Surgical Hand Scrub Learning Outcomes By the end

Surgical Hand Scrub

Learning Outcomes By the end of the session you will be able to: • Follow basic surgical etiquette • Understand the principles and benefits of performing hand decontamination • Apply asepsis to the skill of surgical hand scrub

Protocols and Competency • • Guides and protects practice Supports update of knowledge Act within your limitations Practice must be supervised and documented until graduation • Supervision proximity should be negotiated with your supervisor • Keep your skills passport as evidence of training and competency

Aseptic Non Touch Technique (ANTT) ANTT is a framework which maintains Asepsis in order to protect patients from potentially harmful organisms. “Key Parts (hands) must only come into contact with other aseptic Key parts (instruments, sterile fields, gloves) or Key Sites” (www. antt. co. uk) Asepsis is achieved by: • Hand decontamination • Non touch technique • Sterile equipment • Cleaning equipment/site until aseptic

Purpose of surgical hand scrub • Remove debris and transient micro-organisms from the nails, hands and forearms • Reduce resident microbial count to a minimum • Inhibit rapid rebound growth of micro-organisms

Hand Facts • Hands are an important tool in medicine. They feel, diagnose, cure and examine • The hands can be a portal and transmitter of infection • Hand washing is the simplest way to control infection • Surgical site infections contribute to nosocomial infections

Scrub • Remove jewellery • Use warm water. Hot water damages the skin, cold water prevents soap from lathering • Use nail cleaner if needed • Clean hands and forearms • Elevate hands to shoulder height so that water runs from clean to dirty area • Wipe hands thoroughly

Types of scrub agents • Liquid - chlorhexidine gluconate and iodophor • Brushes – impregnated with chlorhexidine gluconate or iodophor • Dry brushes

Characteristics of surgical scrub • Antimicrobial action – broad spectrum of antimicrobial activity against pathogenic organisms. Work rapidly • Persistent activity- keeps the bacterial count low under gloves • Safety – non-irritant, non-sensitizing, be safe on skin and to environment • Standardised – Users follow a recognised approach

General advice • Visit theatres prior to placement • Try and meet the patient pre- and post-surgery to experience the patient journey • Nail varnish/ false nails have no place in theatre • Remove all jewellery excluding a plain wedding band • Keep hands elevated and follow asepsis guidelines • Take a clean pair of socks as these must be worn • Find a friendly ODP/ theatre nurse • Take part in the WHO checklist

WHO Checklist

Sizes • • • Small (yellow trim) Medium (brown trim) Large (white trim) XLarge (pink trim) XXLarge (orange trim) XXXLarge (red trim)

Questions, True or False 1) Surgical site infections contribute to nosocomial infections 2) A timed scrub should last for 3 minutes 3) The best water temperature is very hot; this tends to kill bacteria more quickly 4) Vigorous scrubbing causes the skin to become damaged and should be avoided 5) The surgeon is normally gloved and gowned by the circulating nurse

Questions True or False 6) The purpose of surgical hand scrub is to sterilize the hands prior to gloving 7) An ideal surgical scrub agent would have a broad spectrum of antimicrobial activity against pathogenic organisms 8) Bacteria grow faster under gloved than un-gloved hands 9) When donning sterile gloves, the surgical scrub becomes less important 10) Effective surgical scrubs are one of the most powerful strategies of infection prevention

Answers 1) True 2) False 3) False 4) True 5) False 6) False 7) True 8) True 9) False 10)True