Only essential and easily
movable furniture present
Air under mild pressure
Air flows out not in
Ideally 2 separate theatres
Otherwise, clean before
contaminated surgeries
2. Patient Preparation
Skin preparation
Hair removal
Clipping, not saving
Preferably outside theatre
Pre-induction
10-15cm away from intended site
Can incise further if the need
arises mid surgery
Cover feet (+ tails)
Clean skin
Scrub solution
Gross prep
Until clean
Rinse in between
Rub white swab over at end
No traces of dirt
Plenty of water
Gloved hands
Disinfect skin
Gloved hands
Scrub solution + water
Start at site
Work outwards
5 mins
Final disinfectant
Left in place
Antiseptics
Clorhexidine
Low residual activity
Binds to protein in skin
Lasts longer (~3 hrs)
Low toxicity
Can be toxic to fibroblasts
Remember in older wounds
Iodine compounds
Stains, radioopaque,
smells
Only free iodine is bactericidal
Providone iodine
Releases free iodine when
diluted with detergent
Sets a cascade which
releases iodine
Low toxicity
Inactivated in presence of organic debris
Patient must be
completely clean
before use
Synergistic effect with alcohol
Alcohol
Only effective against bacteria
Inactivated in presence of
organic debris
No residual activity
Evaporates
Commonly used as a rinse after
surgical scrub
Gets rid of soap scum
Draping
Aim to prevent movement of
debris and bacteria from
non-sterile areas to surgical site
Impermeable,
disposable drapes are
best
Drape from clean to
dirty
Keep hands on sterile part of drape
Double gloves
Reduce contamination
Remove one pair pre-incision
Use additional drapes if
concerned about
contamination mid
surgery
Towel clamps to fix in
place
If removed - tips are not sterile
3. Surgeon's Preparation
Clothing
Scrubs
Cap
Designated footwear
Applies to all
theatre personnel
Hand disinfection
Scrubbing
Remove gross
contamination and reduce
bacterial count on skin
Ideally a prolonged effect
Follow protocol
Annotations:
1. Wash hands and forearms with water and soap
Clean finger nails
2. Use surgical scrub brush to wash with antiseptic
soap (povidone iodine or chlorhexidine gluconate). Chlorhexidine is superior
because of it’s prolonged residual activity. Contact time is important, so soap should be applied on hands and forearms before continuation with through scrub.
3. Make sure to include front and back of hands, four sides of each finger and thumb, fingertips, finger nails, between each finger, wrists and forearms. Repeat twice with rinsing after each time.
4. Keep hands above elbows at all times to avoid contaminated water from elbow running back down on forearms and hands.
5. Total scrub time 3-5 mins
6. Dry with sterile towels. Dry hands first, then dry forearms from wrist to elbow (not back up) and then discard towel. Use second towel for other hand and forearm.
Alcohol based hand rubs
Just as/even more effective
Long duration of action
Thorough pre washing required
Removal of gross contamination
Gloving and gowning
Never touch outside surface
Gowns
Annotations:
Folded inside out in sterile packing. Find and hold the neck of the gown with one hand, place both hands in arm holes and shake out gown. An assistant will tie up gown behind you. Pull card of short tie and give to assistant, turn around, grap tie from assistant (do NOT touch the card) and tie knot. Gowns should be water resistant, comfortable and breathable
Gloves
Closed gloving preferable
Fingers do not leave gown until
covered with glove