Surgical hand antisepsis and donning sterile gloves

By Leslie Canham, CDA, RDA

Surgery assistants perform surgical hand antisepsis and understand how to don sterile gloves; however, many dental assistants do not routinely perform surgical asepsis. When surgical asepsis is required, special care must be taken to prevent transmission of pathogens via the hands to sterile or aseptic areas of the surgical field. Here are some things you need to know about surgical hand antisepsis and donning sterile gloves.

The first step in infection control is hand hygiene

Hand hygiene is any method that removes or destroys microorganisms on hands. It is well documented that the most important measure for preventing the spread of pathogens is effective hand washing. This is achieved by vigorously rubbing together all surfaces of lathered hands for at least 20 seconds, followed by rinsing. Hand washing suspends microorganisms and mechanically removes them by rinsing with water. The fundamental principle of hand washing is removal, not killing.

The preferred method for hand hygiene depends on the type of procedure, the degree of contamination, and the desired persistence of antimicrobial action on the skin. For routine dental exams and nonsurgical procedures, hand washing and hand antisepsis are achieved by using soap and water. If the hands are not visibly soiled, an alcohol-based hand rub is adequate. The purpose of hand antisepsis and sterile gloves is to eliminate transient flora and reduce resident flora during a procedure to prevent introducing organisms into the wound if the gloves become torn. Skin bacteria can rapidly multiply under surgical gloves if hands are washed with soap that is not antimicrobial. Agents used for surgical hand antisepsis should reduce microorganisms on intact skin. They should contain a nonirritating antimicrobial preparation with a broad spectrum of activity, be fast-acting, and have a persistent effect.¹ The minimum duration for surgical hand antisepsis is two to six minutes.

Donning of sterile gloves

Some dental procedures require sterile gloves. Dental assistants must adhere to proper protocols when donning sterile gloves to prevent transmission of pathogens. There are two techniques for donning sterile gloves. The first is called “closed donning” or the “closed cuff method.” The second is “open donning” or the “open cuff method.”

“Closed donning” or “closed cuff method”

1. Open sterile glove package by peeling apart the outer packaging from the corners. Be careful not to touch the sterile inner pack.
2. Perform surgical hand antisepsis and don a sterile gown, keeping fingers inside the sleeves of the gown.
3. Open the sterile inner glove pack by gripping it with your fingers through your gown sleeves.
4. With your gown covering your fingers, use your right hand to remove the left glove from the open sterile package. Hold your left hand palm up, and keep your fingers straight. Lay the glove on your left wrist with the fingers of the glove pointing toward you.
5. Grip the cuff of the glove with your left thumb.
6. Place your right thumb inside the top cuff of the glove’s edge. Make a fist with your right hand and stretch the glove over your left fingertips.
7. Keeping your left fingers straight, pull the glove down over your fingers and hand. Then completely cover the cuff of your gown with the remaining glove material.
8. Repeat the above procedure to don the other glove. Use your gloved left hand to lay the right glove on your right wrist. Slide your left thumb inside the top of the cuff, make a fist, and stretch the cuff over your right fingertips. Pull the glove down over your hand. Then completely cover the cuff of your gown sleeve with the remaining glove material.

“Open donning” or “open cuff method”

1. Peel open the sterile glove package to expose the gloves without touching the gloves.
2. Don a sterile gown.
3. Perform surgical hand antisepsis.
4. Using your bare left hand, pick up the right glove by touching only the folded cuff (the rest of the glove remains sterile).
5. Slide your right hand into the glove until snugly fit over the thumb joint and knuckles.
6. Unfold the glove cuffs to cover your gown sleeves.
7. To don the left glove, slide your right fingertips into the folded cuff of the left glove, pull the glove over your fingertips, and fit your left hand into it.
8. Unfold the glove cuff to cover your gown sleeves.
9. Do not allow gloved fingertips to touch your bare forearms or wrists. After donning sterile gloves, the surface powder must be removed from powdered gloves. Use either sterile water from a pour rinse or a sterile wipe.

To remove gloves

1. Grab the glove material at the wrist of the first hand.
2. Fold the glove over, pulling it away from skin by turning it inside out.
3. Hold the removed glove in your other gloved hand.
4. To remove the other glove, place your bare fingers inside the cuff of the glove next to your skin without touching the glove’s exterior.
5. Roll the glove off your hand from the inside, turning it inside out. Use it to envelope the other glove.
6. Dispose of both gloves.
7. Perform hand hygiene.

CLICK HERE to see step-by-step instructions for surgical hand antisepsis and donning and removing sterile gloves.

Author bio
Leslie Canham is a dental speaker and consultant specializing in infection control and OSHA compliance. She has more than 36 years of experience in dentistry. Canham is the founder of Leslie Canham Seminars, providing in-office training, mock inspections, consulting, and online seminars and webinars to help the dental team navigate state and federal regulations. Reach Canham at (888) 853-7543 or Leslie Canham.

References

1. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care setting — 2003. MMWR Recomm Rep. 2003; 52(RR-17):15-18 Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm.