Scrubbing, Gowning, Suturing
Surgical Scrubbing: ideal scrubbing time is 3 minutes
• Preparing to scrub: General instructions:
1. Wear your surgical mask, theatre hat (with hair tied up), glasses and ID
badge. Remember: they will not be adjustable after scrubbing.
2. Remove watches and rings.
3. Open your gown and gloves pockets before you scrub using the edges of
the paper and keep them in the sterile area.
• Scrubbing procedure:
1. Run the tap to an adequate temperature and flow of water (use your knee
to run and turn it off).
2. Open the package containing the (nail brush/scrub sponge) and the (nail
pick). Nail brush/scrub sponge has 2 types: Betadine (many people are
allergic to it) and Chlorhexidine.
Nail pick
Nail brush/Scrub sponge
3. Rinse the hands and arms thoroughly, allowing the water to run from the
hands to the elbows.
4. Start by cleaning under the nails with the nail pick and then discard it in
the bin.
5. Moisten the nail brush with water.
6. Use the bristle side (rough side) of the nail brush, scrub the spaces under
the fingernails back and forth. Avoid using the rough side on other parts
of the hand as it causes scratches.
7. Use the sponge-side of the brush to scrub the (palm, lateral side of the
fingers, medial side of the fingers, dorsum of the hand, then the
forearm up to the elbow), then repeat the same steps on the other hand
and forearm.
Scrubbing the
medial side of
fingers
Palm scrubbing
Dorsum scrubbing
8. Discard the nail brush in the bin.
9. Wash your hands from the tip of the fingers to the elbow. Don’t move
arms back and forth in the water.
10. Keep your hands away from your body and above the level of the elbow.
Helpful video: https://www.youtube.com/watch?v=WpZqLbWL0c0
In case the nail brush is not available, we use the soap instead and we follow the
following steps:
1. Wash your hands and forearms up to the elbow with water.
2. Apply a good amount of soap on your hands.
3. Clean the soap into the hands as follows:
i. Palm to palm with finger interlaced
ii.
Palm to dorsum with finger interlaced
iii.
Rotational rubbing backwards and forwards with clasped fingers
iv.
Rotational rubbing of the thumb
v.
Rubbing the fingertips of the hand on the palm of the other hand
vi.
Continue rubbing with the rotating action on the forearm to the elbow.
4. Wash your hands from the tip of the fingers to the elbow (don’t move arms back
and forth in the water)
5. Keep your hands away from your body and above the level of the elbow.
After scrubbing either by the nail brush or by the soap, hold one end of the towel with
one hand and dry the fingers of the opposite hand then move to the dry area of the towel
and continue in this manner down the forearm to the elbow.
Gowning + Gloving:
1. Pick up the entire folded gown from the wrapper by grasping the gown through all
layers, being careful to touch only the inside top layer.
2. Carefully insert your arms partway into the gown one at a time, keeping hands at
shoulder level away from the body. Be careful that no part of the hand
protrudes from the sleeve cuff.
3. A theatre assistant will fasten the gown behind you to secure the gown at the
neck and upper back.
4. Open the inner glove packet.
5. Pick up one glove with your sleeve-covered hand. Remember: you are not
allowed to touch the external surface of the gloves with your bare hands.
6. Wear the gloves using the closed technique as shown in this video (to 1:14)
https://www.youtube.com/watch?v=7x2xPc7YsF4
Note: the doctor said it’s ok to use the open technique as well which is shown in
the following video:
https://www.youtube.com/watch?v=CvAsZolGF8I
7. After gloving, do final tying of your gown by detaching the cardboard slip from
the short tie, ensuring you keep hold of the short tie in your left hand.
8. Pass the cardboard slip to the theatre assistant, ensuring not to make direct
contact with their hand.
9. They will pass the long tie around your back, let them pull the cardboard off the
tie so that you can tie a bow at your waist.
Suturing:
Needle holder (Needle driver): hold it
with your dominant hand as shown in
this picture
Toothed forceps: hold it like a pen
Scissors: position your index finger at the base
of the blades to make your movements more
precise.
Suture set: we use the non-absorbable
synthetic type of sutures for skin wounds.
Sutures have different sizes depending on the
wound area, some patients have much thicker
skin than others and will require a larger suture
to facilitate wound closure, but the usual size is
(2-0, 3-0). In cornea, we use a smaller size (100).
Pain management:
1. Make sure the wound area is sterile with betadine.
2. Locally inject lidocaine (1% or 2%) around the wound before suturing.
3. For 1% lidocaine, give ½ of the patient weight. If the patient is 60 kg, he
will be given 30 mL of lidocaine that will be distributed around the wound
area. Exceeding this dose can cause toxicity which results in preoral numbness,
hypotension, coma.
4. For 2% lidocaine, give ¼ of the patient weight.
5. Before infiltrating lidocaine into the edge of the wound, aspirate to make sure
you are not infiltrating into a blood vessel.
6. Try to move to the next area that is close to the previous anesthetized area to
minimize the sensation of pain.
Simple interrupted suture:
1. Hold the needle in one-third two-thirds from the needle tip.
2. Lift the skin with the forceps and pierce the skin surface with the needle
perpendicular (90°) to the skin at approximately 1 cm from the wound
edge.
3. Supinate your wrist so that the needle passes through the dermis and rises out
of the middle of the wound (1 bite).
4. Use toothed forceps to hold the needle.
5. Re-grasp the needle in the same place (one-third two-thirds) with your needle
holder
6. Lift the opposing skin edge gently with toothed forceps.
7. Reinsert the needle perpendicularly through the dermis from inside to
outside with equal distance (1 cm).
8. Pull the suture through so there is approximately 10 cm of length on the
opposing side.
9. Hold the suture in your non-dominant hand and the needle holder in your
dominant hand.
10. Loop the suture around the needle holder twice, then grasp the suture end with
your needle holder. Pull the needle holder towards you and push your nondominant hand away to lay the first knot (fixation knot).
11. Loop the suture around the needle holder once, then grasp the suture end with
your needle holder. Pull the needle holder away from you and push your nondominant hand away to lay the second knot. Repeat this step twice to end up
with 4 knots. Don’t forget to change the direction of the needle holder while
you’re pulling it, one knot it must be pulled towards you, and the other knot
away from you.
12. Cut the suture 1 cm in length.
13. Repeat the same steps and keep 1 cm between knots until you cover the whole
wound.
Helpful video: https://www.youtube.com/watch?v=z8oWv-nVO6g
Done by: Fatimah Al Mazrou
Med217 (F2)