DUTIES OF SCRUB NURSE

• Ensures that the circulating nurse has checked the equipment

• Ensures that the theater has been cleaned before the trolley is set
• Prepares the instruments and equipment needed in the operation
• Uses sterile technique for scrubbing, gowning and gloving
• Receives sterile equipment via circulating nurse using sterile technique
• Performs initial sponges, instruments and needle count, checks with circulating nurse

When surgeon arrives after scrubbing

• Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite
• Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet. Then, assist in
draping the patient aseptically according to routine procedure
• Place blade on the knife handle using needle holder, assemble suction tip and suction tube
• Bring mayo stand and back table near the draped patient after draping is completed
• Secure suction tube and cautery cord with towel clips or allis
• Prepares sutures and needles according to use

During an operation

• Maintain sterility throughout the procedure

• Awareness of the patient’s safety
• Adhere to the policy regarding sponge/ instruments count/ surgical needles
• Arrange the instrument on the mayo table and on the back table

Before the Incision Begins

• Provide 2 sponges on the operative site prior to incision

• Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon
• Hand the retractor to the assistant surgeon
• Watch the field/ procedure and anticipate the surgeon’s needs
• Pass the instrument in a decisive and positive manner
• Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with
moist sponge
• Always remove charred tissue from the cautery tip
• Notify circulating nurse if you need additional instruments as clear as possible
• Keep 2 sponges on the field
• Save and care for tissue specimen according to the hospital policy
• Remove excess instrument from the sterile field
• Adhere and maintain sterile technique and watch for any breaks

End of Operation

• Undertake count of sponges and instruments with circulating nurse

• Informs the surgeon of count result
• Clears away instrument and equipment
• After operation: helps to apply dressing
• Removes and siposes of drapes
• De-gown
• Prepares the patient for recovery room
 • Completes documentation
• Hand patient over to recover room

Scrub duties

1. Perform surgical hand scrub.

2. Gown and glove using closed glove technique.
3. Regown and glove when breaks in technique occur.
4. Assist the 1st scrub in setting up case (back table, mayo stand and O.R. basins). The tasks include:
A. Arrange instruments and supplies (back table, mayo stand and O.R.).
B. Count needles, instruments and sponges.
C. Check instruments for proper functions.
D. Prepare irrigating solution.
E. Draw medications properly.
F. Gown and glove surgeon and assistant.
G. Assist with draping.
H. Prepare electric cautery, suction and light handles for proper use.
I. Prepare necessary sutures.
J. Pass instruments to surgeon and assistant.
K. Retract, sponge, and suction during case as necessary.
L. Proper identification and handling of specimen.
M. Prepare instruments for decontamination at completion of case.
N. Dispose of sharps properly.
O. Discard soiled drapes and trash properly.
P. Transport soiled drapes and trash properly.
Q. Anticipate the surgeon and assistant needs.
R. Anticipate the operative procedure needs.
S. Help apply wound dressing.

The student will be encouraged to progress from second scrub technologist to first scrub as soon as possible. The scrub
(technologist) nurse should make this judgement and assign student to first scrub. The Surgical Technology student keeps a log of
all the cases that he/she has worked with. Whenever possible, this information should be used to help assign students to a variety
of surgical specialties.

DUTIES OF CIRCULATING NURSE

Before an operation

• Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table
• Make sure theater is clean
• Arrange furniture according to use
• Place a clean sheet, arm board (arm strap) and a pillow on the OR table
• Provide a clean kick bucket and pail
• Collect necessary stock and equipment
• Turn on aircon unit
• Help scrub nurse with setting up the theater
• Assist with counts and records

During the Induction of Anesthesia

• Turn on OR light
• Assist the anesthesiologist in positioning the patient
• Assist the patient in assuming the position for anesthesia
• Anticipate the anesthesiologist’s needs
• If spinal anesthesia is contemplated:
Place the patient in quasi fetal position and provide pillow
Perform lumbar preparation aseptically
Anticipate anesthesiologist’s needs

After the patient is anesthetized

• Reposition the patient per anesthesiologist’s instruction

• Attached anesthesia screen and place the patient’s arm on the arm boards
• Apply restraints on the patient
• Expose the area for skin preparation
• Catheterize the patient as indicated by the anesthesiologist
• Perform skin preparation

During Operation

• Remain in theater throughout operation

• Focus the OR light every now and then
• Connect diatherapy, suction, etc.
• Position kick buckets on the operating side
• Replenishes and records sponge/ sutures
• Ensure the theater door remain closed and patient’ s dignity is upheld
• Watch out for any break in aseptic technique

End of Operation

• Assist with final sponge and instruments count

• Signs the theater register
• Ensures specimen are properly labeled and signed

After an Operation

• Hands dressing to the scrub nurse

• Helps remove and dispose of drapes
• Helps to prepare the patient for the recovery room
• Assist the scrub nurse, taking the instrumentations to the service (washroom)
• Ensures that the theater is ready for the next case

CIRCULATING RESPONSIBILITIES

The Surgical Technology student can assist the Registered Nurse with the following:

A. Clean operating room and discard suction prior to case.

B. Gather all supplies, instruments and equipment necessary for case.
C. Arrange O.R. furniture properly.
D. Open and flip sterile supplies for the surgical procedure.
E. Assist with IV therapy.
F. Assist the anesthesiologist.
G. Assist with the skin preparation.
H. Tie gowns of the scrub nurse and surgeon.
I. Provide scrub personnel with sitting stools and foot stools as necessary.
J. Turn and help adjust lights as necessary.
K. Supply the scrub nurse with necessary supplies.
L. Receive and label specimen properly.
M. Log and deliver specimen to pathology properly.
 N. Help apply wound dressing.
O. Pull case for following procedure.

OPERATING ROOM ORIENTATION MANUAL

SURGICAL HAND SCRUB

1. A five (5) minute anatomical timed scrub will be used for all surgical hand scrubs.
2. Fingernails must be free of polish/enamel and of medium length. No jewelry is permitted on the hands and arms while
performing as a member of the surgical team.
3. **Remember to put your mask on prior to starting you scrub.**
4. Wash hands and arms with solution to 2 inches above the elbow.
5. Clean fingernails with file. Take sterile brush in right hand. Wet brush with water and soap. Scrub fingernails of left
hand.
6. Start scrubbing fingers of left hand, one at a time, treating each finger as four-sided; palm, knuckles, and back of hand.
Repeat with right hand.
7. Scrub right wrist and continue up arm to 2 inches above elbow. Repeat with left arm. Discard brush. Rinse both hands
and arms under running water keeping hands above level of elbow so that water runs off the elbows and not the hands.

Gloving Procedure - Open

1. Avoid contact of sterile gloves with ungloved hands during closed-glove procedure.
 2. For closed-glove method, never let the fingers extend beyond the stockinette cuff during the procedure. Contact with
ungloved fingers constitutes contamination of the glove.
3. For open-glove method, touch only the cuff of the glove with ungloved hand, and then only glove to glove for other
hand.
4. If contamination occurs during either procedure, both gown and gloves must be discarded and new gown and gloves
must be added.
5. When removing gloves after a procedure is finished, the gloves are removed after the gown is removed inside out, using
glove-to-glove, then skin-to-skin technique.

Treatment List for Acute Gastritis

The list of treatments mentioned in various sources for Acute Gastritis includes the following list. Always
seek professional medical advice about any treatment or change in treatment plans.

• Generally will resolve of its own accord and only fluid replacement and rest needed
• Oral rehydration - water, electrolyte or gastrolyte preparation
• Anti-emetic/anti-nausea medications - e.g. metoclopramide
• IV fluids if severe case or dehydrated
• Antibiotics if severe case, fever present or septicaemic
• Medications to cease diarrhoea or slow intestinal motility are generally not recommended and can
make condition worse
• Vigilant hygiene practices (eg handwashing, care with food preparation) to prevent spread to family
and other close contacts
• Antacids, such as Mylanta or Mucaine
• H2 Antagonists
Gloving Procedure - Closed
Points to Remember about Aseptic Technique

Adherence to the Principles of Aseptic Technique Reflects One's Surgical Conscience.

1. The patient is the center of the sterile field.

2. Only sterile items are used within the sterile field.

A. Examples of items used.
B. How do we know they are sterile? (Wrapping, label, storage)

3. Sterile persons are gowned and gloved.

A. Keep hands at waist level and in sight at all times.
B. Keep hands away from the face.
C. Never fold hands under arms.
D. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from
above the elbow to cuffs. Gloves are sterile.
E. Sit only if sitting for entire procedure.

4. Tables are sterile only at table level.

A. Anything over the edge is considered unsterile, such as a suture or the table drape.
B. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.

5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile items or areas.
A. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile packages. The circulator ensures
a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.

6. Unsterile persons avoid reaching over sterile field; sterile

persons avoid leaning over unsterile area.
A. Scrub person sets basins to be filled at edge of table to fill them.
B. Circulator pours with lip only over basin edge.
C. Scrub person drapes an unsterile table toward self first to avoid
leaning over an unsterile area. Cuff drapes over gloved hands.
D. Scrub person stands back from the unsterile table when draping it
to avoid leaning over an unsterile area.

7. Edges of anything that encloses sterile contents are considered

unsterile.
A. When opening sterile packages, open away from you first. Secure
flaps so they do not dangle.
B. The wrapper is considered sterile to within one inch of the wrapper.
C. In peel-open packages, the edges where glued, are not considered
sterile.

8. Sterile field is created as close as possible to time of use.

A. Covering sterile tables is not recommended.

9. Sterile areas are continuously kept in view.

A. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated.

10. Sterile persons keep well within sterile area.

A. Sterile persons pass each other back to back or front to front.
B. Sterile person faces a sterile area to pass it.
C. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
D. Movement is kept to a minimum to avoid contamination of sterile items or persons.
 11. Unsterile persons avoid sterile areas.
A. Unsterile persons maintain a distance of at least 1 foot from
the sterile field.
B. Unsterile persons face and observe a sterile area when
passing it to be sure they do not touch it.
C. Unsterile persons never walk between two sterile fields.
D. Circulator restricts to a minimum all activity near the sterile
field.

12. Destruction of integrity of microbial barriers results in

contamination.
A. Strike through is the soaking through of barrier from sterile
to non-sterile or vice versa.
B. Sterility is event related.

13. Microorganisms must be kept to irreducible minimum.

A. Perfect asepsis is an idea. All microorganisms cannot be
eliminated. Skin cannot be sterilized. Air is contaminated by droplets.

HAZARDS IN THE SURGICAL SUITE

Electrical
Cautery Units, Defibrillators, OR Beds, numerous pieces of equipment
All equipment must be checked for electrical safety before use!!

Anesthetic Waste

Radiation
Leaded aprons and shields available for use during procedures.

Laser Safety
Protective eyewear for patient and operating team.
Doors remain closed with sign - "Danger, Laser in Use."
Sterile water available in the room and on sterile field.
Smoke evacuation system is to be employed when applicable.
Surgery high filtration masks should be worn during procedures that produce a plume.

General Safety
Apply good body mechanics at all times when transferring patients.
Operating room beds and gurneys will be locked before patient transfer.
Operating safety belts will be used for all patients.
Never disconnect or connect electrical equipment with wet or moist hands.
Discard all needles, razors, scalpel blades and broken glass into special identified containers.

UNIVERSAL PRECAUTIONS SUMMARY

Although the risk of contracting HIV in the healthcare setting is extremely low, there are other bloodborne pathogens which pose
a much more significant risk. Precautions should be followed to reduce the risk of exposure to bloodborne pathogens. Each
healthcare worker should assess their possible risks and take precautions to reduce these risks. Universal Precautions are designed
to protect healthcare workers from occupational exposure and should be followed when potential for exposure might occur.

Universal blood and/or body fluid precautions should be consistently used for ALL patients. Fundamental to the concept of
Universal Precautions is treating all blood and/or body fluids as if they were infected with bloodborne pathogens and taking
appropriate protective measures, including the following:
1) Gloves should be worn for touching blood and/or body fluids, mucous membranes, non-intact skin, or items/surfaces soiled
with blood and/or body fluids. Gloves should be changed after contact with each patient and hands washed after glove removal.
Though gloves reduce the incidence of contamination, they cannot prevent penetrating injuries from needles and other sharp
instruments.

2) Gowns or aprons should be worn during procedures that are likely to generate splashes of blood and/or body fluids onto
clothing or exposed skin.

3) Masks and protective eyewear should be worn during procedures that are likely to generate droplets of blood and/or body
fluids into the mucous membranes of the mouth, nose, or eyes.

4) Needles and sharps should be placed directly into a puncture-resistant leakproof container which should be as close as possible
to the point of use. Needles should not be recapped, bent, broken, or manipulated by hand.

5) Hands and skin surfaces should be washed after contact with blood and/or body fluids, after removing gloves, and between
patient contact.

6) Gloves should be worn to cleanup blood spills. Blood spills should be wiped up and then an EPA registered tuberculocidal
disinfectant applied to the area. The disinfectant should have a one minute contact time and the area rinsed with tap water. If glass
is involved, wear double gloves or heavy gloves. Pick up the glass with broom and dust pan, tongs, or a mechanical device.

7) Healthcare workers with exudative lesions or weeping dermatitis should not perform direct patient care until the condition
resolves.

8) Disposable resuscitation devices should be used in an emergency.

9) Occupational Exposures: Definition

- Puncture wounds
- Needlesticks/Cuts
- Splashes into the eyes, mouth, or nose
- Contamination of an open wound

10) Occupational Exposures:

- Wash the area immediately with soap and water
- If splashed in the eyes mouth or nose have them properly flooded or irrigated with water
- Notify supervisor as soon as possible
- Call Employee Health Center at (409) 772-5582 for information regarding blood and/or body fluid exposure management

COMPARATIVE DIVISION OF DUTIES

Scrub Nurse/Technician

A. Preoperative

1. Checks the card file for surgeon's special needs/requests.

2. Opens sterile supplies.
3. Scrubs, gowns, and gloves and sets up sterile field. Obtains instruments from flash autoclave if necessary. Checks for
proper functioning of instruments/equipment.
4. Performs counts with circulator.

B. Preincisional

1. Completes the final preparation of sterile field.

2. Assists surgeon with gowning/gloving.
3. Assists surgeon with draping and passes off suction/cautery lines.
C. During the Procedure

1. Maintains orderly sterile field.

2. Anticipates the surgeon's needs (supplies/ equipment).
3. Maintains internal count of sponges, needles and instruments.
4. Verifies tissue specimen with surgeon, and passes off to circulator.

D. Closing Phase

1. Counts with circulator at proper intervals.

2. Organizes closing suture and dressings.
3. Begins clean-up of used instruments.
4. Applies sterile dressings.
5. Prepares for terminal cleaning of instruments and nondisposable supplies.
6. Reports to charge nurse for next assignment.

Circulating Nurse

A. Preoperative

1. Assists in assembling needed supplies.

2. Opens sterile supplies.
3. Assists scrub in gowning.
4. Performs and records counts.
5. Admits patient to surgical suite.

B. Preincisional

1. Transports patient to procedure room.

2. Assists with the positioning of the patient.
3. Assists anesthesia during induction.
4. Performs skin prep.
5. Assists with drapes; connects suction and cautery.

C. During the Procedure

1. Maintains orderly procedure room.

2. Anticipates needs of surgical team.
3. Maintains record of supplies added.
4. Receives specimen and labels it correctly.
5. Maintains charges and O.R. records.
6. Continually monitors aseptic technique and patients needs.

D. Closing Phase

1. Counts with scrub at proper intervals.

2. Finalizes records and charges.
3. Begins clean-up of procedure room.
4. Applies tape.
5. Assists anesthesia in preparing patient for transfer to PACU.
6. Takes patient to PACU with anesthesia and reports significant information to PACU nurse.
7. Disposes of specimen and records.
8. Reports to charge nurse for next assignment.