In the operation theatre, OT in-charge is instructing about scrubbing to the staff nurse. Which is the correct order of preference-1 Gloves 2. Gown 3. Scrub 4. Check Instrument 5. Gauze count

Appeared in: NORCET -4 , 2023

Explanation

The sequence follows the principles of surgical asepsis, moving from personal cleaning to creating a sterile barrier and then preparing the sterile field.
The first step is always the surgical scrub (3) to ensure hands are as free of microorganisms as possible.
This is followed by donning a sterile gown (2) and then sterile gloves (1) to create a complete sterile barrier for the nurse's upper body.
Once sterile, the nurse can handle sterile items. The instrument table is prepared and instruments are checked (4) for functionality and completeness.
The final step before the incision is the baseline gauze and instrument count (5), a critical patient safety measure performed with the circulating nurse.

Option A: This sequence is incorrect because scrubbing (3) must be the first step. Donning gloves (1) and a gown (2) before scrubbing would contaminate them.
Option B: This sequence incorrectly places the gauze count (5) before the instrument check (4). While both are done after gowning and gloving, the standard workflow is to set up and check the instruments first, then perform the formal count just before the procedure begins.
Option D: This sequence is incorrect because checking instruments (4) is a sterile activity. It cannot be performed before the nurse has completed the surgical scrub (3), gowning (2), and gloving (1).

Visual 1: Flowchart: A step-by-step visual guide of the scrub nurse's preparation sequence, from hand washing to the final gauze count, highlighting key actions at each stage.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Surgical Asepsis and Role of the Scrub Nurse in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Adhering to this strict sequence is fundamental to preventing Surgical Site Infections (SSIs), a major cause of postoperative morbidity. Each step is designed to minimize the introduction of microbes into the surgical wound.
The instrument and gauze counts are a critical safety protocol to prevent Retained Surgical Items (RSIs). An incorrect count requires immediate action, such as an intraoperative X-ray, to locate the missing item before the patient leaves the OR.
What if? If a sterile glove is punctured or contaminated during setup, the nurse must change it immediately. This is done without re-scrubbing by having the circulating nurse assist or by using the open-gloving technique, ensuring the sterile field is not compromised.

How to Approach the Question

First, identify the question type. This is a process-based question that requires knowledge of a standard operating procedure.
Identify the fixed, non-negotiable steps in the sequence. For surgical preparation, the order is always: 1. Scrub, 2. Gown, 3. Glove. In terms of the numbers given, this is 3 -> 2 -> 1.
Use this fixed sequence to eliminate incorrect options. Any option that does not start with '3, 2, 1' can be immediately discarded. This eliminates options A and D.
Evaluate the remaining options (B and C) by considering the logical flow of the final two steps.
Reason that setting up the work area (checking instruments) must happen before the final safety check (gauze count) is performed just prior to starting the procedure.
This logic confirms that the sequence 4 -> 5 is correct, leading to the final answer of 3, 2, 1, 4, 5.

Concept Tested & Keywords

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Practise the full NORCET -4 , 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.