broke sterility first time =(

[herewego]

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And I feel like crap..

I scrubbed in for the first time today, and the surgery required the attending to move constantly. Machines were setup in such a way where I had very limited mobility. I probably spent 80% of my concentration trying to avoid breaking sterility and staying out of the way. Couple hours in, I was trying to get out of the attendings way and accidentally touched a machine with my finger..anesthesiologist saw it and I admitted to it. I didn't get my head chewed off like I thought I would though, my attending said I could just scrub out, which probably was his way to get me out of his way. I didn't touch the patient or anything afterwards.

I'll probably apologize to the attending next time I see him..but I feel like crap and I'm sure everyone thinks I'm dumb as hell..

I was wondering how common it happens in the OR, as I haven't ever had any experiences in it.

 

[Stellar Clouds]

And I feel like crap..

I scrubbed in for the first time today, and the surgery required the attending to move constantly. Machines were setup in such a way where I had very limited mobility. I probably spent 80% of my concentration trying to avoid breaking sterility and staying out of the way. Couple hours in, I was trying to get out of the attendings way and accidentally touched a machine with my finger..anesthesiologist saw it and I admitted to it. I didn't get my head chewed off like I thought I would though, my attending said I could just scrub out, which probably was his way to get me out of his way. I didn't touch the patient or anything afterwards.

I'll probably apologize to the attending next time I see him..but I feel like crap and I'm sure everyone thinks I'm dumb as hell..

I was wondering how common it happens in the OR, as I haven't ever had any experiences in it.

Don't be so hard on yourself. It happens quite frequently. Just don't make a habit of it.

I wouldn't bring it up again so that you can apologize. Chances are the surgeon forgot about it 10 sec after you left the OR.

 

[Siggy]

Even surgeons break sterility from time to time and have to reglove. That's one of the advantages of undergloves. Have the circulator pull a new set of gloves, take off the contaminated glove and put on a new sterile glove. You don't even need to bother the scrub tech to help glove you since the underglove is sterile too.

 

[duckie99]

lol bro! Trust me the surgeon doesn't care. You'll just look lame bringing it up. Live and learn. Everyone makes mistakes, even the surgeon... but NOT the scrub techs. They are the gods in the OR.

But seriously it's just the way the OR is... no matter what anyone tells you no one likes med students around, especially inexperienced ones. It just makes things that much more difficult and last that much longer (especially if the student is allowed to close). This is despite the fact that med students need to be trained. No one seems to care though.

Anyway just suck it up and move on. Know no one really wants you there. Just stick to doing exactly what people tell you without question and just try to stay awake. I understand it is beyond boring and terrible to be in the OR with surgeons but it'll only be for a couple months and if you don't like it, you'll never have to do it again.

 

[herewego]

Thanks for the replies! Its nice to know I'm overreacting a bit, guess the first time experience really got to me.

 

[Bacchus]

Don't worry about it, at all. It happens to everyone. You'll learn from your mistake.

 

[ArcGurren]

Trust me, I've done worse. You're fine, OP. move on and let it be.

The worst thing I've done in the OR was contradict the circulator nurse and insist on scrubbing when the resident wanted me to. That didnt end well.

 

[herewego]

Trust me, I've done worse. You're fine, OP. move on and let it be.

The worst thing I've done in the OR was contradict the circulator nurse and insist on scrubbing when the resident wanted me to. That didnt end well.

😱😱😱

 

[arez10]

It's better to speak up about it and get your glove changed (or scrub out, in your case) than to keep quiet and contaminate the field. The suction fell off the field twice in one surgery the other day (no one in particular's fault) and the attending barely noticed...the circulator just got another suction tip each time. I guess these things happen pretty frequently!

 

[Winged Scapula]

As others have noted, we've ALL done it. You're overreacting.

 

[maxx52188]

One time i was shadowing a general surgeon doing a hernia repair with mesh (Undergrad at the time).

I'm really blurry now that I try to remember it, but i think it went something like: the surgeon cut out a square of mesh for me to touch so I could see the strength of the weave for myself and then I almost put it back on the sterile tray that everything was on--complete cruise control.

He and the nurse simultaneously are hastily saying, "NONONONONO" and then I pulled away. After they were kinda chuckling about it.

I'd imagine this crap happens all the time.

 

[deleted307836]

The worst thing I've done in the OR was contradict the circulator nurse and insist on scrubbing when the resident wanted me to. That didnt end well.

Not to derail this thread, but how is it the nurse's place to contradict the resident? What happened?

 

[herewego]

As others have noted, we've ALL done it. You're overreacting.

Yea I'm beginning to appreciate that now. No prior experiences in OR to compare it too, so I really wasn't sure. Appreciate all the responses.

 

[ILikeFood]

And I feel like crap..

I scrubbed in for the first time today, and the surgery required the attending to move constantly. Machines were setup in such a way where I had very limited mobility. I probably spent 80% of my concentration trying to avoid breaking sterility and staying out of the way. Couple hours in, I was trying to get out of the attendings way and accidentally touched a machine with my finger..anesthesiologist saw it and I admitted to it. I didn't get my head chewed off like I thought I would though, my attending said I could just scrub out, which probably was his way to get me out of his way. I didn't touch the patient or anything afterwards.

I'll probably apologize to the attending next time I see him..but I feel like crap and I'm sure everyone thinks I'm dumb as hell..

I was wondering how common it happens in the OR, as I haven't ever had any experiences in it.

Don't apologize for such a minor incident. You wouldn't believe the **** that's happened to me in the OR. I felt exactly how you did in the beginning, but eventually just stepped aside, re-gloved and continued. You should do the same.

 

[Rendar5]

Don't apologize for such a minor incident. You wouldn't believe the **** that's happened to me in the OR. I felt exactly how you did in the beginning, but eventually just stepped aside, re-gloved and continued. You should do the same.

Happens to attendings too. The only true mistake you can really make in this regard is to realize it happened, but to pretend it didn't.

 

[45408]

If you contaminate yourself, do not wait for the anesthesiologist to call you out. Tell the OR nurse and change.

Don't apologize to the surgeon. It's a nothing.


And I'm a PGY-3 who managed to contaminate myself twice in the OR today by hitting the stupid C-arm while suctioning at arm's length.

 

[ArcGurren]

Not to derail this thread, but how is it the nurse's place to contradict the resident? What happened?

I have no idea but I think she felt gowns were in short supply or something (which was of course patent BS) and that I was an unnecessary addition. Never mind that I ended up closing the bloody incision while my resident was being paged repeatedly. It's all good though; not going into surg anyway.

 

[sonofva]

Dude my first day scrubbed in I had taken a bunch of new beta blocker in the AM and passed out. Haha. Beat that!

 

[K31]

Dude my first day scrubbed in I had taken a bunch of new beta blocker in the AM and passed out. Haha. Beat that!

As long as you didn't pass out into the sterile field...

 

[herewego]

Thanks for all the replies. I think what I will apologize for is just kind of hanging around on the sidelines, not being active part of the team at all. Our school has a load of requirements that need to be finished and I haven't done toward them, plus this attending will evaluate me. I think i was just dreading surgery so much that it got to me. I'm going to do my best to turn it around.

 

[Bacchus]

Thanks for all the replies. I think what I will apologize for is just kind of hanging around on the sidelines, not being active part of the team at all. Our school has a load of requirements that need to be finished and I haven't done toward them, plus this attending will evaluate me. I think i was just dreading surgery so much that it got to me. I'm going to do my best to turn it around.

Don't apologize. Impress him the next time you're in the OR.

 

[herewego]

Don't apologize. Impress him the next time you're in the OR.

I'll try to impress in the OR, but the reason I need to apologize for being extremely unhelpful (not about the sterility incident) is I'm gonna segway into asking to be more active in daily stuff (which I haven't been at all), cause I have requirements that need to get signed off on and at the current rate I won't get them at all. I'm only with this attending fora short time, yet he still has to evaluate me, so its either go big or go home in everything (OR and clinic), or get royally screwed. What I mean is I need to actively change the whole dynamic, immediately, because I'm only with him technically 5 more days (3-4 days before this), and upfront saying I'm sorry I wasn't very helpful before but I'd like to be more active, then obviously doing more, is what would help me right now.

 

[tco]

Not a big deal. Just try to realize where you are at all times and what is sterile and what isn't. A good way to gain the trust of the staff is to, if you were to become unsterile, immediately back away from the patient, state why you're doing it, and unscrub. Everyone does it at some point. Learning when you've done to so as to not contaminate the field is very important.

 

[loveoforganic2]

As long as you didn't pass out into the sterile field...

I'm sure someone at some point has passed out into an open abdomen/thorax... not speaking from personal experience

 

[mmmcdowe]

We make mistakes and it hurts, but learn from them and don't forget the lesson. I was asked by the chairman of the specialty I was going into for possible causes of short term AMS in a child and completely forgot to suggest the possibility of seizures (the answer he was looking). It is embarrassing, but I will never forget to mention seizures again, just like I never forget kidney stones, hypothyroidism, etc, etc. Emotional learning experiences stick.

 

[gravitywave]

I'll try to impress in the OR, but the reason I need to apologize for being extremely unhelpful (not about the sterility incident) is I'm gonna segway into asking to be more active in daily stuff (which I haven't been at all), cause I have requirements that need to get signed off on and at the current rate I won't get them at all. I'm only with this attending fora short time, yet he still has to evaluate me, so its either go big or go home in everything (OR and clinic), or get royally screwed. What I mean is I need to actively change the whole dynamic, immediately, because I'm only with him technically 5 more days (3-4 days before this), and upfront saying I'm sorry I wasn't very helpful before but I'd like to be more active, then obviously doing more, is what would help me right now.

you still don't want to apologize. just be straightforward and ask for feedback about how you can become more involved. an apology gets you nowhere. actions speak much louder.

 

[SouthernSurgeon]

I'll try to impress in the OR, but the reason I need to apologize for being extremely unhelpful (not about the sterility incident) is I'm gonna segway into asking to be more active in daily stuff (which I haven't been at all), cause I have requirements that need to get signed off on and at the current rate I won't get them at all. I'm only with this attending fora short time, yet he still has to evaluate me, so its either go big or go home in everything (OR and clinic), or get royally screwed. What I mean is I need to actively change the whole dynamic, immediately, because I'm only with him technically 5 more days (3-4 days before this), and upfront saying I'm sorry I wasn't very helpful before but I'd like to be more active, then obviously doing more, is what would help me right now.

No. Stop. Do not pass go. Stop. No.

Any attempt at an awkward "apology" for a non-incident or for...I'm not even sure what you're trying to describe now...is going to hurt you.

Just show up, do your work, and be proactive from this point forward. Do not make an issue out of any of this.

 

[mimelim]

If you contaminate yourself, do not wait for the anesthesiologist to call you out. Tell the OR nurse and change.

Don't apologize to the surgeon. It's a nothing.


And I'm a PGY-3 who managed to contaminate myself twice in the OR today by hitting the stupid C-arm while suctioning at arm's length.

+1

I too hit the f'ing c-arm yesterday and had to rescrub. It happens. The main thing is to learn how you can avoid it as much as possible, which you can only do by spending time in the OR. Also, no apology necessary. Don't feel bad, do not bring it up.

 

[SLUser11]

As others have noted, we've ALL done it. You're overreacting.

True. Still, in the student's mind, it's a much bigger deal.

I think the most important teaching point for the students is that if someone says you've contaminated yourself, avoid the urge to argue about it. Scrub techs watch the students like hawks and pounce on potential violations of sterile technique, whether they truly occurred or not....however, there's nothing to be gained from trying to argue your way out of it.

Not to derail this thread, but how is it the nurse's place to contradict the resident? What happened?

News flash: Residents and nurses often butt heads.....usually because the resident asks a question similar to yours.

As long as you didn't pass out into the sterile field...

I've seen students vagal down relatively often, but I've only seen a nosedive into the field once, and we were all very nice and helpful, but I'm sure she was still mortified.


Truthfully, attendings violate sterile technique all the time, and sometimes people notice and sometimes they don't. It's not always clinically relevant. For example, I was told that I contaminated a proctoscope yesterday since I assembled it with regular gloves instead of sterile ones. I insisted that we did not have to open another set, given that I was about to stick that scope directly into a patient's anus.....which isn't sterile.....

 

[45408]

Truthfully, attendings violate sterile technique all the time, and sometimes people notice and sometimes they don't. It's not always clinically relevant. For example, I was told that I contaminated a proctoscope yesterday since I assembled it with regular gloves instead of sterile ones. I insisted that we did not have to open another set, given that I was about to stick that scope directly into a patient's anus.....which isn't sterile.....

Yeah, I'm never sure how important all the drapes are when I have to scoop out a little turd in the way before I start a hemorrhoidectomy or fistulotomy.

One of my funnier memories on colorectal was as a med student when I saw the attending intentionally elbow the monitor out of his way and give me a look like "They didn't see me do that, did they? 😀"

 

[DreamingTheLive]

I've seen students vagal down relatively often, but I've only seen a nosedive into the field once, and we were all very nice and helpful, but I'm sure she was still mortified.

Wow. Not good if during ex lap for ruptured intestines. Fecal matter in face and mouth violates a bit more than sterile field.....

 

[herewego]

No. Stop. Do not pass go. Stop. No.

Any attempt at an awkward "apology" for a non-incident or for...I'm not even sure what you're trying to describe now...is going to hurt you.

Just show up, do your work, and be proactive from this point forward. Do not make an issue out of any of this.

After a couple more experiences in the OR, I'll follow this advice and those similar suggested in this thread. Appreciate the input

 

[fahimaz7]

We've had kids pass out and land in an open abdomen. You'll be fine.

 

[45408]

We've had kids pass out and land in an open abdomen. You'll be fine.

After that incident, we stopped letting the kindergarteners shadow us in the OR.

 

[Bacchus]

After that incident, we stopped letting the kindergarteners shadow us in the OR.

Ignorant on this a bit, but here goes... In these instances what is done? Do you flush the abdomen with antibiotic solution?

 

[SLUser11]

Ignorant on this a bit, but here goes... In these instances what is done? Do you flush the abdomen with antibiotic solution?

Intraabdominal antibiotic lavage has never been shown to decrease infection rates, and it's been shown in animal models to cause more adhesions. That being said, plenty of people still do it.

In general, we respond to peritoneal contamination with large amounts of warm saline or sterile water, i.e. "The solution to pollution is dilution." Maybe it helps, maybe it doesn't.

If the student faceplants in the abdomen, I'm more worried about the student's well-being than I am about the sterility of the case. The patient will be fine.

 

[Bacchus]

Thanks 🙂.

Never thought to ask and never saw it happen, though I've seen lavage with colon cases, etc.

 

[45408]

In general, we respond to peritoneal contamination with large amounts of warm saline or sterile water, i.e. "The solution to pollution is dilution." Maybe it helps, maybe it doesn't.

It certainly spreads things out. We know that an abscess is fairly impenetrable, but is it better or worse to slosh it all around?

I'll still be liberal with the irrigation for now. And I thought sterile water was mostly reserved for oncologic cases?

 

[fahimaz7]

They used like 10L of saline to wash the belly and sent the kid out of the OR to get cleaned up. Things like this happen with fatigue, gowns, and warm OR rooms.


🙁

 

[KnuxNole]

We've had kids pass out and land in an open abdomen. You'll be fine.

Not gonna lie, almost did this once due to falling asleep...but when I saw my head bob, I stepped back and try to move my body to stay awake.