(h) The cap, worn on the head of team members, should completely
cover the hair to prevent particles of dandruff or hair from falling on the sterile field or in
the room. Refer to figures 1-28 and 1-29.
(2) Mucous membrane. Some areas cannot be scrubbed. Mucous
membrane is not scrubbed since scrubbing would damage the tissue. When the site of
operation is the mucous membrane of the nose, mouth, throat, or anus, the number of
microorganisms present is great. However, the various parts of the body do not usually
become infected by organisms that normally inhabit those parts. Even so, an effort is
made to reduce the number of organisms present in an operative area and to prevent
scattering the remaining ones.
(a) As much of the operative area is cleansed, as is feasible and the
surrounding skin is scrubbed.
(b) When the specialist is scrubbing the patient's skin, the surgeon
makes an effort to use a sponge only once for mopping an area. Once he removes the
sponge from contact with the skin, he discards the sponge into a kick bucket.
(3) Infected areas. Infected areas are grossly contaminated. The "sterile"
team members should avoid scattering the contamination. In addition, cases involving
infected areas require a special cleanup procedure following the operation.
Air. The air is contaminated by dust and droplets.
(a) Team members are required to wear a mask covering the nose and
mouth (refer to figure 1-28). A mask is worn not only during an operative procedure, but
also any time personnel enter the OR. The mask must cover the mouth and
nose entirely and be tied securely to prevent venting. The strings should not be crossed
when tied because the sides of the masks will gap. A pliable metal strip is inserted in
the top hem of most masks to provide a firm contour fit over the bridge of the nose.
This strip also helps prevent fogging of eyeglasses. Air should pass only through the
filtering system of the mask. Masks should be either on or either off. They should not
be saved from one operation to the next by allowing them to hang around the neck or by
tucking them into a pocket. Bacteria that have been filtered by the mask will become
dry and airborne if the mask is worn necklace fashion. By touching only the strings
when removing the mask, contamination of the hands will be reduced. Masks should be
changed between procedures and sometimes during a procedure, depending on the
length of the operation and the amount of talking done by the surgical team.
(b) When possible, the respiratory tract of the patient should be
isolated from the incision. In some cases, isolation is achieved by using the ether
screen. This serves as a barrier between the incision and the respiratory tract.