Reference
Berry & Kohn’s
OPERATING ROOM TECHNIQUE
8 th
Edition, 1996
Mosby-Yearbook, Inc.
Asepsis – Exclusion of microorganisms
Aseptic Technique – to maintain asepsis
Sterile Technique – Methods by which contamination with microorganisms is prevented
Principles
Attire – Effective barriers between personnel and patient
Attire includes - Head cover, mask with face shields, shoe covers, sterile gown, sterile gloves, eyewear
Personal Hygiene - Those with acute infections such as cold or sore throat should not be permitted in on surgical procedures
Fingernails – are kept short
Jewelry – should be removed
Facial makeup – Should be minimal
Eyeglasses – Should be wiped clean before each procedure
Hands washed – frequently and use soap
Hand cream – To help prevent chapped, dry skin
Facial and Head hair – must be completely covered
Talking – is kept to a minimum

Back of gown – is not sterile, nor is any area below table level . Sterile gloves cover the cuffs of the gown.
If a sterile glove is punctured or torn change immediately
Traffic in or out is kept to a minimum
Movement within is kept to a minimum
Aseptic techniques control the environment
Sterile techniques prevent the transfer of microorganisms into body tissues.
All personnel must be vigilant in safeguarding the sterility of the sterile field
Gowns are considered sterile only in front from the chest to level of sterile field and the sleeves from above the elbows to the cuffs
Sterile persons keep hands in sight at all times at or above waist level or the level of the sterile field
Keep hands away from face and elbows close to sides
Only the top of the sterile draped table is sterile. The edges and sides of drape extending over table level are un-sterile
Only sterile items touch sterile surfaces
Un-sterile persons avoid reaching over sterile field. Sterile persons avoid leaning over un-sterile areas
Edges of anything that encloses sterile contents are considered un-sterile
Inside of wrappers is considered sterile to within I inch of the edges
The inner edge of the heat seal is the line of demarcation between sterile and un-sterile
Sterile persons lift contents from packages by reaching down and lifting straight up, holding elbows high
Sterile field is created as close as possible to time of use
Sterile areas are continuously kept in view

Sterile persons stay within sterile field and do not walk around the room
Keep contact with sterile areas to a minimum
Un-sterile persons maintain a distance of a least 1 foot from any area of the sterile field
Un-sterile persons face and observe a sterile area when passing is and never walk between two sterile areas
Integrity of a sterile package is destroyed by perforation, puncture or strike-through (soaking of moisture through un-sterile layers to sterile or vice versa)

Is the process of removing as many microorganisms as possible from the hands and arms by mechanical washing and chemical antisepsis. It is done just before gowning.
Mechanical scrubbing removes soil and transient organisms acquired by direct contact.
Chemical antisepsis reduces resident flora and inactivates or inhibits growth of microorganisms without necessarily killing.
1.
Don cap, mask and eyewear
2.
Wash and dry hands
3.
Lay out and open all sterile supplies; be sure to inspect each package to ensure that the integrity has been maintained.
4.
Remove all jewelry from fingers, wrists and neck
5.
Adjust water temperature for comfort.
This varies, as does the procedure. Variations depend on frequency, agent used and method.
Prolonged scrubbing raises resident microbes from deep dermal layers and is therefore counterproductive.
Care must be taken no to abrade the skin.
Everyone should scrub according to a standardized written procedure.
The time required may be based on the manufacturer’s recommendations for the agent used.

The scrub may be either a time method or a counted brush-stroke method.
One should think of the fingers, hands and arms as having four sides.
The procedure begins with the thumb
And moving from one finger to the nest,
Down the outer edge of the 5 th
finger,
Over the back of the hand,
Then the palm,
Over the wrist,
Up the arm in thirds
And ending 2 inches above the elbow.
During scrubbing, keep hands higher than elbows to allow water to flow from the cleanest area.
Note: We will always use the brush stroke method when doing an eye or cornea recovery.
1.
Wet hands and arms
2.
Wash hands and arms to 2 inches above elbows with an antiseptic agent
3.
With hands held under running water, clean under fingernails with disposable nail cleaner; discard after use
4.
Rinse hands thoroughly under running water, keeping hands up and allowing water to drip from elbows
5.
Take sterile brush/sponge impregnated with antiseptic from package
6.
Scrub nails of one hand 30 strokes; each side of each finger, starting with the thumb, 20 strokes; the back of the hand 20 strokes; the palm of the hand 20 strokes; the arm 20 strokes for each 3 rd
and each side, to 2 inches above the elbow
7.
Repeat step 6 for the other hand and arm
8.
Rinse hands and arms thoroughly
After scrubbing the hands and arms, they are dried thoroughly before donning sterile gown and gloves.
A towel may be found on top of the sterile gown or a separate or towel may be used.
1.
Reach down and lift towel from package, being careful not to drip water on package

2.
Bend forward slightly to avoid letting towel touch the attire
3.
Dry both hands independently, if using only one towel. Dry one arm holding towel in opposite hand and using as oscillating motion of the arm
4.
Draw the towel up to the elbow
5.
Carefully reverse the towel, holding it away form the body
6.
Dry the opposite arm on the unused, now uppermost end of the towel
If two towels are used, use one towel for each hand and arm.
Sterile packages containing the gown and gloves should have been placed and opened on a separate table to avoid any contamination from dripping or splashed water.
The closed-gloved method is preferred except when changing a glove during a surgical procedure or when donning gloves for procedures not requiring sterile gowns.
This method affords assurance against contamination when gloving oneself, because no bare skin is exposed.
1.
Reach down to the sterile package and lift folded gown directly upward
2.
Step back away from the table, into unobstructed area, to provide a wide margin of safety while gowning
3.
Holding the gown, locate the neckband
4.
Holding the inside front of the gown just below the neckband with both hands, let the gown unfold, keeping the inside of the gown toward the body
5.
Holding the hands at shoulder level, slip both arms into the arm holes simultaneously
6.
If assisted, your assistant brings the gown over your shoulders by reaching inside to the shoulder and arm seams
7.
The gown is pulled on, leaving the cuffs of the sleeves over the hands
8.
The back of the gown is securely tied or fastened at the waist, then the neck, touching the outside of the gown at the line of ties or fasteners in the back only
9.
If unassisted slip into gown by allowing the shoulders of the gown to drape over your own shoulders. The ties and/or fasteners are left undone

1.
Using the left hand and keeping it within the cuff, pick up right glove by grasping the folded cuff
2.
Extend right forearm with palm upward. Place the palm of the glove against the palm of the right hand, grasping the right top edge of the cuff, above the palm. In correct position, the glove fingers are pointing toward you and the thumb of the glove is to the right. The thumb side of the glove is down.

3.
Grasp the back of the cuff in the left hand and turn it over the end of the right sleeve and hand. The cuff of the glove is now over the cuff of the gown with the hand still inside the sleeve.

4.
Grasp the top of the right glove and underlying gown sleeve with the covered left hand.
Pull the glove on over the extended right fingers until it completely covers the cuff.
5.
Glove the left hand in same manner, reversing hands. Use the gloved right hand to pull on the left glove.

This method of gloving uses a skin-to-skin, glove-to-glove technique. The hand, although scrubbed, is not sterile and must not contact the exterior of the sterile gloves. The everted cuff on the gloves exposes the inner surface. The first glove is put on with skin-to-skin technique, bare hand to inside cuff. The sterile fingers of that gloved hand then may touch the sterile exterior of the second glove, that is, glove-to-glove technique.
1.
With the left hand, grasp the cuff of the right glove on the fold. Pick up the glove and step back from the table
2.
Insert the right hand into the glove and pull it on, leaving the cuff turned well down over the hand
3.
Slip the fingers of the gloved right hand under the everted cuff of the left glove. Pick up the glove and step back
4.
Insert the hand into the left glove and pull it on, leaving the cuff turned down over the hand
5.
With the fingers of the right hand, pull the cuff of the left glove up and avoid touching the bare wrist
6.
Repeat step 5 for the right cuff, using the left hand, and thereby completely gloving the right hand
Having gloved using the open glove technique,
1.
Reach down to the sterile package and slide gloved hand under folded upper portion of sleeve. Step back from the table and let the sleeve unfold
2.
Being careful to keep gloved hand protected by the fold in the sleeve, slide opposite hand into sleeve and pull through the cuff
3.
Pull the sleeve to wrist level only. Do not push glove all the way through the sleeve
4.
Pull upper portion of sleeve to 2 inches above elbow. Again, being careful to protect sterile, gloved hand with folded upper cuff
5.
Once you have pulled sleeve to above elbow, do not return to that area with the gloved hand again
6.
Repeat, using opposite hand and sleeve