Surgical Scrub Practices

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Questions and Answers

What is the primary purpose of a surgical scrub?

To increase the moisture level of the skin

To enhance the coloration of the skin

To sterilize the skin completely

To reduce the number of microorganisms to an irreducible minimum (correct)

Which layer of skin is known for containing blood vessels, nerves, and hair roots?

Dermis (correct)

Stratum corneum

Subcutaneous layer

Epidermis

What is the first step in the assisted gloving technique?

Put on the left glove first

Stretch the cuff of the glove

Use a self-gloving technique

Start with the right glove (correct)

What characteristic makes the subungual area particularly prone to contamination?

It is difficult to clean Signup and view all the answers

Which technique is used when changing a contaminated glove during an operation?

Self-gloving with an open technique Signup and view all the answers

During glove removal, how should the glove be held?

By the cuff, about 2 inches from the top Signup and view all the answers

What type of flora consists of bacteria that are normally present below the skin surface?

Resident flora Signup and view all the answers

What does the closed technique for gloving require prior to use?

Completion of a surgical scrub Signup and view all the answers

Which practice can help maintain a minimal population of microorganisms during surgical procedures?

Performing frequent surgical scrubs Signup and view all the answers

What is the purpose of holding a contaminated glove away from the sterile field?

To prevent contamination of the surgical site Signup and view all the answers

What is a recommended guideline for fingernail hygiene in surgical settings?

Fingernails should not extend beyond the fingertip Signup and view all the answers

What is the consequence of performing surgical scrubs infrequently?

Transient flora may significantly increase Signup and view all the answers

What should not be present on the fingernails of personnel involved in surgical procedures?

Fingernail polish Signup and view all the answers

What determines the gloving method to be used?

Level of asepsis and time of gloving Signup and view all the answers

Which of the following best describes the closed gloving technique?

Sleeves and gloves do not touch any skin. Signup and view all the answers

What is an important characteristic of gown fabric?

It must be lint-free and sufficiently porous. Signup and view all the answers

What should be done if a glove is punctured during a procedure?

Change the sterile glove immediately. Signup and view all the answers

What type of gloves are recommended for surgical procedures?

Disposable gloves packaged in peel-packs Signup and view all the answers

Which of the following is a step in the self-gowning process?

Step away from unsterile objects to avoid contamination. Signup and view all the answers

How should gowns be presented to avoid contamination?

Folded inside out to protect the exterior. Signup and view all the answers

What is a key guideline during the gloving process?

Only open enough gloves for the case. Signup and view all the answers

What type of cuff is ideal for sterilization of gloves?

Everted cuff Signup and view all the answers

What should be avoided when handling gloves?

Touching the inside of the glove with bare hands. Signup and view all the answers

What is an indication that a gown has been contaminated?

If it is punctured or torn. Signup and view all the answers

Which material characteristic aids a gown's effectiveness during sterilization?

High drapability and complete steam penetration. Signup and view all the answers

What should be done with gloves if they adhere together due to powder?

Discard them and get a new pair. Signup and view all the answers

What is the purpose of using scrub sinks during surgical scrubs?

To minimize splashback while scrubbing Signup and view all the answers

Which characteristic is NOT necessary for effective chemical antisepsis agents?

Long shelf life without potency loss Signup and view all the answers

What is the correct sequential order for cleansing areas during a mechanical surgical scrub?

Fingernails, fingers, hand, forearm, elbow Signup and view all the answers

Which method requires a prescribed amount of time for scrubbing specific body parts?

Timed method Signup and view all the answers

What is a potential risk associated with using hexachlorophene as an antisepsis agent?

Can be absorbed through the skin as a neurotoxin Signup and view all the answers

What mechanism makes waterless/brushless agents advantageous in surgical scrubs?

Offers antimicrobial protection for extended periods Signup and view all the answers

When performing scrubs, how should hands be positioned to prevent contamination?

Positioned above the elbows Signup and view all the answers

What is the recommended duration for an initial surgical scrub?

10 minutes Signup and view all the answers

What aims to prevent contamination of surgical supplies during a procedure?

Gowning and gloving Signup and view all the answers

What action should be avoided when drying with a sterile towel after scrubbing?

Dripping water onto the sterile pack Signup and view all the answers

During the numbered stroke method, what is typically followed?

A designated stroke count for each area Signup and view all the answers

How should an individual dry their hands after scrubbing?

Utilizing a rotating motion moving from fingertips to elbow Signup and view all the answers

What is the recommended event for using reusable mechanical brushes?

When brushes are freshly sterilized Signup and view all the answers

Which factor is NOT considered when determining the gowning method?

The surgeon’s personal preferences Signup and view all the answers

What is the primary function of alcohol in surgical settings?

As a hand antiseptic before procedures Signup and view all the answers

Study Notes

Surgical Scrub

Skin cannot be sterilized; however, it can be made surgically clean by reducing the number of microbes.
The subungual area under the fingernails is very difficult to clean and particularly prone to contamination.
Fingernails should not reach beyond the fingertip to avoid glove puncture.
Fingernail polish and artificial devices must not cover the natural fingernail.
The number of transient flora is reduced by frequent scrubs, whereas there is a sharp increase in the number of these organisms when the surgical scrub is carried out only occasionally.

Purposes of a Surgical Scrub

Removes soil, debris, natural skin oils, hand lotion, and microorganisms from the dermis of the hands and forearms of sterile team members.
Decreases the number of microorganisms on the skin to an irreducible minimum (near zero).
Keeps the population of microorganisms minimal during the operative procedure by suppression of growth.
Reduces the hazard of microbial contamination of the operative wound by skin flora.

Surgical Scrub Methods

Timed method: A prescribed amount of time is allocated for scrubbing each hand, arm, and elbow area.
Numbered stroke method: A designated number of brush strokes are used for the nails, each finger, palm, back of hand, forearm, and elbow.
Waterless/brushless method: This method utilizes a chemical antiseptic agent as an alternative to the timed or numbered stroke method.

Surgical Scrub Materials

Scrub sinks: Located adjacent to the OR for convenience and safety reasons. Scrub sinks are generally knee- or foot-operated to reduce contamination risks.
Mechanical brushes: Designed for effectively removing microbes from the skin.
- Reusable brushes: Should not cause skin abrasion.
- Single-use brushes: Can be brush-sponge combinations and are individually packaged.
Chemical antisepsis agents: Antimicrobial or antiseptic detergents.
- Requirements: Broad-spectrum antimicrobial agents, fast-acting and effective, non-irritating and non-sensitizing, prolonged action that leaves antimicrobial residue on skin, independent of cumulative action.
- Common brands: Alcohols, Chlorhexidine gluconate (Hibiclens®), Hexachlorophene, Idophors, Povidone-iodine, Waterless/brushless agents, Avagard™.

Surgical Scrub Order

Fingernails
Fingers
Hand
Forearm
Elbow

Surgical Scrub Characteristics

Use firm and brisk brush strokes with short, circular, friction motions.
Devote equal attention to each scrubbed surface.
Use a circular brush stroke rather than a straight stroke.
Hold hands higher than the elbows during and after scrubbing to prevent water from running down the upper arms to the lower arms and hands.
Hold scrubbed hands above the waist, front and center, to prevent touching non-sterile surfaces.

Aseptic Guidelines for Surgical Scrubs

Perform a surgical scrub before each operative procedure.
Wear proper operating room attire when scrubbing in the restricted area.
Hospitals have different policies concerning the length of time to scrub.
Become acquainted with specific hospital scrub policies.
Initial scrub: Generally 10 minutes.
Subsequent scrubs: Generally 3 to 5 minutes.
Thoroughly dry hands and arms with a sterile towel after scrubbing to avoid strike-through contamination of the gown.

Reasons for Gowning and Gloving

Allows personnel to create and work within the sterile field.
Prevents contamination of surgical supplies and equipment.
Protects the wearer and other personnel from contaminants.

Gowning and Gloving Methods

Gowning: Determined by the type of gloving technique and whether it is being performed before or during the procedure.
- Self-gowning: Gowning performed alone.
- Assisted-gowning: Gowning by or for other personnel.
Gloving: Determined by the level of asepsis (gowned or un-gowned) and the time of gloving (prior to or during a procedure).
- Self-gloving: Gloving performed alone.
  - Closed technique: Prevents outside of sleeve or gloves from touching the skin or hands.
  - Open technique: Allows wearer to touch inside of glove with bare hands.
- Assisted-gloving: Gloving by or for other personnel.

Gown Characteristics

Gown types: Single-use (disposable) and reusable.
Gown composition: Must establish an effective barrier, eliminating the passage of microorganisms between sterile and nonsterile areas.
- Lint-free material that is sufficiently porous to eliminate heat buildup.
- Memory-free material.
- Material that possesses a high degree of drapability.
- Material that allows complete steam penetration for sterilization, when reusable.
Gown design: Varies based on usage.
- Sleeves end at the wrist with a tightly fitted cuff.
- Some have fronts and forearms made of double thickness material or water repellent material.
Gown presentation: Folded inside out to prevent contamination of the exterior when picking up the gown to put it on.

Glove Characteristics

Glove types: Disposable and packaged in peel-packs.
Glove composition: Latex or other synthetic material.
Glove design: Should fit snugly with no wrinkling.
- Inside and outside surfaces may be pre-lubricated with an absorbable dry starch powder before sterilization.
Glove presentation: Packaged in pairs with an everted 2-3 inch cuff on each glove to protect its sterility when gloving.

Aseptic Guidelines for Gowning and Gloving

Inspect package for damage or wetness.
Lift gowns and gloves straight up and away from the wrapper.
Gowning:
- Remember gowns are sterile only from waist to chest level in front, including sleeves to 2 inches above the elbow.
- Prevent contamination of the sterile field by changing punctured, torn or wet gowns.
- Self-gowning: Open gown packages on a separate table and away from other packages. Face the sterile field.
- Assisted-gowning: Unfold gown by holding at the neckband, keeping hands on the outside of the gown under a protective cuff. Do not allow gown sleeves to touch below waist level.
Gloving:
- General gloving guidelines: Change gloves immediately if punctured or torn. Hold a contaminated glove away from the sterile field until it can be removed.
- Self-gloving:
  - Open technique: Used for any procedure that does not require a surgical scrub or sterile gown or when changing a contaminated glove during the operation.
  - Closed technique: Used after surgical scrub and after surgical gown is in place.
- Assisted-gloving: Start with the right glove. Hold the palm of the glove toward the person. Unfold the everted cuff over the cuff of the gown sleeve.
Gown removal:
- During an operation (assisted): The contaminated gown is removed after stepping away from the sterile field by having the circulator step up from behind.
- After an operation (self-removal): Roll the gown forward on the arms, then roll up until the gown exterior is enclosed within the gown interior.

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Description

This quiz focuses on the essential practices and protocols of surgical scrubbing, aiming to achieve a surgically clean state for team members. It covers the techniques for reducing microbial presence, the proper care of fingernails, and the importance of frequent scrubbing. Ideal for healthcare professionals seeking to refresh their knowledge on maintaining sterility during surgical procedures.