Sunday, June 03, 2007

Tips On Scrubbing In

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As the name of this blog implies, I should probably offer some advice on how to scrub in, especially since I am on my surgery rotation right now. So, here is some help for all of you out there for whom "sterility" still means that you can't make babies =P

So here goes. Scrubbing in is actually pretty easy, but it can be confusing the first few times. The following pointers are roughly in order of how one scrubs in to an OR.
  • First, as you enter the area where the OR suites are, put on a surgical cap and face mask. I'll assume that you are already wearing scrubs. Supposedly, the 'bath cap/cafeteria lady' caps are more sterile, but... well, the caps just look better. As I later learned, the poofy caps are called bouffant caps.
  • Find out which OR you are supposed to be in. Most hospitals have a whiteboard somewhere outside the OR suites that lists the cases and attending surgeons.
  • After you find the OR, enter it and find the nurses. There are generally two nurses: a scrub nurse who has already scrubbed in and will be assisting with the procedure, and a circulating nurse who is NOT scrubbed in and will take care of prepping the patient and bringing any supplies that are needed during the procedure. Introduce yourself to them as a medical student, and offer to get gloves and a gown for yourself (usually either on a shelf in the room, or in a supply room adjacent to the OR).
  • What glove size should you get? Well, the average male hand is generally about a 7.5. The gloves should fit snuggly, but not to tightly. You want them to protect your fingers from needlesticks, but not so tight that they would tear easily.
  • It is recommended that you double-glove when you start off to provide more protection. If so, you should always put the larger pair of gloves on FIRST (e.g., if you are a 7, put on a pair of 7.5s first, then the 7s). Double gloving increases safety but decreases dexterity and touch sensitivity.
  • When you bring your supplies back, you need to hand them to the scrub nurse in a sterile fashion. To do so, open the packages partially so that the contents inside stick out. This will let the scrub nurse grab them without making contact with you or the external part of the package. If the gown is wrapped like a gift, hold it firmly by one edge, then pull the corners apart one by one, and tuck them underneath. Imagine it was a sandwich with a wrapper on, and the gown is the sandwich: you want your hand on the wrapper to keep the "sandwich"/gown clean, but you want the "sandwich"/gown exposed to the scrub nurse so that they can grab it.
  • Now, help the circulating nurse prep the patient. Once this is done, you can go outside and scrub in. This is where you do the actual "scrubbing." There are many ways to do this, but here is one general approach. Find a sponge with soap on it (usually right above the sink). Open it, and wet it on your hands. Now, scrub each surface of each finger on both hands for several seconds. Then, do the palm and dorsum of each hand. Then do your forearms. How long do you scrub for? The best response I have heard is, longer than your attending/residents if you start scrubbing at the same time.
  • After scrubbing, make sure to rinse by moving your arms under the water in only one direction. Get all the soap off. Now, do NOT dry off with anything around the sink. Let the water drip down your arms towards your elbows and away from your fingertips. Proceed into the OR and find the scrub nurse. They will hand you a sterile towel to dry off with. Keep your arms between your nipples and navel at all times.
  • To dry off, again start at your fingertips and work your way down. Make sure your fingers are VERY dry, as wet fingers are hard to get gloves onto. Do one arm entirely, then flip the towel so that the now-clean arm is touching a dry part, and proceed to clean the other arm.
  • Once dry, dispose of the towel and approach the scrub nurse for your gown. To put the gown on, just put your arms through and reach for the sky (but make sure there's nothing overhead). Put your arms through so all your fingers barely poke through the cuffs. The circulating nurse will button/tie up the back.
  • When the scrub nurse offers you a glove, simply shove your hand downward. Do not worry about getting all the fingers on properly, as you can adjust this later once you have your other glove on. Repeat this for the other hand. For the second glove, you can help with your gloved hand by pulling the second glove open more.
  • Once both gloves are on, you can adjust the fingers appropriately. 
  • Now, to tie the scrub on, hold on to the short strand and tear it (and only it) from the card. Hand the card to the circulating nurse, and turn around. Now, grab the second strand so that you have both strands, one in each hand. The nurse will tear and dispose of the card. Tie the two strands in a knot.
That's it! You're scrubbed in now! Enjoy the procedure =)

Not scrubbed in but still in the OR? Want something to study while your avoid eye contact with the attending? Check out:

While not a primary resource for your surgery shelf, Surgical Recall is great for those random 5 to 10 minute breaks you get during the day on your surgery rotation. Crack open the chapter relevant to your next case, read up, and look like a star when you're pimped on rounds. And yes, it truly does fit into your white coat's pocket!

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