1、Preparation of surgery and patients,Feng Peng,Content,Preparation of the surgical team. General preparation. Skin preparation. Gowning and gloving. Preparation of patients. Skin preparation. Draping.,General preparation of surgical team,Trim the nails. Nail polish is forbidden. Remove all the jewelr
2、y. Complete change to clean OR attire and slippers. Notice that sleeves be rolled up to 12cm above the elbow. Wearing caps and masks.,Skin preparation- Scrubbing,AIM: To decrease the bacterial load and risk of wound contamination from the hands and arms. Methods:,Soap scrub and alcohol soak method.
3、Soap/iodophor scrub method.,Soap scrub & alcohol soak method(1),Use soap and running water to clean hands, forearms, elbows and upper arms. Take a brush dipping liquid soap, scrub from left finger tips to thumb (radialis dorsal ulnaris - palmaris ), and move to other fingers. Then scrub the palm, ba
4、ck of the hand and wrist (palmaris - radialis dorsal ulnaris ). Use another side of the brush scrubbing right hand in same order.,And then scrub left forearm, and right forearm. Followed by left elbow up to 10cm above, and turn to right elbow.,Notice: Hand higher than arm. Directions of scrub. No bl
5、ank area left. Time: last for 3 min.,10cm,Soap scrub & alcohol soak method(2),Rinse off. Always hold up your arms to allow water dripping off your elbows.,Notice: NO touch of anything. NO soap remained. NO wetting attire.,Take new brushes and REPEAT the whole process twice.,Soap scrub & alcohol soak
6、 method(3),Take a folded towel, wipe off both hands. Open the towel to a triangle, with tip pointing to the fingers, and then wipe from the wrist to elbow. Turn over the towel, and wipe off the other side.,Scrubbing is done. Simple scrubbing is NOT disinfection.,Soap scrub & alcohol soak method(4),S
7、oaking in alcohol, up to 6cm above the elbow for NO less than 5min. HOLD UP arms and air dry. Enter into OR, open the door by your back.,Soap scrub & alcohol soak method(5),Use soap and running water to clean hands, forearms, elbows and upper arms. Soap scrubbing once (10cm, 3min). Wipe off with tow
8、el. Iodophor sponge embrocating for 2.5 times (6cm, 5cm, to wrists) . Air dry. Enter into OR, open the door by your back.,Soap/iodophor scrub method(1),Gowning (1),Pick up a sterile gown with both hands. Hold the gown at the edge of the neck piece, away from your body, and sufficiently high.,Gowning
9、 (2),Hold the gown by the inside at neckline, allow it to unfold gently. Gently shake the folds from the gown and insert arms into the armholes, keeping arms extended. Wait for pulling up over shoulders.,Gowning (3),Assistant nurse grasps the inner surface of the gown at each shoulder, the gown is t
10、hen pulled over and sleeves up over the wrist.,Correct,Wrong,Gowning (4),Bow your waist slightly, cross your hands and grasp the tapes, then rise up your waist. The assistant nurse takes over the tapes and fasten them in the back .,Gowning (5),Gloving before touch of tapes. Untie the tapes. Hand in
11、the right tape to assistant. Turn around. Fasten the tapes by yourself.,Gloving (1),Identify the left and right side of the glove. Hands can only touch the inner side of the glove, but fingers in glove can NOT touch the other inner side of the glove. Make sure the glove cuff covers the sleeve cuff.,
12、Gloving (2),Gloving (3),Get ready!,Notice: Hands must be kept within the sterile boundary of the gown. Hands must NOT touch cap, mask or spectacle. Nonsterile assistant can be asked to help. Face to sterile field, NOT back to.,When the operation is done,First remove the gown. Second, remove the glov
13、es (only touch their outer surface). In this way you can retain your hands clean, get ready to join next operation immediately after disinfection with iodophor 2.5 times, gowning and gloving.,Shower - the night before an elective operation. Shaving hair in the operative site should be removed.,Gener
14、al preparation of patients,This is performed by first assistant after the surgical hand scrub/disinfection and before gowning. Stand at the right side of pts. Hold the sterile sponge clamp, get a iodophor pledget to apply antiseptic paint. In aseptic operation, starts paint in the line of planned in
15、cision, while in septic, starts from periphery toward the incision.,Preparation of skin (1),Moving outward or inward from up to down. Each brush must be 1/3 overlapped to previous brush. Aseptic area must be large enough, at least 15cm away from each side of the incision. Get new iodophor pledget an
16、d repeat twice. Aseptic area should be smaller each time.,Preparation of skin (2),Preparation of skin (3),Notice: Directions. An area already washed is NOT returned to with the same pledget. No blank area left.,Aim to isolate the operating area . First, lay out sterile drapes underside, opposite sid
17、e, upside, and selfward. Fix the drapes with towel clips. Then, the scrub nurse and the assistant carry out draping. First sheet isolates the leg, the second sheet isolates the head. Last full sheet must be placed by scrub nurse and surgeon donned gown and gloves.,Draping (1),First assistant needs to disinfection hand and arm by soaking in alcohol for another 5min (or using iodophor 2.5 times), and then gowning and gloving. If the drape needs to be adjusted, it should only be moved in a direction AWAY from the operating area and NEVER towards the sterile site.,Draping (2),Thank you!,
