Perioperative skills

By: Liezel A. Castillo

 Pre-operative preparation
 Principles of sterile technique:
– Only sterile item are use in sterile field
– Gown are considered sterile only from the
waist to shoulder level in front and the
sleeves
*sterile person keep hands in sight and at or above waist
Level
*hands are kept away from face ,elbow are kept close to sides ,
hands are never folded under arms
*changing table level is avoided
*items dropped below waist level are considered unsterile
and must be discarded
-tables are sterile only at the table level
*only the top of the table with sterile drape is considered sterile ,
edges and drapes extending below the table are considered
unsterile
*anything falling or extending over table edge is unsterile
*in unfolding sterile drape, the part that drops below table surface
is not brought back to table level
- person who are sterile touch only sterile items
or areas
* sterile team members maintain contact with sterile fields by
means of gown and gloves
*nonsterile circulating nurse does not directly come into contact
with the sterile field
-unsterile person avoids reaching over sterile
field ; persons avoid leaning over an unsterile
area
* unsterile circulating nurse never reach over a
sterile field to transfer sterile items
*in pouring solution into sterile basin , circulating
nurse holds only lip of bottle over basin to avoid
reaching over sterile field
*scrub nurse drapes a nonsterile table toward self
first to protect gown
- edges of anything that encloses sterile contents
are considered unsterile
*sterile persons lift content from packages by reaching
down and lifting them straight up, holding elbow high
*after sterile bottle is opened ,content must be used or
discarded
-sterile field is created as close as possible to
time of use
*degree of contamination is proportionate to length of time
sterile items are uncovered and exposed to the environment
,precaution should be followed :
*sterile table are set up just prior to the
operation
*covering sterile tables for later use is not
recommended
- sterile areas are continuously kept in
view
*sterile persons face sterile areas
-sterile persons keep well within the sterile
area
* sterile person stand back at a safe distance from
the operating table when draping the patient
* sterile persons pass each other back to back
*sterile person turn back to nonsterile person or area
when passing
*sterile person faces sterile area to pass it
- sterile person keep contact with sterile
area to a minimum
*sterile persons do not lean on sterile tables and on
the draped patient
-unsterile persons avoid sterile areas
* unsterile person maintain atleast 1 foot distance
from area of the sterile field
*unsterile persons face and observe a sterile area
when passing it to be sure they do not touch it
- destruction of integrity of microbial
barriers results in contamination
 Operating room attire
 Consist of the scrub dress, head cover mask and shoes or shoe
cover , sterile gown and gloves are added for scrubbed team
 Purpose: to provide effective barriers that prevents the
dissemination of microorganism to the patient and to protect
personnel from infected patient
scrub dress- worn only in the operating room
head cover- used to cover hair completely
shoes- shld be clean and conductive ,washable and
soft soled
mask- is put on by all personnel before coming into
operating room
sterile gown – are worn over scrub attire
sterile gloves- are worn to complete the attire for
scrubbed team members
 Position for surgery
 Supine position- usual position for induction of general
anesthesia
 Modified trendelenburg position- used for lower abdominal
surgery, pt is positioned as in the supine position , the
entire operating table is slightly tilted so that the
patient head is lower than his feet by 1-5 degrees
 Lithotomy position- used in operation requiring a perineal
approach
 Prone position- having surgery on the posterior part of the
body
 Lateral position- used for operation on the kidneys ,
lungs, or hips
 Modified fowlers or sitting position- mostly in neurosurgery
 Skin preparation
 Lateral thoracoabdominal preparation- includes axilla,
chest, abdomen from neck to crest of the ilium
 Chest and breast preparation- includes shoulder upper
arm, down to the elbow axilla and chest wall to the table
line beyond sternum to opposite shoulder, place on lateral
position
 Abdominal preparation- includes breastline to upper third
of thigh from table line to table line in patient in supine
position
 Knee and lower leg preparation- includes the entire
circumference of affected leg and extends from foot to
upper part of thigh
 Rectoperineal and vaginal preparation-includes
pubis, vulva, labia, perineum anus and
adjacents areas including inner aspect of upper
3rd thigh
 Hip preparation- includes abdomen to the
affected side , thigh to the knees, buttocks to
table line , groin and pubis
 Skin preparation on operating table:
- done after patient has been anesthesized on the
operating table , surrounding is mechanically
cleansed again with an antiseptic agents immediately
prior to draping
- the first assistant is the person who scrubs the
patient after he has scrubbed his own hands and
arms
Procedure:
1. wear sterile gloves
2.wscrub skin , starting at site of incision with circular
motion or over widening circles to the periphery,
use enough pressure and friction to remove dirt and
microorganism from skin and pores
3. discard sponge after reaching periphery,
never bring a soiled sponge back toward
the center
4. repeat scrub with a separate sponge for
each rounds and apply antiseptic
5. paint area with solution from incision
site to periphery with circular motion
 Surgical scrub
 Removal of as many bacteria as possible from hands and
arms by mechanical washing and chemical disinfection
before participating in an operation
 Purpose:
- to help prevent the possibility of contamination of
the operative wound by bacteria on the hands and
arms
 Preparation prior to surgical scrub:
1. skin and nails shld. Be kept clean and in good
condition and cuticles uncut
2. fingersnails shld not reach beyond the fingertip to
avoid glove puncture
3. fingernails polish shld not be worn
4. remove all finger jewelry
 5. be sure all hair is covered by headgear
6. adjust disposable mask snugly and comfortably over
nose and mouth
7. adjust eyeglasses comfortably in relation to mask
 Length of scrubbing:
- varies from one institution to another

 Surgical scrub procedure:

1. time-method
2. counted brush –stroke method
 Time method
 Complete scrub takes 5-7 min. done :
1. in the morning before the 1st gowning and gloving
2. following a clean case if gloves have been removed
inadvertently before the gown
3. following a clean case,if gloves have had a hole between
them
4. before an emergency case at anytime

 Short scrub takes 3 min. this is done ff a clean case, if the

hands and arms have not been contaminated. Done to
remove bacteria that have emerged from the pores and
multiplied while the glove were on.
 Brush-stroke method
 A prescribed number of strokes ,applied
lengthwise of the brush or sponge ,use for each
surface of the fingers ,hands, and arms.
 Scrub nails of one hand 30 strokes ,all sides of
each finger 20 strokes , the back of hand 20
strokes, the palm of hand 20 strokes,the arm 20
strokes for each third of the arm, to 3 inches
above the elbow
 Drying hands after surgical scrub
 Procedure:
1. when picking up the towel ,do it with a swift , efficient motion
2. take the towel in the middle, being careful not to contaminate
the sterile gown under it
3. bend at the waist to help prevent the sterile towel from
touching the unsterile gown while drying your hands and arms
4. dry hands to mid-lower arm, then transfer dry end of towel
to other hand
5. do not dry hand then arm and return to same hand
6. after the second hand and mid-lower have been dried , fold
towel in 3rd and dry elbow
7. be sure hand is well covered
8. discard towel in linen
 Gowning
 Purposes of gowning:
1. to exclude skin as a possible
contaminant and to create a barrier
betweens sterile and unsterile
areas
2. to permit the wearer to come
within the sterile field
3. to carry out sterile techniques
during an operative procedure
 Gowning technique:
1. gowning for open glove
technique
2. gowning for closed glove
technique
3. gowning another person
4. changing gown during
operation
5. removing gown
 Gowning for open glove technique
1. reach down to the sterile package and lift the
folded gown directly upward or scrub nurse
receives sterile gown from the circulating
nurse
2. step back away from the table , into clear area
,to provide wide margin of safety while gowning
3. holding the folded gown ,carefully locate the
neckband
4. while holding the neckband carefully shake the
fold from the gown
5. slip both hands into the sleeves
6.circulating nurse reaches inside the gown and
pull over the hands
7. circulating nurse fasten the back part ,ties
waist band
 Gloving
 Purposes:
1. to exclude skin as a possible contaminant
2. to create a barriers between sterile and unsterile
areas
3. to permit the wearer to handles sterile supplies or
tissues of the operative wound

2 way of gloving
1. close glove technique
2. open glove technique
 Closed glove technique