SHAGG - Amplified

Overview

SHAGG is the sequence for entering a sterile surgical field. Mastering this allows you to scrub in for theatre and assist with procedures. Each step must be done correctly - one break in technique means starting over.

S - Scrub

Remove watch, rings, roll sleeves

Jewellery harbours bacteria and can perforate gloves. Wedding bands are a common oversight. Sleeves must be above elbows.

3-5 min surgical scrub

The first scrub of the day should be 5 minutes. Subsequent scrubs can be 3 minutes if within a few hours. Use a brush for nails on first scrub only.

Under nails → hands → wrists → forearms → elbows

Work from cleanest (fingertips) to dirtiest (elbows). Each area should be scrubbed systematically - don't backtrack to areas you've already cleaned.

Keep hands above elbows

Water should run from clean areas to dirty areas, then into the sink. If your hand drops below your elbow, contaminated water runs back onto clean skin - start over.

H - Hat

Tuck all hair under cap

All hair means all hair. Sideburns, stray hairs, everything. Hair is a major source of contamination. Some theatres require hoods for beards.

A - Antisepsis (Patient Prep)

Expose surgical site

The surgical team preps the patient after you've scrubbed. Understand the boundaries of the sterile field being created.

Paint from centre outward

Start at the incision site, work outward in concentric circles. Never return to the centre with a used swab - that recontaminates the cleanest area.

Allow to dry completely

Alcohol-based preps are flammable. Diathermy + wet prep = fire. Wait until completely dry. Pooled prep solution under the patient is a hazard.

G - Gown

Pick up gown from inside

The gown is folded so the inside faces you. Touch only the inside surfaces. The outside is sterile.

Arms into sleeves, hands at cuffs

Don't push your hands through the cuffs - keep them inside for closed gloving. Let the circulator tie you from behind.

G - Gloves (Closed Technique)

Keep hands inside sleeves

Your skin is not sterile. By keeping hands inside the gown sleeves, you can manipulate the gloves without contaminating them.

Pick up first glove by cuff

Through the sleeve fabric, grasp the folded cuff of the glove. Lay it palm-down on your forearm with fingers pointing toward your elbow.

Roll over hand using sleeve

Using your other sleeved hand, unfold the cuff over your fingers and pull the glove on. The gown cuff should end up inside the glove cuff.

Common Errors

• Touching face or adjusting mask after scrubbing
• Arms dropping below waist level (below sterile field)
• Backing into a sterile trolley
• Turning your back to the sterile field
• Reaching across the table (creating contamination)