IOSR Journal of Nursing and Health Science (IOSR-JNHS)

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 6, Issue 1 Ver. V (Jan. - Feb. 2017), PP 61-64
www.iosrjournals.org

Adequacy of Scrubbing, Gowning and Gloving Among

Operating room Nurses
Ms. Anita Kiruba Jeyakumar1, Ms. Sonia Sabu2, Ms. Florence Segeran3.
1
(OR Nursing Department, College of nursing, Christian Medical College, India)
2
(OR Nursing Department, College of nursing, Christian Medical College, India)
3
(OR Nursing Department, College of nursing, Christian Medical College, India)

Abstract: The patient care in the operating rooms (OR) is delivered by a team. Nurse is the primary member of
the team. A uniform practice among nurses will ensure standard of care. One important practice that forms the
base in the prevention of infection is surgical scrubbing, gowning and gloving. The correct performance of these
procedures help to protect a patient from infection. All members of the sterile surgical scrub team are required
to perform a surgical hand scrub and don sterile gown and gloves before touching sterile equipment or the
sterile field. The prevention of surgical wound infections has been a primary concern of the operating room
(OR) team for more than a century. The traditional strategy for prevention, in addition to good surgical
technique itself, has been scrupulous adherence to classic aseptic practice: scrubbing, gloving, barrier clothing
and drapes, instrument sterilization, and a disciplined ritual designed to protect the integrity of the sterile field.
Therefore, surgical aseptic technique is one that is subject to constant change and hence a continuous research
on this topic is essential to keep abreast with the changing trends in the field of surgery to enhance quality
patient outcome.
Keywords: Gloving, Gowning, OR nurses, Practice.

I. Introduction
The traditional strategy for prevention, in addition to good surgical technique itself, has been
scrupulous adherence to classic aseptic practice: scrubbing, gloving, barrier clothing and drapes, instrument
sterilization, and a disciplined ritual designed to protect the integrity of the sterile field. Therefore, surgical
aseptic technique is one that is subject to constant change and hence a continuous research on this topic is
essential to keep abreast with the changing trends in the field of surgery to enhance quality patient outcome.
Cruse and Foord1 showed that aseptic transgressions as punctured gloves are much less important than such
uncontrollable factors as the type of wound (clean, contaminated, or dirty), and the patient's age, health, and
hospitalization history. Above all, most postsurgical infections are endogenous in origin and beyond control by
such techniques as masking, gowning, and gloving. Walter" and Mogio et al"attribute 80% and 77% of wound
infections, respectively, to endogenous agents that were not acquired in the OR.
Nevertheless, breaks in aseptic technique cannot be dismissed as inconsequential. If 80% of the
infections are endogenous, 20% can be traced to the OR and can therefore be minimized by proper technique.
The purpose of this study is to assess the adequacy of practice regarding scrubbing, gowning and gloving and
also associate selected demographic variables and practice regarding scrubbing, gowning and gloving among
OR nurses. The literature and hospital folklore are replete with anecdotal studies such as these. However, there
are no data available to answer the following questions: What breaks in surgical asepsis actually occur? Do
some occur more frequently than others? Are there individual patterns, ie, do certain persons tend to transgress
certain rules or transgress more rules more frequently than others? Is there any event-response relationship
between aseptic transgressions and infection incidence, ie, are some breaks more serious than others or is it a
matter of the number of transgressions during a specific procedure?
Though prescribed steps in procedure for scrubbing, gowning and gloving are available, there seems to
be a great deal of breach in the procedure among the OR team members. Hence a continuous research on this
topic is essential to maintain standard operating procedures across the surgical team. This article is an effort to
assess the adequacy of practice regarding scrubbing, gowning and gloving among OR nurses. This also attempts
to keep abreast with the changing trends in aseptic techniques to enhance quality patient outcome.

II. Materials and methods

After a thorough review of the literature and extensive interviews with recognized authorities in
surgical asepsis, 30 criteria that could be judged on a yes-or-no basis were selected. This observational checklist
which was prepared based on the procedure manual. Content validity of the checklist was done by 2 experts in
Nursing, 1 Anaesthetist (Head) and 1 Surgeon (OR steering committee chairperson). The Content Validity Index
(CVI) is 0.97. This observational checklist contains 15 items on Scrubbing, 10 items on gowning, 5 items on
DOI: 10.9790/1959-0601056164 www.iosrjournals.org 61 | Page
 Adequacy of Scrubbing, Gowning and Gloving Among or Nurses

closed gloving and 5 items on open gloving, with every Yes scoring 1 and No scoring 0. The total score will be
30. The scores were interpreted as >90% being very good,70%-90% as good and < 70% to be poor.
One of us acted as an observer and recorded infractions on a physician-by-physician, case-by-case
basis. A certain amount of subjectivity, inconsistency, and bias was expected at the beginning. With experience,
however, observer bias should be reduced. The observer used Non- probability purposive sampling technique to
identify the samples for study. One day prior to the observation it was made sure that the selected OR nurses
were on duty. Each participant under study were given a sample number. The practice regarding scrubbing,
gowning and gloving was assessed by using the observational checklist. Non participatory observation
technique was used. Around 70 samples of nurses were assessed.

III. Results
The collected data was analyzed and the results are as follows:

Table: 1 – Distribution of nurses according to their demographic characteristics (n=70)

S.No Demographic Variables Distribution of Nurses
No. %
Age group (years)
1. 21-25 42 60
26-35 20 28.6
36-45 8 11.4
2. Gender
Male 4 5.7
Female 66 94.3
3. Qualification
B.Sc. 2 2.9
Diploma 68 97.1
4. Experience (years)
1-5 38 54.3
6-10 19 27.1
11-15 7 10
16-20 6 8.6

60% (44) of the Nurses under study were in the age group between 21-25 years. 94.3% (66) of the Nurses were
females. About 97.1% (68) of the nurses were Diploma holders. 54.3% (38) of them had a clinical experience in
OR for 1-5 years.

Table: 2 – Distribution of adequacy of practice regarding scrubbing, gowning & gloving among OR Nurses
S.No Variables %
1. Scrubbing 75.1
2. Gowning 74
3. Gloving 98.6

Scrubbing practice among the OR nurses was 75.1% and gowning practice among OR nurses was 74% which is
good. The gloving practice among the OR nurses was identified as 98.6% which is very good 21% (15) of the
OR nurses were from orthopedic specialty.

DOI: 10.9790/1959-0601056164 www.iosrjournals.org 62 | Page

 Adequacy of Scrubbing, Gowning and Gloving Among or Nurses

Table: 3– Distribution of overall practice regarding scrubbing, gowning & gloving among OR Nurses (n=70)
S.No Variables %
1. Overall practice 78.6%

The overall Scrubbing, gowning and gloving practice among OR nurses was 78.6% which is good

Table: 6 – Association between selected demographic variables and scrubbing, gowning & gloving practice
(n=70)
S. No Variables Scrubbing Gowning Gloving
2 p-value 2 p-value 2 p-value
1. Age 1. 50 0.946 8.78 0.802 21. 7 0.992
2. Experience 14.5 0.644 7.91 0.659 13. 5 0.999
3. Educational Qualification 3.98 0.912 2.71 0.744 0.266 0.876

Table: 6 shows no association between selected variables and scrubbing, gowning & gloving practice among
OR nurses

IV. Discussion
This study was conducted with a core purpose of assessing the practice regarding scrubbing, gowning
and gloving among OR nurses. It was also intended to identify association among selected variables and the
knowledge and practice. Around 70 nurses participated in this study. Frequency, percentage and chi square were
used to analyze the data. The demographic variables assessed were age, gender, qualification and experience.
Analysis of the variables showed 60% (44) of the Nurses under study were in the age group between 21-25
years. 94.3% (66) of the Nurses were females. About 97.1% (68) of the nurses were Diploma holders. 54.3%
(38) of them had a clinical experience in OR for 1-5 years. One of the objectives was to assess the practice
regarding scrubbing, gowning and gloving among OR Personnel. The present study assessed the practice
regarding scrubbing, gowning and gloving among OR nurses, using an observational checklist which consisted
of 15 items on scrubbing, 10 items on gowning and 5 items on gloving, with a maximum score of 30. Higher
scores revealed very good practice. It was found that scrubbing practice among the OR nurses was 75.1% and
gowning practice among OR nurses was 74% which is good. The gloving practice among the OR nurses was
identified as 98.6% which is very good. Another objective was to associate selected demographic variables with
the practice regarding scrubbing, gowning and gloving among OR personnel. The present study associated the
practice regarding scrubbing, gowning and gloving among OR nurses, using Chi square and identified that there
were no significant associations.
During the study it was observed that most of the samples scrubbed for less than 2 minutes, with the
recommended solution, but using straight strokes. All of them gave more time to scrub the hand and inbetween
the digits that was acceptable. Most of them failed to scrub 2 inches below elbow. All of them were casual in
doing the scrubbing. There is no study supporting these findings.
Out of 70 nurses, 77.1% (54) of them preferred to use reusable gown and 22.9% (16) of them
disposable gown. Using of reusable gowns requires maintenance and manpower from washing, to folding to
autoclaving and distributing. The technique to tie a wraparound requires an about turn, that poses risk for
making the adjacent sterile articles, unsterile. During the study it was observed that few of the nurses failed to
untie the wraparound before draping the trolley. It was also observed that they used sterile bundles as a hold to
wrap around the side piece. These practices defy the principles of asepsis that is, anything below waiste, beyond
vision and above the head must be considered unsterile, and also sterile items when coming into contact with an
unsterile item becomes unsterile.
Using a sterile disposable gown eliminates the above flaws and makes it easier to wear and adhere to
the principles of asepsis because length is medium, there is no wraparound, and there is a card that can be
handed to either a scrub nurse or circulating nurse to finally secure it. The water resistant layers assure total
sterility, because, after scrubbing, the investigator observed that the OR scrubs become wet and water from the
wet scrubs seep through the sterile reusable gown, but not with the sterile disposable gown. This adds to its
advantage.
Out of 70 nurses, 74.3% (52) of them used open gloving and 25.7% (18) of them used closed gloving
technique. Though the open gloving technique is easier than closed gloving technique, there is a risk of
contaminating the sterile glove with the open gloving technique. Closed gloving technique eliminates
contamination. Closed gloving techniques were followed by few senior nurses and almost all junior nurses.

DOI: 10.9790/1959-0601056164 www.iosrjournals.org 63 | Page

 Adequacy of Scrubbing, Gowning and Gloving Among or Nurses

V. Conclusion
The relationship between modern aseptic practice and postsurgical infection control is a classic enigma
of epidemiology. Many precautions, rituals, and procedures have been introduced and implemented during the
last century without any real validation of their efficacy. Certainly not all precautions are of equal importance;
some are probably essential and others may be irrelevant. Compliance with the overall practice regarding
scrubbing, gowning and gloving among OR Nurses was adequate, there’s still a need for rigorous training
towards excellence in this area. The same study can be conducted on a larger sample size.

References
[1]. Major RH: A History ofMedicine. Springfield, Ill, Charles C Thomas Publisher, 1954.
[2]. Earle AS: The germ theory in America: Antisepsis and asepsis 1867-1900. Surgery 1969;65:508-522.
[3]. Wangensteen OH, Wangensteen SD, Klinger CF: Some pre-Listerian and post-Listerian antiseptic wound practices and the
emergence of asepsis. Surg Gynecol Obstet 1973;137: 677-702.
[4]. Lowbury EJL, Blowers R, Cunliffe AC, et al: Aseptic methods in the operating suite: A report to the Medical Research Council.
Lancet 1968;1:705-709, 763-768, 831-839.
[5]. Atkinson LJ, Kohn ML: Berry and Kohn's Introduction to Operating Room Technique, ed 12. New York, McGraw-Hill Book Co,
2014.
[6]. Association of Operating Room Nurses Standards Committee: AORN Standards of Practice. Denver, Association of Operating
Room Nurses, 2015.
[7]. Altmeier WA: Surgical infections: Incisional wounds, in Bennet JV, Brachman PS (eds): Hospital Infections. Boston, Little Brown
& Co,1979, pp 287-306.
[8]. Beck WC, Deshmukh N: Surgical infections, in Gr\l=o"\schelD (ed): Hospital-Associated Infections in the General Hospital
Population and Specific Measures of Control. New York, Marcel Dekker Inc, 2000, pp 1-24.
[9]. Laufman H: The control of operating room infection: Discipline, defense mechanisms, drugs, design, and devices. Bull NY Acad
Med 1978;54:465-483.
[10]. Walter CW: The surgeon and postoperative wound infection. Arch Surg 1979;114:769-770.
[11]. Cruse PJE, Foord R: A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206-210.
[12]. Mogio M, Goldner JL, McCollum DE, et al: Wound infections in patients undergoing total hip arthroplasty. Arch Surg
1979;114:815 823.
[13]. Walter CW, Kundsin RB: The airborne component of wound contamination and infection. Arch Surg 1973;107:588-595.
[14]. Feagin JA Jr: Bacteriology of the operating room with the use of helmet aspiration systems. Arch Surg 1979;114:790-792.

DOI: 10.9790/1959-0601056164 www.iosrjournals.org 64 | Page