Surgical gown requirements?
Completely cover back
Sleeves long enough to cover arms ￼
- gloves should completely cover cuffs with arms extended
Sterile from chest to level of sterile field and from start of sleeve to 2 inch above elbow
Cuffs not sterile
Surgical gloves when in scrub role?
Wear 2 pairs
- perforation indicator system
Inspect after donning and throughout use
When should you change surgical gloves?
After each pt
Visible or suspected perforation
After touching helmet/hood
After contact with methylmethacrylate
After touching microscope optics or fluoroscopy
When suspected or actual contamination occurs
Contamination and mitigation of sterile equipment?
Any debris - hair, bone blood
= whole set contaminated and not introduced to sterile field
If already introduced into sterile field any items in field is contamination
Further mitigation = changing gloves, drapes, equipment or new set up
Sterile technique quality?
Wound class is changed to reflect break in technique
Report to reporting system
Notify infection preventionist
Investigate route cause
1 - clean
2 - clean / contaminated ex. Break in technique
3 - contaminated ex. Spillage from GI
4 - dirty/ infected ex. Purulent/necrosis
What do isolation techniques do?
Example bowel and metastatic Ca procedures?
Instruments used to respect bowel/Ca are not used again
Gloves changed and new drapes added and new instruments - clean closure
Covering a sterile field?
Decreased risk of contamination if not being used right away
Prevent contamination when covering/uncovering
- lift up and away from sterile field
- do not bring the drapes up from below surface of sterile field
Cover portions that may not be used immediately
*do not use as practice to set up ahead of time
How to cover table with drapes?
1st drape is placed with the cuff halfway
2nd drape is placed on opposite side abs completely covers the cuff of first drape
Moving around sterile field?
Limit number of people in OR
Keep movement to minimuM
Keep doors closed
Scrub nurse movement around sterile field?
Face sterile field Stay within sterile field Avoid changing levels Keep hands within sterile region Move face to face or back to back
Circulator nurse movement?
Face sterile field Maintain distance Do not reach over Do not walk between Minimal talk
Contributing factors to SSI’s?
Intra op delays (> 60 min) Surgical attire Hand hygiene/antisepsis Use of equipment Wound irrigation Table coverings Isolation techniques Movement / doors
Major break in sterile field?
Spillage from GI tract
Open cardiac massage
Unsterile item falling into wound
Gowning barrier levels?
Based on anticipated risk of exposure 1 - minimal 2 - low 3 - moderate 4 - high
Hand condition for Perioperative nurse?
Short and clean
Follow facility policies and approved products ex. Lotions
CDC Recommends washing hands for 20sec
Always follow manufacturers instructions
When are head coverings worn?
Semi restricted and restricted areas
When is head covering, mask and eye protection worn?
How to fit gloves for scrubbed role?
Inner glove is 1/2 size larger than outer glove or both the same size
Glove fit requirements?
Do not cause numbness
Do not slide or roll
Do not expose cuffs of gown
After what activities may surgical gloves be changed but not mandatory?
Before handling implants
Does surgical hand antisepsis eliminate transient microorganisms?
No only reduces
Skin is clean, not sterile