How to "Scrub In"
For many medical students, the O.R. atmosphere can be intimidating because of its strict rules, complex layout and strict attire. Hopefully, this brief guide will help answer some of your questions and alleviate concerns for when that time comes when you get to “scrub in.”
The Surgical Team It is important to be aware of the members of the surgical team. This might be difficult at first because everyone is dressed in near-identical scrubs, but with time, you will understand the role that each team member plays. Introduce yourself to the surgical team and explain why you are there! This will improve your chances of getting involved with the operative activities right from the start. The members of the surgical theatre staff include:
Wearing The Scrubs On your first day, someone will have to show or direct you to the change room where you can change into hospital scrubs. Fresh scrubs are stacked according to their size, which are may be marked by color strips to match the tops with the trousers. If you can’t find an empty locker, just leave your clothes neatly out of the way in the corner or above the lockers. A wedding band is the only jewelery allowed in the O.R. but even small rings may be unsuitable when you’re scrubbed in. Store your valuables in a safe place! Depending on the place, sometimes, shoe covers may be required. These covers slip under your shoes when in the restricted O.R. area. A disposable scrubs cap (usually found by the changing room or O.R. entrance) should be donned to cover all your hair. Long hair should be neatly tied up under the cap. After the case, the used scrubs and cap should be placed in the designated bins. Keep the change room tidy! The Surgery Slate The surgery slate lists the operations being carried out and is usually found at the surgery front desk. It includes the names of the surgeons, the anaesthesiologist, the O.R. number, the patient’s details, and the planned procedure. Entering The O.R. Familiarize yourself with the case that you are attending. This involves meeting the patient, reviewing the history/clinical information, and performing clinical examination if applicable. This will help you understand the procedure. Also, make an effort to do some reading about the relevant anatomy and the procedure before observing the operation if you want to impress the surgeon. Of course, it is important to make sure that you informed the surgeon that you will be participating in the case beforehand! Before entering the O.R., be aware of any extra precautions needed for the case, e.g., eye protection, goggles, or a face shield. Lead aprons may be required if radiological imaging is involved. It should be worn underneath the gown if you get scrubbed. Arrive at the O.R. before the operation is underway to formally meet the surgeons. If this is not possible, enter the O.R. discretely. If you have to leave before the end of the procedure, exit without causing any disturbance. When the patient is on the O.R. table, use the entrance from the anaesthesiologist’s side or the scrub area. Afterwards, choose a sensible point to introduce yourself to the O.R. staff. The anaesthesiologist is usually more than happy to engage in conversation once the patient has been induced. Preparing To “Scrub In” Before you begin scrubbing in, you need to prepare your equipment. The nurses will probably be a good judge of your likely gown and glove size. Gowns are double-packed within an outer plastic sleeve and inner wrapping paper. The inner layer acts as a sterile surface. To remove the contents, tear the packet at the top and empty the contents onto a sterile surface. Unfold the paper packaging by only touching the corners of the outer surface of the paper. Grab each corner individually, fully open, and extend the edges so that the paper is flat. Gloves have to be removed from their outer packaging by pulling apart the folds at the top of the packet and dropping the contents from a reasonable height onto the sterile surface. Hand towels are usually pre-packed with the gown, but can be opened in a similar way to the gloves. Surgical Hand Scrub Be aware of specific surgical hand scrub procedures as each site may have a slightly different technique. Before starting, make sure that your facemask is comfortable and secure. It is non-sterile so it cannot be adjusted once you are scrubbed in. Your hands and arms must be completely bare, and your fingernails must be free of polish and of medium length. There are 3 types of hand hygiene preparations:
See the side panel for a complete description of how to scrub. Scrubbing involves applying a circular motion to clean the skin. It begins at the fingernails and moves towards the elbows. This is such that you are washing from a clean area (the hand) towards the less clean area (the arm). Your hands should always be held above the level of your elbows at all times in order to prevent dirty water from dripping from the upper arm onto lower sterile areas. An effective surgical hand scrub should take no longer than 5 minutes. If your hands touch anything at any time, the scrub must be restarted. After scrubbing, use the sterile hand towels to dry each arm, starting at the hand and making your way up your arm, using one towel per arm in a dabbing motion. Gowning Gowns are folded in a specifically so that when you open the gown, the inside faces you. The gown is packed and folded such that the openings of the arm sleeves are clearly visible. Using both hands, hold the gown at the openings of each sleeve. Maintaining your grip, move your hands apart and unfold the top of the gown. While keeping your hands within the opening of sleeves, release your grip on the rest of the gown so it unfolds itself. Slip your arms into the sleeves and bring the front of the gown around your body without using your hands. The non-sterile assistant will help secure the gown on your back. It is important to keep your hands within the sleeves, not going beyond the cuff. To fully secure the gown, there is a piece of card with two ties on it. Grip the card with both hands. Pull the smaller tie out with your left and hold it. With your right hand pass the card to the assistant, who will grasp the end furthest from you. On the spot, turn around 360° so that the tie wraps itself around you. Pull the larger tie away from the card, and secure your gown with a knot Gloving This describes the “closed technique,” which maintains high sterile standards. At no point should your bare hands go beyond the gown cuffs, or touch the outside of the gloves. Place the glove packet upside down facing you. Grip the packet through the gown so that you do not directly touch the sterile area, and open the packet. The gloves will be marked “right” or “left.” The right glove should now be on the left hand side. Open the right glove half of the packet (i.e., the left half facing you), gripping through the gown. Using your right hand, take a firm grip of the cuff of the glove through the gown. Pick the glove up and rest it on your hand so that your palm is facing upward and the fingers section of the glove is facing you, while maintaining a grip of the cuff edge. With your left hand, grasp through the gown sleeve the other side of the glove cuff. Keeping your left hand still, move your right hand through the opening of the glove while releasing its grip of the glove. This brings the cuff of the glove over the opening of the sleeve. The glove will now surround your right hand, so unroll the glove cuff to cover the cuff of the gown sleeve. You can adjust the right glove using your left hand through the gown to make it fit securely and straighten any gown cuff that may be obstructing your hand. Use the same technique to glove the other hand. With your left hand grasp the edge of the cuff though the gown, and use your gloved right hand to grasp the other edge of the cuff. Bring the cuff of the left hand glove over the cuff of the gown sleeve. Unroll the cuff of the left glove and adjust as appropriate. Summary Hopefully, this guide gave you some insight and highlighted some key principles the next time you find yourself in the O.R.! |
"Scrubbing In"
Proper handwashing technique below...
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