SURGICAL SCRUB, GOWNING AND GLOVING Surgical Scrub Surgical scrub is the removal

of as many bacteria as possible from the hands and arms by mechanical washing a
nd chemical disinfection before taking part in a surgical procedure. Purpose Sur
gical Scrub helps prevent the possibility of contamination and infection of the
operative wound by bacteria on the hands and arms. Types Complete Scrub – it usual
ly takes 10-15 minutes. This time may vary in different hospitals, depending upo
n the frequency of the scrubs. This is done: 1. Before the first gowning and glo
ving. 2. Following a clean case if the gloves have holes in them. 3. Following a
clean case if the gloves have been removed inadvertently before the gown. 4. Fo
llowing a clean case if hands been contaminated in ay other way. 5. Following a
contaminated case, before starting the next case. Short Scrub – it is usually take
s 5-10 minutes. This scrub is done following a clean case if the hands and arms
have not been contaminated. It is done to remove bacteria that have emerged from
the pores and multiplied while the gloves were worn. PREPARATION BEFORE DOING S
URGICAL SCRUB: Attend to your personal needs. Adjusts your cap and mask properly
. The hair should be confined inside the cap. The mask should cover the nose, mo
uth, cheek and chin. Roll up sleeves of the uniform 3 inches above the elbow if
sleeves are long Check on the liquid soap and brush dispenser. Remove your jewel
ry. Check on your fingernails. They must be kept clean and short to reduce the b
acteria count and to prevent the puncturing or tearing of gloves. SCRUB-UP TECHN
IQUE Take note of the time you started scrubbing Wash hands and arms with soap a
nd water to remove superficial dirt and bacteria. Get the sterile brush with the
right hand in such a way that it faces up. Saturate the brush with soap and wat
er and start scrubbing from the fingertip, to the four corners of each finger, t
o the dorsum, palm and wrist. Do this for 2 1/2 minutes, rinse. Transfer the bru
sh to your left hand. Saturate it again with soap and water and do the same as i
n no 3 (5 minute for both hands). Transfer the brush to your right hand. Saturat
e it again with soap and water and brush the left arm from the wrist up to 2 inc
hes above the elbow. Rinse, Do this for 2 ½ minutes. Transfer the brush to your le
ft hand and do the same as in no. 6 (5 minutes for both arms) hence a total of t
en (10) minutes, from the tip of the fingers up to 2 inches above the elbow. Dro
p the brush in a pail provided for used brushes. Rinse both hands and arms well
taking care the flow of water is from the hands down the elbows. POINTS TO REMEM
BER IN SURGICAL SCRUB: Rinse as often as possible using one direction only. Star
t from the hand going to the arm taking care not to touch the faucet and the sin
k. A person with cut or burn should not scrub because of the high bacterial coun
t. The hands and arms can never be rendered sterile no matter how long or how st
rong the antiseptics.
 Surgical scrub is most effective when firm motion is applied. Short horizontal o
r circular stroke could be used. Use an ample supply of antiseptics Since the ha
nds are to be cleaner than any other area, after the initial hand wash, they are
held higher than the elbows during the rest of the procedure to prevent water f
rom running back the scrubbed hands. Gowning The sterile gown is put on immediat
ely following the surgical scrub. Purpose The sterile gown is worn in order to p
ermit the wearer to come within the sterile field and carry out sterile techniqu
e during an operative procedure. Parts of a Gown 1. Right Side 6. Neckband 2. Wr
ong Side 7. Belt 3. Body 8. Hemline 4. Sleeves 9. Back ties 5. Cuffs PREPARATION
FOR STERILIZATION The gown is folded lengthwise with the wrong side out and fac
ing the wearer A. Unassisted (Self-service) • Grasp the gown at the center or you
may receive it from the circulating nurse • Step one or two feet away from the ste
rile field to have an adequate working space. • Unfold the gown and expose the hem
line portion. Dry your hands and arms with this small portion. Use each side of
the folded gown in drying each hand and arm. • Continue unfolding the gown and loc
ate for the armhole. • Slip your hands into each armhole and hold your hands and a
rms straight and obliquely upward. The circulating nurse will fix it. • Stop and s
wing your body to the right, then to the left. The circulating nurse will catch
the belt of its ends as you swing. B. Assisted • This is done by the scrub nurse w
hen she is already completely sterile, i.e. she has donned the gown and the glov
es. • Pick up the gown directly from the table or receive it from the circulating
nurse. • Unfold the gown slowly and serve the hemline portion to the surgeon. • Cont
inue unfolding the gown while the surgeon is drying his hands and arms • When serv
ing the gown, your gloved hands should come in contact with the right side porti
on of the gown under the protecting cuff made. • Show the opening and armholes to
the surgeon. • As soon as the surgeon inserted his hands through the armholes, lea
ve it. The circulating nurse will fix it. RESPONSIBILITY OF THE CIRCULATING NURS
E IN THE APPLICATION OF STERILIZATION She places hands inside of the gown near t
he shoulder of scrub nurse and aids her in putting on the gown. She grasps ends
of the gown’s belt without touching the upper part of sleeves of the gown.
 She ties the belt at the back of the gown, keeping belt ends away from the steri
le part of the gown. She ties the back ties after trying the belt.
POINTS TO REMEMBER IN GOWNING: This is done after the surgical scrub. Use an osc
illating motion pat dry in drying the hands and arms. Start from the hand going
to the arms Do not dry hand then arms and return to the same hand In drying the
hand and arms, the hemline portion of the gown or a towel could be used. If a to
wel is used, dry one hand and arm on one end of the towel and use the opposite e
nd to dry the other hand and arm. In serving the gown, do not turn your back on
the sterile field to prevent contamination. In picking the gown from a sterile l
ine pack, be careful not to touch any other articles in the pack with the bare h
ands. GLOVING TECHNIQUE: This is done after the gowning technique. PURPOSE: Glov
es are worn to complete the sterile dress in order that the one who wears them m
ay handle sterile equipment. PART OF A GLOVE: 1. Palmar Surface 2. Dorsal Surfac
e 3. Finger Holes 4. Cuff 5. Wrist TYPE OF A GLOVE TECHNIQUE: OPEN METHOD OF GLO
VE TECHNIQUE Unassisted (Self-service) Get the right hand gloves with the left h
and by holding it at the edge of everted cuff. Step back from the sterile field.
Explore the finger holes before inserting the whole hand completely. Leave the
everted cuff as is. Slip the gloved right hand under the fold of the everted cuf
f. Insert the left hand by exploring the fingerholes before inserting the whole
hand completely. Leave the folded cuff. Make a pleat at the cuff of the gown and
secure this is place with your right thumb. Slip the four fingers of the right
hand under the fold of the glove and pull it up over the pleated cuff of the sle
eves. Fix the glove firmly. Repeat for the right hand. Assisted (Serving Others)
Get the right hand glove and inflate it first for easy insertion and to detect
for holes. In serving the gloves, the palmar surface or the thumb portion should
be facing the one who is being served/ facing the surgeon. Evert the cuff one i
nch wide. Insert four fingers inside the everted cuff. Stretch the glove well ou
tward. Put your thumbs out. Allow the surgeon to explore the fingerholes
 When the surgeon jerks his hand downward, release and pull upward so that the cu
ff of the glove covers the cuff of the gown. Repeat the same procedure for the l
eft hand.
Closed Method This is the method with the least possibility of contamination. PR
OCEDURE With your right hands inside the gown’s sleeves, lift the glove by the cuf
f. Put thumb down or your upturned left palm, fingers of glove pointed toward yo
ur elbow. At this time, move your left hand so that your fingers are halfway dow
n the cuff of your gown. Do not let them protrude from our gown cuff or touch th
e end of the cuff. With your right hand still inside the sleeve, take hold of th
e folded cuff of the left glove and pull it out and over the left hand and well
over the cuff of the left sleeve. Take the right hand, still inside the sleeve,
and grasp the left glove and gown cuff at the wrist and pull glove unto the hand
. Proceed to the right hand the same way. POINTS TO REMEMBER IN GLOVING: Take ca
re not to contaminate the outside surface of the glove In serving the gloves, th
e nurse must have a wide base of support by putting her foot apart. Always serve
the right hand glove first. In serving, get the right glove with the left and t
he left hand glove with the right hand. Always keep gloved hands at waist level
or above. Keep gloved hands away from your mask. REMOVING THE GOWN AND THE GLOVE
S Regardless of whether the scrub nurse assists in a case or contaminated case r
emove first the gown and then the gloves. Wash the gloved hands if they are gros
sly contaminated before removing the gown. Removing the Gown: With the gloves st
ill in, ask the circulating nurse to loosen the ties and the belt. Grasp the rig
ht shoulder of the gown and slip off the arm allowing use sleeves to turn inside
out. Repeat the same procedure for the opposite shoulder. Discard the gown in t
he hamper. Removing the Gloves: With the gloved right hand, remove the left glov
e by holding it at its outer surface and pull off. (This is the glove to glove t
echnique). To remove the right glove, insert your thumb or three fingers between
the skin and the glove and pull off. (This is the skin to skin technique).