Surgical Scrubbing and Sterile Techniques

I'm Dr. Harold and today at Dove we're running a seminar about how to scrub and get gowned and gloved for surgery. The concept of scrubbing is that what we want to do with the scrub the purpose of it is that we want to reduce our resident bacterial flora on our hands and so we're not making our hands sterile but we just want to reduce the normal bacteria that live on our hands and so that's usually done with a five minute scrub procedure and what we don't want to do so some concepts that we don't want to do is that we don't want to scrub so hard that we're excoriating the skin because that will bring some bacteria from the inside to the outside or it will promote the growth of bacteria in those wounds and stuff and so though we want a thorough scrub we don't want a vigorous or hard scrub. When we're scrubbing we want to think of our fingertips and our hands as the most clean or the most sterile and so when we're scrubbing we're going to move from the fingertips and the palms down to the elbows and so think of clean to dirty and you always want to go from clean to dirty and not dirty to clean and so once you're done scrubbing you rinse in that same concept and so when you rinse you want to rinse so that you're rinsing the water from the cleanest portion your fingertips to the dirtiest portion your elbows and so you want all the water to run in that direction and the same concept for when we're done rinsing and scrubbing is that we want to dry our hands in that manner as well so we want to drive from clean to dirty and then use the clean part of the towel and clean to dirty essentially and then drop the towel and we'll go through that as a demonstration. Also when we scrub again we do a 5 minute scrub and so put a timer to start however the concept of scrubbing is that what you want to do is break up your fingers into 4 surfaces basically the lateral aspects or the inside or the outside and the front in the back and I generally do 20 strokes on each of those surfaces. Okay and then you want to break up your palm into palm and the sides and then the back of it and then your forearms again into four quadrants and do 20 scrubs on that and so that's how you go through the rest of the scrubbing and then you switch hands and do that on this side as well and so all your fingers have 4 surfaces, your hand has 4 surfaces and your forearms as well have 4 surfaces. Before starting to scrub you want to just do a general hand wash except you want to include your forearms in it as well. What you want to do is not touch any of the surfaces we obviously have automated water signaling and you don't want to touch the faucet. If at any time you do end up touching it you just restart the scrub at five minutes over again. What you want to do is keep your elbows sort of separate in a way and hold it like this again so that everything runs from cleanest down to dirtiest rather than the opposite direction so you never want to drop your hands down below your waist or your elbow. Student: Can I ask you a dumb question? So are we doing one whole arm before we go to the next one? Dr. Herold: We rotate and so what I will do is do the cleanest first and so fingers hands and then fingers hands on the opposite side and then forearms and then forearms and then my second scrub I will do just one whole hand and then just one whole arm that way but cleanest to cleanest first and so...just get moist... Do a general hand wash... and so as you guys know our scrub brushes have a nail pick in them so what I usually do I have short nails and so I I generally do not need to pick but you want to open it so that it stays clean and doesn't touch any surface and then set it up there so that you can just grab your brush. I do even though my nails are short I do pick under each one at the first surgery scrub of the day to make sure that they're clean. Student: Should we have our sleeves rolled up too? Dr. Herold: Yes you should and so this sleeve should only come to within about three to four inches of your elbow and that's and so if you're wearing an undershirt under your scrub it should not extend beyond your scrub sleeves. I am short and so my sleeves go all the way to my elbows and so that's why they're rolled up but you don't necessarily have to depend upon how your scope outfits okay. Whenever you have an instrument that you're done using just drop it into the sink and so don't set it down but just drop. With these scrub brushes they work better if they are wet and so initially what I'll do is I'll wet it down and part of that bacterial killing with this scrub solution is contact and so I will again lather my hands up and then lather my forearms so that it has contact with my hands while I start this grub okay. Before this I forgot but you want to start the timer so that I this is the start of my five-minute scrub okay for my fingertips and so remember we said to divide the fingers into 4 surfaces but I start actually with a vigorous scrub of all the fingertips and again twenty strokes in my head because it gives you something to do while you're standing here and scrubbing basically and then start the surfaces. so um Julie this is where you asked about scrubbing the arms first so i switched to the other hand now and so i'm starting this scrub over but i haven't scrubbed my forearms yet and so the first scrub i scrubbed my hands to make them most sterile before i go to the forearms. So I will switch hands and then I'm going to go to scrubbing my forearms again in four quadrants. If you find that your sponge is dry you can get it wet again and so the my timer says I'm at five minutes right now but I want to finish my scrub and again what you want to do is rinse from your fingertips to your elbow so that the water runs down from the cleanest to the dirtiest and you want to hold on to your sponge until you're done using it if you have not reached the five minute mark you can restart a second scrub just like you did the first time when you're done scrubbing and you do your final rinse you can just drop your sponge into the sink without touching or contacting anything what you want to do is allow the water to drip from your fingertips to your elbows and so don't shake the water off. You should already have your gown gloves and sterile towel open and the way that you sterile-y dry off is that the towel is folded in such a way that you can just grab the top or the tip of it you want to drop the towel and open in front of you so that it's not touching your scrubs in any way first what you want to use is use just the top half of the towel and so in my right hand I'm going to dry off my left hand and you want to dry off by patting again starting at your fingertips and moving down to your elbows and again you want to keep the bottom of the towel from touching yourself or anything else in the room when you're done with that what you're going to do is take your left hand and you're going to then move to the unused portion of the towel steriley look at this way and I'm use my left hand to then dry off my right hand by patting and again taking care not to allow the towel to touch the front of your scrubs or anything else. Okay and then when you're done just drop the towel in front of you and hold your hands up again you want to take your gown so these gowns are folded in such a way that the inside of the gown should be facing you and so as you grab the gown you just want to drop in and unfold it and the inside should be facing you and so just put your arms down holes as such and it doesn't have to fit nicely and so your assistant will of course - if I could enlist you - help to put your gown on and secure it but all you have to do is make sure that again the front of the gown isn't touching anything else your gloves and so the method of closed gloving is such that now on the outside everything is sterile and so you've scrubbed your hands and you've made them clean you've reduced the bacterial population but now you're sterile and you want to only touch things that are sterile and so your gloves already open here they should be open in such a way that again they're entirely sterile. What you want to do is work through the cuffs and sleeves of your gown and so you never want your fingers to peek through because those are not sterile but clean but not sterile. You want to open up your gloves so that's there in the right position again left is on the left and right is on the right. You want to take care not to allow your down to touch anything so you want to step back a little bit. The method of clothes gloving can be a little bit tricky for newbies. What you want to do is take the right-hand glove and actually hold it so that your palm is up it's on my right hand palm is up in the cuff you want to lay it so that the fingers are pointing toward my elbow and so I'm basically laying the palm of the glove to the palm of my hand okay and so it seems a little bit backwards in terms of the way that we're putting it on when it's like this what I want to do now is through this sleeve my right hand is going to grab the lower half of the cuff and my left hand is going to grab the upper half of the cuff to open up the glove like this then I'm just going to flip it over my hand as such it does not have to be perfect it can be like this until you are completely sterile and gloved okay. And so I've left my hand here okay I'm going to do that same thing on the opposite side again my left hand is palm up I'm going to put the palm of the glove with the fingers facing me, my left hand grabs the lower half of the cuff and my right hand the upper half of the cuff and I'm just going to flip it over and put my fingers into a cuff. Ok so again doesn't have to be perfect now that I'm entirely sterile and covered and my fingers cannot accidentally sneak you know it's sneak through I want to finish the gloving so you can do so by pulling your surgical cuff down and your glove on my thumb. Straighten up all your fingers so that it's comfortable and so the cuff of the gown is still within my palms all my fingers are through and now I'm entirely sterile. When you're sterile what you want to do is obviously try not to touch anything unsterile you can do so mostly by going with this so that you avoid touching anything sterile when during the surgical suite anything from the waist down is considered not clean and so if you're at their surgical table and say the cautery drops down below your waist that's considered not clean or not sterile, we would trade out the coterie in that method. When you're passing in the surgery suite you want to try to pass not facing other people and so let's say that there were two surgeons in the surgical suite or a surgeon and an assistant if we were to pass behind the surgical table what would do is turn back to back to pass so that we don't inadvertently touch the other person as as we're passing by again because our front and the waist up is considered the most sterile and obviously our hands are considered most sterile okay. If we were to contaminate our gloves would want to change them out okay we have two options for this: one is that we can glove over our current gloves and we would do that with an open technique and so I think there are some gloves on there if you could open this 6 for me..and so the 6 is a larger size then when I ordinarily wear because I'm going to put it over my 5s. This does not have to be done in the closed manner because my hands are still sterile it's just I might have a little poke in the in the fingertip or something and so this we glove in the same way that we would if we were not sterile and so we want to grab the cuffs leave their fingers through and then bring it down that way my hands here okay. The other option is that you can remove your gloves and re-glove with just a new pair of gloves and the way that you want to do that you want to have an assistant remove your gloves steriley. What they're going to want to do is grab the cuff of my gown because our goal will be to get back to where you started and so if you think about me having just finished scrubbing and just putting on my gown I'm exactly in that same position and so I need to again close glove and so I'm entirely sterile and I don't want my fingers to peek through so I'm working through the sleeve of the cuff. You guys probably should practice closed gloving it's hard at first it's a little bit challenging to get the coordination through but you can practice with the same pair of gloves and refold them and stuff like that you don't necessarily have to have you know a gown or sleeves on but you can make it - mock it essentially. Okay any questions? okay all right we are all done then!

I'm Dr. Harold and today at Dove we're running a seminar about how to scrub and get gowned and gloved for surgery. The concept of scrubbing is that what we want to do with the scrub the purpose of it is that we want to reduce our resident bacterial flora on our hands and so we're not making our hands sterile but we just want to reduce the normal bacteria that live on our hands and so that's usually done with a five minute scrub procedure and what we don't want to do so some concepts that we don't want to do is that we don't want to scrub so hard that we're excoriating the skin because that will bring some bacteria from the inside to the outside or it will promote the growth of bacteria in those wounds and stuff and so though we want a thorough scrub we don't want a vigorous or hard scrub. When we're scrubbing we want to think of our fingertips and our hands as the most clean or the most sterile and so when we're scrubbing we're going to move from the fingertips and the palms down to the elbows and so think of clean to dirty and you always want to go from clean to dirty and not dirty to clean and so once you're done scrubbing you rinse in that same concept and so when you rinse you want to rinse so that you're rinsing the water from the cleanest portion your fingertips to the dirtiest portion your elbows and so you want all the water to run in that direction and the same concept for when we're done rinsing and scrubbing is that we want to dry our hands in that manner as well so we want to drive from clean to dirty and then use the clean part of the towel and clean to dirty essentially and then drop the towel and we'll go through that as a demonstration. Also when we scrub again we do a 5 minute scrub and so put a timer to start however the concept of scrubbing is that what you want to do is break up your fingers into 4 surfaces basically the lateral aspects or the inside or the outside and the front in the back and I generally do 20 strokes on each of those surfaces. Okay and then you want to break up your palm into palm and the sides and then the back of it and then your forearms again into four quadrants and do 20 scrubs on that and so that's how you go through the rest of the scrubbing and then you switch hands and do that on this side as well and so all your fingers have 4 surfaces, your hand has 4 surfaces and your forearms as well have 4 surfaces. Before starting to scrub you want to just do a general hand wash except you want to include your forearms in it as well. What you want to do is not touch any of the surfaces we obviously have automated water signaling and you don't want to touch the faucet. If at any time you do end up touching it you just restart the scrub at five minutes over again. What you want to do is keep your elbows sort of separate in a way and hold it like this again so that everything runs from cleanest down to dirtiest rather than the opposite direction so you never want to drop your hands down below your waist or your elbow. Student:  Can I ask you a dumb question?
 So are we doing one whole arm before we go to the next one? Dr. Herold: We rotate and so what I will do is do the cleanest first and so fingers hands and then fingers hands on the opposite side and then forearms and then forearms and then my second scrub I will do just one whole hand and then just one whole arm that way but cleanest to cleanest first and so...just get moist... Do a general hand wash... and so as you guys know our scrub brushes have a nail pick in them so what I usually do I have short nails and so I I generally do not need to pick but you want to open it so that it stays clean and doesn't touch any surface and then set it up there so that you can just grab your brush. I do even though my nails are short I do pick under each one at the first surgery scrub of the day to make sure that they're clean. Student: Should we have our sleeves rolled up too? Dr. Herold: Yes you should and so this sleeve should only come to within about three to four inches of your elbow and that's and so if you're wearing an undershirt under your scrub it should not extend beyond your scrub sleeves. I am short and so my sleeves go all the way to my elbows and so that's why they're rolled up but you don't necessarily have to depend upon how your scope outfits okay. Whenever you have an instrument that you're done using just drop it into the sink and so don't set it down but just drop. With these scrub brushes they work better if they are wet and so initially what I'll do is I'll wet it down and part of that bacterial killing with this scrub solution is contact and so I will again lather my hands up and then lather my forearms so that it has contact with my hands while I start this grub okay. Before this I forgot but you want to start the timer so that I this is the start of my five-minute scrub okay for my fingertips and so remember we said to divide the fingers into 4 surfaces but I start actually with a vigorous scrub of all the fingertips and again twenty strokes in my head because it gives you something to do while you're standing here and scrubbing basically and then start the surfaces. so um Julie this is where you asked about scrubbing the arms first so i switched to the other hand now and so i'm starting this scrub over but i haven't scrubbed my forearms yet and so the first scrub i scrubbed my hands to make them most sterile before i go to the forearms. So I will switch hands and then I'm going to go to scrubbing my forearms again in four quadrants. If you find that your sponge is dry you can get it wet again and so the my timer says I'm at five minutes right now but I want to finish my scrub and again what you want to do is rinse from your fingertips to your elbow so that the water runs down from the cleanest to the dirtiest and you want to hold on to your sponge until you're done using it if you have not reached the five minute mark you can restart a second scrub just like you did the first time when you're done scrubbing and you do your final rinse you can just drop your sponge into the sink without touching or contacting anything what you want to do is allow the water to drip from your fingertips to your elbows and so don't shake the water off. You should already have your gown gloves and sterile towel open and the way that you sterile-y dry off is that the towel is folded in such a way that you can just grab the top or the tip of it you want to drop the towel and open in front of you so that it's not touching your scrubs in any way first what you want to use is use just the top half of the towel and so in my right hand I'm going to dry off my left hand and you want to dry off by patting again starting at your fingertips and moving down to your elbows and again you want to keep the bottom of the towel from touching yourself or anything else in the room when you're done with that what you're going to do is take your left hand and you're going to then move to the unused portion of the towel steriley look at this way and I'm use my left hand to then dry off my right hand by patting and again taking care not to allow the towel to touch the front of your scrubs or anything else. Okay and then when you're done just drop the towel in front of you and hold your hands up again you want to take your gown so these gowns are folded in such a way that the inside of the gown should be facing you and so as you grab the gown you just want to drop in and unfold it and the inside should be facing you and so just put your arms down holes as such and it doesn't have to fit nicely and so your assistant will of course - if I could enlist you - help to put your gown on and secure it but all you have to do is make sure that again the front of the gown isn't touching anything else your gloves and so the method of closed gloving is such that now on the outside everything is sterile and so you've scrubbed your hands and you've made them clean you've reduced the bacterial population but now you're sterile and you want to only touch things that are sterile and so your gloves already open here they should be open in such a way that again they're entirely sterile. What you want to do is work through the cuffs and sleeves of your gown and so you never want your fingers to peek through because those are not sterile but clean but not sterile. You want to open up your gloves so that's there in the right position again left is on the left and right is on the right. You want to take care not to allow your down to touch anything so you want to step back a little bit. The method of clothes gloving can be a little bit tricky for newbies. What you want to do is take the right-hand glove and actually hold it so that your palm is up it's on my right hand palm is up in the cuff you want to lay it so that the fingers are pointing toward my elbow and so I'm basically laying the palm of the glove to the palm of my hand okay and so it seems a little bit backwards in terms of the way that we're putting it on when it's like this what I want to do now is through this sleeve my right hand is going to grab the lower half of the cuff and my left hand is going to grab the upper half of the cuff to open up the glove like this then I'm just going to flip it over my hand as such it does not have to be perfect it can be like this until you are completely sterile and gloved okay. And so I've left my hand here okay I'm going to do that same thing on the opposite side again my left hand is palm up I'm going to put the palm of the glove with the fingers facing me, my left hand grabs the lower half of the cuff and my right hand the upper half of the cuff and I'm just going to flip it over and put my fingers into a cuff. Ok so again doesn't have to be perfect now that I'm entirely sterile and covered and my fingers cannot accidentally sneak you know it's sneak through I want to finish the gloving so you can do so by pulling your surgical cuff down and your glove on my thumb. Straighten up all your fingers so that it's comfortable and so the cuff of the gown is still within my palms all my fingers are through and now I'm entirely sterile. When you're sterile what you want to do is obviously try not to touch anything unsterile you can do so mostly by going with this so that you avoid touching anything sterile when during the surgical suite anything from the waist down is considered not clean and so if you're at their surgical table and say the cautery drops down below your waist that's considered not clean or not sterile, we would trade out the coterie in that method. When you're passing in the surgery suite you want to try to pass not facing other people and so let's say that there were two surgeons in the surgical suite or a surgeon and an assistant if we were to pass behind the surgical table what would do is turn back to back to pass so that we don't inadvertently touch the other person as as we're passing by again because our front and the waist up is considered the most sterile and obviously our hands are considered most sterile okay. If we were to contaminate our gloves would want to change them out okay we have two options for this: one is that we can glove over our current gloves and we would do that with an open technique and so I think there are some gloves on there if you could open this 6 for me..and so the 6 is a larger size then when I ordinarily wear because I'm going to put it over my 5s. This does not have to be done in the closed manner because my hands are still sterile it's just I might have a little poke in the in the fingertip or something and so this we glove in the same way that we would if we were not sterile and so we want to grab the cuffs leave their fingers through and then bring it down that way my hands here okay. The other option is that you can remove your gloves and re-glove with just a new pair of gloves and the way that you want to do that you want to have an assistant remove your gloves steriley. What they're going to want to do is grab the cuff of my gown because our goal will be to get back to where you started and so if you think about me having just finished scrubbing and just putting on my gown I'm exactly in that same position and so I need to again close glove and so I'm entirely sterile and I don't want my fingers to peek through so I'm working through the sleeve of the cuff. You guys probably should practice closed gloving it's hard at first it's a little bit challenging to get the coordination through but you can practice with the same pair of gloves and refold them and stuff like that you don't necessarily have to have you know a gown or sleeves on but you can make it - mock it essentially. Okay any questions? okay all right we are all done then!

Transcript for:Surgical Scrubbing and Sterile Techniques

Transcript for:
Surgical Scrubbing and Sterile Techniques