Handwashing and Garb

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	Handwashing and Garb

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Handwashing and Garb...

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) is unwaivering in their efforts to promote the awareness that a nosocomial infection resulting in death or permanent injury of patients should be treated as a sentinel event. Lack of handwashing and inappropriate use of gloves has been a frequent nemesis for organizations, as staff are observed going from a direct patient-care task to a non-clinical task such as answering the telephone.

Handwashing

To minimize the risk of infection to the patient it is essential to follow the correct procedure before entering examination rooms, as well as the surgical suites and operating areas.

Required garb for invasive procedures and surgery consists of long-sleeved surgical gowns or disposable coveralls (lab coats are not acceptable), face masks, bouffant surgical caps, OR shoes or shoe covers (booties) and eye protection (goggles, face shields).

They must be the right size and properly worn. Bouffant surgical caps should be worn making sure that hair is tucked underneath it. If OR shoes are not available plastic overshoes (booties) should be worn over normal footwear. The overshoes and hats are normally found in the changing room.

The surgical assistant who does not directly participate in a surgery must be dressed up in a clean long-sleeved surgical gown, face mask, bouffant, shoe covers and use either clean latex gloves to handle non-sterile supplies or sterile surgical gloves to handle sterile supplies. Nails must be carefully cleaned, short and without nail polish. It is strongly recommended that rings and watches should be removed.

This is going to sound silly, but be sure to use the restroom before you go into the OR! Usually, after you are scrubbed in and sterile, it will be a pain in the neck to scrub out and then scrub in again. If you really, really, really must go to the bathroom in the middle of an operation, inform the surgeons of the situation and step out (preferably not during a crucial part of the surgery). Be sure to scrub back in!

Prior to handwashing a mask should be worn. It should be tied secure ensuring that it covers both the nose and mouth. It is important that the mask is neither too loose nor too tight and comfortable to wear, as it will be worn throughout the procedure. A sterile gown pack should then be laid out ensuring not to touch the gown as it is sterile. A pair of sterile gloves of the correct size should also be laid out. When opening the packet it is essential not to touch and contaminate the gloves.

The next step is handwashing. A comfortable water temperature should be selected with correct flow and avoiding splashing. One antiseptic solution should be used throughout the procedure. There are several antibacterial skin cleansers. The most commonly used are Providone—Iodine 2% and Chlorhexidine Gluconate 1.5 %. If sensitivities occur these should be reported to the senior nurse and to Occupational Health.

The procedure for handwashing should be practiced religiously. Hands and nails should be socially clean at the beginning of the procedure. Hands should be kept above elbow level so that water washes form the fingertips down to the elbow throughout the procedure.

Open the brush packet and use the nail pick to clean under the nails. The pick should be discarded after use. The hands and forearms are then wet and the sponge side of the brush is used to wash from fingertips to just above the elbow for 30 seconds per arm. The brush is used to clean the fingernails for 30 seconds each hand. The brush should be detached from the sponge and discarded. With the remaining solution on the sponge the hands and arms should be rinsed ensuring to wash form the fingertips to mid forearm for a total of 2 minutes for each hand. Scrub between the fingers and scrub the palms with the nails.

To finish off the hands and arms should be rinsed. The taps should be turned off using the elbows and allow the arms to drip dry for a short time. Ensure that hands are kept higher than the elbows.

The first scrub of the day should last for 5 minutes and all subsequent scrubs should last for 3 minutes. Once the hands are washed, use the towel provided with the gown pack to dry the hands and forearm. Hold the hands above the elbows and dry from the fingertips down. When the hands are dry discard the towel. Holding the gown from the inside open it up ensuring the gown does not make contact with anything. Place the hands through the sleeves of the gown but do not push the fingers through the cuffs. Using the cuffs pick up one glove ensuring not to touch the glove with the skin and put it on. Pull the cuff of the glove over the cuff of the gown. Repeat the same procedure for the other hand.

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Finally, ask a colleague to assist you in fastening the gown at the back. Keep hands up at all times and do not touch anything that is not sterile.

If you start to feel ill or faint during an operation, immediately inform the surgeons and then step away from the table. Do not try to “hold out”, since it would be a disaster if you fainted and fell into the sterile field.

REMEMBER:

Stay a safe distance away from obstacles to prevent contamination of the gown! In general, just remember: if you are sterile, do not touch anything that's not sterile and vice versa. Sterile areas are marked by green or blue colored drapes. These generally include the operative field (i.e. the patient), the scrub table (where are the instruments are kept) and the front and sleeves of your gown. The back of your gown and anything below the waist is considered not sterile or contaminated. Your mask, protective eyewear and hat are also non-sterile.

All disposable garb must be removed and disposed of into the designated garbage basket after leaving the operating room. Non-disposable surgical gowns and scrubs must be put into the laundry basket, usually next to the entrance.