Surgical attire

Surgical attire

Scrub Suits

  • worn to limit dirt, debris and bacteria carried into the operating area
  • made of loose weave fabric
  • V-necked shirt
  • pants have drawstring or elastic waist
  • shirts are tucked into pants
  • cover with clean lab coat outside OR to minimize environmental contamination
  • should not be worn to examine patients or change bandages if additional surgery is planned
  • should be changed at least daily and whenever soiled

Head covers

  • worn to reduce shedding of hair and bacteria into surgical field
  • human hair harbors bacteria (eg. Streptococcus spp, Escherichia coli)
  • decrease infection rates so should be worn by everyone in OR
  • should cover all hair on the head
  • hoods are used to cover facial hair (eg. beard, side burns)

Face mask

  • made of glass fiber mesh sandwiched between 2 layers of cellulose fabric
  • thin metal strip in the top of mask improves fit along the bridge of nose
  • ties secured behind top of head and neck so is minimal venting
    • ties should NOT be crossed at the back as this increases the size of side openings reducing filtering
  • goals:
    • protect surgical wound from saliva droplets and microorganisms from surgical team
    • redirect airflow out sides of the mask away from incision
  • less effective when excessive talking, sneezing and prolonged procedures
  • should not be worn around base of neck between procedures (contaminates scrubs)
  • new mask is worn for each procedure
  • no strong evidence masks decrease infection rates, but currently is recommended

 


Basic Attire

Shoe covers

  • minimize outside dirt and debris in the surgical suites
  • No evidence they decrease infection rates
  • Mainly used in special situations or closed surgical suites
Basic Attire

Surgical hand scrub

Goals of surgical scrub

  • remove dirt and oils from hands and forearms
  • kill microorganisms on surface
  • not irritate or damage skin
  • provide prolonged residual action

Hands have high bacterial counts especially if visibly dirty

  • highest under and around nails
  • Surgeons’ hands have higher numbers and more pathogenic organisms than average person This is because they are frequently exposed to scrub solutions (that kill off sensitive bacteria) and contaminated wounds
  • jewellery is removed (can’t be effectively cleaned)
  • nails are short and clean (easier to effectively clean)
    • no false nails or nail polish (higher resident bacterial levels and can’t be effectively cleaned)

About Scrub procedure

  • Ideal scrub time is NOT known
    • 5 minutes is safe and effective
    • Currently recommended:  first scrub of day is 5 minutes, subsequent scrubs are 3-5 minutes (if minimal contamination of hands in between)  
  • Two commonly used scrub procedures:
    1. timed anatomic scrub
      • all surfaces of each hand and forearm are scrubbed for a specified time
      • time varies with desired total scrub time (3-5 minutes)
    2. counted brush strokes method 
      • all surfaces of each hand and forearms are given a specific number of brush strokes
      • number varies from 10 - 25 depending on desired total scrub time
    • Both result in similar total times
  • use moisturizing lotions between scrubs to reduce skin drying and bacterial shedding
  • ensure lotion is formulated so it does NOT neutralize chlorhexidine’s residual action

Scrub

Before scrub procedure

Scrub Procedure (Movie)

Scrub Hands Up
  • adjust cap to ensure all hair is covered

  • tie clean mask securely ensuring it comfortably covers nose and mouth (ties are not crossed)

  • tuck scrub tops into pants

  • remove jewellery

  • hold hands above elbows so water drains from fingertips towards the elbow

  • open disposable brush and place on shelf above scrub sink

  • perform preliminary wash: wet and wash hands and forearms to 5 cm above elbow using soap from dispenser

  • clean nails and subungual areas using nail cleaner in package

  • rinse hands and arms thoroughly 

Scrub procedure

Detailed Example

  • Remove brush from wrapper
  • Apply water to scrub brush containing antiseptic scrub
  • Apply lather to hands and arms to the elbows
  • begin timed scrub:

    Minute 1: scrub one hand (nails, nail beds, each side of each finger and hand)

    Minute 2: scrub second hand in similar fashion

    Minute 3: scrub top half of each arm in a circular fashion beginning at wrist (1/2 minute each)

    Minute 4: scrub bottom half of each arm in circular fashion (1/2 minute each)

    Rinse hands and arms thoroughly

    Minute 5: apply fresh scrub from dispenser or brush, discard brush and scrub hands only

    Rinse hands and arms a final time and allow excess water allowed to drip off

Hands and forearms are now considered surgically clean ie. NOT sterile

Drying after scrub procedure

  • Hands and arms are held up and away from body
  • the towel should not contact the scrub suit or any non-sterile surface
  • Use one half of the towel for each hand and arm

Gowning and Gloving

Gowns

  • A sterile gown are put on to place a sterile barrier between the surgeon and the patient

  • should be
    • water resistant
    • resist friction, pressure and stretch especially at forearms, elbows and abdomen (ie. not be tight)
    • produce minimal lint
    • comfortable and economical
  • bacteria can penetrate at cuffs and seams
  • packaged individually 

Gloves

goals:

  • protect patient from contamination by microorganisms on surgeon’s skin.
  • protect surgeon from patient’s microorganisms
  • commonly made of latex
  • not an absolute barrier as some gloves have holes
    • accepted industry standard for new surgical gloves: < 1.5% have punctures before use
    • by end of surgery, almost 1/3 have holes
    • most on non-dominant thumb and index finger
    • perforations NOT associated with more post-op infections likely because surgical hand scrubs reduce bacterial counts and suppress bacterial multiplication

    BUT gloves should be changed when punctures are noted

  • Powders are placed inside gloves to make easier to put on
    • talc (magnesium silicate)
      • induces acute inflammation followed by a chronic persistent granulomatous reaction when put into surgical wound (eg. glove punctures)
    • cornstarch
      • causes more intense acute inflammatory reaction (especially in joints) but resolves after 4 weeks

Changing gloves

Removing gloves

  • requires a non sterile assistant to remove gloves
  • cuffs are pulled over hands if closed gloving technique is to be used
  • hands are pushed through cuff if open gloving technique is to be used

 


 

Changing gloves with closed gloving technique 

  • Involves gloving with hands covered by cuffs of gown
  • Used when do not have a sterile assistant
  • Procedure is the same as used when initially gloving


Open gloving 

  • involves gloving with the hands pushed through the cuffs of gown
  • generally reserved for changing glove during surgery
  • procedure requires sterile assistant to assist gloving