Surgical Scrub Practices in the Theatre - Literature review Example

CLINICAL SKILLS CRITIQUE By: Course: Professor Date Introduction According to the medical dictionary, surgical scrub is a bactericidal soap or solution used by surgeons or surgical nurses before and in the middle of performing a surgery. Surgical scrub method originated in the 1800s. Back then, doctors did not perform scrubbing before a surgery. They would move from examining a corpse to helping out a mother giving birth and this led to a high mortality rate in maternity wards and childbed fever. Dr Semmelweis, a director at the Vienna General Hospital was the man behind this revolution. Through research, he found that midwives clinic reduced deaths and that hand washing was the key reason behind this. He thereby instructed all his staff to wash their hands with various antiseptics, and this, in turn, reduced the number of deaths. This paper focuses on surgical scrub practices in the theatre. The video provided shows a well-outlined procedure to go through during a surgical hand scrub. It is a systematic routine, which takes less than 10 minutes where one lathers, soaks, and brushes a hand and an arm (Surgical Guide, 2013). Reasons for adopting aseptic technique Since eliminating fully the bacterium from your skin is impossible, this process drastically reduces the number of bacteria on your skin at the beginning of and throughout the surgery. Small microorganisms that cannot be seen by the naked eye are always present on our skin and Clothes. It is important not to introduce microorganisms into the patient body during theatre procedures. According to Healey (2006), “Hands hygiene is especially important as they come into closest contact with patients. Surgical site infections greatly contribute to contaminated infections. Some of the risk factors for contaminated infections include the behavior of the personnel while carrying out decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions (Brennan et.al, 1991). While hand washing may be the simplest way to control infection, it is often not practiced properly as required. The hands, when not taken good care of, can transmit infections to many patients. Surgical site infections greatly contribute to contaminated infections. Some of the risk factors for contaminated infections include the behavior of the personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions (Awad et. al, 2005). Procedures used in scrubbing Some of the procedures in scrubbing includes: cleaning of the hands and forearm, cleaning the nails, rinsing, turning off the tap, drying among others. A health practitioner should wash his arms and forearms using warm water. With the use of scrubbing solution, finger tips should be washed down to the elbow thoroughly keeping the hands elevated to avoid contamination once they are washed (Mitchell & Flin, 2008). Surgical professions agree on proper hand washing methods as a way of reducing infections. Handshakes play a major role in the spreading of pathogens, viruses, and bacteria that cause nosocomial infections and diseases. Thus, it is necessary for all sterile members of the surgical team to perform a hand and arm scrub before entering the surgical suite. Wash your hands using a firm circular motion on your palms, backs of the hand, webs of the fingers and thumb. Lather down to the wrist of every hand rotating each wrist to the opposite side. While the hands are still lathered, clean under your nails with the orange nail stick and after you are done, discard it into the dustbin. The health practitioner should then apply scrub solution onto the brush and scrub the hands and the arms together with nails and rinse properly. Afterwards, he should wash hands and the forearms again starting from the forearms to the elbow using the scrubbing solution containing alcohol solution taking keen attention with the fingers then rinse off. The surgical sponge may or may not be impregnated with antimicrobial solution. If not you will need to add about 5Ml of antimicrobial solution. Pick up the surgical sponge and visualize each area of your hands and arms as having four parts. Using this technique, scrub each part of your fingers, thumbs, back of your hands, crisis of your palms, knuckles, and wrists. Use a circular motion to scrub upwards on your forearms dividing each of them into lower, middle, and upper regions. Wash to about five centimeters above the elbow and pay attention to the anticubital forsta. You can count your strokes when washing or time each area being washed. Turn off the tap using the elbows is the next step. The health practitioner should remember to keep the hands elevated above the head to avoid any form of contamination. Thereafter, he should wipe each arm using different towel and discard into the dust bin next to his scrubbing area. The hands should be wiped properly starting from the fingertips down the elbow. The scrubbing space should be open enough so as not to contaminate the gown. An assistant should be readily available to assist with the tying up of the gown at the back (Dhamija, et.al 2010). When it comes up to putting on then gown, hold it firmly and take it away from the table. It is folded in such a way that the outside faces away The nurse should put gloves on with the hands still in the gown sleeves while carefully pulling them into the fingers of the gloves. According to Johnson 2013, bare hands should never be allowed to come into contact with the .gloves or outside of the gown. Proper care must be taken before putting on gloves. Hold the gown by the shoulders and allow it to unfold gently. Do not shake the gown. Slowly place your arms inside the armhole and slide each arm through the sleeves raising and spreading them. Do not allow your arms to slide across the gown cuffs. The nurse gowns the surgeon after he/she has performed the surgical scrub. Also, the mask should be changed every 30 minutes or sooner if it becomes damp as effectiveness is greatly reduced when it is moist. Surgical scrub is mainly for disinfection. Disinfection only kills a certain percentage of pathogens but all. Stronger disinfectants should be used in order to kill as many pathogens as possible. All inanimate objects should be boiled in hot water. However, this does not destroy all microorganisms or spores. Scrubbing procedures should not be neglected because there is not time to do it. Forehead or any part of the body should not be scratched during surgery. However, a health practitioner should request assistance from the theatre or surgery staff team present. Any assistance should be sought from the theatre staff if any scrubbing procedure is not clear. According to Lyon (2003), “Scrubbing in should not be done with people with open wounds on the hands as this may bring a lot of infections to both the patient and the theatre staff.” In addition, hands should always be kept next to the chest while in the theatre field. As Johnston (2013) emphasize, notification should be given to the theatre staff in cases of contact with any foreign object in the theatre field. Furthermore, the toilet should be visited before the theatre. Any assistance should be sought from the theatre staff if any scrubbing procedure is not clear. The hands should always be kept next to the chest while in the theatre field. Notification should be given to the theatre staff in cases of contact with any foreign object in the theatre field (Johnson, 2013). Conclusion The following are the main purposes of surgical hand scrub; to remove temporary microorganisms from the nails, hands, and forearms, to reduce the resident microbial count to the lowest level possible. A surgical scrub serves also plays a crucial role of stopping rapid rebound growth of microorganisms. In addition, it eliminates transient microorganisms and debris from the nails. This is done by cleaning of the nails with the orange stick nail cleaner. However, the practice has come under heavy criticisms from scholars who argue that frequent scrubbing can lead to dermatitis of the hand and skin. This is because most antimicrobial agents dry to the skin especially when used together with a surgical brush. References Award, S. et. al. 2005. Bridging the communication gap in the operating room with medical team training. American Journal of Surgery 190, 770–774. Brennan, T. Leape, L. Laird, N. et al. 1991. Incidence of adverse events and negligence in Hospitalized Patients. Results of the Harvard Medical Practice Study: UK Dhamija, P. Bansal, D. Xess, D. Bikash, M. 2010, Scrub Typhus: Clinical Approach, Post Graduate Institute of Medical Education and Research, Chandigarh 160012: India. Healey, A. 2006. Defining the technical skills of teamwork in surgery. Harvard: UK. Johnson, P. 2013. Simulated surgical workshops enhance medical school students’ preparation for clinical rotation. Queensland: Australia.‎ Lyon, P. 2003. Making the most of learning in the operating theatre: student strategies and curricular initiatives. Med Educ. Queensland: Australia Mitchell, L & Flin, R. 2008. Non-technical skills of the operating theatre scrub nurse: Literature review. Blackwell Publishing Ltd: UK. Surgical Guide. 2013. A Comprehensive Guide to the Surgical Scrub. (Online) (Updated on Oct 13, 2010) Available at: (Accessed 12 septeber.2013) Read More