SCRUBBING ,GOWNING AND

GLOVING
 Proper aseptic techniques is one of the most
fundamental and essential principles of infection
control in the clinical and surgical settings
 Aseptic Techniques are those which:
 Remove/reduce or kill microorganisms from hands
and objects
 Employ sterile instruments and other items
 Reduce patients risk of exposure to
microorganisms that cannot be removed
 Aseptic technique also encompasses practices
performed immediately before and during a
surgical procedure to reduce postoperative
infection:
 Hand washing
 Surgical Attire
 Surgical scrub, sterile gowning & gloving
 Patients surgical skin prep
 Using surgical barriers, including sterile surgical
drapes
 Maintaining a Sterile Field
 Using safe operative technique
 Maintaining a safe environment in the OR
 Peri – Operative Nursing
Includes all nursing activities carried out by the nurse during the pre, intra
and post operative phase.
 Pre – Operative phase
- before the surgical procedure
- begins when the decision is made to undergo surgical intervention
and ends up when the patient is transferred to the operating table.
- nursing assessment is done during this phase
 Intra – Operative phase
- during the surgical procedure
- begins from the transfer of the patient to the operating table and
extends to the time the patient is admitted to the recovery room.
 - The implementation process takes place
 Post – Operative phase
- after the surgical procedure
- begins with the admission of the patient to the
recovery room
- evaluation takes place during this phase
 Analgesia
- lessening of or insensibility to pain/absence of pain
 Anesthesia

- a state characterized by loss of sensation

- absence of normal sensation
 Antiseptics
- an agent that inhibits the growth of some
microorganisms.
 Asepsis
- a condition in which living pathogenic organisms are
absent.
 Consent
- permission give voluntarily by a person on his own will.
 Disinfection
- the act of destroying pathogenic microorganisms or to
inhibit their growth and vital activity.
 Homeostasis
- the process through which such body equilibrium is
maintained.
 Medical Asepsis
- practices that limit the transmission of microorganisms and
their growth and spreading action.
 Resident Bacteria
- microorganisms that usually resides on the skin, mucous
membranes, respiratory and GI tract. They cling to the
skin by adhesion and absorption and should be removed
by a brush.
 Sterile
- aseptic; without microorganisms and their spores
 Sterilization
- process that destroys all microorganisms including spores
- complete elimination of microorganisms accomplished by
surgical, chemical or other means.
 Surgery
- branch of medicine concerned with the treatment of disease,
injury and deformity by manual or operative methods.
 Surgical Asepsis
- is a kind of practices that keep an area or object
free from all microorganisms. ( Sterile Technique)
 Surgical Conscience
- an awareness which develops from knowledge
based on the importance of strict adherence to the
principles of aseptic and sterile technique.
 Surgical Team
- is a group of highly trained individuals who must
work together as coordinated team for the welfare and
safety of the patient undergoing the surgery.
 Transient Bacteria
- normally picked out by hands in the usual
activities of daily living which are relatively few on clean
and exposed areas of the skin.
To provide effective barriers that prevent
the dissemination of microorganisms to
patients
To protect personnel from contamination
from blood and body fluids of patients
Proper attire is a part of aseptic
environmental control
Protects personnel against exposure to
communicable diseases and hazardous
material
 Proper attire must be worn within the semirestricted and
restricted areas of the OR suite
 Clean fresh attire is donned daily on arrival to the OR and
intermittently when necessary if suit becomes wet or grossly
soiled-source of cross-contamination.
 OR attire should not be worn outdoors-this protects the OR
environment from microorganisms inherent in the outdoor
environment and vice-versa.
 Before leaving the institution everyone should change to
street clothes/uniforms
 On occasion a cover gown may be worn over OR attire outside
the suite
 The practice of wearing cover gowns is Not encouraged
 Hair is a gross contamination
 Cap or hood is put on before the scrub suit to
protect the garment from contamination by hair.
 All facial and head hair is completely covered in the
semi restricted and restricted areas.
 Light weight caps/hoods made of disposable, lint-
free fabric
 Reusable caps should be freshly laundered daily
 Skull caps do not cover the entire head, and hair
can be shed from the inferior edges.
 Unprotected street shoes can increase floor
contamination
 Shoes restricted to wear in the OR are preferable in
reducing microbial transfer from the outside into
the OR suite
 Shoe covers may be worn as needed to protect
from blood and body fluid
 Some surgeons wear plastic or rubber boots during
procedures wherein extensive fluid irrigation
and/or blood loss can be anticipated
 Shoe covers can inadvertently become soiled and
harbor microorganisms and should be removed
before leaving the OR
 METHODS BY WHICH CONTAMINATION WITH
MICROORGANISIMS IS PREVENTED (ALTERNATE TERM:
ASEPTIC PRACTICE TO MAINTAIN ASEPSIS).
 ABSENCEOF MICROORGANISM
THAT CAUSE DISEASE; FREEDOM
FROM INFECTION.
 ARE THE EFFORTS TAKEN TO KEEP THE PATIENT AS
FREE FROM HOSPITAL MICROORGANISM AS POSSIBLE.

 IT IS AMETHOD USED TO PREVENT CONTAMINATION

OF WOUNDS AND OTHER SUSCEPTIBLE SITES BY
ORGANISMS THAT COULD CAUSE INFECTION…
 THROUGH ENSURING THAT ONLY STERILE EQUIPMENTS
AND FLUIDS ARE USED DURING INVASIVE
MEDICAL/SURGICAL PROCEDURES.
 MEDICAL OR CLEAN ASEPSIS
Aims to reduce the number of
organisms and prevent their spread.

SURGICAL OR STERILE ASEPSIS

Aims to eliminate microorganisms
from a given area.
 AGE.
 NUTRITIONAL STATUS.
 IMMUNO SUPPRESIVE DRUGS.
 PATIENT UNDERGOING SURGERY OR INVASIVE
PROCEDURES.
 NUMBER OF MICROORGANISMS PRESENT.
 VIRULANCE OF THE MICROORGANISMS PRESENT.
DEFINITION:

It is the process of removing as

many microorganisms as possible
from the hands & arms by
mechanical washing & chemical
antisepsis before participating in
an operation.
Transient organisms

Resident organisms
Transient organisms

Resident organisms
 To remove soil, debris, natural skin oil, hand
lotions, and transient microorganisms from the
hands.
 To reduce number of resident microorganism on
skin.
 To suppress the growth of the resident
microorganisms.
 To reduce the hazard of microbial contamination of
the operative wound by skin flora.
 To reduce the risk of infection among other health
care workers.
 To reduce the risk of transmission of infectious
organisms to yourself
 Skin & nails should be kept clean & in good
conditions & cuticles cut.
 Fingernails should not reach beyond the

fingertip to avoid glove puncture.

 Fingernail polish should not be worn.
 Artificial devices must not cover natural

fingernails.
 Inspect hands for cuts & abrasions.
 Remove all finger jewelry.
 Be sure all hair is covered by headgear.
Pierced-ear stud must be contained by the
head cover.

 Adjust disposable mask snugly & comfortably

over nose & mouth.

 Clean eyeglass if worn. Adjust eyewear or

face shield comfortably in relation to mask.
 A broad-spectrum antimicrobial agent.
 Fast-acting and effective.
 Nonirritating and nonsensitizing.
 Prolonged-acting.
 Chlorohexidine gluconate.
 Iodophors.
 Triclosan.
 Alcohol.
 Hexachlorophen.
 Most
frequently
missed

frequently
missed
 Most
frequently
missed

frequently
missed
1. Pick up one glove by the cuff using your
thumb & index finger.
2. Touching only the cuff, pull the glove onto
one hand & anchor the cuff over your thumb.
3. Slip your gloved fingers under the cuff of the
other glove. Pull the glove over your fingers &
hand, using a stretching side-to-side motion.
4. Anchor the cuff on your thumb. With your
fingers still under the cuff, pull the cuff up &
away from your hand & over the knitted cuff
of the gown.
5. Repeat the preceding step to glove your
other hand.

5. The gloving process is complete.

1. Pick up a gown from the sterile linen pack.
Step back from the sterile field & let the
gown unfold infront of you. Hold the gown
at the shoulder seams with the gown
sleeves facing you.

2. Offer the gown to the surgeon. Once the

surgeon’s arms are in the sleeves, let go of
the gown. Be careful not to touch anything
but the sterile gown. The circulator will tie
the gown.
3. Pick up the right glove. With the thumb of
the glove facing the surgeon, place your
fingers & thumbs of both hands in the cuff
of the glove & stretch it outward, making a
circle of the cuff. Offer the glove to the
surgeon. Be careful that the surgeon’s bare
hand does not touch your gloved hands.

4. Repeat the preceding step for the left

glove.
 All articles used for a surgical procedures are sterilized prior
to surgery.

 Gowns are considered sterile only from waist to shoulder

level in front and sleeves.

 Personnel who are sterile only touch sterile articles; personnel

who are not sterile only touch unsterile items.

 Sterile touching sterile remaining sterile.

 Sterile touching unsterile contaminates all.

 Arms not to be folded under axillae.

 If in doubt about the sterility of any item, consider it

unsterile.

 Nonsterile personnel must avoid reaching over a sterile field,

sterile personnel must avoid leaning over a sterile field.

 The area approximate 2.5cm around the edge of the sterile

field is considered unsterile.

 Sterile personnel must be close to the sterile area, unsterile

personnel must be away from the sterile area.
 Moisture may cause contamination.

 Pouring should be done at the edge of the table.

 When passing in a sterile field, remember sterile to sterile.

 The sterile field must be kept insight all the time.

 The gloved hands must be kept insight all the time.

 Once in position, drapes are never moved or shifted.

 Avoid coughing, sneezing or unnecessary talking over a

sterile field.
 Counting procedure is a method of accounting for
items placed on a sterile table for use during
operation. Sharps & instruments are counted 4
times or more.

 Cases that need a count:

Laparotomy
Operation within the chest cavity
Extraperitoneal operations
Substernal thyroidectomies
Deep vaginal operation
Iliac bone graft
Operation of the hip joint or femur
Operation on the spine
1st count: Scrub nurse count the instruments, sponges and
needles before the start of the surgery right after all the
equipments has been arranged and prepared with the
circulating nurse.
2nd count:Counting of sponges with the surgeon right after
draping the patient and before incision.
3rd count:by the circulating nurse & scrub nurse together with
the surgeon before closure of the organ involved.
4th count: by the circulating nurse & scrub nurse together with
the surgeon before closure of the surgical wound.
5th count:before washing and packing the instruments for
sterilization.
 General Responsibility:
◦ Check if the inform and surgical consent has been signed.
◦ The patient has been placed in NPO for 8hrs.
◦ Remove all jewelries, clothing, dentures and any nail polish
◦ Assess if the patient has any pacemaker
◦ Check vital signs before transporting the patient to the
Operating Room ( done in the ward).
◦ Assess patient for any signs of anxiety
◦ Advise patient to take a bath before surgery (if possible)
◦ Prepare patient physically, emotionally, psychologically,
spiritually and culture preferences.
 SCRUB NURSE:
◦ Preoperative
 Checks the card file for surgeon’s special
needs/requests
 Scrubs, gowns, & gloves & sets up sterile field. Checks
for proper functioning of instruments/equipment.
 Performs counts with circulator.
◦ Preincisional
 Completes the final preparation of the sterile field.
 Assists surgeon with gowning/gloving.
 Assists surgeon with draping & passes off
suction/cautery lines.

◦ During the Procedure

 Maintains orderly sterile field.
 Anticipates the surgeon’s needs (supplies/equipment)
 Maintains internal count of sponges, needles &
instruments
 Verifies tissue specimen with surgeon.
◦ Closing phase
 Counts with circulator at proper intervals.
 Organizes closing suture & dressings.
 Assist in applying sterile dressings.
 Prepares for terminal cleaning of instruments &
nondisposable supplies.
 Reports to charge nurse for next assignment.
 CIRCULATING NURSE:
Preoperative
Assists in assembling
needed supplies.
Opens sterile supplies.
Assists scrub in gowning.
Performs & records counts.
Admits patient to surgical suite.

Preincisional
Transports patient to procedure room.
Assists with the positioning of the patient.
Assists anesthesia during induction.
Performs skin prep.
Assists with drapes, connects suction & cautery.
During the procedure
Maintains orderly procedure room.
Anticipates needs of surgical team.
Maintains record of supplies added.
Receives specimen & labels it correctly.
Maintains charges & O.R records.
Continually monitors aseptic technique & patient’s needs.

Closing Phase
Counts with scrub at proper intervals.
Finalizes records & charges.
Begins clean-up of procedure room.
Applies tape.
Assists anesthesia in preparing patient for transfer.
Disposes of specimen & records.
Reports to charge nurse for next assignment.
 To provide care until the patient is fully
awake, conscious, with stable vitals
monitored every 15 minutes for the first two
hours with no signs of hemorrhage, 30
minutes for the next hour and every hour
until the patient is transported to ward

 To provide psychological support to the post

operative patient

 To provide safety and comfort

 Is done by student(s) who are assigned in the morning shift.
They will assess the patient before going to their operating
room exposure and must know the following:
 Pre - Op
Patient profile and History
Anatomy and Physiology
Pathophysiology
 Intra –Op:
Brief Discription of the Operation to be Performed
Packs ( Laparatomy, EENT, Neurological, Orthopedic)
Instuments ( ex. AP set, Lap set, craniectomy set and etc.)
continuation… intra -op
Suture ( Atraumatic [ATR])
ex. Vicryl 0 ( round), Chromic Gut 3-0
Silk 2-0 ( cutting), vicryl 3-0
Sutures may be absorbable or non absorbable. Once
they are sutured inside the body they are consider absorbable
sutures. All sutures are atraumatic sutures.

Skin Preparation will always depend on what type of

operation the patient will undergo.
( abdominal, neurological, orthopedic, EENT or
minor surgery)

Type of Anesthesia/Anesthetic Agent

 Anesthetic :
General: ( induction position flat on bed)
1. Propofol 7. Isoflurane/
Sevoflurane
2. Fentanyl 8. Fentanyl
3. Succinyl Hydrochloride 9. Nitrous Oxide
4. Atracurium/Rocuronium
5. Thiopental
6. Midazolam
SUB-ARACHNOID block : ( lateral position or C
position)
1. Bupivacaine/ Isobaric ( through epidural
catheter)
2. Tetracaine/ Bupivacaine ( Heavy by spinal
needle)
Side effects of SAB are: Hypotension, Spinal Headache, N
&V,hypothermia
 Nursing Intervention:

 Peri – Operatively
◦ Check if the inform and surgical consent has been signed.
◦ The patient has been placed in NPO for 8hrs.
◦ Remove all jewelries, clothing, dentures and any nail polish
◦ Assess if the patient has any pacemaker
◦ Check vital signs before transporting the patient to the
Operating Room ( done in the ward).
◦ Assess patient for any signs of anxiety
◦ Advise patient to take a bath before surgery (if possible)
◦ Prepare patient physically, emotionally, psychologically,
spiritually and culture preferences.
 Intra – Operatively
Transports patient to the operating room theater.
Assists with the positioning of the patient.
 Scrubs, gowns, & gloves & sets up sterile field. Checks for
proper functioning of instruments/equipment.
 Performs counts with circulator.
 Completes the final preparation of the sterile field.
 Assists surgeon with gowning/gloving.
 Assists surgeon with draping & passes off
suction/cautery lines.
 Maintains orderly of the sterile field.
 Anticipates the surgeon’s needs (supplies/equipment)
 Maintains internal count of sponges, needles &
instruments
 Verifies tissue specimen with the surgeon.
  Counts with circulator at proper intervals and inform surgeon
once the instruments used are complete.
 Organizes closing suture & dressings.
 Assist in applying sterile dressings.
 Prepares for terminal cleaning of instruments & non disposable
supplies.
 Reports to charge nurse for next assignment.
 Post – Operatively ( PACU)
 Position the patient according to what type of anesthesia
General ( Semi/ High Fowlers); SAB ( Flat on bed for 6hrs.)
 Apply adequate oxygenation for GA patient and Thermal
Blankets for SAB patient.
 Assess for any signs of bleeding and check patient’s incision
site and for any attachments ( ex. Foley bag, jackson pratt)
 Monitor patient vital signs ( every 15 mins [2hrs]; 30 mins for
next hour and every hour once stable.
 Keep patient safety all the time
 Report to the surgeon and anesthesiologist for any
unusualities.
for active
listening