Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Organizing the District Hospital Surgical Service
Organizational and management of the district surgical service
The District Hospital
Leadership, team skills and management
Ethics
Education
Record Keeping
Evaluation
Disaster and trauma planning
The surgical domain: creating the envioronment for surgery
Infection control and asepsis
Equipment
Operating room
Cleaning, sterilization and disinfection
Waste disposal
Operating Room
 


> SPONGE AND INSTRUMENT COUNTS
> SCRUBBING AND GOWNING
> SKIN PREPARATION
> DRAPING



SCRUBBING AND GOWNING

Before each operation, all members of the surgical team – that is, those who will touch the sterile surgical field, surgical instruments or the wound – should scrub their hands and arms to the elbows. Scrubbing cannot completely sterilize the skin, but will decrease the bacterial load and risk of wound contamination from the hands.

Every hospital should develop a written procedure for scrubbing that specifies the length and type of scrub to be undertaken. It is usual that the first scrub of the day is longer (minimum 5 minutes) than any subsequent scrubs between consecutive clean operations (minimum 3 minutes).

When scrubbing (Figure 2.4):

:: Remove all jewellery and trim the nails
:: Use soap, a brush (on the nails and finger tips) and running water to clean thoroughly around and underneath the nails
:: Scrub your hands and arms up to the elbows
:: After scrubbing, hold up your arms to allow water to drip off your elbows
:: Turn off the tap with your elbow

Figure 2.4A


Figure 2.4B

Figure 2.4C

Figure 2.4D
Figure2.4E
Figure2.4F

Figure 2.4

After scrubbing your hands:

:: Dry them with a sterile towel and make sure the towel does not become contaminated
:: Hold your hands and forearms away from your body and higher than your elbows until you put on a sterile gown and sterile gloves (Figures 2.5 and 2.6).

Figure 2.5A
Figure2.5B

Figure2.5C

Figure2.5D

Figure 2.5
Figure 2.6
Figure 2.6

Surgical gloves prevent transmission of HIV through contact with blood, but there is always the possibility of accidental injury and of a glove being punctured. Promptly change a glove punctured during an operation and rinse your hand with antiseptic or re-scrub if the glove has leaked during the puncture. Patient safety is of primary concern; do not compromise it. Change your gloves only when it is safe for the patient.

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> SPONGE AND INSTRUMENT COUNTS
> SCRUBBING AND GOWNING
> SKIN PREPARATION
> DRAPING