Speaking of pet peeves....

For all of you up and comers to the sterile field, I present you with some not-so-sterile techniques that I pray you never choose to follow. Now I know that there are those who shun the "old" ways. If you look long enough you will find a study to support any theory you choose, often contradictory to what you may have believed for years. I know one anaesthesiologist who jokingly asks why I bother to scrub my hands. "You're just going to put on two pair of gloves anyway." I hear that there is a study that proved that it makes no difference if you take a ring off before you scrub. Yet I have only ever seen one surgeon wear his ring under his gloves.

There is a tech who, in her efforts to see into the belly, will actually lean her face on my arm. She happens to be short and I happen to be tall. Now, I know that your sleeves are only considered sterile to a couple of inches above the elbow, and her non-sterile face is plastered just below my shoulder, but in my opinion, my sleeve is now contaminated. Period. "May I have a sterile sleeve, please!?" She doesn't seem to think that it matters. While many of these things may be benign when it comes to creating an infection, why take the risk? Don't get complacent. Don't be lazy. It is your job and duty as the scrub to be vigilant over the sterile field. If you see or cause a break, tell the surgeon. Ninety-nine percent of the time the surgeon will thank you for letting them know.

Sometimes you may have to physically keep or take something away from the surgeon so that it won't get used again. Then, they'll just have to wait. I work with one orthopod who throws the bovie down on the field instead of trying to put it in the bovie bucket when we are doing total joints. I cannot count the number of times that I see the bovie tip burn or rip through the drapes. I know that he has this habit so I often spot the hole long before the scrub does. I grab the bovie, remove the tip with a hemostat, notify the circulator to come take the contaminated tip, open a new tip, and ask for a medium tegaderm to cover the hole in the drape. The whole time my surgeon is standing there gritting his teeth and holding his hand out in the I wanna' bovie! position. In all honesty, there are three drapes down and the tip has probably only gone through the top one, but it would be remiss of my duties not to point out the break and correct it. Maybe one day he'll make it to the bovie bucket!

Women scrubs, oh wait, I guess this applies to men now too, don't wear earrings when you're scrubbed in!! This rule isn't meant to punish you, it's meant to protect the patient. Consider the following scenario: A first assist to the surgeon is questioned halfway through the procedure about the fact that she is missing one earring. No one can find it before the case is over and the patient gets an x-ray. Fortunately, no retained foreign body. Facilities have become far too relaxed in enforcing this standard in my opinion.

From the scrub sink:
If your facility allows alcohol foam or alcohol gel scrubs. Your first scrub of the day should still be a standard six minute scrub with a nail pick scraping out the gunk under your fingernails. You should also do a complete scrub again after eating meals. If I go from one hospital to another I scrub again. I was taught that if we left the OR suite for any reason upon returning you start over with a complete scrub.

Now that you have finished your six minute scrub and your neatly trimmed, UNPAINTED fingernails are squeaky clean, and you walk from the sink to your gown, KEEP YOUR HANDS UP! I see so many dudes (yeah, sorry, I've only seen males do this) walk in like they think they're a gunslinger with their hands down and "dirty" water rolling down from their "dirty" elbows to their used-to-be clean hands. When did this become okay? I must admit though that I do struggle with the concept of religiously scrubbing properly and then rinsing off with some tap (:^O water from the scrub sink.

If you are opening a room, keep the O.R. doors closed. Ever hear of positive ventilation? It's not very efficient with a big gaping hole leading out to the hall. And if you are opening a total joint please be even more compliant and limit the amount of traffic in the room and have team members enter through a sub-sterile area if possible, not the common hallway. I often see rad techs at one facility I go to prop open the OR doors to an already open room and then wander off down the hallway to retreive the c-arm and roll it into the room. Then they wander back down the hallway and fetch the monitor all the while leaving the doors wide open. NOT OKAY! A better technique would be to roll all of the equipment to the OR before opening the door and then push both pieces into the room at once. Of course the best technique would be to have the equipment in the room before sterile the supplies are open, but this isn't always possible.

The surgical techs that I have mentored were all taught to pull up their back tables and mayo stands up (closer too but safely away from the undraped patient) when they begin to drape. This solves two issues that I commonly see. Number one, walking back and forth across the room to retrieve each drape. The sequence goes something like this: Grab the first down sheet, walk across the room and lay it on the patient, walk across the room and grab the blue towels, cross the room and hand the towels to the surgeon, walk across the room again to get the laparotomy drape, cross the room and hand the drape to the surgeon, walk across the room one more time and bring up the mayo with suction and bovie. While the suction and bovie are being thrown off, the back table is still across the room.

Now the tech has created two sterile fields instead of containing the field in one area. Issue number two, Walking between sterile fields. I see this infraction more than anything and it irritates me the most. If you create a space like this you are inviting axillary staff in the room to walk between sterile fields. Even though most of them know better, very, very few of them will go around the head of the patient or ask you to pull up your back table. I have seen x-ray techs take this opportunity to wheel the entire C-arm and monitor between fields because they realize they are on the wrong side of the room. This is unacceptable! Circulators, DON"T DO THIS! Scrubs, DON"T LET THEM!! I have been to so many places and there are so many nurse and techs who have, in my obsessive compulsive opinion, become way to complacent on this standard.

Well in the interest in getting this posted-I started it in July- I am going to end here for now. I'm sure I have insulted somebody, but I feel it's both my obligation and my hope to make others vigilant.