The surgical field is the sterile field that is set up by the scrub tech and consists of the draped patient, the back table, and any equipment that is draped out, such as microscopes, slush machines, and c-arms. The scrub tech will open the field, supplies, and instruments and then scrub in. Once they are scrubbed they will self-gown and glove and begin the setup process (Figure 12.1). The goal is to create and maintain a sterile environment for the patient.
Whether you are scrubbing in or coming to observe for a case in the operating room, there are a few things that everyone has to do before “crossing over” into the actual operating rooms:
In the operating room dressing area, change into hospital-issued OR scrubs. No shirt should be worn under the scrub top—nothing should be hanging out from the sleeves or neck.
Remove jewelry and put it somewhere secure so you don’t lose it. Allowing earrings and necklaces in the OR is a hot topic of debate, so always check with your facility. If earrings are allowed, be sure they are secure and are covered by your hat. No one wants to search through an open abdomen for your earring because the back fell off (yes, it has happened).
Dedicated OR footwear or shoe covers should be worn. You don’t want to bring anything from home into the OR and you certainly don’t want to take anything from the OR into your home.
Put on a clean hat. The hat must cover all hair and for that reason many facilities no longer allow skullcaps. And don’t forget a mask.
Do not bring bags or other personal belongings into the operating room. It is a clean environment, and bags and other items bring microorganisms in.
When you enter the OR, introduce yourself to the circulating nurse (at a minimum). If you haven’t met the surgeon before, it’s your responsibility to introduce yourself and tell them why you are there.
IF YOU ARE OBSERVING
If you are not going to be putting a gown and gloves on but are coming to watch the case, there are some important tips to remember:
Non-scrubbed staff should stay at least 12 inches away from the sterile field at all times. If it’s blue and you’re not scrubbed, it’s not for you.
Never cross between two sterile fields. For example, if you need to go to the other side of the room, don’t cut between the instrument table and the draped OR bed. Always go completely around.
Do not turn your back to the sterile field. Always be mindful of where you are in relation to it.
Excess traffic should be minimized, including people coming and going from the OR. This increases the risk of contamination and is a source of distraction to the surgical team. If you have to go to a different OR for some reason, use the side doors when possible.
Keep conversations to a minimum. If everyone around the patient is quiet and focusing only on the case, it’s probably not the best time to ask questions.
All of this is really challenging. You will ask (and be asked) a lot of questions. Just do your best.
IF YOU ARE SCRUBBING IN
Before you scrub, double check that the following things are done:
Your mask is on properly, covering both the nose and mouth, and tied tightly. Beard covers should be worn as needed.
Protective eye gear is on, not resting on your forehead or waiting on the counter for you to put it on (Figure 12.2).
If you are going into an OR where x-ray will be used, select a lead apron and put that on before you scrub.
Remove all cell phones and pagers from your pockets. The circulator really doesn’t enjoy having to reach under your gown to find your phone when it rings during the case and you forgot to put it on the counter.
HOW TO SCRUB IN
Always follow specific hospital policies on how to scrub in.
A surgical scrub is performed on clean hands. If hands are soiled they must be pre-washed.
Fingernails should be short and clean. No nail polish or artificial nails are allowed at many facilities. If you have cuts or abrasions on your hands or arms, you should not scrub in.
Clean fingernails of both hands under running water with a disposable nail cleaner.
Rinse hands and arms with running water.
Dispense antimicrobial cleaning agent.
Apply antimicrobial agent to wet hands and forearms using a soft sponge. You will need plenty of soapy water to work with: place the sponge under water and squeeze it to get more soap as needed.
A three- to five-minute scrub is performed according to manufacturer’s guidelines (Figure 12.3).
Each finger, hand and arm has four sides. Scrub all four sides, keeping hands elevated at all times (Figure 12.4).
Repeat for the opposite side. Wash arms to 2 inches above the elbow.
Please turn water off when you aren’t using it to help conserve this resource.
Avoid splashing your attire.
Discard the scrub sponge in the trash.
Rinse hands and arms under running water in one direction, from fingertips to elbows.
Keep hands and fingertips higher than your elbows and away from attire at all times.