Pre Operative Preperation

Pre-Operative Preparation
Bait ullah
2024-Mphil-1579
Preparation of Surgical Team
• Scrubbing Sequence
1) Scrub Gown
2) Cap
3) Mask
4) Scrubbing
5) Surgical Gown
6) Gloving
Surgical scrub
• Surgical Scrub:
• The objectives of a surgical scrub include mechanical removal of dirt and oil,
reduction of the transient bacterial population, and residual depression of the
skin’s resident bacterial population during the procedure.
• Total scrub time should be 2 to 7 minutes and according to the following
pattern.
• Clean under your fingernails with a nail pick.
• Wet your hands and arms.
• Dispense the appropriate amount of solution into the palm of your hand by
depressing the foot pump.
• Insert and twist the fingertips of your opposite hand into the solution for
several seconds. Transfer the solution to your opposite hand and repeat this
step with the fingers of your other hand.
• Rub your hands together, moving up the forearms to slightly past the elbows.
When drying your hands and arms, use one end
of the towel to dry one hand and arm (work
from hand to elbow). Then bring the dry hand to
the opposite end of the towel and dry the other
hand and arm in a similar manner as mentioned
in figure.
Gowning
• Gowns serve as a barrier between the skin of the surgical team member and
the patient. They should be constructed of a material that eliminates the
passage of microorganisms between sterile and nonsterile areas. They should
be resistant to fluid, stretch, pressure, and friction (especially in the forearm,
elbow, and abdominal areas) and should be comfortable, economical, and fire
resistant.
• Grasp the gown firmly and gently lift it away from the table.
• Step back from the sterile table to allow room for gowning.
• Hold the gown at the shoulders and allow it to gently unfold.
• Do not shake the gown because this increases the risk of contamination.
• Once the gown is open, identify the armholes and guide each arm through the
sleeves.
• Keep your hands within the cuffs of the gown.
• Have an assistant pull the gown up over your shoulders, and secure it by
closing the neck fasteners and tying the inside waist tie.
Gloving:
Latex rubber gloves serve as barriers between the surgical team member and
the patient. Gloving can be performed by three separate methods.
• Closed Method Gloving

• Glove Closed method of gloving ensures that the hand never comes in
contact with the outside of the gown or glove. Working through the gown
sleeve, pick up one glove from the wrapper. Lay the glove palm down over
the cuff of the gown with the thumb and fingers of the glove facing
toward your elbow. Grasp the cuff of the glove with your index finger and
thumb. With the index finger and thumb of the other hand (within the
cuff), take hold of the opposite side of the edge of the glove. Lift the cuff
on the glove up and over the gown cuff and hand. Turn loose and come to
the palm side of the glove and take hold of the gown and glove, pulling
them toward the elbow while pushing the hand through the cuff and into
the . Proceed with the opposite hand using the same technique.
Open Gloving:
Open gloving when one hand is sterile.
Open the glove wrapper and pick up the correct glove at the folded edge with your
sterile hand. Gently put your hand into the glove until your fingers are in the fingers
of the glove. Place your thumb inside or near the thumb of the glove and hook the
cuff of the glove over your thumb. Let go of the glove.
Place the finger of your sterile hand under the cuff at the palm of the glove.
Bend the wrist of the hand being gloved 90 degrees.
Gently walk your fingers around the cuff until they are at the front of the cuff and, at
the same time, pull the cuff up and over your gown
Assisted Gloving
Have the assistant pick up one glove and place his or her fingers and thumb
under the cuff of the glove.
• With the thumb of the glove facing you, slip your hand into the glove;
then have the assistant bring the cuff of the glove up and over the cuff of
your gown and gently let it go.
• Have the assistant pick up the other glove. Assist by holding the cuff of the
glove open with the fingers of your sterile hand while putting your
ungloved hand into the open glove.
• The assistant’s thumbs are kept under the cuff while you thrust your hand
into it.
Preparation of Patient
• Complete History of Patient
• Physical Examination of Patient
• Dietary Restrictions
• In adult animals food intake generally is restricted 6 to 12 hours before
induction of anesthesia to avoid intraoperative or postoperative emesis
and aspiration pneumonia.
• Operations of the large intestine often require specialized preparations
(e.g., dietary restriction for 48 hours).
• Excretions
• The animal should be allowed to defecate and urinate shortly before
induction of anesthesia.
Removal of Hairs
• Bathing the animal the day before surgery to remove loose hair, debris,
and external parasites may be warranted.
• Hair should be removed as close to the time of surgery as possible, and
hair removal should always occur outside the room where the surgical
procedure will be performed.
• Removal of hair the night before surgery is associated with a significantly
higher superficial skin infection rate than removing the hair immediately
before surgery.
• The prepared area should be large enough to accommodate extension of
the incision, additional incisions (if needed), and all possible drain sites.
• A general guideline is to clip at least 20 cm on each side of the incision.
The hair can be removed most effectively with an electric clipper.
• Commonly used scrubbing solutions include iodophors, chlorhexidine,
alcohols, hexachlorophene, and quaternary ammonium salts.
•
•
Sterile Skin Preparation
The purposes of the preoperative skin preparation are
• To remove soil and transient microorganisms from the skin,
• To reduce the resident microbial count to sub pathogenic levels in a short
time and with the least amount of tissue irritation,
• To inhibit rapid rebound growth of microorganisms.
• Handle sponges with sterile sponge forceps or a gloved hand using aseptic
technique.
• Use your dominant hand to perform the sterile preparation
• Begin scrubbing at the incision site, usually near the center of the clipped
area.
• Use a circular scrubbing motion, moving from the center to the periphery
• Do not return sponges from the periphery to the center because bacteria
could be transferred onto the incision site.
• Discard sponges after reaching the periphery.
• If using povidone-iodine, spray or paint a 10% solution on the operative
site after preparation has been completed.
Draping
• The purpose of drapes is to create and maintain a sterile field around the
operative site. Draping is performed by a gowned and gloved surgical team
member. Draping should begin with placement of field drapes to isolate the
unprepared portion of the animal.
• Field drapes should be disposable and nonabsorbent towels.
• The use of iodophor-impregnated surgical drapes decreases skin
contamination but does not appear to reduce infection rates in orthopedic
surgery.
• Drapes should not be flipped, fanned, or shaken because rapid movement
of drapes creates air currents on which dust, lint, and droplet nuclei can
migrate.
• Drapes, supplies, and equipment that extend over or drop below table level
should be considered nonsterile because they are not within the visual field
of the surgeon and their sterility cannot be verified.
• Secure field drapes at the corners with sterile Backhaus towel clamps. The
tips of the towel clamps are considered nonsterile once they have been
placed through the skin and should be handled appropriately.

Pre Operative Preperation

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Pre-Operative Preparation

• Closed Method Gloving

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