WE ARE GOING TO BE VIDEOTAPING.

AS YOU CAN SEE WE'VE GOT LIGHTS
AND WE'RE KIND OF BECOMING A
LITTLE BIT MORE OF A PRODUCTION
AROUND HERE.

ISN'T THIS WILD.

WE ARE TRYING TO MAKE DVD'S.
WE TOLD YOU ABOUT THAT

AND SO WE ARE GETTING THOSE
READY TO GO AND LIGHTING WAS
KIND OF AN ISSUE

WHEN WE WENT TO CUT AND THEY
WERE DARK AND SO

THE VIDEO TAPES WE DON'T LIKE TO
REDO. WE WANT TO JUST DO THEM.

THEY ARE WHAT THEY ARE, AND MAKE
THE DVD'S.

SO THAT MEANS IF YOU COME IN
LATE WE WANT YOU TO NOT CROSS IN
FRONT OF THE CAMERA

BECAUSE THIS IS THE REAL THING
AND WE WANT TO DO AS MINIMAL OF
EDITING AS POSSIBLE

SO IF YOU COULD HELP US OUT WITH
THAT.

SO EVERYONE THAT COMES EARLY AND
ON TIME IF YOU KIND OF START OUT
AT THIS END

AND LEAVE LATE SEATS OVER HERE
FOR OTHER PEOPLE, THAT WOULD BE
REALLY HELPFUL.

THE OTHER THING WE REALLY NEED
YOU TO DO THIS SEMESTER

AND BE REALLY CONSCIOUS OF IS
TURN YOUR CELL PHONES OFF AND
YOUR PAGERS.

THAT WON'T SOUND GOOD ON VIDEO
TAPES AND WE HAVE A BIGGER THAN
JUST US PROJECT.

WE WANT TO DISSEMINATE THEM AND
WE HAVE A LARGER AUDIENCE THAT
HAVE REQUESTED THE DVD'S,

SO THAT WILL HELP US A LOT IF
YOU WOULD DO THAT.

WE ARE GOING TO DO ABOUT
FOUR SKILLS TODAY
AND ONE IS PASS-FAIL

AND THREE SKILLS.
AND THEY ARE VERY SIMPLE.

WE START OUT AS USUAL HAND
WASHING AND THIS TIME WE ARE
GOING TO DO A TWO MINUTE SCRUB.

SO IN YOUR SKILLS KIT I GAVE YOU
TWO BRUSHES THIS SEMESTER.

ONE BRUSH TO PRACTICE WITH AND
ONE TO BRING BACK FOR WHEN YOU
DO YOUR SKILLS.

AND THAT REMINDS ME.
ON THE BACK OF YOUR MODULES --
LET'S TURN TO PAGE

SO YOU CAN SEE WHAT
I AM TALKING ABOUT.

ON PAGE 11 IT SAYS WHAT SKILLS
WE'RE GOING TO PERFORM,
NUMBER F,

AND THEN ON G IT SAYS SUPPLIES
REQUIRED FOR PERFORMANCE.

THOSE ARE SUPPLIES THAT YOU HAVE
IN YOUR SKILLS KIT.

YOU HAVE TO BRING THOSE.

AND IF YOU DON'T BRING YOUR
SUPPLIES FROM YOUR SKILLS KIT,
THEN IT'S AN UNEXCUSED LATE.

YOU HAVE TO HAVE THEM, I DON'T
HAVE ENOUGH SUPPLIES FOR
EVERYBODY

AND I CAN'T SELL YOU MINE
BECAUSE I DON'T EVEN KNOW THE
PRICE COS I BUY IN BULK.

SO YOU HAVE TO BRING
YOUR OWN STUFF.

SO MAKE SURE YOU
CHECK THAT LIST.

YOU'RE GOING TO HAVE THESE COOL
LITTLE BAGS.

THEY ARE BLUE AND RED AND THEY
ARE NOT BAD LOOKING AT ALL.

SO YOU CAN CARRY THAT AND THAT
WAY ARE ALWAYS SAFE AND YOU HAVE
ALL YOUR STUFF,

BUT IF YOU CAN'T DEAL WITH THAT,

JUST STICK IN WHAT YOU NEED AND
BRING JUST THE SUPPLIES
THAT YOU NEED EACH WEEK,

BUT MAKE SURE YOU HAVE THEM.

ALRIGHT, I AM GOING TO MOVE BACK
TO THE BACK SINK, SO KIND OF
SHIFT AROUND AND WE WILL DO OUR
LITTLE...

OKAY. WE ARE GOING TO DO
A TWO MINUTE SCRUB

AND WHERE YOU'RE GOING TO USE
THIS TWO MINUTE SCRUB ARE IN
CLEAN AREAS

PARTICULARLY IN THE NEW-BORN
NURSERY THEY MAKE YOU SCRUB

AND SOME OF YOUR ICU'S THEY MAKE
YOU SCRUB

AND SOME OF YOUR CANCER UNITS
THEY MAKE YOU SCRUB.

WHERE IMMUNE SYSTEMS ARE LOW AND
YOU NEED TO DO MORE THAN JUST
YOUR LITTLE 10 SECOND HANDWASH.

SO WHAT I AM TEACHING YOU IS NOT
A SURGICAL SCRUB BECAUSE THAT'S
A FIVE MINUTE SCRUB.

THAT THEY WILL TEACH
YOU IN SURGICAL.

SO YOU CAN'T DO THIS LITTLE TWO
MINUTE SCRUB AND RUN IN AND
ASSIST WITH SURGERY.

BUT IT IS BASICALLY THE SAME
TECHNIQUE THEY WILL TEACH YOU IN
SURGERY,

JUST LONGER THAN WHAT WE'RE
GOING TO DO.

TWO MINUTES IS WHAT'S ADEQUATE.

WHEN YOU DO SOME OF YOUR
READING, YOU'RE GOING TO SEE IN
THE READING

THAT IT SAYS THEY'VE APPROVED
THE ALCOHOL RUBS FOR A SURGERY.

AND THAT IS TRUE, BUT WHAT I DID
IS CALL SOME OF THE SURGERY
CENTERS HERE IN TOWN

TO SEE WHAT THE PRACTICE IS
WITHIN THE COMMUNITY

AS FAR AS USING ALCOHOL VERSUS
SCRUB BRUSH IN THOSE AREAS.

AND WHAT THEY'RE DOING, THE
AORN, WHICH IS THE ASSOCIATION
OF OPERATING ROOM NURSES

DOES NOT APPROVE THE ALCOHOL RUB
OR RECOMMEND THE ALCOHOL RUBS AS
THE ONLY CLEANSER.

THEY ARE STILL RECOMMENDING A
FIVE MINUTE SCRUB AND THEN THE
ALCOHOL GELS BETWEEN SCRUBS,

SO THAT YOU'RE GETTING THE
ANTI-BACTERIAL, BUT THEY WANT
THAT FRICTION

AND THEY WANT THE SCRUB AS WELL.

SO WHAT THEY ARE USING IS THE
BETADINE SCRUB OR HIBICLEN SCRUB
IF YOU'RE ALLERGIC TO IT

AT LEAST AT FRESNO AND A COUPLE
OF THE OTHER INSTITUTIONS ARE
USING CHLORHEXIDINE,

INSTEAD OF THE BETADINE.

BUT STILL USING THE BRUSH AND
STILL SCRUBBING FOR THE ALLOTTED
AMOUNT OF TIME.

JUST BECAUSE IT'S CHEAP I GAVE
YOU BETADINE SCRUB BRUSHES AND
HOPEFULLY THERE IS NO ISSUE,

BUT IF THERE IS I DO HAVE SOME
PLAIN ONES, THEN WE CAN DO.

SO, BUT IT WILL GET THE JOB
DONE.

BETADINE, STAINS AS YOU KNOW,

SO I WOULDN'T BE PRACTICING THIS
AT HOME IN YOUR BEST OUTFIT

OR ANYTHING BECAUSE IF IT
SPLASHES, OOH, WHAT A MESS.

ALRIGHT, YOU'RE GOING TO HAVE A
LITTLE SCRUB BRUSH LIKE THIS

AND THE TECHNIQUE IS VERY
SIMILAR TO A PLAIN HAND WASH

IN THAT YOU'RE GOING TO STAND
AWAY FROM THE SINK.

YOU'RE GOING TO MAKE SURE YOUR
PAPER TOWELS ARE READY AND HAVE
ALL YOUR SUPPLIES TOGETHER.

MAKE SURE YOU HAVE
A TRASH CAN AVAILABLE

BECAUSE YOU DON'T WANT TO BE
PULLING THAT OUT WITH YOUR
ALREADY CLEAN HANDS.

IF YOU FORGET, GRAB SOMETHING TO
BE A BARRIER TO REACH IN FOR
YOUR TRASH

OR JUST THROW 'EM ON THE COUNTER
UNTIL YOU CAN GET TO WHAT YOU
NEED AS FAR AS DISPOSAL.

ALRIGHT, SO I AM GOING TO GET MY
WATER RUNNING.

OPEN UP MY BETADINE SCRUB BRUSH

AND INSIDE IS NOT AN ORANGE
STICK BUT A FINGERNAIL FILE TO
GET THAT KIND OF THING DONE.

SO WHAT I WANT TO DO IS I WANT
TO WET MY HANDS

AND I AM GOING TO LEAVE MY HANDS
THIS TIME WITH FINGERTIPS
POINTED UP.

BECAUSE I AM GOING TO CLEAN ALL
THE WAY TO ELBOW,

AND SO YOU DON'T WANT DRIPPING
DOWN FROM YOUR ELBOW, DIRT,

YOU WANT IT DRIPPING
TO YOUR ELBOW.

SO YOU WANT WHAT'S CLEANEST TO
BE DRIPPING TO WHAT'S DIRTIEST.

THE FIRST THING I WANT TO DO IS
I WANT TO CLEAN UNDERNEATH ALL
MY FINGERNAILS WITH THIS,

EVEN THOUGH THEY DON'T APPEAR TO
BE VERY DIRTY.

MY FINGERNAILS AS YOU CAN SEE
ARE NOT MY NICE TIPS
AS OF LAST SEMESTER.

NATURAL NAIL IS
STILL RECOMMENDED.

THEY WON'T LET YOU IN THE
SURGERY WITH THE ACRYLIC, FAKE
NAILS OR FINGERNAIL POLISH.

IT HAS TO GO.
YOU HAVE TO HAVE NATURAL NAILS.

I LIKE TO POKE MINE, JUST TO GET
IT ALL GOING HERE.

ONCE YOU HAVE YOUR
FINGERNAILS DONE,

YOU WANT TO TAKE YOUR SCRUB
BRUSH, SQUEEZE IT. IT'S WET.

AND YOU WANT TO TAKE
YOUR FINGERNAILS --

WE ARE GOING TO START FROM
FINGERTIPS DOWN

AND WE ARE GOING TO DO 15
BRUSHES ACROSS YOUR FINGERNAILS.

SO 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, 14, 15.

I DIDN'T GET MY THUMBS
VERY GOOD,

SO I AM GOING TO TAKE IT OVER
AND I AM GOING TO SCRUB
MY THUMB OUT.

SO I DID ALL OF THEM AT THE SAME
TIME AS FAR AS MY FOUR FINGERS.

SO I JUST COULDN'T GET MY THUMB.
I DIDN'T FEEL IT GOING IN HERE.

SO I AM GOING TO DO THAT AND
SWITCH AND DO THESE.

YOU DO BOTH HANDS EQUALLY.

YOU DON'T DO ONE TO ELBOW AND
THEN TAKE THAT DIRTY SCRUB BRUSH

AND GO BACK TO YOUR FINGERTIPS
AND COME ON DOWN.

ALRIGHT, WHEN YOU'RE DOING YOUR
HANDS WHAT YOU WANT TO DO IS

YOU WANT TO CONSIDER YOUR HANDS
OR YOUR FINGERS --

I'M GOING TO TURN THAT OFF JUST
SO YOU CAN HEAR BETTER.

AS FOUR SURFACES.

THE BACKSIDE IS ONE SURFACE.

THIS SIDE IS ONE SURFACE.

THE PALM OF YOUR HAND IS ONE
SURFACE AND THE INSIDE OF YOUR
FINGER IS ONE SURFACE.

EACH SURFACE OF YOUR FINGER MUST
BE SCRUBBED 10 TIMES.

OKAY. SO EACH WHITE COUNTS AS
ONE. 1, 2, 3, 4, 5,
6, 7, 8, 9, 10.

AND THEN YOU KEEP GOING.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10
AND YOU SCRUB ALONG.

1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10
AND SO FORTH.

YOU JUST KEEP GOING.

YOU WANT TO MAKE SURE
WHEN YOU HAVE GONE
BETWEEN YOUR FINGERS --

I'M JUST GOING TO BETWEEN ALL OF
THEM AND THEN HIT MY PALMS HERE.

THAT YOU GET DOWN
INTO THE WEBBING.

YOU DON'T WANT TO MISS THE WEBS
OF YOUR FINGERS.

IT WAS INTERESTING, YESTERDAY, I
DID MY SCRUB WITH MY GLO GERM

AND I MISSED THE WEBBING
BETWEEN ONE FINGER.

I MEAN, YOU FEEL LIKE YOU'RE
DOING EVERYTHING,

BUT YOU WANT TO MAKE SURE THAT
YOU HAVE DONE IT.

SO I AM GETTING THE BACK SURFACE
OF MY HAND AND THEN I AM GOING
TO HIT MY HAND WITH THE 10,

HIT MY WEBBING WITH THE 10.

ISN'T THIS EXCITING?

AND MY PALM, 10.

AND THIS SIDE OF SURFACE
ON MY HAND, 10.

SWITCH OVER TO MY OTHER HAND
AND IT'S THE SAME THING.

MORE SURFACES.

SHOULD HAVE HAD SOMEONE TIME ME

TO SEE IF I AM GOING INTO
THE 5 MINUTE OR STAYING
INTO THE 2 MINUTE.

IT'S MESSY. I'M JUST PLOPPING
BEDADINE ALL OVER THE PLACE
OVER HERE.

SO, AGAIN I AM JUST TRYING TO
STAND BACK AND AWAY SO I DON'T
GET ANYTHING ON ME.

MY FINGERTIPS ARE PLUS 10.

YOU GOT TO GET THAT
WATER WARMED UP.

MY BACK SURFACE, 10.

WEBBING. MY THUMB.

I WANT TO GET THOSE NAIL BEDS
GOOD...AND THE BACK SIDE OF MY
HAND.

ALRIGHT, NOW YOU'RE GOING TO HIT
THE WRIST.
SAME THING FOR SURFACES.

YOU CAN COME ON DOWN.

WE'RE NOT GOING TO GO ALL
THE WAY TO THE ELBOWS,
BUT JUST KIND OF MID-ARM.

AND I JUST NEED
A LITTLE WATER HERE.

OKAY. I AM DONE.

YOU CAN TOSS IT IN THE SINK.
YOU CAN TOSS IT OUT.

YOU'RE GOING TO RINSE FROM
FINGERTIPS...DOWN.

AND I AM RUBBING TOGETHER HERE
BECAUSE I CAN SEE YELLOW
ON MY HANDS.

TRY NOT TO TOUCH ANYTHING
BECAUSE IF YOU DO,
YOU GOT TO DO IT OVER.

OKAY, SO SEE THE DRIP
FROM THE ELBOWS.

GET YOUR PAPER TOWELS AS BEST AS
YOU CAN

AND YOU CLEAN FROM FINGERTIPS
DOWN, SO THAT YOU'RE
NOT SCRUBBING UP.

MORE.

TO THE ELBOW AND YOU'RE DONE.

OKAY.

ANY QUESTIONS?

- THE WEBBING WE DO TEN TIMES.

- UH-HUH.

- YEAH.
- OH, SO IT'S THE SIDES OF THE
FINGERS, THE WEBBING.

- UH- HUH. YEAH.

I THINK I -- DID I HIT THEM ALL?

I DON'T KNOW.
IT FELT LIKE I DID.

JUST KEEP GOING, EVERYTHING
COUNTS, EVERY SURFACE COUNTS.

SO THINK OF IT, FOUR SURFACES.

OKAY.

YOU'LL LOVE THIS ONE.

OUR WHOLE FOCUS THIS
TIME IS STERILITY

AND WE ARE NOT REALLY
GOING TO -- WE ARE GOING TO DO
ONE STERILE PROCEDURE,

BUT I WANT TO TEACH YOU THREE
DIFFERENT KINDS OF STERILE
FIELD SETUPS.

SO THAT YOU CAN BE TALKED
THROUGH A STERILE PROCEDURE BY
ONE OF YOUR PRECEPTORS.

WE CAN'T DO EVERYTHING
FIRST WEEK. THEY WANT YOU
TO KNOW EVERYTHING.

SO WE ARE GOING TO DO OUR
STERILE TECHNIQUE

AND IF THEY WANT TO COACH YOU
THROUGH SOME KIND OF PROCEDURE,

YOU'LL AT LEAST KNOW THE
PRINCIPLES OF STERILITY

AND YOU WON'T CONTAMINATE
ANY OF YOUR SETUPS,
SO THAT WILL HELP YOU.

ALRIGHT, THE FIRST THING THAT I
WANT YOU TO DO -- IT'S JUST
PASS-FAIL.

I JUST WANT YOU TO KNOW THE
APPROPRIATE TECHNIQUE FOR
OPENING UP A STERILE KIT.

THERE IS A LOT OF
PRE-PACKAGED STERILE KITS FOR
DOING VARIOUS THINGS.

YOU'RE GOING TO SEE THAT YOU
HAVE THE FOLEY CATHETER KIT,
THE TRADE CARE KIT.

AND ALL THE SUPPLIES YOU NEED
ARE IN THE KIT. IT'S WONDERFUL.

YOU JUST GRAB IT AND GO, RATHER
THAN HAVING TO COLLECT
ALL THESE VARIOUS ITEMS.

YOU NEED TO HANDLE THE THINGS
INSIDE IT SO THAT THEY MAY
MAINTAIN THEIR STERILITY.

WHENEVER YOU'RE WORKING IN A
STERILE ENVIRONMENT,

YOU NEED TO MAKE SURE THAT THE
WORKING AREA AND THE SURFACE
THAT YOU'RE WORKING ON IS CLEAN.

SO MAKE SURE THAT THERE IS NO
WETNESS THERE.

IF YOU NEED TO CLEAN IT OFF
BECAUSE SOMEONE'S EATEN

AND YOU'RE CONCERNED ABOUT THAT,

THEN MAKE SURE THAT YOUR SURFACE
IS CLEAN AND DRY.

BECAUSE IF WETNESS LEECHES UP
THROUGH YOUR STERILE FIELD,

THEN THE FIELD IS
CONSIDERED CONTAMINATED.

YOU CAN'T HAVE WET IN YOUR
STERILE FIELD.

IN A KIT YOU HAVE AN
OUTSIDE WRAPPER.

THIS IS A PLASTIC WRAPPER AND
THAT PROTECTS IT.

MOST OF THE TIME, THEY HAVE A
DATE ON IT FOR BEING STERILIZED

AND SO WANT TO MAKE SURE ABOUT
THE DATE OF YOUR KIT.

ALL OF MINE ARE EXPIRED
AS YOU CAN TELL.

JUST MAKE SURE YOU LOOK AND SEE
WHAT THE DATE IS.

THIS ONE'S BEEN USED BEFORE, BUT
ON YOUR KIT IT SAYS RIGHT HERE,
GRASP.

YOU PEEL THE TOP PIECE OFF SO
THAT IT OPENS UP.
SO YOU HAVE AN OPEN KIT.

EVERYTHING INSIDE THIS KIT IS
STERILE, SO WHEN I REACH IN WITH
MY NON-STERILE HANDS

WHAT I TOUCHED IS NOT STERILE
ANY MORE.

ALRIGHT, I AM GOING TO SET THIS
DOWN.

I LOVE KITS BECAUSE YOU HAVE
THIS AUTOMATIC LITTLE TRASH BAG,
BUILT IN.

SO REMEMBER THAT. THAT'S THE ONE
ITEM I TEND TO FORGET IF I HAVE
TO GRAB A TRASH BAG.

BECAUSE I AM USED TO HAVING IT
WITH MY KITS THAT I'M KIND OF
SPOILT. SO I FORGET.

SO CUP THEM UP. THEY WILL
SIT RIGHT UP FOR YOU

AND YOU'LL HAVE A TRASH BAG
RIGHT READY FOR DRESSINGS AND
THAT KIND OF THING.

ON YOUR KITS, YOU'LL NOTICE THAT
THERE IS A TOP FLAP THAT'S
THERE.

YOU WANT TO TURN YOUR KIT SO
THAT THE FLAP IS AWAY FROM YOU.

SO THAT YOU, WHEN YOU OPEN IT
UP,

AND YOU TAKE YOUR CONTAMINATED
ARM ACROSS THE FIELD,

YOU'RE NOT CROSSING OVER WHAT'S
GOING TO BE STERILE.

SO I AM GOING TO GRAB THE FLAP
AND GO AWAY FROM ME

AND I AM CONSIDERED NON-STERILE
OVER A STERILE.

BUT I STILL HAVE TWO FLAPS THAT
ARE PROTECTING THE INSIDE
INTEGRITY OF THIS PACKAGE,

SO NOW I AM GOING TO GRAB THESE
OUTER FLAPS AND PULL THEM AWAY.

THEN I HAVE ONE LITTLE FLAP HERE
THAT COMES TOWARDS ME.

THE LAST FLAP IS ALWAYS
TOWARDS YOU.

THAT'S HOW YOU OPEN A KIT.
EVERYTHING INSIDE
THERE IS STERILE.

AND YOU'RE GOING TO HANDLE IT
WITH STERILE GLOVES. OKAY,
THAT'S HOW YOU OPEN A KIT.

JUST AS INSTRUCTION RELATED TO
YOUR STERILE FIELDS,

THERE ARE SOME BASIC RULES
ABOUT STERILE FIELDS.

YOU CAN TELL THAT MY STERILE
FIELD ISN'T ON A STERILE TABLE.

SO WE NEED TO CONSIDER
EVERYTHING THAT FALLS BELOW THE
TABLE NON-STERILE

AND ONE INCH AROUND EVERYTHING
ON THE TABLE AS NON-STERILE.

BECAUSE WE DON'T KNOW WHAT'S
GETTING ON FROM THE EDGE OF THE
TABLE

AND SO YOU WANT
TO BE PROTECTED THERE.

SO ANYTHING THAT FALLS WITHIN
THAT ONE INCH BORDER OF THE
EDGE, YOU CAN'T USE AS STERILE.

IT'S CONSIDERED CLEAN.

ALRIGHT, ALL YOU HAVE TO DO
FOR PARTICULAR DRILL
IS OPEN THE KIT.

NOT TOO BAD, HUH?

OKAY.

YOU DON'T NEED IT AGAIN, DO YOU?
THINK YOU GOT IT? OKAY.

SO IT WILL LOOK LIKE
THIS FOR YOU.

OPEN AWAY, OPEN THERE,
OPEN THERE.

OKAY, THAT'S IT. FOLD IT BACK UP
FOR THE NEXT GUY.

I WANTED YOU TO HAVE A REALLY
NICE FIRST WEEK.

YEAH?

- SO PASS-FAIL?
- PASS-FAIL.

- IS THERE...

- NO, THAT'S ANOTHER ONE.

YEAH.

REAL FUN.
IT SHOULD BE PASS-FAIL.

- THIRD ONE.
- THIRD ONE.

HERE COMES 16 POINTS.

OKAY. THAT'S ONE STERILE FIELD,
A PRE- PACKAGED KIT.

THEY ALSO MAKE PRE-PACKAGE
KITS IN LINEN WRAP.

AND YOU SEE THOSE VERY
OFTEN IN SURGERY.

A LINEN WRAP IS LIKE A TOWEL
WRAP THAT'S PUT IN AN AUTOCLAVE.

IT HAS TAPE AROUND IT JUST TO
HOLD IT

AND YOU KNOW THAT IT'S BEEN
STERILIZED IF THE TAPE
HAS BLACK STRIPES ON IT.

THAT MEANS IT'S GONE THROUGH THE
AUTOCLAVE, IT'S BEEN ACTIVATED
AND THE CONTENTS ARE STERILE.

HOWEVER, IT'S DIFFERENT THAN A
PLASTIC CONTAINER,

THINGS CAN POKE THROUGH AND
PERFORATE INTO THE LINEN, INTO
CLOTH,

WHERE THEY CAN'T INTO PLASTIC.
SO YOU HAVE TO PROTECT THEM.

IF THEY ARE DROPPED YOU HAVE TO
DISCARD THEM.

IF THERE IS ANY WETNESS THAT'S
GOTTEN ON THEM,

THEY ARE AUTOMATICALLY
CONSIDERED CONTAMINATED

BECAUSE WE DON'T KNOW HOW DEEP
THE WATER'S GONE

AND IF THEY ARE CONTAMINATED OR
NOT, TO OUR STERILE SUPPLIES.

SO THEY ARE HANDLED A
LITTLE BIT DIFFERENTLY.

THEY MUST STAY ABOVE
WAIST AND SO FORTH.

I AM GOING TO TALK ABOUT SOME OF
THOSE PRINCIPLES HERE IN A
SECOND.

OKAY, THE NEXT THING WE ARE
GOING TO DO IS STERILE GLOVING

AND WE ARE GOING TO SET UP A
STERILE FIELD.

WE ARE GOING TO CREATE A STERILE
FIELD WITH SOMETHING THAT IS NOT
A PRE-PACKAGED KIT.

FOR EXAMPLE, IF SOMEONE NEEDS A
DRESSING CHANGE

AND YOU NEED TO GATHER ALL KINDS
OF WEIRD THINGS.

THAT MAYBE YOU HAVE TO PACK IT
WITH THREE OR FOUR GAUZE

AND THEN YOU HAVE TO LAY OVER
A COUPLE MORE DIFFERENT
KINDS OF GAUZE

AND THEN A BIG, FAT, SURGICAL
PAD AND ALL KINDS OF STUFF

AND YOU NEED IT TO
ALL TO BE STERILE.

AND THAT'S NOT GOING TO COME IN
A KIT, SO YOU'RE GOING HAVE TO
GATHER IT UP.

SO HOW DO YOU SET UP A STERILE
FIELD SO THAT THEY GET
A STERILE DRESSING?

YOU'RE GOING TO HAVE IN YOUR KIT
A STERILE DRAPE.

IN YOUR KITS -- I WANT YOU TO
OPEN UP EVERYTHING AND PRACTICE
WITH EVERYTHING.

TOUCH IT. WORK WITH IT.

THAT'S THE WHOLE IDEA, REALLY.

THIS WHOLE WEEK'S WORTH OF
DRILLS YOU CAN PRACTICE AT HOME.

YOU HAVE EVERYTHING AND SO YOU
CAN WORK WITH IT.

THEN WHAT YOU'LL DO IS YOU'LL
JUST FOLD IT BACK UP AND PRETEND
IT'S STERILE AGAIN.

SO, DRAMA CLASS,
BUT AT LEAST YOU GET
THE IDEA OF HOW IT WORKS.

OKAY, SO YOU'RE GOING TO GATHER
UP A STERILE FIELD

AND THEN WHAT I AM GOING TO HAVE
YOU DO IS PUT A FOUR BY FOUR
ON THERE.

WE ARE ONLY GOING TO DO ONE
THING, SO THAT YOU'RE
LEARNING PRINCIPLE.

WE DON'T HAVE A DRESSING TO
CHANGE IT THIS PARTICULAR WEEK.

AND THEN WE ARE GOING TO PUT ON
STERILE GLOVES, REACH IN TO OUR
STERILE FIELD

AND YOU'RE GOING TO HAND YOUR
INSTRUCTOR A STERILE
FOUR BY FOUR.

THAT'S HOW YOU PASS.
YOU'LL SEE THAT THERE IS A LOT
OF ASTERISKS ON THIS ONE.

THAT'S IT. IT MAYBE THE WHOLE
THING BECAUSE IF AT ANY POINT
IT'S CONTAMINATED

THEN IT'S NOT STERILE ANY MORE
AND THAT'S THE WHOLE POINT.

ALRIGHT, JUST SET UP YOUR
STERILE FIELDS.

BUT THE THING YOU GOT TO DO IS
OPEN UP THE PACKAGE.

THERE IS A TOP OF THE PACKAGE --
WE TALKED A LITTLE BIT
ABOUT THIS

WHEN YOU DID THE DRESSINGS
BEFORE WHEN WE DID OUR
NO-TOUCH TECHNIQUE.

WE ARE GOING TO OPEN
IT UP THE SAME.

YOU WANT TO PEEL IT OPEN...

AND THEN STRETCH IT DOWN.

ALRIGHT, EVERYTHING INSIDE THAT
PACKAGE IS STERILE.

SO THEORETICALLY, I HAVE A
STERILE FIELD INSIDE MY PACKAGE.

SO IF YOU'RE NEEDING
A LITTLE MORE SPACE

OR YOU JUST WANT TO PUT
SOMETHING ON THERE,
USE YOUR PACKAGE.

SOMETIMES, I DON'T NEED ALL THAT
AND IT'S IN THE WAY AND I WILL
TOSS IT OUT.

INSIDE THAT STERILE PACKAGE IS
MY DRAPE

AND I AM LOOKING FOR AN EDGE
WITH WHICH I CAN PICK THIS UP,
BUT I CAN'T SEE IT.

IT'S ON THE OTHER SIDE,
AND YOU PROBABLY CAN SEE IT.

SO I AM GOING TO CLOSE THIS,
FLIP IT OVER AND THERE IT IS.

OKAY?

WHAT I WANT TO DO IS I WANT TO
GRAB A CORNER OF THIS,

THE EDGE OF THE DRAPE BECAUSE
WHAT'S THE RULE ABOUT A STERILE
FIELD? WHAT'S CONTAMINATED?

- ONE INCH BORDER.

SO I CAN TOUCH A CORNER WITHIN
THE ONE INCH BORDER.

SO I AM GOING TO REACH IN...

AND PULL WAY UP.

NOTICE I AM NOT DRAGGING ON HERE
BECAUSE THEN WHAT IS IT?

CONTAMINATED.

SO SINCE IT'S DRAMA CLASS,
WE'RE BACK ON HERE GOING OOPS.

OKAY, IT'S ALL STERILE.

I AM GOING TO GRAB FROM THE TOP
KEEPING IT NICE AND HIGH ABOVE
MY WAIST

AND IN MY SIGHT AND I AM GOING
TO OPEN THIS THING UP.

RIGHT NOW I'M GOING
TO OPEN UP --

THE NEW ONES ARE ALWAYS
SO VERY STICKY.

I AM NOT HAVING VERY GOOD LUCK.

WELL, OKAY.

I HAVE A COUPLE OF OPTIONS HERE,
IT'S NOT OPENING.

I KNOW THE RULE OF MY STERILE
FIELD IS EVERYTHING THAT FALLS
BELOW THE FIELD

I MEAN, BELOW THE TABLETOP IS
CONTAMINATED, RIGHT?

SO I CAN SWEEP THIS OUT AND JUST
LET IT FALL

AND I WILL DEAL WITH IT AND JUST
HAVE A LITTLE SHORT FIELD,

OR I CAN ROTATE,

NOT TO BE OUTDONE BY A PIECE OF
PAPER, AND GET THE CORNER.

SEE WHAT I AM DOING?

NOTHING IS EVER CONTAMINATED,
SO I CAN ROTATE AROUND.

NOW, I NEED TO THROW THIS OUT
LIKE THIS AND DROP IT DOWN LIKE
THIS.

SO THAT THAT WHOLE SURFACE IS
CONSIDERED STERILE AND I HAVE
ONLY TOUCHED ONE INCH CORNERS.

WHAT WOULD HAPPEN IF I WENT LIKE
THIS?

WHAT RULE HAVE I BROKEN?

- YOU'VE CROSSED OVER.
- I HAVE CROSSED OVER.

SO WHEN YOU PULL UP. YOU THROW
OUT AND DOWN, SO THAT YOU'RE NOT
CROSSING OVER YOUR FIELD

BECAUSE YOU'RE CONTAMINATED.

OKAY, THERE IS ONE OTHER
TECHNIQUE I WANT TO SHOW YOU
BEFORE WE GO ON

AND IT'S JUST THE
SIMPLE UNFOLD TECHNIQUE,
WHICH WORKS JUST AS WELL.

BUT WE ARE GOING TO DO THE
PULL UP TECHNIQUE.

YOU COULD PULL THIS AND UNFOLD
THIS, RATHER THAN SWEEP IT.

BUT THE THING I DON'T LIKE ABOUT
WHAT HAPPENS WHEN YOU UNFOLD

AND I DON'T KNOW IF YOU COULD
APPRECIATE IT, BUT THIS EDGE
TOUCHED DOWN

AND THEN THIS EDGE AND CAME BACK
UP AND TOUCHED THE INSIDES.

SO WHAT'S CONSIDERED ONE INCH
CONTAMINATED

ACTUALLY TOUCHED INTO WHAT'S
SUPPOSED TO BE STERILE.

IT DIDN'T STAY FLAT.

SO WHEN I PULL UP I HAVE A
BETTER CHANCE OF IT NEVER
TOUCHING.

OKAY, MY FIELD IS DOWN.

I AM STILL NOT STERILE, RIGHT?

I AM JUST A HAND WASHED PERSON.

BUT I NEED TO GET MORE STERILE
SUPPLIES ON THERE,

SO I AM GOING TO OPEN UP
MY FOUR BY FOUR,
JUST LIKE WE DID BEFORE.

PEEL IT APART.

NO. I DON'T LIKE HOW THAT OPENED
BECAUSE IT RIPPED.

AND IT RIPPED THROUGH AND IT'S
TOUCHING INTO MY GAUZE.

NO GOOD. ALWAYS BRING EXTRA WHEN
WE ARE DOING STERILE TECHNIQUE.

THERE ARE EIGHT MILLION WAYS TO
CONTAMINATE A STERILE FIELD OR
STERILE SUPPLIES

AND YOU NEED TO BE PREPARED
FOR THAT. IT HAPPENS.
ALWAYS TAKE EXTRA.

SO I AM GOING TO RE-PEEL. AND
SOMETIMES I KIND OF SHIMMY IT.

I THINK YOU SAW ME DO THAT AND I
AM GOING TO PEEL IT APART AGAIN.

TRY NOT TO RIP THAT THING.

BEAUTIFUL.

OKAY, NOW I NEED TO GET THIS ON
TO THAT FIELD WITHOUT CROSSING
OVER OR CROSSING IN.

SO I AM GOING TO TOSS IN LIKE
THIS, RATHER THAN LIKE THIS.

SEE THE DIFFERENCE?

BECAUSE IT GOES IN.

NOW INTERESTING THINGS HAPPEN
WHEN YOU THROW FOUR BY FOURS
ONTO FIELDS.

OH, LOTS OF INTERESTING
THINGS HAPPEN.

BRING EXTRA.

THEY GO FLYING OR I AM STARTING
TO RUN OUT OF SUPPLIES.

WHEN YOU DO IT -- I DON'T KNOW
IF I CAN DO THIS IF I PLAN IT...

WHAT HAPPENS IF IT
LANDS LIKE THAT?

NO GOOD. WHAT ARE YOU GOING
TO DO WITH THAT ONE?

- LEAVE IT.
- LEAVE IT.

BECAUSE WHAT IS THE TOP OF IT?

STERILE. JUST EXTENDS YOUR
STERILE FIELD.

YOU JUST CAN'T USE THAT ONE FOR
YOUR DRESSING

BECAUSE THE BOTTOM SURFACE IS
CONTAMINATED, OKAY?

ALRIGHT, SO I HAVE MY STERILE
FIELD, I HAVE MY ONE GAUZE
THAT I NEED

AND IT WOULD BE SILLY TO SET UP
A WHOLE FILED FOR ONE GAUZE

BECAUSE ALL YOU NEED TO DO
IS OPEN A PACKAGE.
BUT YOU GET THE IDEA.

YOU WOULD BE TOSSING ON ALL THE
STUFF THAT YOU NEED FOR WHATEVER
YOU'RE PLANNING TO DO.

OKAY.

IF I NEED TO MOVE THINGS,
I CAN COME UNDERNEATH.

I CAN MOVE AROUND.

I CAN DO -- ABOUT THAT'S IT.

THERE IS NOT A LOT YOU CAN DO
WITH THE STERILE FIELD IF YOU
NEED TO MAKE AN ADJUSTMENT.

ALWAYS WORK FROM UNDERNEATH.
ALWAYS WORK FROM AN EDGE
OR GO TO THE OTHER SIDE.

DON'T REACH AROUND
TO CHANGE THINGS.

IF IT GOT WET YOU WOULD HAVE TO
REMOVE IT.

AND THE OTHER RULE ABOUT A
STERILE FIELD IS THEY WANT IT TO
BE ABOUT WAIST HIGH.

THEY DON'T WANT IT TO BE LOW --
THEY, WHOEVER WRITES THE STERILE
FIELD RULES.

BELOW YOUR WAIST AND IT HAS TO
STAY WITHIN YOUR SIGHT.

THIS IS NO LONGER STERILE.

COS SCOTTY COULD HAVE JUMPED UP
AND THROWN SOMETHING ON THERE
AND I DIDN'T KNOW.

BY THE SAME TOKEN MOST OF US
DON'T SABOTAGE EACH OTHER'S
FIELDS,

BUT THINGS CAN FALL OUT OF THE
AIR VENTS AND YOU DON'T KNOW,
UNLESS YOU'VE GOT AN EYE ON IT.

SO AND YOU DON'T HAVE TO BE LIKE
THIS, BUT IT HAS TO BE
LIKE THIS.

I MEAN WHEN YOU WORK, IT HAS TO
BE IN YOUR PERIPHERY.

SO THAT YOU KNOW WHAT'S
HAPPENING AND YOU CAN PROTECT
THE INTEGRITY OF THAT FIELD.

RIGHT, BEFORE I CAN GET ANYTHING
OUT OF THAT FIELD I NEED TO PUT
ON STERILE GLOVES.

SO TO PUT ON STERILE GLOVES.
I AM GOING TO OPEN THEM UP,
JUST LIKE BEFORE.

DOESN'T MATTER IF
THIS IS RIPPED.

CAN'T REALLY USE IT FOR A FIELD.

BECAUSE WHAT I AM LOOKING FOR IS
THE INSIDE PACKAGE THAT NEEDS TO
BE STERILE.

ALRIGHT, YOU'RE GOING TO GET
THREE PAIRS OF STERILE GLOVES
WHEN YOU BUY YOUR KITS.

YOU NEED TO KNOW YOUR SIZE FOR
YOUR STERILE GLOVES.

THEY COME IN SIZES, NOT SMALL,
MEDIUM AND LARGE.

THEY COME IN REAL SIZES LIKE
SIX AND A HALF, SEVEN,
SEVEN AND A HALF,

EIGHT, EIGHT AND A HALF, NINE.
I WOULD RECOMMEND --

WE ARE GOING TO PUT SOME OUT FOR
YOU TO TRY ON SO THAT YOU CAN
GUESS YOUR SIZE.

DON'T TRY TO GET THE PERFECT
SNUG FIT

BECAUSE YOU'RE GOING TO REUSING
THESE GLOVES OVER AND OVER,

THROUGHOUT THIS SEMESTER
FOR OUR DRAMA CLASS.

YOU'RE GOING TO PRACTICE AND
THEN YOU'RE GOING TO USE THEM
AGAIN.

YOU WANT THEM A LITTLE BIT
BIGGER SO THAT YOU CAN GET THEM
ON AND OFF.

YOUR HANDS ARE GOING TO GET
SWEATY WHEN YOU'RE NERVOUS
IN TESTING.

AND WHEN THEY ARE TOO TIGHT,
OH, IT'S HORRIBLE.

LET ME HELP YOU WITH YOUR SIZES.

IF YOU NORMALLY WEAR SMALL
GLOVES, THE NON-STERILE GLOVES

THAN YOU'RE GOING TO BE LOOKING
AT SIZES SIX AND A HALF, SEVEN,
MOST NORMALLY.

I WEAR A SNUG.
I LIKE SMALL GLOVES
AND SEVEN IS MY BEST SIZE.

SO SEVEN AND A HALF IS WHAT YOU
SHOULD GET FOR TESTING.

GO UP A HALF A SIZE.

IF YOU'RE MEDIUM PERSON, YOU'RE
GOING TO BE IN THE SEVEN AND A
HALF, EIGHT.

IF YOU LIKE THE MEDIUM GLOVES,
SO MAYBE YOU NEED TO GO TO THE
EIGHT, EIGHT AND A HALVES.

AND IF YOU'RE A LARGE HAND,
YOU'RE GOING TO BE THE EIGHT AND
A HALVES POSSIBLY THE NINES.

AND WE ONLY HAVE NINES, SO
YOU'RE OUT OF LUCK IF YOU NEED
ANY BIGGER THAN THAT.

SO GO UP A LITTLE BIT MORE SO
THAT THEY SLIDE ON.

ALRIGHT YOU HAVE YOUR LITTLE
STERILE PACK HERE.

WE ARE GOING TO OPEN IT UP

AND INSIDE THE PACK IT TELLS YOU
THAT YOU HAVE A LEFT HAND
AND A RIGHT HAND.

YOU'RE GOING TO TAKE
THE LITTLE FLAPS.

YOU'RE GOING TO GRAB THEM AND I
HAVE TO BE CAREFUL NOT TO
CONTAMINATE MY FIELD HERE,

SO I AM GOING TO GO LIKE THIS.
I AM GOING TO OPEN AND PULL...

APART.

SO MY STERILE GLOVES ARE SITTING
THERE, BUT I AM NOT STERILE.

WHEN YOU'RE PUTTING
ON STERILE GLOVES,

YOU NEED TO HANDLE ONLY THE
INSIDE OF THE GLOVE WITH YOUR
NON-STERILE HANDS.

SO I AM GOING TO PICK UP THE
FIRST GLOVE WITH MY NON-DOMINANT
HAND,

SO THAT I CAN GLOVE MY DOMINANT
HAND FIRST.

NOTICE THAT I AM PICKING IT UP
BY THE CUFF.

THEY ARE CUFFED OVER SO THAT THE
INSIDE NOW IS ON THE OUTSIDE.

I'M GOING TO TAKE MY HAND,
SLIDE IT IN.

NOTICE WHERE MY HANDS ARE, ABOVE
MY WAIST AND ABOUT 10 TO 12
INCHES AWAY FROM MY BODY,

UP AND OUT SO THERE IS NOTHING
FOR ME TO TOUCH,
TO GET CONTAMINATED

AND NOTHING TO INADVERTENTLY
HIT ME.

IF YOU KEEP WORKING
IN LIKE THIS,

YOU TOUCH THINGS
AND YOU BRUSH YOUR UNIFORMS.

LIKE THIS, UP AND OUT.

ABOVE YOUR WAIST, UP ABOVE,
GET IT AT EYE LEVEL.

I HAVE ONLY TOUCHED THIS INNER
CUFF AND I CAN PULL IT EVEN DOWN
A LITTLE BIT.

NOW THIS HAND IS STERILE, BUT I
GOT TO GET A NON-STERILE HAND
INTO IT.

HOW DO I DO THAT?

I AM GOING TO TAKE MY STERILE
HAND AND SLIDE IT.

I CAN PICK UP THE GLOVE
ANYWHERE.

I CAN TOUCH THE INSIDE WITH THIS
HAND RIGHT NOW,

BUT I AM SLIDING MY HAND INTO
THE CUFF,

SO THAT IT IS STILL PROTECTED
AND STERILE

AND I AM GOING TO PUT MY
NON-STERILE HAND INTO THIS.

WATCH YOUR THUMBS.

BE CAREFUL ABOUT GRABBING LIKE
THIS BECAUSE YOU'LL HIT YOURSELF
WITH YOUR THUMBS.

SO ONCE I HAVE GOT MY HAND IN
THE CUFF, WELL, I PUT MY THUMB
WAY OUT.

LOOK WHERE MY HANDS ARE.

HIGH. EYE LEVEL.

THEN -- OH, MY GOODNESS.

THEY ARE ALL WHACKY.

AND THAT HAPPENS, BUT AT THIS
POINT NOW BOTH HANDS ARE
STERILE,

SO I CAN READJUST HERE
AND GET MYSELF SETTLED
AND I CAN POP THEM.

IF THEY ARE KIND OF WADDED UP,

IF YOU'LL TAKE THEM
AND POP THEM IN THE MIDDLE,

THE AIR WILL RELEASE THE WAD
AROUND YOUR WRIST.

WHEN YOU'RE DOING A
BEDSIDE TECHNIQUE

AND YOU'RE JUST USING YOUR HANDS
TO INTRODUCE A DRESSING ONTO A
CLIENT,

I DON'T WORRY A LOT ABOUT THE
WAD AROUND MY WRIST

BECAUSE I DON'T WORK
WITH MY WRISTS.

I WORK WITH MY HANDS.

SO DON'T FUSS WITH IT
AND RISK TOUCHING YOUR WRIST
WITH YOUR THUMB.

OKAY, I AM STERILE,
HANDS ABOVE MY WAIST,
AT LEAST 10 TO 12 INCHES.

IF I AM NOT DOING ANYTHING AND I
AM WAITING FOR A MINUTE,

I HOLD MY HANDS TOGETHER
ABOVE MY WAIST AND OUT,

SO THAT I DON'T TOUCH ANYTHING.

ONCE YOUR GLOVES ARE ON AND YOU
KNOW YOU'RE STERILE,

YOU'RE GOING TO REACH IN
TO YOUR STERILE FIELD

BECAUSE I AM STERILE NOW
AND I CAN REACH IN.

YOU'RE GOING TO GET YOUR STERILE
FOUR BY FOUR AND HAND IT TO THE
INSTRUCTOR.

TA-DA. YOU'RE DONE.

OKAY, THERE IS ONE OTHER RULE
ABOUT STERILE FIELDS THAT YOU
NEED TO KNOW.

IF ANYONE TELLS YOU
THAT YOU'VE CONTAMINATED,
YOU HAVE CONTAMINATED.

EVEN IF YOU DON'T BELIEVE
THAT YOU DID,

EVEN IF YOU DIDN'T FEEL
YOURSELF TOUCH SOMETHING,
YOU'RE CONTAMINATED.

IT'S THE RULE.

YOU CAN'T ARGUE.

YOU CAN'T CONTINUE ON.

YOU CAN'T.

WHEN I FIRST STARTED TEACHING I
TOLD A STUDENT SHE CONTAMINATED

COS SHE REALLY HAD CONTAMINATED
AND SHE LOOKED AT ME AND SAID,
"NO I DIDN'T."

OH, SHE WAS MAD.

I SAID, "YES, YOU DID."
"NO I DIDN'T."

I WILL TELL YOU RIGHT NOW, YOU
DO THAT TO ME AND YOU'RE GETTING
A ZERO.

SHOCKED ME THE FIRST TIME.

SECOND TIME GETS A ZERO.

AND HERE'S A REASON, ONE, IT'S
VERY DISRESPECTFUL,

AND TWO, SHE BROKE ALL THE RULES
OF STERILE TECHNIQUE.

WHAT ARE YOU GOING TO DO?

PAW THOSE CONTAMINATED HANDS
INTO SOMEBODY
AND TAKE CARE OF THEM.

YOU POOR EXCUSE FOR A NURSE.

IT'S WRONG. IT'S JUST WRONG.

NOW, I WANT YOU TO APPRECIATE
AND UNDERSTAND.

YOU'VE PROPERLY WATCHED ER,
HAVEN'T YOU? AND MEDICAL SHOWS?

AND YOU KNOW HOW THEY TREAT
THE NEWBIE

AND THE INTERN WHEN
THEY GO TO SURGERY

AND THEY JUST TELL THEM
THEY'VE CONTAMINATED

WHEN THEY HAVEN'T CONTAMINATED
BECAUSE THAT'S THE RULE.

YOU HAVE TO UNGLOVE
AND START ALL OVER.

AND SO THEY DO IT TO JUST TAUNT
THEM AND HAZE THEM OR WHATEVER.

CAN I TELL YOU,
WE WON'T DO THAT TO YOU.

WE DON'T HAVE TIME.

WE DON'T WANT TO.

IF WE TELL YOU, YOU'VE
CONTAMINATED, YOU HAVE.

YOU WON'T BELIEVE SOME OF THEM.

YOU DON'T EVEN KNOW
HOW YOU CAN CONTAMINATE.

THERE ARE SO MANY WAYS.

SO NORMALLY WHEN YOU TEST, WE
JUST LET YOU DO THE WHOLE THING
AND WE NEVER SAY ANYTHING,
RIGHT?

AND WE GRADE YOU AND WE TELL YOU
WHAT WE'VE OBSERVED.

HOWEVER, WHEN YOU DO STERILE
TECHNIQUE, AS SOON AS YOU
CONTAMINATE,

WE WILL TAKE A BREATH
AND WE WILL SEE IF YOU
CAN CATCH YOURSELF,

BUT IF YOU DON'T WE WILL TELL
YOU RIGHT AWAY THAT YOU'VE
CONTAMINATED

BECAUSE WE NEED YOU TO MAKE THE
RIGHT ADJUSTMENT.

WE NEED YOU TO SAY, "I'LL GET A
NEW ONE. I'LL PUT ON NEW GLOVES
OR WHATEVER."

IF YOU CONTAMINATE IN THE
PROCESS OF PUTTING ON YOUR
GLOVES,

THEN WE WILL HAVE YOU RE-GLOVE.

IF YOU PUT ON YOUR GLOVES
PERFECTLY

AND YOU MAYBE BRUSH UP AGAINST
THE BED OR YOU HIT YOUR OUTFIT
OR SOMETHING

THEN WE WILL PROBABLY
JUST HAVE YOU SAY,
"I'VE PUT ON NEW GLOVES."

BECAUSE WE JUST NEED YOU
TO DO THE RIGHT THING
AT THE RIGHT TIME.

AND WE DON'T HAVE TIME FOR YOU
TO RE-GLOVE 8 MILLION TIMES.

BUT WHATEVER WE NEED YOU TO DO,
JUST DO IT TO GET IT RIGHT AS
FAR AS THE SKILL GOES.

ALRIGHT, YOU'RE GOING TO NEED TO
SAVE YOUR GLOVES, SO TAKE THEM
OFF,

PUT THEM ALL BACK TOGETHER AND
MAKE YOURSELF A NICE CUP, PUT
THEM IN, FOLD THEM UP

AND VOILA! YOU GOT STERILE
GLOVES AGAIN.

OKAY SO KEEP SAYING IT.
SAME THING WITH THIS.

YOU WANT TO MAKE SURE TO SAVE
YOUR PACKAGES.

REFOLD THESE LIKE YOU GOT THEM.

PUT THEM BACK IN, SAVE IT,
VOILA, YOU'RE STERILE AGAIN.

ALRIGHT. ANY QUESTIONS
ON THAT ONE?

OKAY, WE WANT YOU TO DO STERILE
GLOVES AT THIS STATION AND AT
THIS STATION THAT YOU GO TO,

THIS IS WHERE YOU'LL BE GRADED
ON STERILE GLOVING,

THAT'S THE SHEATH THAT'S JUST
STERILE GLOVING.

SO WE HAVE ONE OTHER STATION
WHERE YOU'RE GOING TO DO ONE
OTHER KIND OF STERILE FIELD

AND IT'S FOR YOUR CENTRAL LINE

AND IT'S WORKING WITH PACKAGES
AND THE INSIDE OF THE PACKAGES
ARE CONSIDERED STERILE

SO WHY WOULD YOU PUT UP ALL THAT
FIELD FOR NO REASON WHEN YOU CAN
JUST WORK OUT OF PACKAGES.

SO I LEFT MY GLOVES.

NOTICE THAT I HAVE A LOT OF
EXTRA SUPPLIES

AND I ALWAYS TAKE AT LEAST TWO
GLOVES WHENEVER I DO ANY
PROCEDURE

BECAUSE AGAIN YOU DON'T KNOW.

SOME OF YOU'LL CONTAMINATE TWO
OR THREE TIMES, SO AT THE END OF
THE DRILL I WILL SAY,

"SO HOW MANY TIMES
DID YOU CONTAMINATE?"
AND YOU'LL GO, "THREE."

AND I AM JUST GO, THEN BRING
THREE GLOVES WHEN YOU GO TO DO
YOUR SKILLS.

YOU KNOW IT'S JUST TO MAKE YOU
AWARE YOU NEED EXTRA BECAUSE
THINGS HAPPEN.

DON'T EVER GO TO ANY SKILL
WITHOUT MORE -- I MEAN, WITHOUT
LESS THAN TWO, IT'S GOOD LUCK.

IF YOU TAKE TWO, YOU PROBABLY
WON'T USE IT,

BUT IF YOU DON'T TAKE IT YOU'RE
GOING TO NEED IT, I PROMISE.

OKAY, MOST OF THOSE
I DON'T EVEN THINK THEY
HAVE HIGH FIVE PROPERTIES.

WE TALKED BOUT WASHING HANDS --
I MEAN STERILE TECHNIQUE,

MOST OF THE TIME NEEDS
A DOCTOR'S ORDER,

BUT YOU CAN INSTITUTE THAT
WITHOUT A DOCTOR'S ORDER

BECAUSE YOU WANT IT TO BE A
SPECIAL THING.

ON THIS PARTICULAR EXERCISE
YOU'RE GOING TO CHANGING A
CENTRAL LINE DRESSING.

WE'RE GOING TO TALK MORE ABOUT
CENTRAL LINES WHEN WE DO IV
THERAPY,

BUT A CENTRAL LINE IS AN IV THAT
GOES IN TO THE HEART.

ITS THREADED INTO
THE HEART CAVITY.

SO THE DRESSING HAS TO PROTECT
THAT EXIT PORT SPOT FROM
MIGRATING BACTERIA.

YOU HAVE TO HAVE AN INCLUSIVE
DRESSING, SOMETHING THAT DOESN'T
ALLOW BACTERIA TO GET INTO IT.

SO IT NEEDS TO BE STERILE AND
MOST TYPICALLY WE DO A
TRANSPARENT DRESSING

THAT LOOKS LIKE THIS. AND I'LL
TRY TO GET HIM SITUATED
HERE IN A SECOND.

SO YOU'RE GOING TO CHECK YOUR
DOCTOR'S ORDER TO SEE WHAT KIND
OF DRESSING THE DOCTOR WANTS.

THEY WILL EITHER HAVE YOU DO A
TRANSPARENT DRESSING

OR THEY WILL HAVE YOU
DO A GAUZE DRESSING.

EVERYONE IN THE VALLEY RIGHT NOW
IS DOING TRANSPARENT DRESSING,

EXCEPT ONE OF THE
CANCER PHYSICIAN'S

AND HE ABSOLUTELY WILL NOT LET
YOU DO A GAUZE DRESSING.

IT WAS INTERESTING A STUDENT A
FEW YEARS AGO HAD LEUKEMIA

AND SO SHE DROPPED OUT OF THE
PROGRAM FOR A LITTLE WHILE

AND SHE HAD GONE THROUGH THE
TREATMENT FOR LEUKEMIA AND THEN
CAME BACK TO TALK TO ME.

AND SHE SAYS I JUST WANTED TO
TELL YOU WHAT HAPPENED WITH MY
CENTRAL LINES.

SHE HAD -- THEY PUT
IN A HICKMAN.

AND HICKMAN IS A LINE THAT IS
SURGICALLY IMPLANTED, IT STARTS
HERE,

THERE'S AN ENTRANCE AND IT'S
THREADED INTO THE HEART

AND THEN IT ACTUALLY GOES
UNDERNEATH THE SKIN FOR A WHILE
AND HAS AN EXIT PORT.

AND THE WHOLE POINT OF THAT IS
THAT GERMS DON'T MIGRATE.

THEY ARE NOT ABLE TO GET TO THE
HEART IF THEY GOT ALL THAT SKIN,

THEY GOT TO TRY TO
PASS THROUGH IT,

AND THE IV LINE HAS
A LITTLE MESH ON IT,
AN ANTI BACTERIAL MESH

UNDERNEATH THE SKIN THAT TRAPS
MIGRATING BACTERIA.

AND THE PURPOSE OF THESE CENTRAL
LINES IS THAT THEY LAST FOR
WEEKS AND MONTHS

AND FOR SOME YEARS DEPENDING ON
WHAT KIND OF LINE THEY PUT IN.

SO SHE HAD HER LINE FOR A FEW
WEEKS AND SHE HAD GONE HOME

AND SHE HAD BEEN DOING THE GAUZE
DRESSING, THAT'S WHAT THEY HAD
HER DO IN THE HOSPITAL

AND SHE HAD BEEN COVERING THAT
EXIT SITE WITH GAUZE.

SHE WENT IN TO SEE A NURSE AT
THE HOSPITAL TO DO A FOLLOW UP
VISIT

AND THE NURSE GOES, "WHY ARE WE
DOING GAUZE DRESSING? WE ALWAYS
DO TRANSPARENT DRESSING."

AND SO SHE TOOK THE GAUZE OFF
AND SHE PUT A TRANSPARENT
DRESSING ON.

THE VERY NEXT DAY SHE SAID I
STARTED HAVING PUS COMING OUT OF
MY EXIT SITE

AND THEY HAD TO PULL THE LINE.

I LOST MY LINE. I WASN'T ABLE
TO GET MY TREATMENT.

I HAD TO GET ANOTHER LINE
AND SO FORTH.

AND THE PHYSICIAN WAS
ABSOLUTELY LIVID.

HE SAYS, "I NEVER USE THE
TRANSPARENT DRESSING.
I USE ONLY USE GAUZE.

THAT'S THE REASON." AND YOU
CAN APPRECIATE HIS FURY.

INTERESTING, AFTER SHE DID
THAT I STARTED TRYING
TO READ THE RESEARCH

AND FIND OUT BECAUSE IT'S
COMMON PRACTICE TO USE THE
TRANSPARENT DRESSING.

AND INTERESTINGLY SOME RESEARCH
THAT WAS DONE LAST YEAR,

CAME OUT TO SAY THAT THEY HAD
CULTURED

AND THEY HAD FOLLOWED THE
CENTRAL LINES WITH BOTH THE
GAUZE AND WITH THE TRANSPARENT

AND THERE WAS NO SIGNIFICANT
DIFFERENCE IN INFECTION
BETWEEN THE TWO.

SO MAYBE IT'S JUST HIS LUCK OF
THE DRAW AND HIS EXPERIENCE,

BUT SO FAR RESEARCH HASN'T BORNE
OUT THAT ONE IS BETTER
THAN THE OTHER.

WE LIKE THE TRANSPARENT DRESSING
BECAUSE WE CAN SEE THE SITE.

IF IT GOT INFECTED AND PUSY
UNDERNEATH THAT GAUZE,

I WOULDN'T KNOW IT UNTIL THE
NEXT CHANGE,

WHEREAS IF IT STARTED TO GET
INFECTED WITH THE TRANSPARENT,

I WOULD PROBABLY PICK UP ON IT A
LITTLE BIT SOONER BECAUSE YOU
CAN SEE THROUGH IT.

IF YOU WERE LOOKING FOR SIGNS
AND SYMPTOMS OF INFECTION,
WHAT WOULD YOU SEE?

- REDNESS.
- REDNESS.

NOT JUST REDNESS, THOUGH.
THEY CAN GET SOME REDNESS
AROUND THE SITE

BECAUSE IT'S THE NATURAL BODY
RESPONSE TO TAKE THOSE WHITE
CELLS TO SOMETHING THAT'S BEEN,

YOU KNOW, PUT INTO THE SKIN THAT
IS NOT NATURAL.

SO ITS GOING TO BE A LITTLE RED
AT THE SITE, BUT IF IT STARTS
GETTING SWOLLEN,

AND HOT, AND FEVERISH
IT MAYBE INFECTION.

WHAT ELSE?

I GAVE YOU THE CLUE.

WHAT HAPPENED TO THAT GIRL?
PUS.

YOU'RE GOING TO SEE PUS.

THAT'S NOT GOOD.
PUS IS NOT GOOD.

REMEMBER THAT, GREEN STUFF
COMING OUT.

IT'S NOT GOOD.

MOST OF THE TIME THEY WILL PULL
THE LINE WHEN THERE'S AN
INFECTION.

I DID WORK IN A COUPLE OF
CIRCUMSTANCES WHERE THEY TRIED
TO SAVE THE LINE,

IT WAS REALLY CRITICAL THAT THE
CLIENT RECEIVED TREATMENT

AND SO THEY TREATED HIM WITH
ANTIBIOTICS TO SEE IF THEY COULD
SAVE THE LINE.

BUT WE EVEN THEN THEY ENDED UP
PULLING THE LINE OUT.

SO YOU WANT TO BE WATCHING
VERY CAREFULLY FOR
SIGNS OF INFECTION.

THERE IS ONE OTHER THING THAT
HAPPENS UNDERNEATH THAT

AND WE ARE GOING TO CHECK IT
WHEN WE TAKE THE DRESSING OFF.

WE'RE NOT ONLY GOING TO LOOK FOR
INFECTION, BUT WE ARE GOING TO
LOOK FOR WHAT WE CALL CREPITUS.

IV'S CAN LEAK INTO THE SKIN AND
THEY CAN -- AIR OR FLUID
CAN GET UNDERNEATH.

AND CREPITUS IS FLUID OR AIR
THAT GETS UNDER THE SKIN,

SO THAT WHEN YOU PRESS ON THE
SKIN YOU CAN FEEL THE SHIFT.

YOU CAN JUST FEEL IT.
YOUR SKIN DOESN'T DO THAT.

AND SO YOU'RE LOOKING
FOR ANY KIND OF...

ANY KIND OF THING THAT'S JUST
WRONG, THAT'S NOT NORMAL AND SO
YOU'RE LOOKING FOR THOSE.

ALRIGHT, WE'VE GOT OUR
DOCTOR'S ORDER.

WE'RE GOING TO DO A TRANSPARENT
DRESSING. WE'VE GATHERED
UP OUR EQUIPMENT.

AND OUR EQUIPMENT IS GOING TO BE
A LITTLE TRASH BAG TO PUT THE
DRESSING IN.

I NEED SOMETHING TO CLEAN THIS
SKIN WITH AND I AM GOING TO

AND YOU'RE GOING TO USE BETADINE
SWABS AND ALCOHOL SWABS.

I WILL PROVIDE THOSE FOR YOU.
I DIDN'T PUT THEM IN YOUR KITS.

I WANT TO SHOW YOU HOW TO OPEN
UP THESE PACKS IF YOU CAN'T FIND
THE SWAB STICKS.

WE NEED OUR
TRANSPARENT DRESSING.

I NEED TAPE TO SECURE THE TUBING
SO IT'S NOT FLOPPING ALL OVER.

AND I NEED MY STERILE GLOVES.

ALSO YOU WANT TO CONSIDER
WEARING A MASK.

MOST OF YOUR HOSPITALS WITH
CENTRAL LINES HAVE YOU
PUT A MASK ON,

SO THAT YOU'RE NOT
INTRODUCING BACTERIA

ONCE YOU HAVE TAKEN THAT
DRESSING OFF INTO THE EXIT SITE.

SO I AM NOT GOING
TO WEAR A MASK,

I AM GOING TO SAY IT BECAUSE YOU
CAN'T HEAR ME TALK WHEN I HAVE
IT ON.

ALRIGHT, I'VE GATHERED
UP MY EQUIPMENT.

I HAVE WASHED MY HANDS.

I HAVE IDENTIFIED MY CLIENT,
GOOD MORNING, I AM GOING TO...

I AM DIANE YOUR NURSE TODAY AND
I AM GOING TO CHANGE YOUR
CENTRAL LINE DRESSING.

SAM SPADE, GREAT.

I HAVE IDENTIFIED MY CLIENT AND
I AM GOING TO PROVIDE PRIVACY

SO DON'T FORGET YOUR HIGH FIVE,
GET BACK TO THAT.

IN MY PREP I'M GOING TO GO AHEAD
AND GET A PIECE OF TAPE READY
HERE TO SECURE.

I'M NOT GOING TO OPEN MY STUFF
UP YET, BUT I AM GOING TO GET
SOME NON-STERILE GLOVES SO THAT
I CAN REMOVE THE DRESSING.

WHEN I REMOVE THE DRESSING I AM
GOING TO DO ALL THE STUFF I
ALREADY TALKED TO YOU ABOUT.

I AM GOING TO LOOK FOR SIGNS AND
SYMPTOMS OF INFECTION AND I AM
GOING TO LOOK FOR CREPITUS

TO MAKE SURE THERE
IS NO DRAINAGE...

REDNESS, FEVER, PAIN.

PAIN IS SOMETIMES THE SYMPTOM OF
INFECTION. IT'S HURTING THEM
AND IT SHOULDN'T HURT THEM.

ALRIGHT, I AM GOING TO...

WILL YOU SIT UP, MR. SPADE? I AM
GOING TO UNDO YOUR GOWN HERE,

SO I CAN GET TO YOUR
LITTLE DRESSING.

THE NURSE THAT PUT THIS ON
DIDN'T A DATE, TIME.

I DON'T KNOW HOW LONG THIS
DRESSING'S BEEN ON

AND IF I DON'T KNOW I AM GOING
TO CHANGE IT UNLESS HE SAYS,

"OH, SHE PUT THEM ON THIS
MORNING AND THEN THE DRESSING
LABEL GOT WADDED UP, SHE FORGOT.

THEN I WOULD CHECK THE CHART OR
SOMETHING AND SEE,
RATHER THAN JUST RIP IT OFF.

THESE DRESSINGS ARE GOOD FOR
THREE DAYS,

UNLESS THEY'VE FALLEN OFF.
WHEREAS GAUZE HAS TO BE CHANGED
EVERYDAY.

AND THAT'S THE DIFFERENCE
BETWEEN THE TWO.

SO I AM LOOKING FOR SIGNS AND
SYMPTOMS OF INFECTION.

I AM GOING TO PRESS HERE AND SEE
IF I FEEL ANY CREPITUS.
EVERYTHING LOOKS OKAY.

I AM GOING TO GO AHEAD AND TAKE
THIS DRESSING OFF.

YOU REMEMBER WITH YOUR
TRANSPARENT DRESSING

THAT IF YOU STRETCH IT WILL
RELEASE ITSELF,

BUT IF THEY TAPED ALONG THE
EDGES IT KEEPS IT
FROM STRETCHING.

SO I AM GOING TO PULL UP FROM
THE EDGE AND TRY TO STRETCH IT.

HOWEVER, THE MANNEQUINS THEY
DON'T STRETCH VERY WELL.

YOU WANT TO PULL THE DRESSING
TOWARDS THE IV LINE,

RATHER THAN RIP IT STRAIGHT DOWN
BECAUSE YOU DON'T WANT TO PULL
THE IV LINE OUT.

OH, THAT WOULD BE A SAD DAY.

SOMETIMES YOU EVEN PUT A LITTLE
PRESSURE ON THE OUTSIDE THE
DRESSING JUST TO STABILIZE IT.

THE DRESS -- THE IV LINES
ARE SUTURED IN.

SO IT'S NOT LIKE THEY'RE GOING
TO SLIDE AROUND,

NEVERTHELESS YOU WANT TO
STABILIZE THAT BASE SO THAT
YOU'RE NOT PULLING IT OFF.

ONCE I HAVE TAKEN THE DRESSING
OFF, I'M GOING TO PUT THAT OLD
DRESSING INTO MY GLOVE

AND THEN GET RID OF IT HERE IN
MY LITTLE BAG.

I AM GOING TO GO AHEAD AND SET
MY TRASH BAG UP

AND YOU CAN PUT IT WHEREVER YOU
THINK ITS CONVENIENT,

BUT IF YOU PUFF IT AGAIN IT WILL
STAY OPEN NICE FOR YOU,

WHEREAS IF YOU DON'T,
THEY TEND TO FLOP.

ALRIGHT, I AM GOING TO SET UP MY
SUPPLIES. I WANT TO OPEN UP MY
TRANSPARENT DRESSING.

AND THE TRUTH OF THE MATTER IS
I REALLY DON'T NEED TO KEEP IT
THAT STERILE

BECAUSE IT'S ALREADY PROTECTED
ON BOTH SIDES.

IT'S PROTECTED HERE SO THE
INSIDE IS STERILE

AND THE SURFACE THAT'S GOING TO
GO AGAINST THE CLIENT IS
PROTECTED BY THE BACKING.

SO IT'S REALLY VERY STERILE.

I AM NOT SEEING A TAB ON HERE
FOR THE DATE, TIME AND INITIALS,

SO I AM GOING TO GET ONE MORE
PIECE OF TAPE FOR MY LABEL.

DON'T WRITE ON CLIENT'S.
IT HURTS AND IT JUST
DOESN'T WRITE WELL.

SO I TRY TO DO WITH
MY WRITING HERE.

AND I AM GOING TO SAY CHANGED --
WHICH IS A TRIANGLE.
CHANGED TODAY. WHICH IS...

WHAT IS TODAY? THE 23RD?

23/04 AT 09 DB.

SO DATE, TIME AND INITIALS ON
YOUR LITTLE TAPE.

ALRIGHT, THE NEXT THING I WANT
TO DO IS GO AHEAD AND GET MY
SWABS READY.

MAKE SURE YOU OPEN UP THE RIGHT
END OF THE STICKS.

SOUNDS SILLY, BUT IF YOU OPEN UP
THE WRONG END,

ALL THE LIQUID FALLS OUT AND OH,
WHAT A MESS ON THE BETADINE.

THERE IS LITTLE TEAR
TABS INSIDE. FEEL THE RIGHT END.

TRY TO KNOCK ALL THE FLUID DOWN
AND THEN I AM GOING
TO OPEN THIS UP,

AWAY FROM ME BECAUSE IT SPITS
BETADINE AND THEN I TRY TO LEAVE
A LITTLE TAB.

I WILL SHOW YOU WHAT I DO.

SQUISH THOSE STICKS OUT SO THAT
YOU CAN GET TO THEM.

AND THEN I TRY TO LEAVE
ME A LITTLE STAND
BECAUSE I THINK IT'S COOL.

BUT IT HELPS ME REACH THOSE
STICKS WITHOUT GETTING MY
STERILE HANDS --

I AM GOING TO PUT GLOVES ON,
ONTO TABLE AND STUFF.

ALTHOUGH THE END OF THE STICK IS
ALL THAT'S GOING TO TOUCH
THE PATIENTS --

SO THE STERILE GLOVES ARE ONLY
TO FACILITATE THIS ACTIVITY AND
NOT INTRODUCE ANY MORE BACTERIA.

I'M NEVER REALLY GOING TO
TOUCH THEM.

SAME THING WITH ALCOHOL STICKS.

ALCOHOL STICKS ARE ONE OF
THE HARDEST THINGS TO FIND
IN THE FACILITIES.

THEY ALWAYS HAVE BETADINE, BUT I
NEVER CAN FIND THESE CRAZY
ALCOHOL STICKS

AND THEY ARE WONDERFUL,
YOU JUST NEED THEM.

SO, AGAIN I'M GOING TO SET
MYSELF A LITTLE STAND

AND GET MY LITTLE STICKS
WHERE I CAN REACH THEM.

HOWEVER, IF YOU CAN'T FIND THE
ALCOHOL STICKS YOU CAN USE
ALCOHOL SWABS.

AND WHAT I DO IS I TEAR IT DOWN
THE MIDDLE

WITHOUT TEARING IT THROUGH SO
THAT MY ALCOHOL IS STICKING OUT

AND I SET MYSELF UP A LITTLE
STAND. SO THAT I CAN GET TO IT.

I CALL THEM MY LITTLE BIRDS.
AND I SAID IT.

MY LITTLE BIRDS ALL OVER HERE
SO THAT YOU CAN GET TO THAT
WITHOUT TOUCHING.

ALRIGHT, I DON'T REALLY NEED IT,
BUT YOU CAN APPRECIATE
WHAT I DID.

OKAY, I NEED TO STERILE GLOVE
AGAIN SO YOU GET TWO CHANCES TO
STERILE GLOVE.

BRING ALL OF YOUR GLOVES.

WE'RE GOING TO REUSE STERILE
GLOVES WHEN WE DO STERILE
DRESSINGS,

AROUND WEEK -- I DON'T KNOW,
AFTER IV.

AND WE WILL USE THEM ONE MORE
TIME TO ACCESS CENTRAL LINE.

SO YOU HAVE THREE ACTIVITIES
THAT YOU'RE USING STERILE GLOVES
FOR, SO KEEP SAVING THEM.

ALRIGHT, YOU'RE GOING TO BE
WATCHING ME.

YOUR JOB, WHENEVER YOU'RE
INVOLVED IN ANY
STERILE PROCEDURES

IS TO WATCH THE PROCEDURE
AND TELL THE PERSON
IF THEY'VE CONTAMINATED.

THAT IS YOUR JOB,
SO YOU WATCH ME LIKE A HAWK.

WE'RE GOING TO PULL AND STRETCH.

IF YOU KIND OF PULL TO GET YOUR
FOLDS OUT --

NOT TOO HARD BECAUSE YOU'LL RIP
THE PACKAGE. IT WILL STAY OPEN.

OKAY, UP AND OUT.

I AM HANDLING IT
BY THE OUTSIDE CUFF.

NOT TOUCHING, GRAB AND STICK MY
HAND IN HERE.

UP AND OUT. NICE AND HIGH.
I SLIDE MY HANDS IN.

NOTICE I HAVE NO RINGS ON.

RINGS ARE A PROBLEM WHEN YOU'RE
DOING STERILE TECHNIQUE.

AND REALLY YOU SHOULDN'T
BE WEARING THEM IN
THE WORKPLACE AT ALL.

BECAUSE THEY HAVE BEEN CULTURING
UNDERNEATH RINGS,

EVEN BANDS AND THEY HAVE
BEEN FINDING BACTERIA,
SO GET RID OF IT.

OKAY, HERE I AM VERY STERILE,

BUT I HAVE GOT TOUCH HIM
WHO'S NOT STERILE.

WHAT'S THE POINT OF MY
STERILE TECHNIQUE?

TO NOT INTRODUCE ANYTHING
TO HIM.

HE'S ALREADY HIM SO
IF I TOUCH HIM WITH HIM
WHAT'S THE DIFFERENCE?

I JUST DON'T WANT TO INTRODUCE
ANYTHING OUTSIDE OF HIM, GOT IT?

ALRIGHT, I AM GOING TO HAVE TO
TOUCH THESE PACKAGES, THOUGH.
SO THAT I CAN GET TO THEM.

SO I AM GOING TO CONTAMINATE
THIS HAND.

I AM GOING TO SACRIFICE THIS
HAND TO HOLD MY PACKAGE

SO THAT I CAN GET TO IT WITH MY
STERILE HAND.

I AM STARTING WITH ALCOHOL.

THE REASON IS YOU'RE GOING TO
CLEAN FIRST WITH ALCOHOL.

ALCOHOL IS CONSIDERED A
DE-FATTING AGENT.

IT GETS THE FATS OFF OF THE SKIN
SO THAT WHEN YOU PUT THE
ANTI-BACTERIAL,

ANTI-MICROBIAL ON WHICH IS OUR
BETADINE, THEN IT WILL
WORK BETTER.

SOME INSTITUTIONS ONLY USE
BETADINE AND SOME USE BOTH.

SO WE ARE GOING TO USE BOTH.

I THINK IT'S A GOOD TECHNIQUE.

I DON'T HAVE ANY REASON TO NOT
USE IT. SO GO WITH WHATEVER YOUR
QUALITY ASSURANCE SAYS.

BUT THE ALCOHOL MUST GO FIRST,

NOT SECOND BECAUSE YOU DON'T
WANT TO CLEAN OFF THE
ANTI-MICROBIAL.

ALRIGHT, I AM GOING TO GRAB BY
THE STICK.

I AM GOING TO LIFT UP THIS IV
LINE A LITTLE BIT

BECAUSE I NEED TO GET TO THE
CENTER, WHERE THE IV IS COMING
OUT.

WHERE I NEED IT TO BE MOST CLEAN
AND GO OUT TO WHAT'S MOST DIRTY.

AND I AM GOING TO GO IN A
CIRCULAR MOTION FOR
ABOUT TWO INCHES...

AND CLEAN. AND TOSS.

- I'LL TAKE ANOTHER ONE.
- IT'S NOT GOING TO BURN HIM?

- NOPE. IT SHOULDN'T.

NEVER HAD ANYONE COMPLAINING
ABOUT IT, NOW THAT YOU SAY THAT.

AND OUT AND THEN A THIRD.

OH, SHOOT, I FORGOT TO CLEAN THE
LINE, BUT I WILL DO THAT WITH
THIS NEXT ONE.

I AM CLEANING -- NOTICE I AM
CLEANING WITH THE FLAT SURFACE.

I'M NOT GOING IN WITH THE
LITTLE POINT BECAUSE YOU
GET BETTER COVERAGE

AND I CLEAN WITH THAT FLAP AND
THEN I AM GOING TO TAKE THE
OTHER SIDE OF SWAB

AND GO UP THE TUBING
AND CLEAN THE TUBING.

I SHOULD HAVE DONE IT WITH THE
OTHER TWO,

BUT I DIDN'T AND IT'S TOO LATE
AND I AM GOING TO MAKE SURE I DO
IT WITH MY BETADIN.

AND THEN THROW IT OUT.

THIS NEEDS TO DRY.

IT'S THE DRYING TIME
THAT KILLS THE BACTERIA.

DON'T FAN. DON'T BLOW.
WAIT IT OUT.

PEOPLE WILL TAKE ABOUT 20
SECONDS TO A MINUTE TO DRY,
MANNEQUINS NEVER DRY.

SO WE ARE GOING TO SAY, IT'S
DRY.

IT'S EASIER IF YOU HOLD THIS AND
WORK CLOSE TO YOUR ENVIRONMENT,

RATHER THAN LEAVE IT ON THE
TABLE AND KEEP TRYING TO PICK UP
AND COME BACK.

SO PUT IT IN YOUR HAND, USE YOUR
LITTLE FINGER TO LIFT AND GO
AGAIN TO THE CENTER.

I TRY TO GIVE MY BETADINES, JUST
A LITTLE SQUEEZE BECAUSE
THEY ARE SOPPY

AND I DON'T WANT BETADINE
RUNNING DOWN THEIR
ARMPITS OR ANYTHING,

SO SQUEEZE IT OUT A LITTLE.

AND THEN AGAIN FROM THE
CENTER...OUT.

AND THEN ONE WIPE HERE.

WHAT YOU DON'T DO IS SCRUB BACK
AND FORTH.

BECAUSE YOU TAKE WHAT'S DIRTY
BACK INTO WHAT YOU NEED
TO BE CLEAN.

SO ALWAYS ONE AND YOU'RE DONE.

SQUEEZE...

OUT ONE.

SQUEEZE. IT'S REALLY GET SOPPY
ON HERE.

SO SEE MY HANDS REALLY NEVER
TOUCH, BUT THEY ARE IN THE FIELD

AND SO THAT'S WHY WE KEEP THEM
STERILE.

AND WE'RE GOING TO GO ON HIS
BACKSIDE AND OUT.

ALRIGHT, LET IT DRY.

AT THIS POINT I DON'T REALLY
NEED TO BE STERILE ANY MORE
BECAUSE THIS IS ALREADY STERILE.

WHEN YOU'RE WORKING WITH YOUR
TEGADERM -- THAT'S DRYING. I CAN
START GETTING MY STUFF READY.

YOU WANT TO TAKE OUT THIS
MIDDLE PIECE AND SO YOU'LL
HAVE YOUR FRAME.

LEAVE THE FRAME.

I GAVE YOU TWO PIECES OF
TEGADERM WHEN YOU CHECK YOUR
KITS,

ONE TO PRACTICE WITH,
AND ONE TO BRING TO TESTING.

OKAY SO YOU'LL NEED THAT OTHER
ONE BECAUSE I DON'T HAVE ENOUGH
FOR EVERYONE, EXCEPT FOR THESE.

ALRIGHT, THEN WE ARE GOING TO
PEEL OFF THE BACK

AND I AM NOT GOING TO TOUCH THIS
SURFACE BECAUSE I NEED THAT TO
BE STERILE.

THE FRAME KEEPS THAT FROM
PUFFERING ON ITSELF.

I'M GOING TO GO AHEAD AND LAY
THIS ON,

SO THAT I CAN SEE THE IV LINE
RIGHT IN THE MIDDLE

AND LAY IT FLAT AND PUT ALL MY
EDGES DOWN NICE AND SMOOTH

BECAUSE YOU DON'T WANT
WRINKLES IN THERE.

AND THEN THERE SHOULD BE A
LITTLE EDGE RIGHT HERE AND AS
YOU'RE PULLING THIS EDGE OFF --

THIS IS COMING OFF
VERY GOOD HERE.

HOW ARE YOU DOING THERE,
MR. SPADE?

I AM ALMOST DONE.

SMOOTH THOSE EDGES SO THAT
THEY ARE NOT WRINKLY
AND THEY WILL STAY ON.

THEN PEEL THE FRAME OFF.

IF YOU GUYS GOT NEW TEGADERMS --
AND I DON'T KNOW WHAT THEY HAVE
SENT YOU.

SOMETIMES THEY HAVE A LITTLE
LABEL THAT'S ON THE FRAME AND
YOU CAN PEEL --

YOU CAN HAVE ALREADY WRITTEN
YOUR DATE, TIME AND INITIALS ON
THAT LITTLE PIECE OF PAPER.

I LOVE THOSE AND THEN JUST STICK
THAT PAPER HERE ON THE EDGE.

BUT THIS ONE DIDN'T HAVE IT.
SO I PUT MY DATE,
MY CHANGED LABEL HERE.

YOU WANT TO PUT YOUR CHANGED
LABEL ON THE DRESSING,

BUT AWAY FROM THE CENTER POINT,

SO THAT YOU CAN SEE IF YOU'VE
GOT ANY SIGNS OF INFECTION,

ANY DRAINAGE, REDNESS,
THAT KIND OF STUFF.

BUT I HAVE MY DATE HERE.

THEN I NEED TO SECURE THIS
TUBING SO IT'S NOT
FLOPPING ALL OVER

AND PULLING MY DRESSING OFF.

WHEN YOU STABILIZE YOUR TUBING,

YOU WANT TO MAKE SURE THAT YOU
STABILIZE IT TO A STABLE POINT
OF THE BODY.

SO I'M NOT GOING TO TAPE IT TO
THE ARM, THAT WILL DO NO GOOD.

SO YOU MAKE SURE THAT YOU TAKE
YOUR TAPE,

I PUT IT ON THE TUBING AND THEN
I STICK IT TO ITSELF
ON THE BACK.

AND THEN I STICK IT ON TO THE
SHOULDER.

THAT WAY THE TUBING
TAKES THE TRAUMA,

RATHER THAN IT GETTING PULLED
OUT OR THE TAPE TAKES THE TRAUMA
WHEN IT GETS TUGGED,

RATHER THAN PULLING ITSELF OUT
OF THE CLIENT.

ALRIGHT, THERE YOU GO.

HOW DOES THAT FEEL?

LOOKS GOOD. SHOULDN'T NEED
TO CHANGE THAT FOR
A COUPLE OF DAYS.

GET YOU DOWN ON HERE.

NOW, THE DOCTOR DOESN'T WANT YOU
TO TAKE A SHOWER YET WITH THAT
BECAUSE OF YOUR IV TUBING.

SO GO AHEAD AND WAIT, WE WILL DO
SPONGE BATHS FOR NOW.

YOU CAN PROBABLY TAKE A TUB BATH
AND GET THE WAIST WET,

BUT YOU STILL DON'T WANT
TO SOAK THAT BECAUSE
THEY CAN'T SOAK THEM YET.

WE USUALLY DON'T LET
THEM SHOWER WITH IV LINES

BECAUSE ITS STILL --
IT'S NOT THAT OCCLUSIVE.

BECAUSE WHERE THE TUBING IS,
IT LIFTS THE DRESSING AND IT'S
GOING TO GET WET.

ALRIGHT, I'M GOING TO GO AHEAD
AND REMOVE MY GLOVES,
CLEAN UP MY AREA.

I ALREADY TOLD YOU ABOUT HOW
OFTEN TO CHANGE THE DRESSING.

I CAN'T THINK OF A THING.

I WASHED MY HANDS AND DOCUMENT.

MAKE SURE YOUR BED'S
IN THE LOW POSITION.

DON'T FORGET ABOUT YOUR BEDS
AND YOUR SIDE RAILS.

BETTER GET THAT BACK INTO YOUR
MIND AGAIN.

AND VOILA! THAT'S IT.

THREE STATIONS.
YOU'RE GOING TO SCRUB.

YOU'RE GOING TO OPEN THAT LITTLE
KIT AND DO YOUR STERILE FIELD,

STERILE GLOVING AT ONE STATION
AND YOU'RE GOING TO COME TO THE
THIRD STATION

AND DO YOUR LITTLE
STERILE THING.

ALL THE MANNEQUINS IN 179 ARE
SET UP WITH CHEST IV LINES,

BUT THEY ARE REALLY FOR TESTING,

YOU KNOW THAT WE WANT FIRST
SEMESTER TO PRACTICE
PRETTY MUCH IN 179.

YOU'VE ALSO BEEN MOVED AGAIN AND
YOUR PRACTICE ROOM IS 182 AND
YOU CAN OVERFLOW INTO HERE.

SO YOU CAN PRACTICE
OFF THIS MANNEQUIN.

BERTHA THERE, SHE DOESN'T HAVE A
CENTRAL LINE,

BUT YOU CAN PRACTICE OFF HIM.

BUT YOU CAN SEE THAT WE HAVE ALL
THESE CHESTS ON THE TABLE
IN THERE

AND THOSE ARE SET UP FOR YOU TO
PRACTICE ON THOSE IF YOU WANT.