a.

Gloves are packaged so that the scrub may don his gloves without contaminating the glove's outer surfaces. Pair of gloves is packaged in an individual sterile wrapper. b. While the specialist is wearing his sterile gown and gloves, he must take particular care to avoid contaminating these sterile garments because such contamination could possibly result in the transfer of pathogenic microorganisms to the patient's wound. The specialist should therefore observe certain rules, to include the rules outlined Table 1-2. Table 1-2. Rules to observe while wearing sterile gown and gloves. NEVER Drop his hands below the level of the sterile area at which he is working. NEVER Touch his surgical gown above the level of the axilla or below the level of the sterile area where he is working. NEVER Put his hands behind his back; he must keep them within his full view at all times. NEVER Tuck his gloved hands under his armpits, as the axillary region of his gown is contaminated. NEVER Reach across an unsterile area for an item. NEVER Touch an unsterile object with gloved hands unless ordered to do so by the surgeon. NOTE: The surgeon will not give such an order as to allow someone to touch an unsterile object with gloved hands unless a dire emergency exists (such as cardiac arrest) when the time element is of paramount importance in saving the patient's life NOTE: If the scrub contaminates his gown and gloves in any of the ways just mentioned in Table 1-2, he needs to discard and replace his gown and gloves. 1-21. CLOSED CUFF METHOD a. Discussion. The closed cuff method of gloving is preferable to the open cuff method when the specialist must glove himself. The closed cuff method eliminates potential hazards in the glove procedure as follows: (1) The danger of contamination of gloves caused by the glove cuffs rolling on skin is eliminated because the skin surface is not exposed. (2) The gown cuffs can be anchored securely by the gloves without the danger of contamination that exists when gloves are donned by the open cuff method. b. Procedure.

(1) Take a tuck in each gown cuff if the cuffs are loose. Make the

tuck by manipulating the fingers inside the gown sleeve; do not expose the bare hands while tucking the gown cuffs. (2) The circulator opens the outer wrapper of the glove package and flips them onto the sterile field. (3) Open the inner package containing the gloves and pick up one glove by the folded cuff edge with the sleeve-covered hand (see Figure 1-21).

Figure 1-21 (4) Place the glove on the opposite gown sleeve, palm down, with the glove fingers pointing toward your shoulder (see Figure 1-22). The palm of your hand inside the gown sleeve must be facing upward toward the palm of the glove. (5) Place the glove's rolled cuff edge at the seam that connects the sleeve to the gown cuff (see Figure 1-23). Grasp the bottom rolled cuff edge of the glove with your thumb and index finger. Figure 1-23 (6) While holding the glove's cuff edge with one hand, grasp the uppermost edge of the glove's cuff with the opposite hand (see Figure 1-24). Take care not to expose the bare fingers while doing this. (7) Continuing to grasp the glove (see Figure 1-24); stretch the cuff of the glove over the hand (see Figure 1-25).

Figure 1-22

Figure 1-24

Figure 1-25

(8) Using the opposite sleevecovered hand, grasp both the glove cuff and sleeve cuff seam and pull the glove onto the hand (see Figure 1-26). Pull any excessive amount of gown sleeve from underneath the cuff of the glove. (9) Using the hand that is now gloved, put on the second glove in the same manner. When gloving is completed, no part of the skin has touched the outside surface of the gloves. Check to make sure that each gown cuff is secured and covered completely by the cuff of the glove (see Figure 1-27). Adjust the fingers of the glove as necessary so that they fit snugly.

Figure 1-26

Figure 1-27

NOTE: The scrub should don the first glove in accordance with the hand he uses most of the time, i.e., a right-handed specialist can perform the closed cuff gloving procedure more quickly and efficiently by putting on the left glove first. A left-handed specialist will facilitate the procedure for himself by putting on the right glove first. Principle of aseptic technique All items in a sterile field must be sterile. Sterile packages or fields are opened or created as close as possible to time of actual use. Moist areas are not considered sterile. Contaminated items must be removed immediately from the sterile field. Only areas that can be seen by the clinician are considered sterile (i.e., the back of the clinician is not sterile). Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow. Tables are considered sterile only at or above the level of the table. Nonsterile items should not cross above a sterile field. There should be no talking, laughing, coughing, or sneezing across a sterile field. Personnel with colds should avoid working while ill or apply a double mask. Edges of sterile areas or fields (generally the outer inch) are not considered sterile.

When in doubt about sterility, discard the potentially contaminated item and begin again. A safe space or margin of safety is maintained between sterile and nonsterile objects and areas. When pouring fluids, only the lip and inner cap of the pouring container is considered sterile; the pouring container should not touch the receiving container, and splashing should be avoided.

Tears in barriers and expired sterilization dates are considered breaks in sterility.

Surgical Hand Washing

Hand washing for hand hygiene is the act of cleaning the hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms. Medical hand hygiene pertains to the hygiene practices related to the administration of medicine and medical care that prevents or minimizes disease and the spreading of disease. The main medical purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. This is especially important for people who handle food or work in the medical field, but it is also an important practice for the general public. People can become infected with respiratory illnesses such as influenza or the common cold, for example, if they don't wash their hands before touching their eyes, nose, or mouth. Indeed, the Centers for Disease Control and Prevention (CDC) has stated: "It is well documented that one of the most important measures for preventing the spread of pathogens is effective hand washing." As a general rule, handwashing protects people poorly or not at all from droplet- and airborne diseases, such as measles, chickenpox, influenza, and tuberculosis. It protects best against diseases transmittedthrough fecal-oral routes (such as many forms of stomach flu) and direct physical contact (such as impetigo). In addition to hand washing with soap and water, the use of alcohol gels is an effective form of killing some kinds of pathogens.

Arellano University College of Nursing

DLP
(DYNAMIC LEARNING PROGRAM)
SUBMITTED BY: Jerome Paul Mercado

SUBMITTED TO: MRS. JULITA TALINIO RN. (CLINICAL INSTRUCTOR)

Removal of Thyroglossal Duct Cyst Sistrunk Procedure General Information: A thyroglossal duct cyst or sinus tract is a remnant of the thyroid gland, a gland within the mid-portion of the neck. Removal of a thyroglossal duct cyst or sinus tract, also known as the Sistrunk procedure after Dr. Sistrunk, involves a neck incision with dissection up to a small bone in the upper neck called the hyoid bone. The hyoid bone is closely connected to the thyroglossal duct tract as it runs up to the deep substance of the tongue; therefore, the mid-portion of the hyoid bone is removed with a small amount of tongue tissue. The wound is closed with absorbable suture, followed by skin closure with Derma-Bond (super glue for the skin) or Steri-Strips (small narrow strips of tape). A light pressure dressing of gauze wrapped gently around the neck is applied, and the patient is observed overnight in the hospital. What to Expect: Most children require five to seven days to recover from the surgery. Swallowing will be uncomfortable and may feel different due to removal of the mid -portion of the hyoid bone. If a drain was placed in the operating room, it will be removed the morning after surgery. A light pressure dressing of gauze wrapped gently around the neck is left in place for 48 hours after surgery and can be removed at home. Following dressing removal, the wound is left open to heal. There are no sutures to remove the skin incision will either have DermaBond skin adhesive or small narrow SteriStrips of tape in place. Derma-Bond will dry and peel away during gentle bathing. Steri-Strips will dry and curl, the edges of which can be trimmed. SteriStrips that remain in place beyond a week can be removed safely at home. Avoid direct sunlight exposure to the wound for six months following surgery as this will cause excessive pink coloration. Gentle massage will help the incision line soften and thin. Monitor for signs of worsening redness and drainage from the incision and contact the office immediately if this occurs.

Pain: Children will have moderate to severe throat pain after surgery. For the first day after surgery, use the prescribed pain medication around the clock (every 4-6 hours) to prevent pain from preventing oral intake. Gradually transition to over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) as the pain subsides. DO NOT USE aspirin for 2 weeks before or after surgery as it may cause bleeding. Diet: Encourage plenty of fluids and soft foods after surgery. Offer mild juices (apple), sports drinks, popsicles, pudding, yogurt, and ice-cream. There are no food restrictions. If your child refuses to drink, offer small amounts

often. For young children, use an oral syringe and give 1 teaspoon every 10 minutes for 1 hour. If you are concerned about your childs nutrition, offer Carnation Instant Breakfast or Pedia Sure. Fever: A low-grade fever commonly occurs for several days after surgery. If temperature reaches 102F, please contact the office; otherwise, continue to encourage oral intake and administer pain medication Activity: Rest in bed or on the couch is recommended for a few days after surgery. Activity may be increased slowly, with a return to school after your child is eating well, no longer using narcotic pain medication, and sleeping through the night. Your child may bathe at home after removal of the gauze neck dressing, though do not submerge the incision under water until one week after surgery.