically clean, so, now the gloves are sterile. Same thing on the second hand. Fingertips to the- up towards your elbow, and the thumb down towards your palm or your thumb.
Closed gloving. So the second pair of gloves, it doesn't matter how you put them on because you've already made- you've already created your sterility by putting the gowns on in a closed glove fashion.
Second pair of gloves. Always double glove, no matter what. The research supports double gloving. It helps to prevent any spread of infection from needle sticks or any kind of sharp injury.
So then you're going to take your… left hand, hold the tag. You're going to give the tag to the circulator. The circulator's going to walk around you. You're going to grab the other tie and tie it, again maintaining your sterility. Your back is never sterile, but you still have to have a sterile back.
So, you're sterile from your- a little bit above your elbow to your fingertips and from your chest to your waist.