Fig. 5.1. Correct technique for putting on a sterile gown. Operator is assisted into gown. A: The assistant pulls the gown up and back over the operator’s shoulders by grasping the inside surface and ties the

neck ties at the back of the operator’s neck. B: Operator hands tip (protected with a removable cardboard

tab) of sterile tie to assistant. C, D: Operator carries the tie around to the front where the operator takes tie

(without the cardboard tab) and ties the gown.

Chapter 5 ■ Aseptic Preparation 37

(3) Rinse forearms and hands, keeping them elevated above elbows.

(4) Dry hands and then forearms with two sterile

towels. Keep wrists and hands elevated until drying is complete.

(5) Put on sterile gown with the aid of an assistant

(Fig. 5.1).

(6) Put on sterile gloves, without contaminating

external surface with ungloved hand (Fig. 5.2).

(a) Have assistant open packet without contaminating contents.

(b) Pull gloves well over sleeve ends.

c. Preparation of patient skin

(1) Prior to procedure, have assistant:

(a) Wash area, if soiled, with soap and water.

(b) If necessary, remove hair using small scissors, taking care not to nick skin. Do not

shave the area.

(2) Apply antiseptic with three separate sponges.

Start at center of circle, and work centrifugally

to at least 5 cm outside immediate area of procedure. Alcohol (70%) should not be used. An

iodophor preparation is commonly used in nurseries in the United States.

(3) Allow antiseptic to dry. Do not wipe off antiseptic prior to procedure.

H. Complications

1. Dry skin caused by repeated use

2. Hexachlorophene

a. Transcutaneous absorption with CNS vacuolation (8)

b. Possible teratogenicity when used for hand washing

by a pregnant staff member (18)

3. Iodine

a. Burns

b. Allergic contact dermatitis has been reported (19).

c. Skin absorption/hypothyroidism (5,12,13)

(1) A high incidence of transient neonatal hypothyroidism has been observed in premature infants in

Europe after routine skin cleansing with iodine.

The same high incidence has not been noted in

North America. This difference in incidence may

be due to the prior iodine status of the neonate.

A

C

B

Fig. 5.2. Correct technique for putting on sterile gloves.

A: Assistant has opened outer pack, allowing removal of uncontaminated inner pack by operator. B: Correct method for lifting

second glove with gloved hand to avoid contact with skin as second glove is pulled up over sleeve ends. C: Pulling first glove up

over sleeve ends. The inside surface of the glove is never touched

by the gloved hand.