• Evolution of special operating room (OR) attire as an adjunct to asepsis

paralleled the development of aseptic & sterile techniques in the latter

half of the 19th century
• First use of caps & sterile gowns occured in Germany while principles
of antiseptic surgery were still being debated
• Use of sterile gowns antedated the routine use of caps, gloves & masks
although in 1883 Gustav Neuber insisted that team members wear caps
also
• Various styles of turbans & shower cap- style head coverings were
worn from about 1908 to the 1930s when hair was generally aknowledge
to be an attraction for & shedder of bacteria
• 1897 American surgeon William Halsted designed a semicircular
instrument table to separate himself, in sterile gown & gloves from
observer in street clothes who watched him operate
• Rubber surgical gloves were introduced, not to protect the patient but
to protect the wearer’s hands from harsh irritating solutions
 • Romanian surgeon advocated the wearing of cotton gloves
• Disposable latex gloves introduced in 1958 was a welcome innovation
that saved countless hours of daily glove reprocessing, repairing &
sterilizing
• Gauze masks were advocated by Mikulics in 1897 when the droplet
theory of infection was demonstrated
• In 1924 one of the surgical nursing texts described the attire of the OR
nurses:circulator wore an OR cap but no mask & a gown with a pocket for
a pad & pencil; scrub nurse wore both a mask & a gown with extra pocket
in front for the surgeon’s intruments
• 1930’s & 1940’s scrub dresses began to replace nurse’s regular uniforms
wore under the sterile gown
• In 1950 OR personnel were required to change shoes when entering the
the OR suite & to wear those shoes only when within the suite
 The purpose of the OR
attire is to provide
effective
barriers that prevent the
dissemination of
microorganisms to patients
& protect personnel from
blood & body substances
of patients
OR attire consists of body
covers: 2 piece pantsuit,
head cover, mask & shoe
covers as appropriate;with
a purpose to combat sources
of contamination exogenous
to the patient
A sterile gown & gloves are
added to this basic attire for
sterile team members at the
sterile field
1. Dressing rooms located in the unrestricted area adjacent to the
semirestricted area of the OR suite are reached through the outer
unrestricted corridor
2. Only approved, freshly laundered attire intended for use in the OR is
worn within the semirestricted and restricted areas
3. OR attire should not be worn outside the OR suite or outdoors
4. Impeccable personal hygiene is emphasized
• A person with acute infection, such as a cold or sore throat should
not be permitted within the OR suite;person with cuts, burns, or skin
lesions should not scrub or handle sterile supplies because serum, a
bacterial medium may seep from the eroded area
• Some sterile team members who are known carriers of pathogenic
microorganisms should be treated with appropriate antibiotics until
nasopharyngeal culture findings are negative
 • Fingernails should be kept short
• Jewelry including rings & watches should be removed before
entering semirestricted and restricted areas
• Facial makeup should be minimal
• Eyeglasses should be wiped with a cleaning solution before each
surgical procedure & secured to face with a head strap to prevent
slippage
• External apparel that does not serve a functional purpose should not
be worn
• Hands are washed frequently & thoroughly to remove bioburden
5. Comfortable supportive shoes should not be worn to minimize fatigue
and for personal safety
• Body cover
• Head cover
• Shoe covers
• Masks
• Personal Protective Equipment: Aprons,Eyewear, Gloves
• Surgical Gown
• Surgical Gloves
STERILE GOWN:
 is worn over the scrub suit to permit the wearer to enter the sterile
Field
 it prevents intercontamination between the wearer & the field &
Differentiates sterile from nonsterile team members
 should provide a protective barrier from strike through
STERILE GLOVES:
 complete the attire for sterile team members
 they are worn to permit the wearer to handle sterile supplies &
tissues of the surgical site
 made of natural rubber latex, synthetic rubber, thermoplastic
elastomers, neoprene, vinyl or polyethylene
 is the process of removing as many microorganisms as possible from
The hands & arms by mechanical washing & chemical antisepsis before
Participating in a surgical procedure
 the surgical hand and arm cleansing is done just before gowning &
Gloving for each surgical procedure
 the process of scrubbing is not a sterile procedure
 in scrubbing, the skin is cleansed of as many microorganisms as
Possible; Two processes are commonly used:
1. Mechanical: the process removes soil & transient organisms with
Friction
2. Chemical: the process reduces resident florae & inactivates
Microorganisms with antimicrobial or antiseptic agent
PURPOSE:
• To decrease the number of resident microorganisms on skin to an
irreducible minimum
• To keep the population of microorganisms minimal during the surgical
procedure by suppression of growth
• To reduce the hazard of microbial contamination of the surgical wound
by skin florae
SCRUB SINK:
 adequate scrubbing & handwashing facilities should be provided for
all operating team members adjacent to the OR for safety & convenience
 individually enclosed scrub sinks with automatic sensor controls or foot
knee operated faucets are preferred to eliminate the hazard of
contaminating the hands after cleansing
 the sink should be deep, wide and low enough to prevent splash;a
sterile gown cannot be donned over damp scrub attire without resultant
contamination
 EQUIPMENTS:
• Plastic, single use disposable nail cleaning products are available & are
usually supplied with disposable scrub brushes
• Sterilized reusable scrub brushes or disposable sponges may be used;
single-use disposable products may be a brush-sponge combination are
preferred with impregnated with antiseptic-detergent agents
ANTIMICROBIAL SKIN-CLEANSING AGENTS:
 the following are desirable characteristics of antimicrobial agents:
• Broad spectrum
• Fast-acting & effective
• Nonirritating & nonsensitizing
• prolonged action
• Independent of cumulative action
 ANTIMICROBIAL SKIN-CLEANSING AGENTS:
1. Chlorhexidine Gluconate: reacts poorly against TB microorganisms;
residual effect maintained for more than 6 hours;rarely irritating to the
skin but highly ototoxic & irritating to the eyes;used in brushless/
waterless hand cleaners
2. Iodophors: a povidone-iodine complex in detergent fulfills the criteria
for an effective surgical scrub; minimal residual effect; can be irritating
to the skin
3. Triclosan: does not work with fungi;antiviral action is unknown;
blended with lanolin cholesterols & petrolatum into a creamy mild
detergent; may be used by personnel sensitive to other antiseptics;less
effective
4. Alcohol: ethyl or isopropyl alcohol is rapidly antimicrobial against all
microorganisms;it is volatile & does not have residual activity;nontoxic
but has drying effect to the skin;if other agents cannot be used because
of sensitivity mechanical cleansing with soap could be done followed by
cleansing with alcohol
ANTIMICROBIAL SKIN-CLEANSING AGENTS:
5. Hexachlorophene: is most effective after buildup of cumulative
suppressive action; the action is slow but effective against most gram
positive bacteria;high potential for neurotoxicity makes it unsuitable for
routine use
6. Parachlorometaxylenol: does not substantially reduce microorgansims
immediately; it does not produce sustained residual activity;
its antimicrobial activity can be altered significantly by the composition of
the antiseptic product
 Terminal decontamination, disinfection & sterilization are the
procedures carried out to destroy pathogens on items after their use on
patients during surgery
 process by which chemical or physical agents are used to clean
Inanimate, noncritical surfaces
 a specific contact time is not specified
 a low level disinfectant is commonly used for this purpose

 chemical or physical process of destroying most forms of pathogenic

microorganisms except bacterial spores
 used for inanimate objects but not on tissue
 the degree of disinfection depends primarily on the strength of the
agent, the nature of the contamination and the purpose for the process
 performed in a designated area, not in the operating room immediately
after completion of the surgical procedure
 decontamination begins by wiping instruments as they are used on the
sterile field & then prerinsing, washing, rinsing and disinfecting /sterilizing
for safe handling in the processing department
 decontamination combines mechanical cleaning and a physical or
chemical microbicidal process to make instruments safe for handling
A. Prerinsing / Presoaking
B. Manual Cleaning
C. Washer-Sterilizer / Washer-Decontaminator
D. Ultrasonic Cleaning
E. Lubricating
F. Inspecting & Testing
 Earle H. Spaulding developed a classification system in 1968 to
determine the appropriate processing method to attain the desired level
of disinfection required for patient care items
• Critical items
• Semicritical items
• Noncritical items
LEVELS OF DISINFECTION
1. High level disinfection: process that destroys all microorganisms
except high numbers or bacterial spores
2. Intermediate-level disinfection: process that inactivates vegetative
bacteria, including M. tuberculosis & most fungi & viruses but does not kill
bacterial spores
3. Low- level disinfection: process that kills most bacteria, some viruses
& some fungi but does not destroy resistant microorganisms
•Manual wiping with a chemical-impregnated cloth or sponge
•Soaking by total immersion
•Processing by flush-through machinery
TYPES OF DISINFECTANTS:

1. Chemical Disinfectants (Table 17-1)

2. Physical Disinfectants
• Boiling water
• Pasteurization
• Ultraviolet Irradiation
  process by which all pathogenic & nonpathogenic microorganisms,
including spores are killed
 refers only to process capable of destroying all forms of microbial life
including spores
 it utilizes a sterilizer – a piece of equipment used to attain either
physical or chemical sterilization

1. Thermal (Physical): Steam under pressure / moist heat ; Hot air /

dry heat
2. Chemical:ethylene oxide gas; formaldehyde gas & solution; hydrogen
Peroxide plasma/vapor;ozone gas, acetic acid solution;glutaldehyde
Solution;peracetic acid 0.2% solution; hypochlorous acid
3. Radiation: microwave (nonionizing); x-ray (ionizing)