In Kickboxing, one of the first moves you will learn is how to put your "guard up." You bend your arms, clench your hands to make fists and raise your bent arms and fists right in front of your face. The purpose of this position is protection.Now imagine the same idea- arms out in front- after scrubbing in for surgery. In a way, you do keep you "guard up" after you scrub to prepare for surgery, except, the purpose is different: preventing contamination. You walk into the OR, water dripping down your arms with your arms out in front of your face, a cardinal help signal to get some one's attention to help you get gowned before you arms touch something.
Monday concluded our quarter-long Surgical Skills Elective with a Scrubbing and Gowning Session in a real functioning OR (obviously there were no patients just a group of medical students in blue scrubs scurrying around lost and confused). In a series of sessions, we learned the tricks and trades of how to successfully scrub into an OR without "messing things up" (as stated by second year medical students).Here are some of the take-home points I took home:
1. Do not touch anything (well anything blue unless you are scrubbed in)!!! OK, this is an overstatement but there is a basal amount of truth to this statement. During a surgery, a sterile field is constructed where the surgery is performed to protect the patient. If you have scrubbed in, part of you becomes an extension of this field. But the moment you touch anything unsterile, you are no longer sterile.
2. Follow the OR traffic rules and do not contaminate yourself or anyone else.
3. The blue gowns are too big for most normal size people. Gowning requires a bit of coordination and help. Remember to pull the tag off, have someone grab the white part and spin in the correct direction.
4. Scrubbing in really meaning scrubbing in--it takes time and is a thorough process that leaves you smelling so fresh and clean and dripping wet
5. Wear eye protection in case things squirt
6. Once scrubbed, do not touch your mask
7. If you feel lightheaded- walk away from the table (and find an appropriate place to sit)
8. Remember to enjoy the experience and not get mired by all the details that come from scrubbing in
9. When washing you arm, you are doing an "upper cut" (another kickboxing move) through the water. You arm moves in a scooping action, fingers first and elbow last to ensure the proper flow of water and prevent contamination
10. There is complicated theory to scrubbing (lots of strokes and they are in some multiple of 5). Well, it's not complicated- just difficult to explain in writing. It's one of those things you just have to see.
Now that we have learned to scrub in, suture and tie knots, we can now actually move closer to the table and play more active roles in learning and contributing to the patients care (at least that is the goal).
We'll see how much better we can navigate this blue sterile field with our training. Something tells me that have a ways to go before we figure it out.
Images:
"Scrubbing in"
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