Surgical Hand Antisepsis and Scrub Attire

The Centers for Disease Control and Prevention recommends health care workers wash hands for at least ______ seconds.

15

Ensure that nails are natural, no longer than ________ in length, and free from chipped nail lacquer or enhanced nail lacquer.

2mm

A surgical scrub is performed for each encounter at the surgical field and the MLH policy for length of time required is ______ minutes or per the manufacturer's directions.

3

High-touch object:

A frequently touched item or surface.

When is a manual scrub required?

A manual scrub is required for the first scrub of the day and after prolonged breaks

Assisted gloving

A method by which a gowned and gloved person assists another gowned person to don sterile gloves.

Disinfection:

A process that kills pathogenic and other microorganisms by physical or chemical means

What are the Gown Classes

A rating system has been developed by ANSI and AAMI that describes the gown's level of protection US Food and Drug Administration approved Level 1: Minimal Level 2: Low Level 3: Moderate Level 4: High

Open assisted gloving

A technique for donning sterile gloves during which the gown sleeve of the team member being gloved is pulled up so that the gown cuff is at the wrist level, leaving the fingers and hand exposed. The glove to be donned is held open by a scrubbed team member, while the team member being gloved inserts their hand into the glove without touching the outside of the glove.

Closed assisted gloving

A technique used for donning sterile gloves during which the gown cuff of the team member being gloved remains at or beyond the fingertips. The glove to be donned is held open by a scrubbed person, while the team member being gloved inserts their hand into the glove with the gown cuff touching only the inside of the glove

After removing and discarding a contaminated surgical gown and gloves during an operative or invasive procedure, what should the scrub person do next? A. Don new sterile gown and gloves. B. Perform a waterless surgical hand scrub. C. Perform a traditional surgical hand scrub. D. Perform hand hygiene.

A: After removing and discarding a contaminated surgical gown and gloves, the scrub person should immediately don a new sterile gown and sterile gloves. If the scrub person was not contaminated during removal, performing surgical hand antisepsis (traditional scrub or waterless gel) before donning a new sterile gown and gloves is not necessary. At the end of the operative or invasive procedure, the scrub person should perform hand hygiene after removing and discarding the gown and gloves.

How should the scrub person present the glove when gloving additional scrubbed perioperative team members? A. With the glove fingers pointed downward and thumb oriented toward the scrubbed perioperative team member B. With the glove fingers pointed downward and thumb oriented toward the scrub person C. With the glove fingers pointed downward and thumb oriented to the scrubbed perioperative team member's left D. With the glove fingers pointed downward and thumb oriented to the scrub person's right

A: By presenting the sterile glove with fingers pointed downward and the thumb oriented toward the additional scrubbed perioperative team member, the scrub person creates the most natural and comfortable hand position for gloving. As the scrubbed perioperative team member inserts a hand into the glove, the fingers and hand easily slide into place. Donning gloves easily decreases the risk of contamination because the scrubbed perioperative team member would not need to shift or twist the hand in the glove to get an appropriate fit. By presenting the sterile glove with fingers down and the thumb presented toward the scrub person's right or to the additional scrubbed perioperative team member's left there is an increased risk of shifting or twisting the glove to attain an appropriate fit.

While discarding the contaminated gown and gloves, the scrub person's bare hand touches the rim of the trash receptacle. What is the scrub person's next step? A. Perform surgical hand antisepsis. B. Continue to don a new gown and gloves. C. Continue to don a new gown and double-glove. D. Perform hand hygiene.

A: By touching the rim of the trash receptacle with a bare hand, the scrub person's hand is now contaminated. To create a sterile environment, the scrub person must perform surgical hand antisepsis (traditional scrub or waterless gel) before donning a new sterile gown and gloves. Donning a new gown and gloves, or double-gloving, without performing surgical hand antisepsis increases the risk of contamination and a subsequent SSI for the patient. Performing hand hygiene is not an adequate for an operative or invasive procedure; surgical hand antisepsis prepares the scrub person to don a new sterile gown and sterile gloves.

An equipment vendor in street clothes is observed entering the semirestricted area of the OR. What is true regarding this action by the equipment vendor? A. It is unacceptable because clean surgical attire and head and facial hair covering are required. B. It is unacceptable because proper surgical attire, hair covering, and masks are required in this area. C. It is acceptable because the equipment vendor is not near the OR doors or scrub sinks. D. It is acceptable because the equipment vendor is in the area only to drop off instruments.

A: Clean surgical attire in the semirestricted area must include organization-approved surgical scrubs and a head and facial hair covering to preserve attempts at infection control. Masks are not required in the semirestricted area. Regardless of the equipment vendor's position in the area in relation to the ORs, street clothes are not permitted in the semirestricted area. Equipment vendors entering the semirestricted area are bound by the same restrictions as the health care team members and should be in clean surgical attire and head and facial hair covering.

What is the best way to ensure that a break in the sterile field is identified? A. Continually observe the sterile field for breaks in aseptic technique. B. Perform random cultures of drapes and instruments. C. Check sterile packages for breaks before opening them onto the sterile field. D. Keep traffic in and out of the OR or procedure room to a minimum.

A: Direct observation increases the likelihood of detecting a break in aseptic technique. Random cultures would not identify a breach in the sterile field. Checking sterile packages for breaks is always appropriate; however, doing so does not guarantee that the sterile field will remain sterile. Keeping traffic to a minimum to decrease air disturbance that can redistribute contaminant microbes onto the sterile field is appropriate, but this does not guarantee that the sterile field will remain sterile.

What characteristics should an FDA-approved antiseptic solution have? A. Fast acting, nonirritating, inhibit regrowth of microorganisms B. Fast acting, nonirritating, allow regrowth of microorganisms C. Irritating, persistent antimicrobial effect, broad spectrum D. Nonirritating, broad spectrum, allow regrowth of microorganisms

A: FDA-approved antiseptic solutions should be fast acting, broad spectrum, and nonirritating, should inhibit regrowth of microorganisms, and should have a persistent antimicrobial effect. The solution should not allow regrowth of microorganisms or be irritating to the skin.

After performing surgical hand antisepsis using a waterless hand-rub product, what should the scrub person do next? A. Keep the hands above the elbows until gown and gloves are donned. B. Keep the hands and the elbows up if using an alcohol-based hand-rub product to allow excess hand rub to drip off the elbows. C. Take a paper towel from the hands-free dispenser by the sink to dry the hands and arms. D. Don a mask, gloves, and gown at the scrub sink before entering the OR.

A: Keeping the hands above the elbows allows the water to drip from clean to dirty. The scrub person should never place hands and arms below the waist; hands and arms lower than the waist are considered contaminated and redoing the surgical hand antisepsis would be required. When using an alcohol-based hand rub, the hands should be rubbed together until the solution completely dries. A nonsterile paper towel would contaminate the surgical hand antisepsis and be considered a break in sterile technique. A mask should be in place before the surgical hand antisepsis, and gloves and gowns should be donned near the sterile field.

Which is a restricted area of the perioperative complex? A. Operating room B. Postanesthesia care unit C. Locker room D. Sterile storage

A: Restricted areas include the ORs and the invasive procedure rooms. A designated restricted area allows access only to the perioperative team members and patients essential to the surgical procedure. The postanesthesia care unit is an unrestricted area. Locker rooms and sterile storage are semirestricted areas.

What does adherence to the principles of asepsis help prevent? A. SSIs B. Scrub person fatigue C. Hypotension D. Infiltrated peripheral IV

A: Rigorous adherence to the principles of asepsis helps to prevent SSIs. An SSI is among the most common health care-associated infections that may lead to delayed wound healing, increased use of antibiotics, and increased length of inpatient stays. Maintaining the principles of asepsis does not help prevent scrub person fatigue, hypotension, or an infiltrated peripheral IV.

As the unscrubbed perioperative team member begins to perform patient skin preparation, the scrub person notices that that the unscrubbed perioperative team member has left the OR door ajar. What is the appropriate response for the scrub person to the unscrubbed perioperative team member? A. Tell the unscrubbed perioperative team member to close the OR door. B. Continue setting up the sterile field and let the unscrubbed perioperative team member finish the patient skin preparation. C. Tell the unscrubbed perioperative team member that the patient skin preparation is the practitioner's job. D. Let the unscrubbed perioperative team member finish the patient skin preparation, and then tell the team member to close the OR door.

A: The doors to the OR or procedure room should be closed as much as possible except during the entering and exiting of patients, required health care team members, and necessary equipment. If the scrub person sees a break in sterile technique, it should be verbalized to the unscrubbed team member. Patient skin preparation is not just the practitioner's job; it can be completed by the unscrubbed team member. The scrub person should not wait until after the unscrubbed team member has completed the skin preparation before telling the team member to close the OR or procedure room door because this could lead to environmental contamination and increase the patient's risk for an SSI.

The practitioner is sitting during an operative procedure and the unscrubbed perioperative team member notices that the scrub person is standing. What should the unscrubbed perioperative team member do? A. Ask the scrub person to sit for the procedure because the rest of the team is sitting. B. Ask all scrubbed perioperative team members to stand, because they are violating the sterile field. C. Ask the practitioner to stand because this is the correct operative and invasive procedure practice. D. Say nothing and discuss the situation with the scrub person after the operative or invasive procedure.

A: The only time sitting is permitted during an operative or invasive procedure is when the entire scrubbed perioperative team is sitting for the duration of the operative or invasive procedure. Changing from a standing position to a seated position and vice versa during an operative or invasive procedure may compromise the sterile field. Asking everyone to stand after sitting jeopardizes the sterile field because the sterile field was already established when the scrubbed perioperative team members initially sat down. The practitioner does not necessarily need to stand to perform the operative or invasive procedure, and it is not appropriate for the unscrubbed team member to suggest this as correct practice. Discussing the situation with the scrub person after the operative or invasive procedure is not necessary in this instance and does nothing to correct the situation as it is happening.

When should the scrub person provide a dry, sterile towel for the additional scrubbed perioperative team member? A. After the scrubbed perioperative team member has performed surgical hand antisepsis and before the operative or invasive procedure starts. B. After the scrubbed perioperative team member has performed a surgical scrub using an antiseptic hand gel and before the operative or invasive procedure starts. C. After the operative or invasive procedure has started, during the tie-in activities with the unscrubbed perioperative team member so the perioperative team member's hands are covered. D. After the operative or invasive procedure has started and the scrubbed perioperative team member dons gloves to wipe away excess powder.

A: The scrub person should provide the additional scrubbed perioperative team member with a sterile towel before the start of the operative or invasive procedure and after an antiseptic solution and a sponge were used to perform a surgical scrub. Antiseptic hand gel should not be dried off with a towel; it must air dried. The drying towel has no role in covering the hands or wiping powder from the gloves.

As the unscrubbed perioperative team member and scrub person are setting up the sterile field, the anesthesia provider comes into the OR without a mask on. What should the unscrubbed perioperative team member do? A. Ask the anesthesia provider to put on a mask. B. Continue setting up the sterile field. C. Have the scrub person break scrub to get the anesthesia provider a mask. D. Ask the anesthesia provider to leave the room.

A: The unscrubbed perioperative team member should ask the anesthesia provider to put on a mask. Masks are required where open sterile supplies or scrubbed team members are present. Continuing to set up the sterile field does not address the issue of the anesthesia provider not wearing a mask and can increase the chance of the patient contracting an infection. Breaking scrub to get the anesthesia provider a mask is not appropriate because the focus for the scrub person is to set up the sterile field. The anesthesia provider can obtain a mask without help. Asking the anesthesia provider to leave the room is also not appropriate because of the need to help care for the patient.

During the operative procedure, the scrub person has identified a contaminated glove. What is the first step the scrub person takes to remove the contaminated glove? A. Ask an unscrubbed perioperative team member in the operating room to remove it. B. Grasp the everted cuff and remove the glove by turning it inside out. C. Slide one hand under other opposite hand's glove and pull off inside out. D. Grasp the fingers of the opposite glove's hand and pull off the glove.

A: When removing contaminated gloves, the scrub person should ask an unscrubbed perioperative team member to remove the glove. A scrub person can try to remove a contaminated glove, but if the cuff is everted, that will contaminate the scrub person's other sterile gloved hand, so asking an unscrubbed perioperative team member to assist with the removal is a better option. Turning the glove inside out prevents cross-contamination within the operating room or procedure room; however, there is still an increased potential to contaminate the other sterile gloved hand. By sliding a gloved hand under the opposite glove, the scrub person contaminates the surgically scrubbed hands and becomes exposed to possible harmful microorganisms. Grasping the fingers of the opposite gloved hand to remove the glove increases the risk of cross-contamination within the operating room or procedure room because the glove will not be removed inside out.

An additional scrubbed perioperative team member comes in from using a waterless hand-rub product and the hands are still wet. The additional scrubbed team member asks the scrub person for a towel. Why does the scrub person deny the request? A. Waterless hand-rub products should not be wiped off. B. The scrub person does not have an extra sterile towel. C. The additional scrubbed perioperative team member should dry the hands on a paper towel. D. The additional scrubbed perioperative team member should rinse off the waterless hand-rub product and then dry the hands.

A: When using a waterless hand-rub product, all areas should be rubbed until they are completely dry without wiping off the excess. Letting the hand rub dry ensures there is a sufficient quantity of waterless hand-rub product on the hands and arms to reduce bacteria that potentially could cause an infection to the patient. If needed, the scrub person could ask the unscrubbed perioperative team member for a sterile towel, but the excess waterless hand-rub product should not be wiped off. The additional scrubbed perioperative team member should not dry the hands on a paper towel because the waterless hand-rub product is used by the scrubbed perioperative team members to make the hands surgically clean by reducing the number of microorganisms. The additional scrubbed perioperative team member should not rinse off the waterless hand-rub product and then dry the hands.

In preparation for an operative or invasive procedure, the scrub person performs surgical hand antisepsis with a sponge. What is part of the correct procedure for performing a surgical hand scrub? A. Visualize each finger, hand, and arm as having four sides, scrubbing each of the four sides effectively. B. Scrub the fingers, hand, and arm, anterior and posterior, in a circular motion. C. Rinse the entire arm from the elbows to the fingertips three times. D. Use a sterile towel, taking care not to drip water on the sterile field, and then place the towel on the corner of the sterile field.

A: to perform surgical hand antisepsis appropriately, the scrub person should visualize each finger, hand, and arm as having four sides and each of the four sides should be washed effectively. For appropriate surgical hand antisepsis, the hands and arms should be divided into four different areas, not anterior and posterior. The appropriate technique for rinsing is from the fingertips to the elbows, leaving the hands as the cleanest part of the upper extremities. A used towel should never be placed on the sterile field, not even on the corner.

Alcohol-based hand rub

An alcohol-containing preparation (eg, liquid, gel, foam) designed for application to the hands to inactivate microorganisms and temporarily suppress their growth

Surgical suite:

An area or areas of the building containing the preoperative, intraoperative, and postoperative patient care areas and provisions for support areas.

Fomite:

An inanimate object that, when contaminated with a viable pathogen (eg, bacterium, virus), can transfer the pathogen to a host

What is the Perforation Indicator System

An inner glove of a contrasting color to the outer glove allows for early detection of holes, rips, and tears in the outer glove.

Continuous ultraviolet system:

An ultraviolet light delivery system that delivers UV-C light in a constant-on mode for a set time. Low pressure mercury lamps are most often used for UV-C delivery.

Pulsed xenon ultraviolet system:

An ultraviolet light delivery system that uses a xenon lamp to produce intense pulses of UV-C light.

Focused multivector ultraviolet light system:

An ultraviolet light delivery system that uses modular panels and reflectors to create a target zone that allows UV -C light to contact item surfaces from many directions.

Instrument table

Another term for back table

Back table

Another term for instrument table

Hand hygiene

Any activities related to hand condition and cleansing.

During a long transplant case, the unscrubbed perioperative team member notices many people coming into the OR to talk to select people in the room regarding other patients or issues. What should the unscrubbed perioperative team member do? A. Continue with the tasks at hand; it does not affect the patient. B. Ask the extra people to call into the room instead of coming into the OR. C. Lock the OR doors so that the extra people are forced to call into the OR. D. Ask the charge nurse to limit visitors into the OR.

B: Asking the visitors to call into, rather than enter, the OR decreases the number of times the door is opened. Calling into the OR rather than visiting also reduces air disturbances that redistribute contaminant microbes onto the sterile field, which could infect the patient. Continuing the tasks at hand does not address the increased room traffic. Locking the OR doors is never acceptable when there is an operative or invasive procedure taking place, because some other health care team members may need to get into the OR quickly, especially if there is an emergency. The charge nurse is not able to monitor visitors into and out of specific ORs.

The practitioner is making multiple requests for specific items necessary for an operative procedure that are not in the OR. This necessitates the door to the OR being opened multiple times with traffic in and out of the room. To minimize air turbulence, what should be done? A. Offer an alternative to the requested items with supplies that are already in the OR. B. Call outside of the OR for the items to be delivered to the OR door. C. Notify the practitioner that the requested items are not available. D. Ask the practitioner to make another choice because the items are not available.

B: Calling for a perioperative team member outside of the OR or procedure room, having the items brought to the door, and opening the door only slightly to retrieve the supplies reduces traffic in and allows a minimal amount of air turbulence. The practitioner requested specific items necessary for the procedure that are not maintained in the OR, so it is not appropriate, for the patient's safety, to tell the practitioner that the supplies are not available. The requested items are necessary for the procedure, and efforts should be made to obtain them.

How should the scrub person who is participating in an operative or invasive procedure be positioned in relation to the sterile field? A. Facing away from the sterile field B. Facing toward the sterile field C. As far away from the sterile field as possible D. In a sitting position behind the sterile field

B: Facing the sterile field allows the scrub person to keep a watch on the sterile field and everyone passing around the sterile field. This ensures safety for both the patient and the perioperative team. Facing away from the sterile field, being positioned as far away from the sterile field as possible, and sitting behind the sterile field all increase the possibility of compromising the integrity of the sterile environment.

An experienced scrub person teaches a new scrub person that fingernails should be kept no longer than what length? A. 1 mm B. 2 mm C. 3 mm D. 4 mm

B: Fingernails should be natural and no longer than 2 mm (0.08 inch) in length. The greatest number of microorganisms on the hands is found in the subungual area of the fingernails. Short fingernails are easier to clean and collect less debris than longer fingernails. The risk of tearing a glove or scratching a patient during transfer or positioning is decreased with short fingernails. A length of 1 mm (0.04 inch) is shorter than the recommended maximum length; 3 mm (0.1 inch) and 4 mm (0.16 inch) are longer than the recommended maximum length.

During an invasive procedure, the practitioner makes multiple requests for specific items vital to the case that are not available in the OR. These requests necessitate the door to the OR being opened multiple times and traffic in and out of the room. To minimize air turbulence, what should the unscrubbed perioperative team member do? A. Tell the central supply department to order the necessary equipment and deliver it when it arrives. B. Call to perioperative team members outside of the room and ask for the items to be delivered to the door. C. Notify the practitioner that the requested items are not available and the practitioner must use what is available in the OR. D. The unscrubbed perioperative team member should leave the OR to get the necessary specific items each time the practitioner requests an item.

B: Having the requested items brought to the OR door by perioperative team members on the outside of the OR and only slightly opening the door to retrieve supplies helps ensure that a minimal amount of air turbulence is created. The practitioner requested specific items necessary for the procedure that are not maintained in the room, so efforts should be made to obtain them. Telling the central supply department to order the necessary equipment would not solve the issue of not having the equipment available for the current procedure, nor does it address increased traffic in and out of the OR. The unscrubbed perioperative team member should not leave the OR to get the necessary specific items each time the practitioner requests an item. These actions would put the patient at risk, compromise the sterile field, and cause an increase in traffic in and out of the room.

During an operative procedure where there are three additional scrubbed team members, one scrubbed team member's gown and gloves become contaminated. How should this scrubbed team member don a new pair of sterile gloves? A. Using the closed-unassisted gloving method B. Using the open-assisted gloving method C. With assistance from the unscrubbed perioperative team member D. Using the open-gloving method

B: If one scrubbed team member's gown and gloves become contaminated during an operative or invasive procedure involving multiple scrubbed team members, the open-assisted gloving method should be used to don a new pair of sterile gloves. In this scenario, the closed-gloving technique is not necessary because there are multiple scrubbed team members available to assist the scrub person with regloving. The open-assisted gloving method may be used when the closed-assisted gloving method is not possible. The unscrubbed perioperative team member is an unscrubbed team member and thus should not assist a scrubbed team member with regloving, only with removing a contaminated glove. There is no closed-unassisted gloving method.

A scrub person who is preparing for surgical hand antisepsis uses a standard surgical hand scrub and is allergic to the povidone-iodine. What should the scrub person do? A. Ask the unscrubbed perioperative team member to scrub instead. B. Use an antimicrobial solution that does not contain povidone-iodine. C. Use a povidone-iodine solution anyway because the water rinses the irritant away. D. Use a povidone-iodine solution and then use an alcohol solution.

B: The scrub person should use an antimicrobial solution that does not contain povidone-iodine if the scrub person is allergic to povidone-iodine. There are several antimicrobial solutions available for the scrub person to use, including alcohol-based and chlorhexidine-based products. Products containing iodophors are known to be common skin irritants. Because there are solutions that are not made with iodine, it is not necessary to ask the unscrubbed perioperative team member to switch roles. The scrub person may have an allergic reaction even after rinsing the povidone-iodine solution off the skin with water or alcohol. Using an alcohol rub after a povidone-iodine solution is unnecessary, and it is likely to cause skin irritation.

In what areas must beard coverings be used

Beards must be covered in restricted areas the clean assembly area of the sterile processing department

Who is responsible for monitoring for possible breaks in sterility that can cause contamination? A. All scrubbed perioperative team members at the sterile field B. All scrubbed perioperative team members present in the operating room or procedure room C. All perioperative team members present in the operating room or procedure room D. All unscrubbed perioperative team members present in the operating room or procedure room

C: All perioperative team members who are present are responsible for monitoring for breaks in sterility. The risk of an SSI is increased if the patient is exposed to harmful microorganisms. Any team member present in the operating room or procedure room should speak up and disclose a possible contamination. Monitoring is necessary, because there can be causes of contamination that happen and go unnoticed. Without monitoring, the possibility of an SSI increases.

An unscrubbed health care team member is precepting a new graduate in the OR. Which statement from the preceptor to the new unscrubbed team member is the most appropriate regarding the perioperative setting? A. "The air in an OR or procedure room is sterile, so any breaks in technique are minimal and do not play a part in causing surgical site infections." B. "Unscrubbed perioperative team members may walk between two sterile fields if they take care not to touch anything." C. "Unscrubbed team members should never walk between two sterile fields." D. "If you notice a break in sterile technique, wait until after the procedure to tell the scrub person so that it can be documented."

C: An unscrubbed health care team member should never walk between two sterile fields or scrubbed team members for any reason. If passage is necessary, the two sterile fields should be repositioned so that the unscrubbed team member may have access to whatever is needed while maintaining sterility. Movement increases air currents, which can pick up exogenous materials that are shed from the patient and team members and spread them to the sterile field. The air in an OR or procedure room is not sterile. The new graduate should voice concerns if a break in sterile technique is observed at the time it occurs.

An unscrubbed perioperative team member is approaching the sterile field to deliver a sterile item to the scrub person. Which action is the most appropriate for this team member? A. Stand as far away as possible from the sterile field when delivering the sterile item to the scrub person. B. Stand as close to the sterile field as the practitioner is standing to the sterile field when delivering the sterile item to the scrub person. C. Stand at a safe distance away from the sterile field when delivering the sterile item to the scrub person. D. Refrain from approaching the sterile field because unscrubbed perioperative team members are not allowed to approach the sterile field.

C: An unscrubbed health care team member should stand at a safe distance from the sterile field when delivering the sterile item to the scrub person. Standing as close as the practitioner is to the sterile field is standing too close for maintaining the sterile field because the unscrubbed team member is not donned in sterile attire. Standing as far away as possible from the sterile field is not necessary and may impede any tasks the unscrubbed team member needs to perform such as handing sterile supplies to the scrub person. The unscrubbed team member is allowed to approach the sterile field when delivering a sterile item to the scrub person, as long as a safe distance is maintained and movement and nonessential conversations are restricted.

Which statement is true regarding antiseptic hand gel? A. It can be dried quickly by waving the hands back and forth in a light flapping motion. B. It dries evenly under the sleeves of the gown. C. It is alcohol based and must be completely dry before the sterile gown and gloves are donned. D. It is less effective for killing microorganisms than using a sponge and surgical hand antiseptic solution.

C: Antiseptic hand gel is alcohol based and should be completely dry before the gown and gloves are donned. Waving the hands and arms creates unnecessary turbulence that stirs up particulate matter in the operating room or procedure room. Donning a gown while antiseptic gel is still wet may cause strikethrough in the gown. Studies have shown that antiseptic hand gel performs better than traditional scrubbing with a sponge.

After placing the main sterile drape on the patient, a small hole is noted distal to the operative or invasive procedure site. To preserve the integrity of the sterile field, what action should the scrub person take? A. Alert the team to the contaminated area and instruct them to avoid it. B. Do nothing; the hole is distal to the operative or invasive procedure site and therefore requires no action. C. Request another sterile drape and cover the small hole. D. Notify the practitioner and await further instructions.

C: Any break in a sterile drape's integrity compromises the sterile field and should be immediately identified and covered with another sterile drape. Regardless of the location of the hole, it is still a break in the integrity of the sterile drapes and must be corrected. Attempting to avoid the hole is unacceptable because it has compromised the sterile field. The only appropriate action in this instance is to remove and replace the drapes or cover the hole in the drape with another sterile drape.

A vendor has delivered a large, corrugated box of implants to the unrestricted area leading to the main OR. The container has no inner liner; the implants are simply stacked in the container. To avoid cross-contamination, what action is the most appropriate? A. Remove the implants and place them in a similar corrugated container that has been checked for debris. B. Damp-dust the container with an approved disinfectant and take the container to the OR. C. Remove the implants from the external container and place them on a cart for transport to the designated OR. D. Leave the container with implants in the unrestricted area for retrieval during the procedure.

C: Any items that need to be brought into the semirestricted or restricted areas of the OR should be placed in an appropriate cart or transport device that has been appropriately cleared and cleaned for use in these areas. To prevent cross-contamination, the outer container should not be brought into either the semirestricted or restricted area of the OR. Damp-dusting the external container may not guarantee that all contaminants have been removed. Placing the implants into another container is not acceptable because the replacement container could be contaminated as well. Retrieving the implants during the procedure causes increased traffic in and out of the OR, increasing the chance of contamination of the sterile field.

An orienting scrub person asks why the preceptor cuffs the neck and shoulders of the sterile gown when presenting it to an additional scrubbed perioperative team member. What is the preceptor's best response? A. To make donning the gown easier for the scrub (preceptor) person B. To prevent contaminating the scrubbed perioperative team member as the gown is donned C. To prevent contaminating the scrub person (preceptor) as the gown is donned D. To make donning the gown easier for the additional scrubbed perioperative team member

C: By cuffing the neck and shoulders on the sterile side of the opened gown, the scrub (preceptor) person is protecting the gloved hands from contamination through contact with the nonsterile part of the scrubbed perioperative team member. The additional scrubbed perioperative team member has not donned a sterile gown and gloves yet, so cuffing the neck and shoulders of a gown does not prevent contaminating this person. Cuffing does help the scrub person (preceptor) who is actually helping the additional scrubbed perioperative team member don a sterile gown. Cuffing of the neck and shoulders has no effect on the ease of donning the gown.

At the end of a procedure, the unscrubbed perioperative team member sees a newly graduated scrub person place soiled supplies next to a sterile instrument. What should the team member do? A. Explain to the scrub person that sterile and clean supplies should be separated to make restocking of the unused sterile supplies more efficient. B. Explain to the scrub person that sterile and clean supplies should be separated to decrease the time required for room cleanup at the end of the case. C. Explain to the scrub person that sterile supplies should be separated from soiled supplies to decrease the risk of cross-contamination and infection. D. Explain to the scrub person that sterile and clean supplies should be separated to maintain a neat and orderly room.

C: Clean and dirty supplies placed in proximity enhance the risk of cross-contamination, which increases the risk for infection. Although having the clean and dirty supplies separated may decrease room cleanup time, cross-contamination is the most important concern in this instance. Having the sterile supplies in one place is advantageous, but patient safety takes precedence over restocking procedures. An organized room contributes to an efficient room, but the focus should be on infection control.

Before setting up the sterile field, the scrubbed perioperative team member examines a sterile supply package and notices a perforation in the packaging. What should the scrubbed team member do next? A. Use the supply for the procedure because the break occurred less than 2 hours ago. B. Continue the setup with this supply because the inner package is double wrapped. C. Consider the package nonsterile and do not use the supply. D. Use the supply because the organization's practice dictates that it is safe to do so

C: If there is any evidence of a break or perforation in the packaging, the package should be considered nonsterile and the supplies should not be used. All sterile supplies to be used for the operative or invasive procedure should be gathered before the procedure and inspected individually for integrity and sterilization. Sterile items may become contaminated during transfer from a sterile processing area or sterile storage areas. Any break or perforation in the sterile packaging, regardless of the condition of the inner package, the time of disruption to the package, or the organization's practice regarding use of a corrupted package, renders the package not sterile.

The practitioner enters the procedure room as the resident is placing the first of the retractors for the operative procedure. The scrub person hands the practitioner a towel from the back table. Which is true regarding this action? A. This action is appropriate for gowning and gloving any additional scrubbed perioperative team member who wishes to enter the sterile field. B. This action is appropriate because the practitioner has not touched any area of the patient at this point. C. This action is not appropriate because biologic material from the patient may be present on the scrub person's gloves. D. This action is not appropriate because it interrupts the flow of surgery by having the scrub person move away from the patient to gown and glove the practitioner.

C: Once the operative or invasive procedure has started, handing a sterile towel from a working sterile field table to anyone to dry hands is not appropriate because biologic material from the patient may be present on the scrub person's gloves. Preopening gowns and gloves on a separate surface prevents any delay in gowning and gloving another person. The unscrubbed perioperative team member may open anything necessary with appropriate timing; therefore, the surgery may be interrupted but this answer is not appropriate because it is the easiest way to keep the flow of surgery running. Rather, it is not appropriate because the scrub person's gloves may be contaminated with biologic tissue from the patient and contaminate the practitioner if sterile gowns or gloves are touched with contaminated hands.

How can a scrub person make surgical hand antisepsis more effective and prevent bacteria transmission? A. Wear artificial nails as long as the nail lacquer or enhanced nail lacquer is unchipped, avoid wearing long-sleeved tops under scrubs, and remove watches and bracelets. B. Keep nails trimmed, remove all jewelry except wedding rings, wear unchipped nail lacquer or enhanced nail lacquer, and put a dressing on any cut. C. Keep nails trimmed, remove jewelry, avoid artificial nails, and avoid scrubbing for an operative or invasive procedure if skin is not intact. D. Keep nails trimmed, remove jewelry, avoid artificial nails, and cover any cuts with a bandage before scrubbing hands.

C: Surgical hand antisepsis is more effective if good hand hygiene practices are followed such as trimming nails, removing jewelry, not wearing artificial nails, and avoiding scrubbing for operative or invasive procedures if skin is not intact. To prevent cross-contamination, personal items (e.g., wedding ring, watch, and bracelet) should not be worn. Artificial nails increase the risk of infection, and long nails may puncture sterile gloves. Bandages are not considered waterproof dressings, and it is inappropriate to put a dressing on the wound before scrubbing because bacteria stay around the dressing site.

The scrubbed perioperative team member is pushing a hand into the sterile glove while the scrub person pulls the glove up. The scrubbed perioperative team member pushes extremely hard and the gloved hand falls below waist level. What is the next step? A. Don the next sterile glove. B. Don an additional sterile glove on the hand that fell below the waist. C. Remove the glove that fell below the waist and don a new sterile glove. D. Remove the glove, perform surgical hand antisepsis, and don new sterile gloves.

C: The area below the waist is considered contaminated because it is below the level of the sterile field. Because the glove dropped below the waist, there is a potential for contamination. The glove should be removed, and a new glove donned. Donning the next glove does not address the issue of possible contamination of the previous glove. Donning a second glove on that hand still has an increased risk of contamination and it is safer to remove the glove and don a new sterile glove. Unless there has been contamination to the scrubbed perioperative team member's hand (which was inside the glove during this incident) there is no need for the scrubbed perioperative team member to rescrub.

After the scrub person identifies the sterile gown as contaminated, the unscrubbed perioperative team member observes the scrub person removing the gloves. Why is this action not appropriate? A. The gown sleeve and glove should be removed one at a time. B. The gown and gloves should be removed at the same time. C. The gown should be removed first. D. The scrub person should first perform hand hygiene.

C: The contaminated sterile gown should be removed first to decrease the risk of transmitting contamination from harmful microorganisms to the scrub person and surgical environment. Removing the gown and gloves at the same time, removing one sleeve and glove at a time, or performing hand hygiene is not the proper procedure for removing a contaminated sterile gown.

When is it appropriate to use the open-assisted gloving method? A. When first donning sterile gloves after surgical hand antisepsis B. When the scrub person needs to don new sterile gloves C. When the scrub person is changing a contaminated glove D. When the scrub person has contaminated both gloves

C: The open-assisted gloving method should only be used when changing a contaminated glove and if it is not feasible for the scrubbed perioperative team member to change the gown and gloves in order to use the closed-assisted gloving method. When the scrubbed perioperative team member's hand passes through the porous cuff of the gown, there is an increased risk of glove cuff contamination. To avoid increased risk of contamination, which increases the patient's risk of an SSI, the open-assisted gloving method should not be used whenever one wants or when the practitioner says to, but only during very specific circumstances as outlined.

When can the open-assisted gloving method be used during an operative or invasive procedure? A. Any time sterile gloves need to be changed during an operative or invasive procedure B. Whenever the scrubbed team member wants to change both gloves C. When changing one contaminated glove during the procedure D. When additional scrubbed perioperative team members enter the sterile field

C: The open-assisted gloving method should only be used when changing one contaminated glove (not both gloves) with the aid of the remaining sterile glove. When the scrubbed perioperative team member's hand passes through the porous cuff of the gown, there is an increased risk of glove cuff contamination. To avoid an increased risk of contamination, which also increases the patient's risk of an SSI, the open-assisted gloving method should not be used to change both gloves or when additional scrubbed perioperative team members enter the sterile field during an operative or invasive procedure. The open-assisted method is not appropriate for all sterile glove changes.

The unscrubbed perioperative team member leaves the OR to interview the next patient and notices that the patient's bedsheets and gown are very dirty with food particles and dried blood. What should the unscrubbed perioperative team member do? A. Finish the interview and return to ready the OR for the patient. B. Tell the practitioner about the patient's dirty gown and bedsheets. C. Ask the preoperative nurse to help with changing the patient's bedsheets and gown. D. Call the OR charge nurse to report the preoperative unit as irresponsible for sending the dirty patient.

C: The unscrubbed perioperative team member should ask the preoperative nurse (if available) for help in changing the patient's bedsheets and gown to clean ones. Any patient entering the OR should wear a clean gown, be covered with clean linens, and have hair covered to minimize particulate shedding during the operative or invasive procedure. Finishing the interview and returning to ready the OR does not address the issue of particulates, and neither does telling the practitioner; the particulates could increase the chance of a surgical site infection. Reporting the preoperative unit as irresponsible for the patient's condition does not address the particulates; this situation is best addressed by asking for help to change the patient's gown and bedsheets from those responsible for sending the patient to the OR with a dirty gown and bedsheets.

When performing traditional surgical hand antisepsis, the scrub person uses only the sponge side and not the brush side of the scrub sponge. Why does the scrub person not use the brush side of the scrub sponge? A. The scrub person has sensitive skin and the brush hurts. B. It would take too long to use the scrub brush. C. The brush increases the number of bacteria shedding. D. The scrub person has not seen anyone else use the brush.

C: Using a brush for the surgical hand antisepsis may damage the skin and increase the number of bacteria shedding from the hands. Performing surgical hand antisepsis with a sponge is as effective as scrubbing with a brush. Using a brush is not dictated by the scrub person's skin sensitivity. It does not take any longer to use the scrub brush than the sponge. When performing a task, it is important to know why something should be done, not just do what others are doing.

Enhanced environmental cleaning:

Cleaning of surfaces that extends beyond routine cleaning and is performed following the care of a patient who is infected or colonized with a multidrug-resistant organism

The scrub person has an open, infected cut on the back of the hand. The unscrubbed perioperative team member notices this when the scrub person comes into the OR after performing surgical hand antisepsis using a waterless hand-rub product. What should the unscrubbed perioperative team member say to the scrub person? A. "Wow, that looks like it really hurts. How did that happen?" B. "You should cover that with a transparent dressing before you scrub." C. "You should put some skin glue on that before you scrub." D. "You should not scrub with an open wound like that."

D - If breaks in skin integrity are present, the scrub person should not perform surgical hand antisepsis for a sterile procedure. Open lesions, hangnails, dermatitis, new tattoos, infections, exudative lesions, and any other breaks in the skin increase the risk of infection to the patient and scrub person by allowing microorganisms to enter the skin. State and federal guidelines and the organization's practice should be followed to determine the need for work restrictions on perioperative team members with bloodborne infections. Discussing how the wound happened or that it hurts is not something that is related to patient safety or the appropriateness of the surgical hand scrub. Covering the lesion with a transparent dressing or skin glue does not stop the possibility of infection to the patient and scrub person.

What is the main purpose of removing a contaminated gown and gloves correctly? A. To place the patient at risk for becoming contaminated instead of the scrub person B. To decrease the risk of an SSI for the unscrubbed perioperative team member C. To place the scrub person at risk for becoming contaminated instead of the patient D. To decrease the risk of an SSI for the patient

D: Appropriate removal of a contaminated sterile gown and gloves prevents transmission of harmful microorganisms to the operative or invasive procedure environment, thereby decreasing the risk of an SSI for the patient. Although removing the contaminated gown and glove does decrease the risk of infection and contamination to the unscrubbed perioperative team member, the priority is to keep the patient free of an SSI. Removing a contaminated gown and gloves correctly is not meant to put the scrub person at risk for contamination instead of the patient; correct removal decreases the risk of contamination to the scrub person and other perioperative team members, as well as the patient.

After removing a contaminated gown, what should the scrub person immediately do next? A. Discard the gown into an appropriate trash receptacle and then perform hand hygiene. B. Hold on to the gown while removing the contaminated gloves and then discard them both into an appropriate receptacle. C. Remove contaminated gloves, perform surgical hand antisepsis, and then don a new sterile gown and gloves. D. Discard the gown into an appropriate receptacle per the organization's practice.

D: Once the contaminated gown is removed, it should be discarded immediately into the appropriate receptacle per the organization's practice to decrease possible contamination to the operative or invasive procedure environment and other perioperative team members. After removing a contaminated gown, the gloves should also be removed after the gown is discarded into an appropriate receptacle. If the scrub person does not self-contaminate during removal of the contaminated gown and gloves, then surgical hand antisepsis does not need to be performed before donning a new sterile gown and sterile gloves.

An unscrubbed perioperative team member witnesses contamination of the scrub team member's sterile glove. What is the most appropriate and immediate action for the unscrubbed team member to take? A. Save the contaminated item for the end of the procedure to review with the perioperative team members. B. Document in the patient's record and notify the scrubbed team members at the end of the procedure. C. Complete an appropriate incident report and notify the scrubbed team members at the end of the procedure. D. Notify the scrubbed team member, who corrects the action as soon as possible unless the patient's safety is at risk.

D: The break in technique should be immediately called to the attention of the scrubbed team member, who should take corrective action before other items are contaminated unless the patient's safety is at risk. Contaminated sterile gloves are not typically part of required operative or invasive procedure documentation. Waiting until the end of the procedure to alert the scrubbed team members is inappropriate. Completing an incident report is appropriate, but this is not the most immediate action to take. Saving the contaminated item does nothing to alert the scrubbed team member to correct the break in technique.

To prevent cross-contamination of clean and sterile supplies while organizing the OR, what action is the most appropriate? A. Place contaminated supplies on the bottom shelf of a case cart and cover them with clean linen, then place sterile supplies on the top shelf of the same cart. B. Place contaminated supplies on the bottom shelf of the case cart and sterile and clean supplies on the top shelf. C. Remove the sterile and clean supplies from the room to avoid having them come into contact with the contaminated supplies. D. Place clean and sterile supplies on one cart and contaminated supplies on another cart.

D: The clean and sterile supplies must be separated from the used and contaminated supplies to prevent cross-contamination. Placing both sterile and contaminated supplies on the same cart is inappropriate, even if they are on separate shelves. Removing the sterile and clean supplies from the room creates air turbulence when the door is opened, and the supplies may be needed later during the procedure. Regardless of whether the contaminated supplies are covered or not, placing both clean and dirty supplies on the same cart is inappropriate because of the chance of cross-contamination.

What method of gloving should be used by the scrub person to glove an additional scrubbed perioperative team member at the beginning of the operative or invasive procedure? A. Open-gloving method B. Open-assisted method C. Closed-gloving method D. Closed-assisted method

D: The closed-assisted gloving method should be used by the scrub person to gown and glove the sterile perioperative team member at the beginning of the operative or invasive procedure. At the beginning of the operative or invasive procedure, the entire field is sterile; there is no bioburden present until after the procedure has begun. The open-gloving method or open-assisted method should only be used in select circumstances (e.g., changing a contaminated glove) and never at the beginning of an operative or invasive procedure because the risk of glove cuff contamination increases when the perioperative team member's hand passes through the cuff (as happens during open-gloving or open-assisted gloving methods). The closed method of gloving is used by the scrub person when setting up the sterile field for the operative or invasive procedure because there are no other scrubbed perioperative team members available to assist with gloving.

In a hurry to set up the sterile field, the scrub person begins to scrub but fails to remove a watch. What should the scrub person do? A. Keep the watch on and proceed to don a sterile gown and gloves. B. Ask an unscrubbed perioperative team member to remove the watch and proceed to don a sterile gown and gloves. C. Remove the watch and proceed to don a sterile gown and gloves. D. Remove the watch and perform surgical hand antisepsis again per the manufacturer's IFU.

D: The scrub person must remove the watch, then perform surgical hand antisepsis again to remove the bacteria that were transferred from the watch to the skin. A watch harbors microorganisms and must be removed before surgical hand antisepsis is performed. If the watch is not removed, it is less likely that the area will be washed correctly. Removing the watch after scrubbing and keeping the watch on the wrist while donning a sterile gown and gloves are inappropriate because microorganisms may remain on the skin where the watch was or is worn and could contaminate the sterile gown and gloves.

How should the scrub person present the sterile gown to the additional scrubbed perioperative team member? A. Keep the gown on the sterile back table, do not handle the gown, and allow the scrubbed perioperative team member to don the gown from the sterile back table. B. Hand the gown to the scrubbed perioperative team member with the thickest part of the gown fold angled inward and let the gown unfold completely as the scrubbed perioperative team member pulls it up over the shoulders. C. Orient the inner aspect of the gown toward the scrubbed perioperative team member, grasp the shoulders of the gown, and unfold the sleeves and ties as the gown is donned. D. Orient the inner aspect of the gown toward the scrubbed perioperative team member, make a cuff of the neck and shoulders, and expand the armholes.

D: The scrub person should present the inner aspect of the gown to the additional scrubbed perioperative team member while protecting the gloved hands under a cuff made from the neck and shoulders of the gown. The armholes should be held open for ease of donning. The gown cannot be donned while it is folded. Handing a folded gown or a partially unfolded gown to the perioperative team member wastes time and assumes that contamination will be avoided, which can be erroneous. The gown should not be used if it is on the working back table during an operative or invasive procedure; it would be considered contaminated.

The practitioner, scrub person, and anesthesia provider are involved in a passionate discussion about last night's football game at the sterile field during the current procedure. What is the unscrubbed perioperative team member's best response to this discussion? A. "Can we put this conversation on hold just long enough for the scrub person and me to count?" B. "I didn't get to see the game last night; can you fill me in?" C. "Wasn't that a horrible call by the referee last night?" D. "You should finish this conversation later, after the procedure."

D: The unscrubbed perioperative team member should encourage the perioperative team to finish the conversation later, after the procedure. Nonessential conversations near the sterile field should be minimized because microorganisms are transported on particles in the air. Joining in the conversation or asking to be filled in on what happened during the game only encourages increased conversation at the sterile field. Although the conversation should be stopped so that the scrub person and unscrubbed perioperative team member can count, it should not be resumed while the procedure is still being performed because nonessential conversation near the sterile field should be kept to a minimum.

A trauma patient is being wheeled into the OR while health care team members perform chest compressions. The other health care team members entering the room are not in the correct surgical attire. What should the unscrubbed perioperative team member do? A. Ask everyone to don appropriate surgical attire before entering the OR. B. Take head coverings and masks to anyone that does not have head coverings and masks. C. Change the patient into a clean gown and place a head covering on the patient's head. D. Help escort the additional health care team members into the room and help with the patient.

D: The unscrubbed perioperative team member should help escort any additional health care team members into the OR and help with patient care during an emergency situation. Some situations, such as emergent patient situations, fire, and safety hazards, may necessitate changes in traffic control practices. The gravity of the patient's situation outweighs any of the precautions for traffic control and donning the correct surgical attire. Asking staff to don the appropriate surgical attire or taking them head coverings and masks would interrupt care to a patient in critical condition. Attempting to change the patient into a clean gown and put a head covering on the patient's head is also not an appropriate action during this time, because this would also interrupt patient care and is not a priority.

An unscrubbed perioperative team member witnesses contamination of the scrub person's sterile glove. What is the most appropriate and immediate action for this team member to take? A. Save the contaminated item for the end of the operative or invasive procedure to review with the perioperative team members. B. Document in the OR record and notify the scrubbed perioperative team members at the end of the procedure. C. Complete an appropriate incident report and notify the scrubbed perioperative team members at the end of the procedure. D. Notify the scrub person and ensure that corrective action is taken immediately.

D: The unscrubbed perioperative team member who observes a break in technique should immediately notify the scrub person of the break and ensure that the scrub person takes corrective action immediately unless the patient's safety is at risk. The item does not need to be saved for the end of the procedure to be reviewed with the other perioperative team members or documented. An incident report does not need to be completed at the end of the procedure unless that is part of the organization's practice, but notifying the scrub person should occur when the break in technique occurs, not at the end of the procedure.

During the tying process, the right tie disconnects from the paper tab and falls below the scrubbed perioperative team member's waist. How should the unscrubbed perioperative team member respond? A. Don sterile gloves and complete the tying sequence. B. Reconnect the paper tab and proceed with the wraparound tie. C. Retrieve the lost tie and hand it to the scrub person to secure at the waist. D. Secure both ties behind the scrubbed perioperative team member's back.

D: Ties that fall below the level of the sterile field are contaminated and may be tied only by an unscrubbed perioperative team member. If necessary, the scrubbed perioperative team member may use a sterile hemostat or forceps to grasp the tie to hand to the unscrubbed perioperative team member. The paper tab may not be reconnected by anyone with or without sterile gloves because contamination has taken place and the scrub person may not touch them under any circumstances. The tie is already contaminated, so donning sterile gloves is not necessary.

When should the scrubbed and unscrubbed perioperative team members begin setting up the sterile field? A. As soon as the unscrubbed perioperative team member says it is time to begin the setup B. As soon as all the supplies are gathered for the operative or invasive procedure C. As close as possible to the time the scrubbed team member arrives for work D. As close to the start of the operative or invasive procedure as possible

D: Timing the setup as close as possible to the start of the operative or invasive procedure decreases the likelihood that dust and other contaminants will build up and compromise the sterile field. The unscrubbed perioperative team member and scrub person should discuss the timing of the setup and take into account the time the operative or invasive procedure is scheduled. The sterile setup should be a collaborative effort. The setup should begin at an appropriate time that is based on the actual time of the operative or invasive procedure and length of time required to set up the sterile field safely with all surgical supplies and instruments needed for the operative or invasive procedure.

Why is the open-assisted gloving method preferred for gloving after the operative or invasive procedure has been started? A. This method is part of the scrub person's job function to assist with gloving. B. This method of gloving is the easiest for scrubbed perioperative team members. C. This method of gloving is preferred for setting up a sterile field. D. This method of gloving creates less gown cuff contamination.

D: Using the open-gloving assisted method poses less risk of contaminating the gown cuff areas and is more efficient than self-gloving using the closed-gloving method. The scrub person's job is to perform per the standards and recommendations for providing safe care to patients. The open-assisted gloving method should be used because it is the best practice not just because it is the scrub person's job. Scrubbed perioperative team members also follow standards and recommendations to provide safe care to patients; therefore, ease of gloving should not be a priority. The closed-gloving method is used to set up a sterile field, not the open-assisted gloving method.

During an operative or invasive procedure, how should the scrub person turn in relation to another scrubbed team member when changing positions? A. Move at will, as long as both scrubbed team members are moving slowly and maintaining a safe distance from the other scrubbed team members and the sterile field. B. Turn toward the other scrubbed team member while facing the team member's back and then proceed to the sterile field. C. Move behind the sterile back table and face the scrubbed team member's back to guard against bumping into other scrubbed team members. D. Turn back-to-back or face-to-face and immediately face the scrubbed team member while maintaining a safe distance from the other scrubbed team members and the sterile field.

D: When changing positions during an operative or invasive procedure, the scrub person should turn either back-to-back or face-to-face in relation to another scrubbed team member, turning nonsterile surface to nonsterile surface or sterile surface to sterile surface, while maintaining a safe distance from the other scrubbed team members and the sterile field. Facing the scrubbed team member's back, going behind the sterile back table, or moving at will (even slowly) without observing techniques to maintain the sterile environment all could compromise the sterile field.

what are the 3 types of cleaning in the OR and when are they performed?

Damp dusting - first thing in the morning before surgical supplies are brought into the OR - before surgical supplies are opened End of procedure cleaning and disinfecting - cleaning and disinfecting between every patient during the day Terminal cleaning and disinfecting - cleaning and disinfecting done at the end of the day

Gloves that fit right Do not _______ Do not _____ or _______ Do not expose gown _______

Gloves that fit right Do not cause numbness Do not slide or roll Do not expose gown cuffs

The ______________ is worn in semi-restricted areas.

Head Coverings

Restricted area.

Includes the OR and is accessible only from a semi-restricted area.

Semi-restricted area

Includes the peripheral support areas of the surgical suite and has storage areas for sterile and clean supplies, work areas for storage and processing of instruments, and corridors leading to the restricted areas of the surgical suite.

Why must all jewelry from hands and wrists be removed before performing hand hygiene.

Jewelry prevents effective cleaning of skin surfaces

Regulated medical waste:

Liquid or semi-liquid blood or other potentially infectious materials, contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed, items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling, contaminated sharps, and pathological and microbiological wastes containing blood or other potentially infectious materials.

Why is it important to use a facility-approved lotion

Many lotions interfere with glove integrity and antiseptic products.

Fingernails should be _____, ______, and ______ what's policy on nail polish

Natural Short and clean Freshly polished and without chips, (if nail polish is allowed by the facility policy and procedure) Check with facility policy to see if nail lacquer or nail lacquer with enhancements are allowed Artificial nails have been linked to infection outbreaks and are not recommended.

Scrub attire

Nonsterile apparel designed for the perioperative practice setting that includes two-piece pantsuits and scrub dresses.

Scheduled cleaning:

Periodic cleaning (eg, weekly, monthly) of areas and equipment that are not cleaned daily or after every use.

Environmentally preferable:

Products or services that have lesser or reduced effect on human health and the environment compared to competing products or services that serve the same purpose.

What is the purpose of Sterile gowns?

Protect the wearer from exposure to blood, body fluids, and other potentially infectious materials during an invasive procedure.

________ Areas may include: • Operating room

Restricted

________ Areas may include: • Storage equipment areas • Work areas for processing instruments • Sterile processing areas • Hand scrub stations • Corridors leading from the unrestricted area to the restricted area • Entrances to locker rooms

Semi-restricted

Sterile field

Sterile field The area surrounding the site of the incision or perforation into tissue, or the site of introduction of an instrument into a body orifice that has been prepared for an invasive procedure. The area includes all working areas, furniture, and equipment covered with sterile drapes and drape accessories and all personnel in sterile attire

Artificial nails

Substances or devices applied or added to the natural nails to augment or enhance the wearer's own nails. They include, but are not limited to, bonding, extensions, tips, wraps, gel and acrylic overlays, and tapes.

Preoperative area

The portion of the surgical suite in which preoperative care takes place. May include admission areas, waiting rooms, and patient care stations in which care is administered before the patient enters the intraoperative area

Intraoperative area

The portion of the surgical suite that includes the operating room, interventional radiology room, hybrid operating room, and the semi-restricted corridors connecting the unrestricted area to the restricted area.

Environmental cleaning:

The process of cleaning, disinfecting, and monitoring for cleanliness.

Contact time:

The specific length of time a disinfectant must remain in contact with a microorganism to achieve disinfection. Synonyms: dwell time, kill time.

Invasive procedure

The surgical entry into tissues, cavities, or organs or the repair of major trauma injuries

Sterile technique

The use of specific actions and activities to prevent contamination and maintain sterility of identified areas during operative or other invasive procedures

Terminal cleaning:

Thorough environmental cleaning that is performed at the end of each day the room or area is used.

If your gloves are wrinkling that may indicate that your gloves are too _____

Too loose

If you experience hand numbness that may indicate that your gloves are too _______

Too tight

True or False: Hand hygiene is the single most effective method of infection prevention available

True Follow the manufacturer's instructions for use (IFU) when using an alcohol-based hand rub.

True or false: do not scrub for an operative or invasive procedure if breaks in skin integrity are present

True - Open lesions, hangnails, weeping dermatitis, new tattoos, infections, exudative lesions, and any other breaks in the skin increase the risk of infection to the patient and scrub person by allowing microorganisms to enter the skin

__________ Areas may include: • Preoperative patient care area • Postoperative patient care area • Central control points to monitor personnel, patients, and material into semirestricted areas • Locker rooms • Lounges • Offices • Waiting rooms • Access to procedure rooms (eg, endoscopy procedural rooms)

Unrestricted

Cleaning equipment for semi restricted and restricted areas should be dedicated equipment because

Using dedicated equipment for the semi restricted and restricted areas may decrease the risk of cross-contamination from other areas in the hospital.

Utility water:

Water obtained directly from a faucet that has not been purified, distilled, or otherwise treated. Synonym: tap water.

Glove fit The inner glove can be a ______ larger than the outer glove. Both gloves can be the ______ size.

half-size same

Follow the manufacturer's _____________ when using an alcohol-based hand rub.

instructions for use (IFU)

Don a _________ and ___________ in restricted areas.

surgical mask eye protection

What are the areas of sterility once you are gowned?

the chest to umbilicus, glove tips to mid-arm.