POPE 4023SURGICAL HAND HAND HYGIENE, GOWNING AND GLOVING

POPE 4023 THE PERIOPERATIVE ENVIRONMENT

HAND HYGIENE, GOWNING AND GLOVING

SITI ZAIRINI AHMAD
ILKKM KUBANG KERIAN

LEARNING OUTCOMES

At the end of this learning session, the student will be able to
1. Perform the proper method of hand hygiene

2. Perform the proper method of gowning and gloving before
establishing the sterile field

3. Perform the proper method of removal contaminated
gown and gloves

SURGICAL HAND HYGIENE

Surgical hand hygiene or
surgical scrub is the process

of removing as many
microorganisms as possible
from the skin of the hands
and arms before donning

sterile surgical attire

(The process of surgical scrubbing is not a
sterile procedure)

SCRUB ROOM CHARACTERISTICS

• The scrub room is adjacent to the OR for safety and
convenience.

• Scrub sinks with automatic sensor controls or foot- or knee-
operated faucets are preferred to eliminate the hazard of
contaminating the hands after hand and arm washing.

• Protective eyewear should be worn when performing a
surgical scrub.

SCRUB ROOM CHARACTERISTICS

• The sink should be deep, wide, and low enough to prevent
splashes.

• Aerated faucets prevent splatter.

• A sterile gown cannot be donned over damp scrub attire
without resultant contamination.

SCRUB ROOM CHARACTERISTICS

• Scrub sinks should be used only for scrubbing or
handwashing.

• They should not be used to clean or rinse contaminated
instruments or equipment.

• Bioburden could inadvertently be transferred to personnel
who scrub in the vicinity.

MICROBIOLOGY OF THE SKIN

The skin is inhabited by the following list of organisms

Resident organisms below the Transient organisms
skin surface in hair follicles acquired by direct
and sebaceous and sweat
glands contact

PURPOSE OF SPECIALIZED HAND HYGIENE

The purpose of surgical hand and arm hygiene

To remove or deactivate soil, debris, To decrease the number of
natural skin oils, hand lotions, and resident microorganisms on skin
transient microorganisms from the
hands and forearms of sterile team to an irreducible minimum

members

To keep the population of To reduce the hazard of
microorganisms minimal during microbial contamination of the

the surgical procedure by surgical wound by skin flora
suppression of growth

ANTIMICROBIAL SKIN CLEANSING AGENTS

• Various antimicrobial soaps are used for surgical hand cleansing

• The desirable characteristics of antimicrobial agents are as
follows:
• Broad spectrum
• Fast acting and effective
• Nonirritating and nonsensitizing
• Prolonged action (i.e., leaves an antimicrobial residue on the
skin to temporarily prevent growth of microorganisms)
• Independent of cumulative action

ANTIMICROBIAL SKIN CLEANSING AGENTS

• Variables in effectiveness of the antimicrobial cleansing
process are
• Bioburden
• Mechanical factors
• Chemical factors
• Individual differences in skin flora

ANTIMICROBIAL SKIN CLEANSING AGENTS

• Chlorhexidine Gluconate
• Iodophors
• Triclosan
• Alcohol
• Hexachlorophene
• Parachlorometaxylenol

ANTIMICROBIAL SKIN CLEANSING AGENTS

Chlorhexidine Gluconate

• 4% aqueous • This agent produces
chlorhexidine effective, intermediate
gluconate (CHG) in a action and cumulative
soap base or 0.5% in reductions of resident
alcohol and transient flora for
more than 6 hours
• Fight against gram
positive, gram • CHG is rarely irritating
negative, bacteria, to the skin, but it is
fungal and viral highly ototoxic and will
microorganism irritate if splashed in
the eye

ANTIMICROBIAL SKIN CLEANSING AGENTS

Iodophors

• Available in • A povidone-iodine
concentrations of 10%, complex in detergent
7.5%, 2%, and 0.5% fulfills the criteria for
an effective surgical
• Iodophors are scrub
intermediate-acting
antimicrobial agents • Iodophors have
against gram-positive minimal residual
and -negative, TB, effect. Iodophors can
fungal, and viral be irritating to the skin
microorganisms.

ANTIMICROBIAL SKIN CLEANSING AGENTS

Alcohol

• Ethyl or isopropyl • Alcohol preparations,
alcohol (60%-90%) is usually in foam, contain
rapidly antimicrobial emollients to minimize
against all drying.
microorganisms
• If other agents cannot
• It is volatile and does be used because of skin
not have residual sensitivity, mechanical
activity cleansing with soap to
remove transient
• It is nontoxic but has a organisms may be
drying effect on skin followed by cleansing
with an alcohol-based
skin cleanser

ANTIMICROBIAL SKIN CLEANSING AGENTS

Triclosan

• A solution of 1% • Triclosan does not
triclosan is a work as well against
nonirritating, fungi
intermediate
antimicrobial agent that • Triclosan is less
inhibits growth of a wide effective than
range of gram-positive chlorhexidine
and -negative and TB gluconate and
microorganisms by iodophors
interruption of
hormonal activity within
the cell

ANTIMICROBIAL SKIN CLEANSING AGENTS

Hexachlorophene

• In concentrations up to • The action is slow but
3%, hexachlorophene effective against most
is most effective after gram-positive bacteria;
build-up of cumulative it has poor action
suppressive action. against all other
microorganisms
• Its high potential for
neurotoxicity makes it • Hexachlorophene is
unsuitable for routine available by
use prescription only

ANTIMICROBIAL SKIN CLEANSING AGENTS

Parachlorometaxylenol

• Used in a • It does not produce
concentration of 1% to sustained residual
3.75%, activity
parachlorometaxylenol
(PCMX)

• Does not substantially • Efficacy data should be
reduce reviewed before these
microorganisms products are used for
immediately surgical scrubs

SURGICAL HAND HYGIENE

https://youtu.be/WpZqLbWL0c0
https://youtu.be/DhlIQskLhKU

GOWNING AND GLOVING

PURPOSE
A sterile gown and gloves are worn to exclude skin as a
possible contaminant and to create a barrier between the
sterile and nonsterile areas. The gown protects the patient
and the wearer from cross-contamination.

GOWNING AND GLOVING

GENERAL CONSIDERATIONS
1. The scrub person gowns and gloves from a surface separate

from the main sterile field using the closed-gloving method and
then gowns and gloves the surgeon and the rest of the sterile
team using the open-assisted or closed-assisted gloving
method.
2. Gown packages preferably are opened on a separate table from
other packages to avoid any chance of contamination from
dripping water.
3. Splashing water on scrub attire during the surgical scrub should
be avoided because moisture may contaminate the sterile
gown.

GOWNING AND GLOVING

DRYING THE HANDS AND ARMS

The hands and arms are dried as follows:

1. Reach down to the opened sterile gown package and pick
up the towel with one hand by one corner. Be careful not
to drip water onto the pack because contamination may
occur. Be sure no one is within arm’s reach. Be aware of the
environment to prevent contamination.

GOWNING AND GLOVING

DRYING THE HANDS AND ARMS

The hands and arms are dried as follows:

2. Grasp the opposing corner of the towel with the other
hand and open the towel full length. Use one end of the
towel to dry one hand and arm. Use a circumferential
motion to rub in one direction from hand to upper arm. Do
not rub back and forth. Bend slightly forward to avoid
letting the towel touch the attire.

GOWNING AND GLOVING

DRYING THE HANDS AND ARMS
The hands and arms are dried as follows:
3. To dry the second arm, hold the dry, clean end of the towel

in the opposite hand and use a circumferential motion to
dry the hand and all areas of the arm to the elbow.

4. Discard the towel with the hand that is currently holding it
without letting it touch the scrub suit. Do not wad the used
towel and toss it across the room to the laundry hamper or
trash.

GOWNING AND GLOVING

https://youtu.be/wXJRBD_7Xvo
https://youtu.be/hWFjY-C2Zw8
https://youtu.be/hTBR3yJ5IEs

METHOD FOR REMOVING A
CONTAMINATED GOWN AND GLOVES

https://youtu.be/yJwN6ysEneg
https://youtu.be/n3ukNJIg8e4

THANK YOU……