Scrub, Gown, and Glove Procedures - Multimedia Edition

1-20. INTRODUCTION

a. Gloves are packaged so that the scrub may don his gloves without contaminating the glove's outer surfaces. A pair of gloves are packaged in an individual sterile wrapper.

b. While the specialist is wearing his sterile gown and gloves, he must take particular care to avoid contaminating these sterile garments because such contamination could possibly result in the transfer of pathogenic microorganisms to the patient's wound. The specialist should therefore observe certain rules, to include the rules outlined Table 1-2.

Table 1-2. Rules to observe while wearing sterile gown and gloves.

NEVER

drop his hands below the level of the sterile area at which he is working.

NEVER

touch his surgical gown above the level of the axilla or below the level of the sterile area where he is working.

NEVER

put his hands behind his back; he must keep them within his full view at all times.

NEVER

tuck his gloved hands under his armpits, as the axillary region of his gown is contaminated.

NEVER

reach across an unsterile area for an item.

NEVER

touch an unsterile object with gloved hands unless ordered to do so by the surgeon.

NOTE: The surgeon will not give such an order as to allow someone to touch an unsterile object with gloved hands unless a dire emergency exists (such as cardiac arrest) when the time element is of paramount importance in saving the patient's life.

Watch a video showing the closed cuff method of surgical gloving

NOTE: If the scrub contaminates his gown and gloves in any of the ways just mentioned in Table 1-2, he needs to discard and replace his gown and gloves.

1-21. CLOSED CUFF METHOD

a. Discussion. The closed cuff method of gloving is preferable to the open cuff method when the specialist must glove himself. The closed cuff method eliminates potential hazards in the glove procedure as follows:

(1) The danger of contamination of gloves caused by the glove cuffs rolling on skin is eliminated because the skin surface is not exposed.

(2) The gown cuffs can be anchored securely by the gloves without the danger of contamination that exists when gloves are donned by the open cuff method.

b. Procedure.

(1) Take a tuck in each gown cuff if the cuffs are loose. Make the tuck by manipulating the fingers inside the gown sleeve; do not expose the bare hands while tucking the gown cuffs.
(2) The circulator opens the outer wrapper of the glove package and flips them onto the sterile field.

Watch a video demonstrating the surgical glove flip or drop onto a sterile field

(3) Open the inner package containing the gloves and pick up one glove by the folded cuff edge with the sleeve-covered hand (see Figure 1-21).
Figure 1-21
(4) Place the glove on the opposite gown sleeve, palm down, with the glove fingers pointing toward your shoulder (see Figure 1-22). The palm of your hand inside the gown sleeve must be facing upward toward the palm of the glove.
Figure 1-22
(5) Place the glove's rolled cuff edge at the seam that connects the sleeve to the gown cuff (see Figure 1-23). Grasp the bottom rolled cuff edge of the glove with your thumb and index finger.
Figure 1-23
(6) While holding the glove's cuff edge with one hand, grasp the uppermost edge of the glove's cuff with the opposite hand (see Figure 1-24). Take care not to expose the bare fingers while doing this.
Figure 1-24
(7) Continuing to grasp the glove (see Figure 1-24); stretch the cuff of the glove over the hand (see Figure 1-25).
Figure 1-25
(8) Using the opposite sleeve- covered hand, grasp both the glove cuff and sleeve cuff seam and pull the glove onto the hand (see Figure 1-26). Pull any excessive amount of gown sleeve from underneath the cuff of the glove.
Figure 1-26
(9) Using the hand that is now gloved, put on the second glove in the same manner. When gloving is completed, no part of the skin has touched the outside surface of the gloves. Check to make sure that each gown cuff is secured and covered completely by the cuff of the glove (see Figure 1-27). Adjust the fingers of the glove as necessary so that they fit snugly.
Figure 1-27

NOTE: The scrub should don the first glove in accordance with the hand he uses most of the time, i.e., a right-handed specialist can perform the closed cuff gloving procedure more quickly and efficiently by putting on the left glove first. A left-handed specialist will facilitate the procedure for himself by putting on the right glove first.