This is the technique you will need to use for 'scrubbing-up' prior to undertaking sterile procedures, such as prior to surgery (in the operating room).
Washing & Preparation
Prior to washing your hands and 'scrubbing', ensure that your sterile equipment is opened and ready to use. It is possible to open the 'clear' packaging and leave the opened items on the trolley. Make sure you do not directly touch the contents of the packages. You will require a gown and sterile gloves. If this is the first time that you are scrubbing up (ie. before the first operation on the list), then also open a disposable scrubbing brush. Make sure your mask and theatre hat are already on and watches/rings etc. have been removed. You should already be changed into theatre 'scrubs'.
1. Turn on the taps, and get the water to a comfortable temperature (it is very embarrassing to burn yourself in front of everyone else because you didn't check!). Use your elbows to operate the taps (they usually have long handles in theatres). Keep the water pressure moderate or else you will again embarrass yourself by getting soaked.
2. With your hands positioned upwards (in a 'prayer' formation - kept higher than your elbows to allow water to drain away from your hands into the sink), wet your hands and forearms, from distal to proximal.
3. Using the scrubbing solutions (use betadine (iodine)/chlorhexidine washes in alternation), wash your hands and forearms thoroughly for 1 minute. Initially, using the sponge of your disposable scrub brush to clean under your nails for the first minute. Don't use the brush elsewhere as you may expose more commensals. Pay special attention to areas around the base of the thumb, between the fingers and the wrist areas, as these are often neglected or missed. Always rinse the soap from your fingertips to your elbows.
4. Then repeat the process, washing your hands upto your wrists. Ensure you clean each finger, web spaces, the base of the thumb, and the palms and backs of each hand.
5. Finally, repeat the rinse thoroughly from your fingertips to your elbows. Remember that wet theatre scrubs can contaminate a sterile gown!
6. The whole washing process should take about 3-5 minutes. Once complete, dry both hands, using the towels provided with the sterile gown. Ensure that your hands and forearms are thoroughly dried all the way from your fingertips to elbows.
Putting on the gown:
1. Once your hands have been washed, pick up the sterile gown with both hands. The neck collar is a clue to ensuring that the gown is the right way up.
2. Step away from the trolley so that you can open the gown without touching anything and contaminating the gown.
3. Facing the inside of the gown, open it up by gently shaking it downwards.
4. Slide your hands and arms into the arm-holes by slowly advancing the gown up your arms. Remember that your scrubs are not sterile, so you shouldn't touch the external part of the gown.
5. Keep your hands proximal to emerging from the cuffs of the sleeves of the gown (if you will be putting gloves on using the 'closed' technique). If you plan to use the open technique, then you can continue to advance your hands out through the sleeves.
6. Get an assistant to pull the gown onto your shoulders (by minimally touching only the inside of the gown). They should also secure the ties at the back of the gown for you.
7. Secure the front straps of the gown, by pulling away one end of the tie from it's cardboard attachment. Give the cardboard bit (attached to the other end of the tie) to your assistant, and spin round. Once the cord has wound around you, pull on the second bit of cord whilst your assistant pulls back on the cardboard, therefore releasing the second cord. Tie this round your waist.
Putting on sterile gloves
Putting on sterile gloves ('closed' method)
1. With your hands still inside the sleeves of the sterile gown, place the thumb of one hand across the palm (with the palm facing upwards).
2. Pick up a glove, and place it onto your palm, with the thumb of the glove placed on top of the thumb of your hand. The fingers of the glove should face upwards along your arm (towards your body).
3. Hold one side of the 'cuff' of the glove through your sleeved hand, and the other side with your free hand.
4. Bring the glove over the tops of your fingers and push your fingers up into the glove. Using your free hand, pull the glove down onto your sleeved hand (go over the sleeves).
5. Once the glove is secured over your fingers, pull the 'overlapped' sleeve of the gown towards your body, edging the sleeve of gown slowly out of the glove. Don't forget to leave some overlap (some of the gown should remain under the glove).
6. Adjust until you are comfortable. Repeat for the other side
Putting on sterile gloves ('open' method)
1. Pick up a glove from the packet by touching only the insides of the 'cuff' of the glove (the gloves are packed 'folded back' upon themselves).
2. Advance your hand into the glove with the assistance of your other hand, making sure that you only touch the insides of the glove (this will keep the external surface as sterile as possible).
3. Once one hand has been gloved, using this 'already-gloved' hand, pick up the other glove, again by only touching the outside of the cuffed area of the glove.
4. Advance the ungloved hand into glove (with the help of the other hand).
5. Be careful when turning the cuff area downwards that you don't accidentally contaminate the glove.