Unrestricted/ Unsterile Area

 this area is isolated by doors from the main

hospital corridor.
Semi-restricted/ Semi-sterile Area

 OR attire is required. This area includes peripheral

support areas and access corridors to the OR.
Restricted/ Sterile Area
 marks are required to supplement OR attire. Sterile
procedures are carried out in this room.
Dressing Rooms and Lounges

 Clothes changing areas must be provided for both

men and women. Access is from an unrestricted area
to change from street clothes to OR attire before
entering the semi restricted areas or vice versa.
 Operating Room Attire
 Consists of body covers such
as scrub suit, head cover, mask
and scrub shoes.
Purpose:
To provide effective barriers
that prevents the
dissemination
of microorganism to the
patient.
 Points to Remember:
 Only approved, clean OR attire must be worn within the
restricted area of the OR.
 OR attire is not worn outside the OR suite.
 Eyeglasses should be wiped with the tissue wet with antiseptic
solution to prevent cross contamination.
 Personal hygiene must be emphasized.
 Points to Remember:
 No unauthorized person should be permitted in the OR.
 Personnel with skin diseases or wounds must never be
allowed to scrub.
 Jewelry and nail polished should not be worn inside the OR.
 Components of attire:
 Body Cover – must be done
before entering a restricted or
semi restricted areas.

 Head Covers – cap protects the

garment/ body cover from
contamination by hair.
 Shoe Covers/ Scrub  Mask – must be worn in
Shoes – must be worn to restricted area to contain or
prevent spread of filter microorganisms
microorganisms. expelled from the moth and
nasopharynx by coughing.
  Gloves – a pair of
sterile gloves
completes the attire for
sterile team members.

 Gown

– a sterile gown is worn over the

scrub suit to permit the wearer
to come within the sterile field.
Criteria for Attire:
Effective barrier for microorganisms
Resistant to blood and aqueous fluid abrasion to prevent
penetration by microorganism.
Designed for maximal skin coverage.
Hypoallergenic, cool and comfortable.
Pliable material to permit freedom to movement.
Easy to don and remove.
Surgical Scrubbing
The process of removing as many as microorganisms as
possible from the hand and arms by mechanical washing
and chemical antisepsis before participating in an operation.
 Purpose:
To decrease the number of microorganism on the skin.
To keep the population of microorganism minimal during the
operative procedure by suppression of growth.
To reduce the hazard of microbial contamination of the operative
wound by skin flora.
Preparation for Surgical Scrubbing:

Skin integrity of hands and arms must be

intact.
Remove all finger jewelry because it
harbors microorganism
Be sure that all hairs are covered by
headgear because they are potential
foreign body inside the operative
wound
Preparation for Surgical Scrubbing:

Adjust mask snugly and comfortably on

the nose and mouth

Adjust eyeglasses comfortably in relation

to mask.

Adjust water to comfortable

temperature.
Method of Surgical Scrubbing
Time Method Brush Stroke Method
allotting a prescribed length allotting prescribed number of
of time. strokes to each sides of the
hands.
Principle involved
 Surgical scrubbing starts from the cleanest area to the
dirtiest area. (fingers, hands, arms and elbows 3 inches
above)
Prerequisites to Surgical Scrubbing

Wear scrub suit, put on mask cover all hair with a cap.
Remove jewelries
Fingernails must be short and no nail polish.
Hands must be free from wounds.
Eyeglasses must be washed and secured.
Click icon to add picture

Scrub Room
– area wherein surgical scrubbing is done.
Scrub Room
 for surgical scrubbing and must be provided adjacent
to each OR.
Equipments for Surgical Scrubbing
Antimicrobial Solution – contained in a liquid soap
dispenser near the sink often operated by foot pedal.
Deep sink with foot or knee controls for water
Nail cleaning tool-file or orange stick.
Surgical scrub brushes
 Procedure: Time scrub method

Wet hands and forearms under running water, holding

the hands above the level of the elbows so that the
water runs from the fingertips to the elbows.
Apply 2-4 mL of antiseptic solution to the hands. Use firm
rubbing circular motion to wash the palms and the back
of the hands, wrists and forearms, interlace the fingers
and thumbs and move the hands back and forth.
Clean the nails with a file or an orange stick. Rinse hands and
arms under running water while keeping the hands higher than
the elbows.
Get a sterile brush and rinse it under running water. Apply
antiseptic on the brush. Start brushing the fingernails, back
and the palm of the hand, forearm and the elbow while
allotting a prescribed time of brushing for each part.
At the end of the scrub dry your hands with a sterile towel
beginning at the tip of the fingers to the elbow. Rotate the
towel and repeat the procedure on the other hand. Proceed to
put on a sterile gown.
 Time allotted:
 Left hand – 1 minute  Left hand – 1 minute
 Left arm – 1 minute  Right arm - 1 minute
 Left elbow – ½ minute  RINSE BRUSH
 RINSE BRUSH  Right hand - 1 minute
 Right hand - 1 minute  Right arm - 1 minute
 Right arm - 1 minute  RINSE HANDS, ARMS
 Right elbow – ½ minute AND BRUSH
 RINSE HANDS, ARMS  Left hand – ½ minute
AND BRUSH  Right hand – ½ minute
 RINSE HANDS, ARMS
AND BRUSH AND
PROCEED TO OR
BRUSH STROKE METHOD
 Follow the procedure of time method from nos. – 1-5 except
that instead of allotting time, you’re going to allot
prescribed no. of strokes for each part.
Prescribed no. of Strokes
 Left hand: Nails – 20 stroke across nails.
 Fingers – 10 strokes to each side
 Hand – 10 strokes to each side
 Left arm – 6 strokes to each side
 Left elbow – 6 strokes
 RINSE BRUSH
 Repeat the above procedure to your right hand.
 RINSE HANDS, ARMS AND BRUSH
Prescribed no. of Strokes
 Left hand – nails – 10 strokes, fingers – 5 and hand - 5
Left arm – 3 strokes to each side.
 RINSE BRUSH
 Repeat above for right hand then rinse hands, arms and
brush.
 Left hand – nails – 5 strokes, fingers – 3 and hand – 3 then
brush then rinse
 Repeat above for right hand then rinse hands, arms and then
discard brush, rinse hands, arms. Turn off the faucet then
proceed to OR.
Gowning and Gloving
The sterile gown is put on after the surgical
scrubbing.
The sterile gloves are put on immediately after
gowning.
 When Surgeon Arrives After
Scrubbing
Gown and glove the surgeon and his assistants as
soon as they arrive.
Assist in draping the patient according to routine
procedure.
Purpose:
Sterile gowns and gloves are worn exclude skin as
possible contaminant and to create a barrier
between sterile and unsterile areas.
Gowning
Reach down to the sterile package and lift the folded
gown upward.
Move one step backward for safety margin while

gowning.
Gowning
Holding the folded gown, carefully locate the neck
band.
Unfold the gown and be careful not to touch the

outside portion of the gown.

Gowning
Slip both hands into the arm holds simultaneously.

Gowning
 The circulating nurse brings gown shoulders by
reaching inside the shoulder and arm seams. The
gown is pulled out the lowering the sleeves extended
to both hands. The back of the gown is securely tied
or fastened at the neck and waist.
Closed Gloving Technique
Using the left hand, while keeping it within the
cuff of the left sleeve, pick up the right glove.
 Place the palm of the right glove against the

palm of the right hand. Glove fingers must be

pointing toward the wearer.
Closed Gloving Technique
 Secure hold the lower portion of the cuff of
the right glove with right hand that is still
hidden inside the sleeves. Secure upper
portion of cuff of the glove with your left
hand.
Closed Gloving Technique
Slip/slide your right hand into the right glove.
Arrange sleeve and glove with your left hand.
Do the same procedure in donning the left

glove.
Removing gowns and gloves:
 the gown is removed first before the gloves.
Sterile Field
– any area covered with a sterile drape.
Principle of Sterile Technique
 Only sterile items are used within the sterile field.
 If you are in doubt about the sterility of anything,
consider it unsterile.
 During Operation
Step away from sterile field of contaminated.
Change gloves when pricked by needles.
Do not turn your back from sterile field.
Keep sterile field as dry as possible
Discard soiled sponges from a sterile field.
Keep talking to a minimum.
Principle of Sterile Technique

 Gowns are considered sterile ONLY from the

waist to shoulder level in front and themselves.
 Sterile persons keep hands in sight and at or
above waist level.
Principle of Sterile Technique
 Hands are kept from the face and never held
under the axillaries region.
 Changing table levels are avoided.
 Items dropped below waist level are considered
unsterile.
Principle of Sterile Technique
 Tables are considered sterile only at table level.
 Anything that extends below the table level is
considered unsterile.
 In unfolding sterile drape, the part that drops
below the table level is considered unsterile.
Principle of Sterile Technique

 Sterile persons touch only sterile items or areas,

unsterile persons touch only unsterile items or areas.
 Unsterile persons should not directly get in contact
with the sterile field. Use sterile transfer forceps.
Principle of Sterile Technique
 Unsterile persons a void reaching over a sterile field
and sterile persons avoid leaning over an unsterile
field.
 In pouring into a sterile field and sterile persons
avoid leaning over the basin to avoid over reaching.
 During Operation
Provide 2 sponges on the operative site prior to skin
incision.
Pass the first knife for the skin to the surgeon's needs.
Pass instruments in a decisive and positive manner.
watch out for signals and keep instruments as clean as
possible.
Principle of Sterile Technique
 The scrub nurse should set the basin or glasses to
be filled at the edge of the sterile table.
 Surgeons turn away from the sterile field and to
have perspiration removed from the brow.
 Principle of Sterile Technique
 Sterile persons keep well within the sterile area.
 Sterile persons pass each other back to back.
 Sterile persons turn back to non-sterile person or
area when passing.
Principle of Sterile Technique
 Unsterile persons avoid sterile areas.
 Unsterile person should maintain at least 1 foot
distance from any sterile area.
 Unsterile persons never walk between 2 sterile
areas.
Principle of Sterile Technique
 Sterile field is created as
close as possible to the
time of use.
 Sterile areas are
continuously kept in
view.
 Destruction of integrity
of the microbial barriers
results in contamination.
 Microorganisms must be
kept to a minimum.