scrubbing in / maintaining sterility... pretty difficult!

[leechy]

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maybe this is just a sign i'm not meant for surgery, but has anyone else found scrubbing in and maintaining sterility and all that, WHILE being bossed around and trying to assist to be really challenging? it requires this incredible presence of mind...

i got (rightfully) barked at a zillion times today for spinning before putting on gloves, being too slow putting on gloves, nearly touching a sterile tray with my back, not keeping my arms perfectly horizontal, nearly taking off my surgical mask before leaving the OR, etc etc. i've scrubbed in a couple of times now but it doesn't seem to get easier, mainly because there always seem to be 400 things to remember to do or not do...

oh well...

 

[Blade28]

We ALL foul up during our MS-III year...even MS-IV...even as an early intern!

It's just not intuitive or natural. It takes lots of practice.

If you've only scrubbed in a couple times, then you gotta be a little more patient - I probably scrubbed in around 20-30 times on my OB/GYN rotation and maybe 40 times on my G Surg rotation as an MS-III, and still occasionally contaminated myself!

 

[RockShox]

Agree with above.

And I might add that it does not help that the scrub techs are so happy thanks to years of working with surgeons that they jump at the chance to spread the love to someone they perceive as no threat.

My advice is always to take a deep breath, try to follow the same exact routine everytime, and it will come together. Everyone makes a mistake and gets contaminated at every level of training so if it happens don't feel bad...

And the most important....leave all pride at the door and take nothing that happens in there personally. This is perhaps the hardest thing to learn but by far the most important to sanity.

 

[elwademd]

what worked for me as a student was keeping my hands in front of me near my chest, and moving as little as possible!

 

[fakin' the funk]

i got (rightfully) barked at a zillion times today for spinning before putting on gloves, being too slow putting on gloves, nearly touching a sterile tray with my back, not keeping my arms perfectly horizontal, nearly taking off my surgical mask before leaving the OR, etc etc. i've scrubbed in a couple of times now but it doesn't seem to get easier, mainly because there always seem to be 400 things to remember to do or not do...

It may be of some consolation that a lot of the "OR rules" that are enforced (especially by circulators and scrubs) are evidence-less voodoo.

For example: wearing masks in the OR has no effect on wound infection rates; they're there for the protection of the wearer.

Carrying your hands this way or that, or scrubbing this way or that, there is no evidence that these rules have any effect on patient outcomes.

I'm not advocating a break in aseptic technique (it's obviously quite important), just acknowledging that a lot of OR conduct is tradition and superstition.

 

[Kubed]

...
And the most important....leave all pride at the door and take nothing that happens in there personally. This is perhaps the hardest thing to learn but by far the most important to sanity.

Second that! Just today i got my head bit off by a scrub tech because I absent mindedly used my ungloved left hand to adjust the right sleeve while putting on my gown. Did she scream at me a little more than was really necessary? Totally. Did I say anything about it? Nope. I just channeled my best inner buddhist monk, went and re-scrubbed, and just kept smiling (although now that I think about it, i'm not sure they could tell under the mask 😀 ).

 

[smq123]

maybe this is just a sign i'm not meant for surgery, but has anyone else found scrubbing in and maintaining sterility and all that, WHILE being bossed around and trying to assist to be really challenging? it requires this incredible presence of mind...

i got (rightfully) barked at a zillion times today for spinning before putting on gloves, being too slow putting on gloves, nearly touching a sterile tray with my back, not keeping my arms perfectly horizontal, nearly taking off my surgical mask before leaving the OR, etc etc. i've scrubbed in a couple of times now but it doesn't seem to get easier, mainly because there always seem to be 400 things to remember to do or not do...

oh well...

Wow, you're nice. I don't think that I would use the word "rightfully." Sure, touching a sterile tray with your back isn't a good thing, but the other things that you mentioned don't seem to be a big deal.

Not keeping your arms "perfectly horizontal"?!? Being "too slow putting on gloves"??? Getting yelled at for stuff like that is crap. And whoever offered to help you spin can hold the gown tie for a few seconds while you get gloved. That's also not a big deal.

A couple of times isn't enough to make it easy. As Blade pointed out, it takes a while to get used to scrubbing in and staying sterile.

 

[Winged Scapula]

Some truths:

- it takes awhile before scrubbing and maintaining sterility become second nature
- some OR staff enjoy torturing medical students and watching them like a hawk
- this treatment becomes less as you get better and gain status
- you will continue to contaminate yourself or someone else, even as an attending
- the rules are often just made up...as noted above, there is no evidence that wearing the mask reduces contamination rates, that not holding your arms in position x reduces the risk, etc.

We have all been through it...sort of a rite of passage.

 

[cbass1350]

Just as an advice in case you haven't done so already: Make sure that you befriend the OR staff. Use all your charms, sillyness, etc... to get them to like you a little bit. It helps tremendously for a med student if the scrub tech or the rotating OR nurse likes you at least somewhat. They can help you learn things much quicker and it will less painful than the good-ol' trial and error method.

 

[Blade28]

Just as an advice in case you haven't done so already: Make sure that you befriend the OR staff. Use all your charms, sillyness, etc... to get them to like you a little bit. It helps tremendously for a med student if the scrub tech or the rotating OR nurse likes you at least somewhat. They can help you learn things much quicker and it will less painful than the good-ol' trial and error method.

For those of us in the surgical field, this is excellent advice.

Cases go by MUCH smoother when the OR staff is on your side.

In June I did around 35 thyroids/parathyroids, pretty much always in the same OR with the same staff. A week in I had them so well trained that whenever the attending would leave the room, they'd rush over and turn on the radio to my favorite station! 👍 (He liked the room dead-quiet...I'm not a big fan of the room when the only thing you can hear is the "beep...beep...beep" of the anesthesia machine/monitor.)

 

[Tired]

- the rules are often just made up...as noted above, there is no evidence that wearing the mask reduces contamination rates, that not holding your arms in position x reduces the risk, etc.

Oh my God, this is such a pet peeve of mine. Some of the rules may not have evidence, but at least make sense. But I periodically get yelled at for stuff that is just stupid ("Don't shuffle your feet! You're stirring bacteria up into the air!" or "Don't grab that screw with your glove! It's more sterile if you use an instrument!") Dumb.

 

[RockShox]

Oh my God, this is such a pet peeve of mine. Some of the rules may not have evidence, but at least make sense. But I periodically get yelled at for stuff that is just stupid ("Don't shuffle your feet! You're stirring bacteria up into the air!" or "Don't grab that screw with your glove! It's more sterile if you use an instrument!") Dumb.

I agree...one famous pimping question from one of our surgeons...

"Why do you have to do the paint three times?...'cause there are three brushes in the prep kit."

 

[Tired]

I agree...one famous pimping question from one of our surgeons...

"Why do you have to do the paint three times?...'cause there are three brushes in the prep kit."

How about, "What is the mechanism of bacterial killing of betadine?" The answer being, "Desication". Of course, anyone with three minutes of background in chemistry knows this is just stupid.

 

[leechy]

Omigosh, thanks so much everyone. You guys really helped me put this in perspective. It's funny, I don't think of myself as particularly sensitive, but after a generous dose of scrub tech condescension, I'm sometimes so annoyed I can't concentrate on the surgery for a little while. Definitely need to get than under control. And yeah, kissing up to the OR staff collectivity would definitely help. Gotta add them to the list 🙂

Now that I've scrubbed in a few more times and feel more knowledgeable about the process, I do feel like there's an element of hazing to it. One fellow told me that where she went to school, the OR staff would find some minor flaw with her sterile technique, and if she denied it, they'd place their hands on her and tell her to scrub again...

Ahhh well, another part of the hardening process of third year!

 

[Blade28]

It's a rite of passage, honestly. It'll get better.

 

[misery]

I'm so glad you all posted this. I worked in surgery for several years before medical school. Even with all my experience I still get yelled at!!! I swear this morning I was about to smack our f***ing circulator, your within 18 inches of this, dont get close to that. Being a MS3 is like having a sign that says "I"m a F***ing Idiot" on your back. But, you have to realize that this is the only power these people have in life. Let them have their fun. Take it with stride and laugh at what they get their panties in a wad about.

 

[Blade28]

It'll still happen in your MS-IV year.

And the beginning of internship.

Especially if it's your first week on a new rotation and the OR team (tech and circulator) are experienced.

 

[Tired]

I'm so glad you all posted this. I worked in surgery for several years before medical school. Even with all my experience I still get yelled at!!! I swear this morning I was about to smack our f***ing circulator, your within 18 inches of this, dont get close to that. Being a MS3 is like having a sign that says "I"m a F***ing Idiot" on your back. But, you have to realize that this is the only power these people have in life. Let them have their fun. Take it with stride and laugh at what they get their panties in a wad about.

You can always return the favor when you have the power to do so. A few favorites from my staff:

"You're already scrubbed in, so maybe now you could start paying attention."

"This isn't the first time you've scrubbed with me. How is it you have no idea what's going on?"

"I see they sent the B-team today."

"It doesn't matter how many times you hand me the wrong instrument, I'm not going to pretend like it's the right one."

 

[SLUser11]

You can always return the favor when you have the power to do so. A few favorites from my staff:

"You're already scrubbed in, so maybe now you could start paying attention."

"This isn't the first time you've scrubbed with me. How is it you have no idea what's going on?"

"I see they sent the B-team today."

"It doesn't matter how many times you hand me the wrong instrument, I'm not going to pretend like it's the right one."

And so the cycle of antagonism continues......

 

[DiverDoc]

I remember the first time I scrubbed in to observe and hold some good ol richardsons. I had already gowned up and gloved up when I had a horrible itch on my head. I was sorta new to the whole hardcore STERILITY rules. I asked the scrub nurse (my mother) if I could scratch my head, but she thought I asked her if my surgical cap was on straight or something (probably due to sinatra being to loud in OR), so I scratched my head and it was game over. Luckily I re-scrubbed back in and helped setup before the surgeon showed up.

 

[Ashers]

I remember the first time I scrubbed in to observe and hold some good ol richardsons. I had already gowned up and gloved up when I had a horrible itch on my head. I was sorta new to the whole hardcore STERILITY rules. I asked the scrub nurse (my mother) if I could scratch my head, but she thought I asked her if my surgical cap was on straight or something (probably due to sinatra being to loud in OR), so I scratched my head and it was game over. Luckily I re-scrubbed back in and helped setup before the surgeon showed up.

I love the total space suit stuff I wore into total knee and hip replacements, as an M1-2, with the head thing with a fan. Then you've got a sterile cover over your head so you can adjust the fan, scratch your head, etc and you don't have to wear a mask. I really don't like masks.

 

[DiverDoc]

I love the total space suit stuff I wore into total knee and hip replacements, as an M1-2, with the head thing with a fan. Then you've got a sterile cover over your head so you can adjust the fan, scratch your head, etc and you don't have to wear a mask. I really don't like masks.

Masks are a pain if you wear glasses. I normally wear contacts, but if I stare for awhile, they tend to pop out with ease. So when I observe, I wear glasses, but if you dont get that cheap sticky crap sealed right, everytime you breath your glasses fog up and you cant see anything!

 

[Blade28]

I love the total space suit stuff I wore into total knee and hip replacements, as an M1-2, with the head thing with a fan. Then you've got a sterile cover over your head so you can adjust the fan, scratch your head, etc and you don't have to wear a mask. I really don't like masks.

Ah, I've worn that space helmet too! Even have a great picture snapped by the circulator (using my camera phone, no less).

Wait until you're wearing loupes and a headlight on your head...then there'll be a ton of things you want to adjust, but can't!

 

[smq123]

...and you don't have to wear a mask. I really don't like masks.

This will sound weird, but I like wearing masks. That way, if I lose my patience and make a face, at least I'm mostly covered and no one can see my facial expression. 😉

 

[mules05]

This will sound weird, but I like wearing masks. That way, if I lose my patience and make a face, at least I'm mostly covered and no one can see my facial expression. 😉

I agree with that, just remember that rolling your eyes won't be hidden- I made that mistake once. Also, I learned my lesson about what to eat for lunch on OR days...I ate a tuna sandwich right before scrubbing in once and had to smell tuna for hours.

 

[Blade28]

Also, I learned my lesson about what to eat for lunch on OR days...I ate a tuna sandwich right before scrubbing in once and had to smell tuna for hours.

Or...be thankful you got to eat! 🙂

Most days we skip breakfast and/or lunch. 🙁

 

[Winged Scapula]

I agree with that, just remember that rolling your eyes won't be hidden- I made that mistake once. Also, I learned my lesson about what to eat for lunch on OR days...I ate a tuna sandwich right before scrubbing in once and had to smell tuna for hours.

What's this "lunch" thing?😕😉

 

[fakin' the funk]

Or...be thankful you got to eat! 🙂

Most days we skip breakfast and/or lunch.

Lunch...Ok, sure, you're busy, I got it.

But breakfast?! That's crazy! At least find the 10 minutes it takes to run to the hospital caf and tank up on eggs, bacon, and french toast!

 

[smq123]

Lunch...Ok, sure, you're busy, I got it.

But breakfast?! That's crazy! At least find the 10 minutes it takes to run to the hospital caf and tank up on eggs, bacon, and french toast!

Where are you rotating? And how fast do you eat?

On Gyn, this was my schedule:
- Preround on patients at 5:30.
- Round with team on patients at around 6:15-6:30 AM. (Depending on patient load)
- Morning report at 7 AM.
- Prep for first surgery of the day at 7:30.

(The schedule for L&D was worse, just because the patient load was a lot heavier.)

Seeing as our hospital cafeteria doesn't open until 6:45, there's no time to get breakfast. (It also takes about 5 minutes to get to the cafeteria from L&D, and then another 5 minutes to find something decent to eat.)

I don't know about surgery (haven't done it yet), but I find it hard to believe that the schedule on surgery is lighter than it is on Gyn. But maybe it is, though.

 

[Ashers]

I ate breakfast before heading to the hospital on OB/gyn -- got there at 5:20 on gyn, and 5:40 on OB. I also carry granola bars and protein bars in my pockets in case I don't have time to eat lunch, since I'll get a migraine if I don't eat, even if I'm not hungry. Kinda sucks.

 

[Meatwad]

I ate breakfast before heading to the hospital on OB/gyn -- got there at 5:20 on gyn, and 5:40 on OB. I also carry granola bars and protein bars in my pockets in case I don't have time to eat lunch, since I'll get a migraine if I don't eat, even if I'm not hungry. Kinda sucks.

That does suck, but at least you aren't the type that gets hypoglycemic easily and can pass out. That'd really suck.

 

[Blade28]

But breakfast?! That's crazy! At least find the 10 minutes it takes to run to the hospital caf and tank up on eggs, bacon, and french toast!

Trust me, you won't always have the time.