Veterinary Surgical Nursing

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Veterinary Surgical Nursing

• SCRUBBING

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Scrub sequence

1. Scrub Gown
2. Cap
3. Mask
4. Scrub
5. Surgical Gown
6. Glove

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Attire

• Ideally, scrub-shoes and or shoe covers
• Cotton scrub suits
• Shirt tucked into pants

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Cap

• Caps
• Prevent hair and scurf falling onto sterile field
• Various disposable types

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Mask

• Filters out micro-organisms when breathing and
  speaking
• Ideally replaced for each operation

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Masks Caps
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Scrub

• Reduces rather than eliminates bacterial flora
• Transient flora (from environment)
• Most are harmless
• Resident flora
• Most (95) are harmless
• Surface can be removed by scrub
• Deep (glands and follicles) cannot be removed
  by scrub

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Scrub

• Scrub required even when gloves used
• Arms done
• Protection if glove punctures/tears
• Punctures very common
• Enables aseptic gowning

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Scrubbing solutions should

• Wide antimicrobial spectrum
• Quick action
• Long residual action
• Effective in organic matter (blood etc)
• Safe ( no irritation/allergy)
• Quick application
• Economical

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Scrub solutions

• povidone iodine
• chlorhexidine
• triclosan
• alcohol
• Not used as a scrub but may be used after
  chlorhexidine

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Povidone iodine Scrub

• Iovone
• Iodophore detergent
• Excellent spectrum
• Bacteria, viruses, fungi
• Some individuals react severely
• Impaired by organic matter

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Chlorhexidine Scrub

• Hibiclens
• Broadest spectrum
• Bacteria, viruses, fungi, spores
• Effective in organic matter
• Longer residual activity than povidone iodine
• Relatively low toxicity
• Occasional sensitivity reactions

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Triclosan

• Newer
• Bacteria

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Alcohol

• 70
• Note that 100 alchohol is less effective
• Also acts as a degreaser
• Moderate spectrum only
• Notably ineffective against spores

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Scrub preparations

• Antiseptic-impregnated disposable brushes, or
• Pump pack scrub liquid
• would use re-autoclavable brushes

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Disposable Scrub Brush
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Cartridge of re-usable brushes is autoclaved
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Before Scrubbing

• Don Cap
• Don Mask
• Jewellery removed
• Fingernails trimmed/cleaned

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2 scrub methods

• Count brush strokes, or
• Count time

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Count strokes

• Also known as the anatomic scrub
• Count 10 brush strokes on each skin surface of
  hands and arms (up to just below elbows). 4
  surfaces of
• Fingers
• Palms
• Arms
• Rinse
• Repeat scrub and rinse (4 x)

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Count time

• Also known as the timed scrub
• 1st scrub of day 10 mins
• Between surgeries can do 5 min scrubs (unless
  gross contamination has occurred) e.g.
• Each Fingernail 10 strokes
• Each Finger surface 5 strokes
• Each palm and back of hand 5 strokes
• Each arm surface 5 strokes

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Principles of scrubbing

• Good thick lather OF SCRUB
• Important areas
• Do finger nails
• Do all surfaces
• Do webs between fingers
• Avoid harsh scrubbing damages skin and probably
  doesnt help may actually bring more deep
  bacteria to surface/

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After scrubbing

• Hold hands elevated so that water does not drip
  from elbows to hands

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After scrubbing

• Rinse
• Turn off water
• with elbow or pedal tap

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Scrub Station
Pedal tap
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Drying Hands

• Sterile hand towel provided
• With sterile gown, or
• With sterile surgical pack, or
• In individual pack
• Use one half of towel for each hand
• Hold hands in front, elbowsbelow hands

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Gowning

• Hold by inside shoulder seams
• Hold forward at chest level
• Allow to drop to unfold
• Slide hands into sleeves
• but not through cuff openings

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Gowning

• Assistant grabs inside of gown and pulls up over
  shoulders
• Through the sleeves grab waist ties and to each
  side
• Assistant grabs ties for either back tying or
  side tying

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Gowning 1

• Hold inside at collar
• Chest height

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Gowning 2

• Slip in hands
• Keep barehands inside cuffs

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Gowning 3

• Hold ties to thesides for theassistant

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Gowning 4

• Assistant tiesat back

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Receiving Gloves

• From assistants hand, or
• From sterile field
• after assistant has placed onto this

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Receiving Gloves
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Receiving Gloves
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Gloving

• Of bare arms (open)
• Hands exposed
• Method used when a gown is not required
• Over sleeved sterile gown (closed)
• Hands not exposed
• With an Assistant
• assisted gloving, fastest method
• Without an Assistant
• Without exposing bare hands from gown, best method

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Open Gloving 1
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Open Gloving 2

• With Gown but exposed hands

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Open Gloving 3

• With Gown but exposed hands

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Closed Gloving 1

• Keep bare hand inside cuff

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Closed Gloving 2

• Pick up a glove by cuff

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Closed Gloving 3

• Rest glove backwards on that same hand, holding
  by edge of cuff

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Closed Gloving 4

• Grab cuff with otherhand

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Closed Gloving 5

• Slide second hand into glove without exposing hand

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Closed Gloving 6

• Pull glove on with first hand, grabbing only
  outside of glove through gown

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Closed Gloving 7

• Repeat on other hand but slip gloved fingers
  under the cuff
• Avoid handling powdered inside of glove with
  gloved fingers
• Glove powder causes severe wound reactions

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Assisted Gloving

• Gloved assistantholds gloves open

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The End