Scrub and pre scrub guidelines

[bowjangles]

Simple question, but one I can't find a definitive answer to:
Do you need to be wearing a mask to perform a Pre-Scrub?

I know you need to when performing the surgical scrub (prior to procedure). Seems nit picky, but I am investigating because someone tried to make me out like a fool that I had never heard (and I reallly haven't) of having to wear a face mask for the first of the day pre-scrub. Now, I know many of you are with me on this, but what is the official ruling?

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[Psai]

rofl who is telling you this ****? Some dumb clipboard nurse?

You don't need to wear a face mask to scrub. Why would you? There are many bugs floating around in the dust in the air even without your breathing. Even scrubbing itself is basically a ritual since you're wearing a sterile gown and gloves set. I'm not even certain of the utility of putting on masks intraop as long as you're not coughing and sneezing right into the surgical site.

The only reason why you wear a face mask when you're scrubbing is because you can't put on a mask without making your hands dirty again. If someone else tries to tie the mask for you, it will be uncomfortable and could fall off into the sterile field. There is no rule that says that you need to put a mask on to scrub. Whoever tried to make you put on a mask for a prescrub is very stupid.

 

[Winged Scapula]

What's a "pre-scrub"?


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[bowjangles]

rofl who is telling you this ****? Some dumb clipboard nurse?

You don't need to wear a face mask to scrub. Why would you? There are many bugs floating around in the dust in the air even without your breathing. Even scrubbing itself is basically a ritual since you're wearing a sterile gown and gloves set. I'm not even certain of the utility of putting on masks intraop as long as you're not coughing and sneezing right into the surgical site.

The only reason why you wear a face mask when you're scrubbing is because you can't put on a mask without making your hands dirty again. If someone else tries to tie the mask for you, it will be uncomfortable and could fall off into the sterile field. There is no rule that says that you need to put a mask on to scrub. Whoever tried to make you put on a mask for a prescrub is very stupid.

Exactly what I figured. I had to throw to the SDN masses. It was actually a resident, but she is a prideful one. Regardless, I will pay her no attention. The guidelines do state that you and anyone around you during the presurgical scrub must be wearing masks (FYI..). Obviously it's different in reality, but I did find that in the CDC notice.

What's a "pre-scrub"?

Pre-Scrub, akak, "first scrub of the day" is the 5 minute scrub that you can do when you first get to the surgical floor prior to a procedure. Then, later when you talked with the pt and done all your orders, you can just use the alcohol prep prior to entering the OR.

 

[evilbooyaa]

What in the world is a pre-scrub?

Pre-Scrub, akak, "first scrub of the day" is the 5 minute scrub that you can do when you first get to the surgical floor prior to a procedure. Then, later when you talked with the pt and done all your orders, you can just use the alcohol prep prior to entering the OR.

Lolwut?

First scrub of the day should be just prior to your first OR case.

Why do you have to scrub (5!!! minutes??) before you go talk to the patient? Why in the world would you have to wear a mask unless you were going to go straight from the scrub sink into the OR? What is this voodoo?

I never understood this whole "Oh, if you scrub really good the first time then go and touch a bunch of non-sterile things outside of the OR, you can then just use the alcohol prep on subsequent re-entries into the OR" aspect of some ORs.

 

[Winged Scapula]

Pre-Scrub, akak, "first scrub of the day" is the 5 minute scrub that you can do when you first get to the surgical floor prior to a procedure. Then, later when you talked with the pt and done all your orders, you can just use the alcohol prep prior to entering the OR.

I've been in practice for 10 years and residency/fellowship prior to that and have never heard the term (and it appears that I'm not the only one, amirite @evilbooyaa ?)

Why not just call it the "first scrub of the day"?

 

[bowjangles]

I've been in practice for 10 years and residency/fellowship prior to that and have never heard the term (and it appears that I'm not the only one, amirite @evilbooyaa ?)

Why not just call it the "first scrub of the day"?

Well hell, you got me there doc, I can't know why you never came across it. "first scrub of the day" is definitely a thing though. 5 minute scrub when you get in and then 3 minutes prior to OR (if you don't immediately enter the OR with the 5 min scrub). I used "talking with pts and doing orders" as a general example. Essentially it's lined out as being a thorough scrub when you get to the floors.

 

[Smurfette]

I've been in practice for 10 years and residency/fellowship prior to that and have never heard the term (and it appears that I'm not the only one, amirite @evilbooyaa ?)

Why not just call it the "first scrub of the day"?

You are definitely not alone. I've never heard of that at any hospital I've worked or been a student at.

 

[evilbooyaa]

Well hell, you got me there doc, I can't know why you never came across it. "first scrub of the day" is definitely a thing though. 5 minute scrub when you get in and then 3 minutes prior to OR (if you don't immediately enter the OR with the 5 min scrub). I used "talking with pts and doing orders" as a general example. Essentially it's lined out as being a thorough scrub when you get to the floors.

I guess the more salient question is not "What is this you speak of" but rather, "Why in the world do they make you guys scrub anytime BESIDES immediately prior to putting on a gown/gloves and cutting someone open?"

I would love to know the rationale of "scrubbing" anytime besides when you're about to go into a sterile field.

Am I understanding right with the second bolded point that you are expected to scrub when you hit the surgical floors? Meaning not the OR, but the floors where the patients are peeing and pooping all over all the things on the entire floor?

I feel like I'm taking crazy pills because I truly have no idea what in the what you're talking about, or why you make it sound like a totally normal thing that you put yourself through on a daily basis.

 

[Pir8DeacDoc]

The point, I think, is that you can't use the waterless scrub unless you've done a thorough scrub first. So for the first case of the day if you prefer the "goop" versus a traditional scrub then you need to have done a thorough scrub before using the goop.. subsequent cases can all be done with goop

 

[Pir8DeacDoc]

Or you can do non-sterile cases all day and use goop when the mood strikes..
#ent

 

[Winged Scapula]

I'm not asking why I've never heard of it or for the OP to ascertain why that is the case; I'm not so egocentric to think that I know the ways of all strange beings in strange towns across this strange country.

But it appears that several of us have never heard of it, which perhaps implies that it is by no means standard. I fail to see the rationale and am not familiar with any data that suggests a "5 minute pre-scrub" somehow reduces infection rate (which is presumably the purpose). Do all staff have to do it? When nursing places an IV are they "pre scrubbing"? A foley? Hell, those first few minutes after I walk into the hospital at the start of the day are probably when I'm the cleanest without patient goo, lunch, random atmospheric particles and carbon atoms wafting down on me.

Feel free to ignore me but being required to "pre scrub" when you walk into the hospital seems odd.

 

[Winged Scapula]

Ok now I get it...

the OP is OB-Gyn.

What flies as "common practice" in your field and program is not the same for general surgery.

My question still remains: for those requiring you to wear masks and to "pr scrub" where is the data that supports such activity?

 

[rigid]

What's a "pre-scrub"?


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I think its where you join hands and dance in a circle - it gives a statistically significant reduction in haematoma rates, although not clinically important.

 

[LucidSplash]

Glad I'm not the only person who had no ideal WTF OP was talking about.

 

[Psai]

Maybe they should teach you real things like how to not hit the urinary system

 

[TraumaLlamaMD]

The point, I think, is that you can't use the waterless scrub unless you've done a thorough scrub first. So for the first case of the day if you prefer the "goop" versus a traditional scrub then you need to have done a thorough scrub before using the goop.. subsequent cases can all be done with goop

The Avagard goop touts itself as good for "the first scrub of the day and every scrub of the day" as long as you also use a nail pick with the first use - the trick is finding one without wasting a scrub brush package. The VA nearby my med school had jars of nail picks set out for just that purpose.

 

[Pir8DeacDoc]

Interesting..as mentioned above I don't generally do sterile operations so I'm out of the loop on that stuff

 

[evilbooyaa]

Ok now I get it...

the OP is OB-Gyn.

What flies as "common practice" in your field and program is not the same for general surgery.

My question still remains: for those requiring you to wear masks and to "pr scrub" where is the data that supports such activity?

I know it's not general surgery, but I still question voodoo when things are voodoo. If the answer is "b/c it's Ob-Gyn lulz" then so be it.

Maybe they should teach you real things like how to not hit the urinary system

 

[bowjangles]

Seems like some of you are taking liberties to what I was attempting to explain. I never said a pre scrub was a required practice. Also, being an obgyn definitely has nothing to do with it since I first came across it during a general surgery rotation. Multiple programs following actually. The 3, 5 or 10 minute scrub times is still not completely standardized in research. 10 was more for ortho.
studies included: WHO
https://www.ncbi.nlm.nih.gov/books/NBK144036/
American college of surgeons follows 3 minutes.

From everything I have gathered from searching through countless guidelines, the point is to remove visible dirt/guck from hands prior to being able to use avagard/alc prep. Still probably not statistically proven. Also, the use of brushes seems to be phasing out.

Also found this:
"Note: The Association of Operating Room Nursing (AORN) recommends preceding the scrub/scrubless-waterless-brushless skin prep with a thorough washing, rinsing, and drying of hands and arms at the beginning of the day or if skin is visibly contaminated ."

 

[Slack3r]

Seems like some of you are taking liberties to what I was attempting to explain. I never said a pre scrub was a required practice. Also, being an obgyn definitely has nothing to do with it since I first came across it during a general surgery rotation. Multiple programs following actually. The 3, 5 or 10 minute scrub times is still not completely standardized in research. 10 was more for ortho.
studies included: WHO
https://www.ncbi.nlm.nih.gov/books/NBK144036/
American college of surgeons follows 3 minutes.

From everything I have gathered from searching through countless guidelines, the point is to remove visible dirt/guck from hands prior to being able to use avagard/alc prep. Still probably not statistically proven. Also, the use of brushes seems to be phasing out.

Also found this:
"Note: The Association of Operating Room Nursing (AORN) recommends preceding the scrub/scrubless-waterless-brushless skin prep with a thorough washing, rinsing, and drying of hands and arms at the beginning of the day or if skin is visibly contaminated ."

The AORN also recommends not wearing skullcaps, so I'm not sure that's rock solid ground you're standing on there.

 

[Pir8DeacDoc]

AORN...enough said

 

[Winged Scapula]

Seems like some of you are taking liberties to what I was attempting to explain. I never said a pre scrub was a required practice. Also, being an obgyn definitely has nothing to do with it since I first came across it during a general surgery rotation. Multiple programs following actually. The 3, 5 or 10 minute scrub times is still not completely standardized in research. 10 was more for ortho.
studies included: WHO
https://www.ncbi.nlm.nih.gov/books/NBK144036/
American college of surgeons follows 3 minutes.

From everything I have gathered from searching through countless guidelines, the point is to remove visible dirt/guck from hands prior to being able to use avagard/alc prep. Still probably not statistically proven. Also, the use of brushes seems to be phasing out.

Also found this:
"Note: The Association of Operating Room Nursing (AORN) recommends preceding the scrub/scrubless-waterless-brushless skin prep with a thorough washing, rinsing, and drying of hands and arms at the beginning of the day or if skin is visibly contaminated ."

No, I think you're changing your question here.

None of us who do surgical procedures argue with doing a soap and water scrub prior to using the alcohol-based lotions as a first scrub of the day. That's not called a pre-scrub, it's called scrubbing. That's not what you described in your original post. You described doing a soap and water scrub when you enter the hospital prior to seeing patients on the floor.

You have a wide selection here on SDN of people who have trained and/or are in training across the country who have never heard of it. In addition you being OB/GYN probably does have nothing to do with it because in the OR yesterday I polled six separate OB/GYN attending a ll of whom have trained at various places and they too had never heard of it. Thus this seems to be something unique to your program.

There's no doubt that the ideal surgical scrub tech nique and solution has not been elucidated. You will find all sorts of practices and beliefs everywhere you go. I believe you received the answer to your question about whether or not what you're either being required or suggested to do, is not common place.

Finally, quoting AORN makes you look foolish at best. Any group that tries to claim "commonsense" as data is not one you should be using to bolster your argument.


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[Winged Scapula]

But back to your real question which is: are you required to wear a mask during a pre-scrub?

The fact of the matter is that there is no data that indicates wearing a mask either in or out of the operating room changes infection rates. Indeed, there are first world countries that look at some of our practices, many of which are ritualistic rather than evidence-based, and shake their head.

So if you are doing a pre-scrub and then walking into the operating room, then yes you should be wearing a mask because that is standard in the United States.

If you are simply walking into the hospital, scrubbing, and then going seeing patients on the floor then I cannot see why a mask would be required. And let's clarify that when you say "surgical floor" you are not talking about the operating room.

The reason I mentioned you being an OB/GYN resident was because you come onto a general surgery board and are asking us what we find standard. What's acceptable for us may be totally different for you.

This sounds like you're a junior resident with the bitchy senior resident who is trying to lay the smack down on you but she has no data to back her up. We've all had one of those. I can't say that ignoring her is the best thing to do; it's better to have a real argument in the form of data to support your side but that's only if you really want to pursue this.

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[Psai]

Seems like some of you are taking liberties to what I was attempting to explain. I never said a pre scrub was a required practice. Also, being an obgyn definitely has nothing to do with it since I first came across it during a general surgery rotation. Multiple programs following actually. The 3, 5 or 10 minute scrub times is still not completely standardized in research. 10 was more for ortho.
studies included: WHO
https://www.ncbi.nlm.nih.gov/books/NBK144036/
American college of surgeons follows 3 minutes.

From everything I have gathered from searching through countless guidelines, the point is to remove visible dirt/guck from hands prior to being able to use avagard/alc prep. Still probably not statistically proven. Also, the use of brushes seems to be phasing out.

Also found this:
"Note: The Association of Operating Room Nursing (AORN) recommends preceding the scrub/scrubless-waterless-brushless skin prep with a thorough washing, rinsing, and drying of hands and arms at the beginning of the day or if skin is visibly contaminated ."

Bro, I've been in several different institutions at 3 different medical schools and haven't seen anyone who does this. Why would you need to scrub before seeing patients? Sounds very stupid.

Even more stupid is listening to any nursing association. You're a physician. Please act like it. Also no **** you should wash your hands at the beginning of the day or if your hands are dirty, did you really need an association of nurses to tell you that?

 

[Slack3r]

Bro, I've been in several different institutions at 3 different medical schools and haven't seen anyone who does this. Why would you need to scrub before seeing patients? Sounds very stupid.

Even more stupid is listening to any nursing association. You're a physician. Please act like it. Also no **** you should wash your hands at the beginning of the day or if your hands are dirty, did you really need an association of nurses to tell you that?

I thought it was particularly amusing that it took "countless guidelines" to elucidate the fact that you should wash visibly soiled hands. Groundbreaking stuff.

 

[Winged Scapula]

Bro, I've been in several different institutions at 3 different medical schools and haven't seen anyone who does this. Why would you need to scrub before seeing patients? Sounds very stupid.

Even more stupid is listening to any nursing association. You're a physician. Please act like it. Also no **** you should wash your hands at the beginning of the day or if your hands are dirty, did you really need an association of nurses to tell you that?

I thought it was particularly amusing that it took "countless guidelines" to elucidate the fact that you should wash visibly soiled hands. Groundbreaking stuff.

This is the essence of nearly all AORN guidelines.

Its either stuff that's obvious - like washing visible dirt off your skin, or guidelines without any evidence but they have decided to make it so because "it makes sense" (seriously, read some of their "data").

 

[Psai]

This is the essence of nearly all AORN guidelines.

Its either stuff that's obvious - like washing visible dirt off your skin, or guidelines without any evidence but they have decided to make it so because "it makes sense" (seriously, read some of their "data").

I have no doubt that I've read more nursing research than any of the idiots that expound their merits.

 

[bowjangles]

No, I think you're changing your question here.

None of us who do surgical procedures argue with doing a soap and water scrub prior to using the alcohol-based lotions as a first scrub of the day. That's not called a pre-scrub, it's called scrubbing. That's not what you described in your original post. You described doing a soap and water scrub when you enter the hospital prior to seeing patients on the floor.

You have a wide selection here on SDN of people who have trained and/or are in training across the country who have never heard of it. In addition you being OB/GYN probably does have nothing to do with it because in the OR yesterday I polled six separate OB/GYN attending a ll of whom have trained at various places and they too had never heard of it. Thus this seems to be something unique to your program.

There's no doubt that the ideal surgical scrub tech nique and solution has not been elucidated. You will find all sorts of practices and beliefs everywhere you go. I believe you received the answer to your question about whether or not what you're either being required or suggested to do, is not common place.

Finally, quoting AORN makes you look foolish at best. Any group that tries to claim "commonsense" as data is not one you should be using to bolster your argument.


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holster those pistols. I just came across something and threw it out there. I never claimed AORN to be gospel. Also, I must have proposed my question wrong because I never meant it to be mandatory prior to seeing pt's either. It was just an example situation. I understand we've all had those co-workers, but that's why I came to this board with a question, to ask an outside source. I never came here to argue, although some on this thread seem to love pouring gas on a brush fire. Very interesting to hear of this not being as common practice as I thought. I figured it would be since I had seen at at multiple programs (not just obgyn).

 

[Winged Scapula]

holster those pistols. I just came across something and threw it out there. I never claimed AORN to be gospel. Also, I must have proposed my question wrong because I never meant it to be mandatory prior to seeing pt's either. It was just an example situation. I understand we've all had those co-workers, but that's why I came to this board with a question, to ask an outside source. I never came here to argue, although some on this thread seem to love pouring gas on a brush fire. Very interesting to hear of this not being as common practice as I thought. I figured it would be since I had seen at at multiple programs (not just obgyn).

Sorry didn't mean to seem argumentative, its just how we are. 😉

I think we were all confused because you seemed to imply that it was common and we are posting from many different states etc. and haven't heard of it.

So is your question, "do you have to wear a mask when you scrub (ie, before an OR case)"? Or is it, "do you have to wear a mask when you wash your hands prior to examining a patient"? I think we are still struggling with what this pre-scrub business is.

Or maybe its just me.

 

[E5type]

I would like to provide a different point of view.
I am a CST for the heart team and currently enrolled in a surgical first assist program. I will never claim to know more about medicine than a doctor, but I do know an awful lot about sterility, I mean that's literally half of what cst boards cover. Many of you have quoted AORN, while myself prefer to adbide by AST standards. AST standards are set by evidenced based practice.

First to address the "pre-scrub" which is not a colloquial term . The implication of this first scrub hand wash is to remove gross debris from under the fingernails, nail beds, folds of skin in the hand wrist and elbow, places where transient flora is considered highest. This physical removal of debris is required for a brushless hand scrub to be effective.

-Someone said they thought the hand scrub was "ritual" because we wear gowns and gloves, I would recommend rethinking that statement. We all know you can not sterilize tissue, so even the best scrub cant make you aspetic, but you can reduce the transient and resident flora, which is the entire purpose of a hand scrub. You then wear a gown and glove to create a sterile barrier between you and the patient. If you spend any time in surgery you're going to contaminate. So let's say you break a glove. If you have preformed an adequate hand scrub you have significantly reduced the change of an SSI than if you had not preformed a hand scrub.

As far as the mask goes no, there is absolutely no reason to wear a mask unless you are scrubbing into a case.

The mask is considered PPE for a reason it's not protecting the patient as much as it you. Think laser plumes, or things like vitagel spray.

As a side note, I always preform a hand scrub before our case starts then use a brushless scrub. My reasoning is after rinsing you are only as clean as the water coming out of the tap. I like to give that little bit of extra barrier.

 

[vhawk]

I've been in practice for 10 years and residency/fellowship prior to that and have never heard the term (and it appears that I'm not the only one, amirite @evilbooyaa ?)

Why not just call it the "first scrub of the day"?

But....surely you know about "intra-scrubbing" which is where at the 2hr mark of every case you break scrub, go out in the hallway and do another 5 min scrub since the effects of the pre-scrub and then the other scrub you did at the beginning of the case have worn off right? And then similarly the "post-scrub" where after closing skin you go in the hallway and do an 8 minute scrub before doing the op note?

 

[vhawk]

I would like to provide a different point of view.
I am a CST for the heart team and currently enrolled in a surgical first assist program. I will never claim to know more about medicine than a doctor, but I do know an awful lot about sterility, I mean that's literally half of what cst boards cover. Many of you have quoted AORN, while myself prefer to adbide by AST standards. AST standards are set by evidenced based practice.

First to address the "pre-scrub" which is not a colloquial term . The implication of this first scrub hand wash is to remove gross debris from under the fingernails, nail beds, folds of skin in the hand wrist and elbow, places where transient flora is considered highest. This physical removal of debris is required for a brushless hand scrub to be effective.

-Someone said they thought the hand scrub was "ritual" because we wear gowns and gloves, I would recommend rethinking that statement. We all know you can not sterilize tissue, so even the best scrub cant make you aspetic, but you can reduce the transient and resident flora, which is the entire purpose of a hand scrub. You then wear a gown and glove to create a sterile barrier between you and the patient. If you spend any time in surgery you're going to contaminate. So let's say you break a glove. If you have preformed an adequate hand scrub you have significantly reduced the change of an SSI than if you had not preformed a hand scrub.

As far as the mask goes no, there is absolutely no reason to wear a mask unless you are scrubbing into a case.

The mask is considered PPE for a reason it's not protecting the patient as much as it you. Think laser plumes, or things like vitagel spray.

As a side note, I always preform a hand scrub before our case starts then use a brushless scrub. My reasoning is after rinsing you are only as clean as the water coming out of the tap. I like to give that little bit of extra barrier.

It seems like a TON of words to type rather than just citing a few well-done studies....

 

[E5type]

It seems like a TON of words to type rather than just citing a few well-done studies....

It practice for my term paper.

 

[Winged Scapula]

I would like to provide a different point of view.
I am a CST for the heart team and currently enrolled in a surgical first assist program. I will never claim to know more about medicine than a doctor, but I do know an awful lot about sterility, I mean that's literally half of what cst boards cover. Many of you have quoted AORN, while myself prefer to adbide by AST standards. AST standards are set by evidenced based practice.

We only quote or reference AORN to make sport of not because we believe or concur with their "research".

I can barely write AORN and research in the same sentence without laughing.

 

[vhawk]

It practice for my term paper.

....you alluded to some studies...

 

[Psai]

I would like to provide a different point of view.
I am a CST for the heart team and currently enrolled in a surgical first assist program. I will never claim to know more about medicine than a doctor, but I do know an awful lot about sterility, I mean that's literally half of what cst boards cover. Many of you have quoted AORN, while myself prefer to adbide by AST standards. AST standards are set by evidenced based practice.

First to address the "pre-scrub" which is not a colloquial term . The implication of this first scrub hand wash is to remove gross debris from under the fingernails, nail beds, folds of skin in the hand wrist and elbow, places where transient flora is considered highest. This physical removal of debris is required for a brushless hand scrub to be effective.

-Someone said they thought the hand scrub was "ritual" because we wear gowns and gloves, I would recommend rethinking that statement. We all know you can not sterilize tissue, so even the best scrub cant make you aspetic, but you can reduce the transient and resident flora, which is the entire purpose of a hand scrub. You then wear a gown and glove to create a sterile barrier between you and the patient. If you spend any time in surgery you're going to contaminate. So let's say you break a glove. If you have preformed an adequate hand scrub you have significantly reduced the change of an SSI than if you had not preformed a hand scrub.

As far as the mask goes no, there is absolutely no reason to wear a mask unless you are scrubbing into a case.

The mask is considered PPE for a reason it's not protecting the patient as much as it you. Think laser plumes, or things like vitagel spray.

As a side note, I always preform a hand scrub before our case starts then use a brushless scrub. My reasoning is after rinsing you are only as clean as the water coming out of the tap. I like to give that little bit of extra barrier.

Don't know and don't care what a cst is. Don't know what ast is either. Doesn't matter to me

If you break a glove you shouldn't be touching a patient. If you did and you touched a patient, they're going to get contaminated whether or not you scrubbed.

Do you have any studies saying that scrubbing reduces infection when a glove breaks? No? Then feel free to let yourself out.

 

[E5type]

Don't know and don't care what a cst is. Don't know what ast is either. Doesn't matter to me

If you break a glove you shouldn't be touching a patient. If you did and you touched a patient, they're going to get contaminated whether or not you scrubbed.

Do you have any studies saying that scrubbing reduces infection when a glove breaks? No? Then feel free to let yourself out.

If you are not a surgeon then it won't matter if you know what a cst is, but if you are then I would ask you to reconsider not caring. If not, don't bother reading any farther.

A CST is a certified surgical technologist, govered by the Association of Surgical Technologist.
Why should you care about the AST, because they set the standards for surgical sterility. Even your instruments are sterile because we process them and AST sets the guidelines to insure their sterility.
You know that person with the mayo, that's has all things you need all prepared for you, that hand you what you need for usually before you even ask for it, yeah that's me.
The CST, usually referred to as a scrub, is responsible for your case. That means pulling the required items based on your preference card. Insuring you have the appropriate instruments. That means positioning, prepping, and draping the patient. I could go on.
Now you might say, they hire people of the streets to do that job, and you would be correct. There are a large number of scrubs with no formal education, but that is changing. Currently 10 states require certification as a condition to employment, and dozens more are processing legislation for similar requirments.

As for research
Without surgical antimicrobial prophylaxis, glove perforation increases the risk of SSI: https://www.ncbi.nlm.nih.gov/m/pubmed/19528389/

backing my claim that you are only as clean as the water you rinse with: https://www.ncbi.nlm.nih.gov/m/pubmed/15257431/

Theses studies and more a discussed in more detail here:
https://www.ncbi.nlm.nih.gov/books/NBK144036/#!po=11.5385

 

[vhawk]

I hate to break it to you but your cited article doesnt show what you meant it to. If anything it shows the opposite. Basically it says that in general, there are more SSI when you have a tear in your glove, but even that can be negated by giving abx perioperatively. So not only does it NOT appear to be the case that handwashing is a major factor, but even having breaks in sterile technique like glove tears doesnt actually matter as long as you give periop abx. Did you think "antimicrobial prophylaxis" meant handwashing? Its Keflex.

100% of my patients receive periop abx. So.....I'm not wearing gloves on Monday. You with me?

 

[Psai]

If you are not a surgeon then it won't matter if you know what a cst is, but if you are then I would ask you to reconsider not caring. If not, don't bother reading any farther.

A CST is a certified surgical technologist, govered by the Association of Surgical Technologist.
Why should you care about the AST, because they set the standards for surgical sterility. Even your instruments are sterile because we process them and AST sets the guidelines to insure their sterility.
You know that person with the mayo, that's has all things you need all prepared for you, that hand you what you need for usually before you even ask for it, yeah that's me.
The CST, usually referred to as a scrub, is responsible for your case. That means pulling the required items based on your preference card. Insuring you have the appropriate instruments. That means positioning, prepping, and draping the patient. I could go on.
Now you might say, they hire people of the streets to do that job, and you would be correct. There are a large number of scrubs with no formal education, but that is changing. Currently 10 states require certification as a condition to employment, and dozens more are processing legislation for similar requirments.

As for research
Without surgical antimicrobial prophylaxis, glove perforation increases the risk of SSI: https://www.ncbi.nlm.nih.gov/m/pubmed/19528389/

backing my claim that you are only as clean as the water you rinse with: https://www.ncbi.nlm.nih.gov/m/pubmed/15257431/

Theses studies and more a discussed in more detail here:
https://www.ncbi.nlm.nih.gov/books/NBK144036/#!po=11.5385

"After adjusting for 6 confounders in multivariate logistic regression analysis, however, the odds of contracting SSI in the event of glove puncture were not significantly higher when compared with procedures with intact gloves (adjusted OR, 1.3; 95% CI, 0.9-1.9;P = .26) (Figure 1)."

Haven't been in a case where they didn't give abx unless the patient was already on some. It's on the checklist that the nurse goes through in every op. The second study is saying that tap water has pseudomonas aeruginosa. So they're basically on my side.

This is why I don't argue with nonphysicians. It's really a waste of my time. Why explain things to people that don't understand?

 

[dpmd]

My favorite is when the nurse does a painstakingly thorough prep for stuff like abscess I+D or any case that starts with me putting fingers and instruments in a stool filled rectum. But I let them do it and use my avagard like usual because explaining why it doesn't matter is more trouble than just going with the flow.

As for this "pre-scrub" thing, I don't do anything like that because I use avagard. I am terrible at actually washing with soap and water after each case (which you are supposed to do) unless there is blood on me. But back when I was a student and resident I did whatever the person I was working with at the time wanted because that is how you avoid trouble.

 

[thedrjojo]

"After adjusting for 6 confounders in multivariate logistic regression analysis, however, the odds of contracting SSI in the event of glove puncture were not significantly higher when compared with procedures with intact gloves (adjusted OR, 1.3; 95% CI, 0.9-1.9;P = .26) (Figure 1)."

Haven't been in a case where they didn't give abx unless the patient was already on some. It's on the checklist that the nurse goes through in every op. The second study is saying that tap water has pseudomonas aeruginosa. So they're basically on my side.

This is why I don't argue with nonphysicians. It's really a waste of my time. Why explain things to people that don't understand?

Many cases don't have an indication for periop Antibiotics (that clean lipoma case that's under 90 minutes) that most people mindlessly give ancef for but has no evidence for...

I also think it's important to give right Antibiotics. We reviewed the biogram of our hospital and I was shocked that unasyn only covered 45% of our e coli. I'm never using unasyn for enteric flora prophylaxis again here (used to be my go to for appy's and chole's... Now it's ancef/Flagyl for appy's, ancef alone for chole's)... And mefoxin only covers like 70% of b frag nationwide I believe, so my chief of general surgery also hates that so I never use that for my colons on the general surgery service. The trauma guys love mefoxin so they all get it (but rarely get adequately redosed).

Antibiotic stewardship is a fascinating topic