I have some issues, based on over 15 years of Surgical experience in the States with the way some of these activities were performed. Firstly, I am a retired Certified Surgical Technologist (Scrub Technologist) - aka USA version of an Operating Department Technician - Scrub in the UK - with 15+ years experience. Nothing should be taken as an accusation of inferiority by any means, more of a request for information, or rationalization based on current standards of practice. 😷 #1 - Why are the scrub sinks controlled by long handles you must touch with your elbows, instead of foot-pedal or knee-pedal controls that don't require such touching? A single "bump on bump off" knee pedal which turns the water on and off at a moderate, predetermined comfortable temperature is the standard in most of the ORs in which I have worked, including as a Traveler, which took me to numerous facilities of all sizes and configurations for short term contracts, usually around 13 weeks at a time. (A couple of facilities I worked at hired me as PRN staff at the end of my contract.) #2 - Why isn't your circulating nurse/tech not wearing a mask when tying up your gown and turning you? Her breathing isn't any cleaner than yours is, and in fact is much less so, when you have a mask on while she does not. Do circulating staff without masks work in the OR while cases are being done? If not, what's the difference? #3 - Why are the gown and glove packs being opened in the same area as the (dirty) scrub sinks? That area is not considered sterile, as only recently cleaned hands/arms are done in the scrub area here, while gowning and gloving with sterile supplies are done in the OR, but away from the sterile tables, where the other sterile gowns/gloves/instruments/drapes, etc., are used in the OR? Nobody gowns/gloves in the sink area in the States - it is considered only clean at best. The sink area, especially when more than one person is scrubbing, or even when it's not by more than one, is not considered a sterile area by any means. #4 - Holding one's glove pack over top of the sterile field to open it is definitely not acceptable practice. In fact, one skill we must learn, among hundreds (if not thousands) of others, is to be able to open the glove pack, standing back at least a foot from the sterile area, and to be able to gently but accurately toss the gloves from the pack onto the sterile field, most hopefully not to land on top of the white towel - we get one towel, and dry each hand/arm using alternate halves - on top of the gown. Holding the glove pack directly over the sterile field also holds your hands and arms over the sterile field, which is considered an automatic contamination error of the sterile field. Also, peeling the package open in that manner directly over the gown *will* shake off any and every loose particle of dust or other contaminants (visible or invisible) from the outside of the glove package directly down on your sterile field. And laying the gloves down on the gown that way will do likewise. These statements are based on practice approved by the OR Nursing and Technologists Societies who determine our practice standards. It's not like it's something I made up. My concern is based on potential contamination issues, and how does one get out of the scrub sink area into the OR proper once you are gowns and gloved? Only our RNs (nurses) can circulate, and there are usually not more than one per room and per case. She doesn't get to be available to play doorman very often. I have frequently "turned the room over" from the end of one case, cleared all the contaminated trash, linens, instruments, unopened supplies, etc., reset everything, i.e. made beds, new liners for trash/linen hampers, cleaned up after anesthesia, brought in all instruments, equipment, supplies, etc., laid everything out, popped lids and opened my own room, scrubbed in, gowns, gloved, set up back table(s), mayo stand, etc., per each case, broke scrub, poured fluids, waited for the circulator to return with the next patient, since we can't leave an opened room unattended, then helped get the patient get settled, scrubbed back in, gowns and gloved myself again, turned, did counts with the circulator, prepped wet lap sponges, made sponge sticks if needed, sorted sutures and laid out ties, gowned/gloved incoming surgeon(s), medical students, nursing students, resident medical students, etc., draped the sleeping patient with the doc, pulled up all the tables, mayo stand, etc., passed off tubes and cords, sterile light handle covers, handed off dry sponges, scalpel to whomever was in "charge" of the case, retractors to the other, made sure no observers were close enough to contaminate my stuff, explained what we were all doing, and we're off to the races!
I have some issues, based on over 15 years of Surgical experience in the States with the way some of these activities were performed.
Firstly, I am a retired Certified Surgical Technologist (Scrub Technologist) - aka USA version of an Operating Department Technician - Scrub in the UK - with 15+ years experience.
Nothing should be taken as an accusation of inferiority by any means, more of a request for information, or rationalization based on current standards of practice.
😷
#1 - Why are the scrub sinks controlled by long handles you must touch with your elbows, instead of foot-pedal or knee-pedal controls that don't require such touching? A single "bump on bump off" knee pedal which turns the water on and off at a moderate, predetermined comfortable temperature is the standard in most of the ORs in which I have worked, including as a Traveler, which took me to numerous facilities of all sizes and configurations for short term contracts, usually around 13 weeks at a time. (A couple of facilities I worked at hired me as PRN staff at the end of my contract.)
#2 - Why isn't your circulating nurse/tech not wearing a mask when tying up your gown and turning you? Her breathing isn't any cleaner than yours is, and in fact is much less so, when you have a mask on while she does not. Do circulating staff without masks work in the OR while cases are being done? If not, what's the difference?
#3 - Why are the gown and glove packs being opened in the same area as the (dirty) scrub sinks?
That area is not considered sterile, as only recently cleaned hands/arms are done in the scrub area here, while gowning and gloving with sterile supplies are done in the OR, but away from the sterile tables, where the other sterile gowns/gloves/instruments/drapes, etc., are used in the OR? Nobody gowns/gloves in the sink area in the States - it is considered only clean at best. The sink area, especially when more than one person is scrubbing, or even when it's not by more than one, is not considered a sterile area by any means.
#4 - Holding one's glove pack over top of the sterile field to open it is definitely not acceptable practice. In fact, one skill we must learn, among hundreds (if not thousands) of others, is to be able to open the glove pack, standing back at least a foot from the sterile area, and to be able to gently but accurately toss the gloves from the pack onto the sterile field, most hopefully not to land on top of the white towel - we get one towel, and dry each hand/arm using alternate halves - on top of the gown.
Holding the glove pack directly over the sterile field also holds your hands and arms over the sterile field, which is considered an automatic contamination error of the sterile field. Also, peeling the package open in that manner directly over the gown *will* shake off any and every loose particle of dust or other contaminants (visible or invisible) from the outside of the glove package directly down on your sterile field. And laying the gloves down on the gown that way will do likewise.
These statements are based on practice approved by the OR Nursing and Technologists Societies who determine our practice standards. It's not like it's something I made up. My concern is based on potential contamination issues, and how does one get out of the scrub sink area into the OR proper once you are gowns and gloved? Only our RNs (nurses) can circulate, and there are usually not more than one per room and per case. She doesn't get to be available to play doorman very often.
I have frequently "turned the room over" from the end of one case, cleared all the contaminated trash, linens, instruments, unopened supplies, etc., reset everything, i.e. made beds, new liners for trash/linen hampers, cleaned up after anesthesia, brought in all instruments, equipment, supplies, etc., laid everything out, popped lids and opened my own room, scrubbed in, gowns, gloved, set up back table(s), mayo stand, etc., per each case, broke scrub, poured fluids, waited for the circulator to return with the next patient, since we can't leave an opened room unattended, then helped get the patient get settled, scrubbed back in, gowns and gloved myself again, turned, did counts with the circulator, prepped wet lap sponges, made sponge sticks if needed, sorted sutures and laid out ties, gowned/gloved incoming surgeon(s), medical students, nursing students, resident medical students, etc., draped the sleeping patient with the doc, pulled up all the tables, mayo stand, etc., passed off tubes and cords, sterile light handle covers, handed off dry sponges, scalpel to whomever was in "charge" of the case, retractors to the other, made sure no observers were close enough to contaminate my stuff, explained what we were all doing, and we're off to the races!
V badly explain