gowning off the back table

GadgetRN71, ASN, RN · Oct 18, 2008

Gowning off of the back table is generally frowned upon by most ORs. The recommended practice is to gown from a separate gown table. I'm pretty sure AORN recommends this as well.

ewattsjt · Oct 18, 2008

The first place you should look is in your facility’s policies. This issue is addressed in some and it would look better if you are enforcing facility policy instead of making your boss to forbid something.

If there is nothing in policy form, then you should consider submitting something and using references to back you. The AORN RSOP is one that is seldom turned down when it comes to policy making. The AST now has a RSOP but it is not complete yet. It helps when both organizations are saying the same thing.

Most literature is against it. Some of the rationale behind it is that one is still dripping and can easily contaminate the backtable as the procedure starts.

The “Surgical Technology for the Surgical Technologist” which is a book that all CAAHEP accredited surg tech programs are supposed to be using, does not specifically say but in Section Two under “Principles and Practice of Surgical Technology” it does say, “The gown for the STSR (Surgical Technologist scrub role) is set up on a separate Mayo stand during the establishment of a sterile field and the opening of supplies. The STSR usually self-gowns and then assists with the gowning and gloving of other team members.” I take it that the scrub gowns off mayo and gowns others from the backtable.

Many nursing programs use Alexander’s. So here is what mine says; The “Alexander’s Care of the Patient in Surgery” Twelfth Edition, Chapter 4 under “Infection Prevention and Control” pg 138, 139 states “A small sterile field is created by the gown wrapper, which is opened over the flat surface. The gown and gloves shold not be opened on the sterile back table because of the increased chance of contamination to the field.”

shodobe · Oct 18, 2008

Everywhere I have worked at, the scrubs gown off the back table. I see nothing wrong with it. Just because AORN frowns upon it doesn't mean it is wrong. AORN just makes recommendations, they don't lay down the laws or rules. Hospitals make their own policies and you should adhere to them. My particular OR policy states gowning off the back table is acceptable. 31 years and no problems

linda2097 · Oct 18, 2008

I think it's bad because you are reaching over the back table with a bare hand whether or not your hand is dry.

GadgetRN71, ASN, RN · Oct 18, 2008

I think it's bad because you are reaching over the back table with a bare hand whether or not your hand is dry.

Yes, that's our facilty's rationale too. Also, the drip factor. But like someone else said, find out your hospitals policy. In mine, they'd beat you with a stick if they saw you gown off of the back table. Actually, in every single place I've been, as student or employee, it was the same way.

Granted, in specialties like Cysto or some GYN/General cases, you're dealing with "dirty" areas and procedures aren't really sterile, they're clean. but in Ortho land, we are very anal about sterility.

shodobe · Oct 19, 2008

WE use a waterless hand prep so there is never anything to drip. The only time we gown off a covered mayo is for a total joint procedure where we need to put on hoods. Also, we have had a pretty impecable infection rate for many, many years so no problems. I also open my gown close to the edge of the table along with my gloves, so there is no reaching over a table. If you think logical on how you open your supplies you will have no break in a sterile area.

GadgetRN71, ASN, RN · Oct 19, 2008

In my OR, the first scrub of the day has to be the traditional 5 minute scrub with a scrub brush. After that, we can use the waterless stuff. So, drippage still is a factor.

I can respect that certain facilities may do things a different way but I try to pick my battles. I'm not going to make a big stink that we should be able to gown off of the back table...we have techs as it is that you have to watch like a hawk for sterility. Personally, I think it is bad practice and wouldn't do it. Having the separate gowning table works for my facility so why change it?

ewattsjt · Oct 19, 2008

Poor technique is exactly that. If you see nothing wrong with it, that is your choice.

The authors of all the books on the operating room, sterile technique, etc.. have made the articles using accepted principles and practices. Nothing says that one has to agree with the facts or proven principles but it would be highly arguable that anything against the grain of proven and accepted technique would place the patient at a greater risk.

In saying that, one also has to pick their battles and is this one worth the fight?

shodobe · Oct 19, 2008

No it isn't worth the so-called battle. Like I said, follow your policy. Also, if you are using the waterless prep properly and allow your arms to dry you WILL NOT have any dripping whatsoever. Period.

linda2097 · Oct 19, 2008

No it isn't worth the so-called battle. Like I said, follow your policy. Also, if you are using the waterless prep properly and allow your arms to dry you WILL NOT have any dripping whatsoever. Period.

It doesn't matter if your arms are dry. You're not supposed to reach over the field.

Good sales reps use laser pointers because they don't want to reach over the field in order to point to items.

I gown off the field despite the fact that I am the only one at my facility who does so. AORN standards are referred to during lawsuits. I care more about being a patient advocate than conforming to sloppy technique.

It is NOT difficult to gown off the field, so why use sloppy technique? Because it's easier? Also, if you are CNOR, you are expected to follow AORN standards.

shodobe · Oct 20, 2008

This thread is getting ridiculous. I will not allow anyone to question my skills and abilities. I am NOT sloppy and when you have worked as many years as I have had, THEN you might be able to question my work techniques. The problem here is too many people who have a little knowledge seem to "think" they have all the answers. Like I said before, it seems funny I can ask this question to many nurses who have been around the block a few times and they look at many and think that is a stupid question. I highly respect these individuals for their opinion. Also, there is NO law or rule that we have to abide by anything AORN states! THey are only there to recommend practices and nothing more. They are not the answer to all situations. I have been CNOR cert for 25 years so I think, no I know what I am doing. So how many years have you been in the OR? and are you CNOR cert? This discussion is closed!!!!!!!!!!!!!!!!!