Surgical Hand Scrub.pdf

COLLEGE OF NURSING Silliman University Dumaguete City SURGICAL HAND SCRUB Definition: The removal of as many dirt and bacteria as possible from the hands an...

COLLEGE OF NURSING Silliman University Dumaguete City SURGICAL HAND SCRUB Definition: The removal of as many dirt and bacteria as possible from the hands and arms by mechanical washing and application of antiseptic before taking in surgical procedure. Purpose: 1. Remove debris and transient organisms from the rates, hands, and forearms. 2. Reduce the resident microbial count to a minimum. 3. Inhibit rapid rebound growth of microorganisms. 4. Minimize regrowth of microorganisms on hands and reduce contamination of the operative site by recognized or unrecognized breaks in surgical gloves. Equipment:  Toilet soap in a soap dish  Betadine cleanser in a dispenser  Hand Brush  Sink with knee operated control Note: The hand brushes are soaked in a sterile container with untinted zephiran solution. STEPS RATIONALE ASSESSMENT 1. Follow institution’s policy regarding Guidelines vary regarding ideal time needed required length of time for hand wash. for surgical scrub. 2. Be sure fingernails are short, clean and Long nails and chipped or old polish increase healthy. Artificial nails should be number of bacteria residing on nails. Long removed. fingernails can puncture gloves, causing contamination. Artificial nails may harbor  Critical decision Point: gram-negative microorganisms and fungus. Nail polish should be removed if chipped or worn longer than 4 days because there is a tendency after that time for nails to harbor greater numbers of bacteria (AORN, 1999b). 3. Assess for presence of allergies to soap Reporting allergies to soap or disinfectants or disinfectants. Report such to the may prevent hypersensitivity reactions. clinical instructor and O.R. Supervisor immediately. 4. Inspect condition of cuticles, hands and Cuts, abrasions, exudative lesions, and forearm for presence of abrasions, cuts or handnails tend to ooze serum, which may  open lesions. contain pathogens. Broken skin permits microorganisms to enter various layers of the skin, providing deeper microbial breeding grounds (AORN, 1999b). 5. Be sure if wearing a two-piece pant and Prevents brushing against sterile area. top scrub suit, that the top is secured at the waist and tucked into the pants. NURSING DIAGNOSIS Nursing Diagnoses Risk of infection Risk for injury Related factors are individualized based on patient’s condition or needs. Indicates microorganisms are not transferred to PLANNING the patient and sterile field. 1. Identify expected outcomes following completion of procedure: Patient will not develop signs of surgical wound infection. 2. Remove watch, rings, and bracelets. Jewelry harbors microorganisms and interferes with access to all surfaces of skin to be cleaned. 3. Wash hands. Reduces transfer of microorganisms. 4. Prepare equipment. Ensures availability before the procedure. 5. Be sure sleeves are above elbows and Scrubbed hands and arms can become uniform is fitted or tucked at waist. contaminated by brushing against loose garments. IMPLEMENTATION 1. Put on surgical attire: shoe covers, cap, Masks prevent escape into air of facemask, and protective eyewear. microorganisms that can contaminate hands. Other protective wear prevents exposure to blood and body fluid splashes during the procedure. 2. Turn on water using knee or foot Knee or foot controls prevent contamination of controls. hands after scrub. 3. Wet hands and arms under running water Water runs by gravity from fingertips to and lather with detergent up to 2 inches elbows. Hands become cleanest part of upper  above the elbows. (Hands need to be held extremity. Keeping hands elevated allows above elbows at all times). water to flow from least to most contaminated areas. Washing a wide area reduces risk of contaminating overlying gown that the nurse later applies. 4. Under running water, clean under nails of Removes dirt and organic material that harbor both hands with orange stick. Discard large numbers of microorganisms. after use. 5. Rinse hands and arms thoroughly under Rinsing removes transient bacteria from running water. Remember to keep hands fingers, hands, and forearms. above elbows. 6. Pick one brush and rinse off disinfectant under running water using forceps provide for. 7. Saturate brush with antimicrobial detergent and get enough solution to spread over both hands and arms. 8. Holding brush perpendicular, scrub the Scrubbing loosens resident bacteria that adhere palm, each side of the thumb, and fingers, to skin surfaces. Ensures coverage of all and the posterior side of the hand with 10 surfaces. Scrubbing is performed from cleanest strokes each. The arm is mentally divided area (hands) to marginal area (upper arms). into thirds and each third is scrubbed 10 times. Entire scrub should last at least 3 minutes (AORN, 1999b). Rinse brush and repeat the sequence for the other arm. 9. Rinse brush as well as both hands and arms. 10. Saturate brush with betadine and spread solution to both hands and forearms. 11. Holding brush perpendicular, scrub the palm, each side of the thumb, and fingers, and the posterior side of the hand with 10 times. Entire scrub should last at least 2 After touching skin, brush is considered minutes (AORN, 1999b). Rinse brush contaminated. Rinsing removes resident and repeat the sequence for the other arm. bacteria. Prevents accidental contamination. 12. Drop brush and rinse hands and arms thoroughly allowing water to flow from fingertips down to elbow. Turn off water with foot or knee control and back into room entrance with hands elevated in front and away from the body. 13. Enter major room. 14. Bending slightly forward at the waist, pick a sterile hand towel. Step back from the table and slightly leaning forward,  dry one hand thoroughly moving from fingers to elbow. Dry in a rotating motion. Dry from cleanest to least clean area. 15. Repeat drying method for other hand, Drying prevents chapping and facilitates using a different area of the towel or a donning of gloves. Leaning forward prevents new sterile towel. accidental contact of arms with scrub attire. 16. Discard towel. Prevents accidental contamination. EVALUATION Observe the patient for signs of localized Signs of infection include redness, heat, wound infection (usually occurs 2 to 3 days swelling, pain, and drainage. post-op). RECORDING AND REPORTING No recording is required for hand washing. Record area and description of surgical site postoperatively to provide baseline for monitoring would. UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS  Redness, heat, swelling, pain, or drainage may develop at surgical site as a result of infection. Institute appropriate would care.  In the event a pattern of surgical would infections occurs, the hospital infection control team will monitor trends from the opening rooms in an effort to trace origin. This may include cultures of nails and hands of staff, soap dispensers, etc.  COLLEGE OF NURSING Silliman University Dumaguete City PERFORMANCE CHECKLIST THE SURGICAL HAND SCRUB Student: _________________________________ Instructor: _______________________________ Instructor’s Signature: ____________________ Date: _______________ 1 2 3 4 ASSESSMENT 1. Follow institution’s policy regarding required length of time for hand wash. 2. Make sure fingernails are short, clean and healthy. 3. Assess for presence of allergies to soap or disinfectants. Resort such to the clinical instructor and O.R. Supervisor immediately. 4. Inspect condition of cuticles, hands, and forearm for presence of abrasions cuts, or open lesions. 5. Make sure if wearing a two-piece pant and top scrub suit that the top is second at the waist and tucked into the pants. NURSING DIAGNOSIS Develops appropriate nursing diagnoses based on assessment data. PLANNING 1. Identify expected outcomes following completion of procedure:  Patient will not develop signs of surgical wound infection. 2. Remove watch, rings, and bracelets. 3. Wash hands. 4. Prepare equipment. 5. Make sure sleeves are above elbows and uniform is fitted or tucked at waist. IMPLEMENTATION 1. Put on surgical attire: shoe covers, cap facemask, and protective eyewear. 2. Turn on water using knee or foot controls. 3. Wet hands and arms under running water and lather with detergent up to 2 inches above the elbows. (Hands are held above elbows at all times). 4. Under running water, clean under nails of both hands with orange stick. Discard after use. 5. Rinse hands and arms thoroughly under running water. Keeps hands above elbows. 6. Pick one brush and rinse off disinfectant under running water using forceps provided for. 7. Saturate brush with antimicrobial detergent and gets enough solution to spread over both hands and arms. 8. Hold brush perpendicular, scrubs the palm, each side of the thumb, and fingers, and the posterior side of the hands with 10 strokes each. The arms are mentally divided into thirds and each third is scrubbed 10 times. Entire scrub last at least 3 minutes (AORN, 1996b). Rinses brush and repeats the sequence for the other arm. 9. Rinse brush as well as both hands and arms. 10. Drop brush as well as both hands and arms thoroughly allowing water to flow from fingertips down to elbow. Turn off water with foot or knee control and back into room entrance with hands elevated in front and away from the body. 11. Enter major room. 12. Bend slightly forward at the waist, pick a sterile hand towel. Step back from the table and slightly leaning forward, dry one hands thoroughly moving from fingers to elbow. Dries in a rotating motion. Dry from cleanest to least clean area. 13. Repeat drying method for other hand, using a different area of the towel or a new sterile towel.