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U.S. 21st Special Forces Group (Rangers Pathfinders Airborne) |
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(Composite Provisional) |
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JUWTF SOG |
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At FORT KAFFENBERGER |
SECURITY CLASSIFICATION: Cleared for Public Dissemination
UPDATED : 23 MARCH 2008
Scrub, Gown, & Glove Procedures
(For Future Physicians & Surgeons, Scrub Nurses, Scrub Technicians, Circulating Technicians, Dentists, Veterinarians, Paramedics, Combat Medical)
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This period of instruction, is placed here for the education of humanity interested in careers in Medicine, Nursing, or Paramedical allied careers. It is provided here by Dr. & Mrs. ALBERT A. KAFFENBERGER, Sr., M.D., "U.S. ARMY Medical Corps" (16 April 1970 - 27 April 2006). Doctor KAFFENBERGER served a 4 year surgical residency training while assigned "regular U.S. ARMY" to the "4th Surgical Hospital" (M.A.S.H.) [or "4th SH(MA)"], later designated as the "4th Combat Support Hospital". Doctor KAFFENBERGER trained in "Orthopedic Surgery" and "Plastic Reconstructive Surgery" techniques, for Soldiers hurt during enemy Combat. Dr. KAFFENBERGER served "The People Of The United States Of America" during "VietNam", after VietNam, and during "Operation Iraqi Freedom". |
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Please, allow me to now introduce our Surgical "Circulating Technician", Operating Room Specialist JOSE. His chosen "Military MOS Code is: 91D". Following JOSE's completion of "Basic Combat Training" (9 weeks of training in "common skills" for ALL Soldiers) , JOSE then went on to 17 weeks of resident specialty "U.S. ARMY Enlisted Medical School", and was then extensively schooled and trained in surgical "operating room" procedures. The U.S. Government paid every dollar of the cost of training JOSE, and all through his schooling (from Day 1 of "Basic Combat Training"), JOSE was paid his salary, which started at over $1,000 per month for a Kid just out of High School (that salary was advanced as he demonstrated satisfactory increases in knowledge, growing skills, and increasing positive attitude and performance in his career). Additionally, the U.S. Government provided (at no charge to JOSE) his housing, his uniforms of clothing for his job, at least 3 good meals per day of cafeteria style food, all of his medical, dental, optical, surgical, pharmaceutical, and veterinary care, for himself, his family, and his pets. JOSE paid $16.50 per month for $400,000 of life insurance, with NO EXCLUSIONS. Further, IF JOSE was killed while in service (very LOW likelihood that such would happen), the U.S. Government would provide everything for JOSE's funeral at NO EXPENSE to his family....even if/when JOSE died as an old "Papa Grande"; an EARNED benefit because of JOSE's "honorable service as a Soldier of the United States Of America". JOSE has earned these "VETERAN BENEFITS" because he has already completed more than 180 consecutive days of active duty honorable service as a Soldier. Further, after successful graduation from "operating technician" school, JOSE was assigned to work in the career that HE had selected to be educated in. After completion of 3-4 years of honorable U.S. Military service, JOSE will have acquired very substantial experience in his career, have been promoted perhaps 3-5 times in rank and pay, and would be able to gain steady civilian employment as a "Surgical Technologist" at $25-40 per hour or more, fulltime work.
JOSE will be our "leading man" for this period of instruction, on how to properly gown for a major surgical procedure.
Note that JOSE is intentionally NOT wearing a surgical gown and sterile gloves (although he often does do so), because in his present role as a "circulating technician" he needs freedom of movement to gather supplies needed by our sterile gowned and gloved "surgical team". Were he to attempt this less restricted movement needed to gather supplies while wearing sterile gown and gloves, any "circulating technician" would quickly CONTAMINATE that gown and gloves by touching numerous NON-STERILE surfaces. Rather JOSE is considered medically CLEAN [a lesser level of STERILITY (freedom from germs)], and can now gather needed supplies, and may open the outer wrappers of STERILE "packs" of supplies and instruments. IF he touches any of the INNER contents, they are considered CONTAMINATED, and can NOT be used for patient care. IF they are 'disposable" then they must be disposed of; IF they are NON-DISPOSABLE, the "contaminated" items are returned to "CMS" (Central Material Supply) for resterilization!
THIS photo (above): JOSE is reaching across a surgical backtable toward a 10 inch tall "sponge forceps jar" [containing fresh BENZALKONIUM CHLORIDE (aka: "ZEPHIRAN") SOLUTION in strength of 1 part in 750 parts distilled water], for a "FOERSTER SPONGE FORCEP", that has been sitting "tips down" into this ZEPHIRAN solution for no less than 30 minutes. Prior to being placed into the jar of Zephiran solution for "cold sterilization", this FOERSTER FORCEP had been sterilized in a STEAM AUTOCLAVE for 30 minutes at over 212 degrees Fahrenheit, OR had been sterilized by gassing it with ETHYLENE OXIDE gas. JOSE will skillfully place his THUMB and MIDDLE FINGER into the finger holes at the upright end of the FOERSTER FORCEPS, and will operate them as needed, to open sterile edges of surgical packs, to move specific items around and onto (the edges only of ) "sterile fields", but will be very conservative in doing so, in order to minimize chances of CONTAMINATION with germs. JOSE will return the FOERSTER FORECEPS frequently to the cold sterilizing Zephiran solution to "zap" germs that may try to hitchhike on the FOERSTER forceps. JOSE will automatically return the FOERSTER FORCEPS to the SPONGE FORCEPS JAR whenever he does not need to be using the FOERSTER FORCEPS. |
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NOTE: Our MASH "Nurse Anaesthetist" (C.R.N.A.) Major CALLENDER seated on her Anaeshetist Stool in the background, at the head of the "Operating Table" near her "Anaesthesia Cart" and her "Heidbrinck's Machine". |
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Please allow me to introduce Sergeant Sharon Hightower, who is our "Scrub Nurse" for the following "operation". A "Scrub Technician" could perform (in these photos) in an identical manner as our "Scrub Nurse" will be; however, SHARON has the advantage of having been fully trained as a "Nurse" before she was trained to assist in Surgery. SHARON has two "Military MOS Codes: 91D and 91C". Her successful completion of Military "91C" school, could authorize SHARON to take the "challenge exams" to become an "Associate Degree Registered Nurse" in certain U.S. States. IF she passes the "Challenge Examinations"(and, as a "91C" there is a good chance that she would), SHARON may then submit her ID Photo and Licensure Fees as a Registered Nurse, and then be licensed by the State Board Of Nursing, to work as an "R.N." in the civilian world. |
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JOSE and SHARON have different "paintjobs" of skin; however, both Soldiers are CHRISTIAN AMERICANS, mature, and both have "enlightened souls" doing GOOD. Therefor, they have worked together many times, and are good friends, honorably serving "The People of The United States Of America". |
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Please note the "MAYO STAND" to the RIGHT REAR of SHARON in the Photo. SHARON will be working from "trays" of "surgical instruments" placed on the MAYO STAND (during the actual surgical operation). |
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As soon as JOSE sees that SHARON has gained "control" of her "sterile surgical gown", JOSE releases the grip he had (with the FOERSTER FORCEPS) on the neck of the gown. |
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Closeup of "jaws" of our FOERSTER SPONGE FORCEPS: Please note the smooth rounded "serrations" on the jaws, that assist in gripping an item, but are designed NOT to rip through or cut through it. |
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Jose now reinserts the tips of his FOERSTER SPONGE FORCEPS into the jar of "Cold Sterilizing Solution". He is careful to NOT touch the Forceps to any part of the Forceps Solution Jar (either outside/top/inner walls), rather he slides the FORCEPS straight down centered into the Sterilizing Solution that the jar contains, then releases his grip of the Forceps, and lets them rest naturally. |
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NOTE: Jose touches only the very border on the back of Sharon's STERILE Surgical Gown, in order to fasten it closed with snaps and ties. The entire back of Sharon's surgical gown is now considered NON-STERILE. Any portion of Sharon's surgical gown below her waistline or near her neck in front, is also considered NON-STERILE (NOT germ free). If Sharon lowers her hands at/near/below her waistline, or touches the neckline or back of her surgical gown, at any time during this operation, Sharon must remove the CONTAMINATED Surgical Gown and her GLOVES, and start over. |
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Jose will remove the expended outer wrapper that the Surgical Gown came in. |
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Jose now produces a STERILE wrapped pair of prepowdered Surgical Gloves, in the correct size for Sharon's hands. The outer wrapper is NOT STERILE. Everything on the INSIDE of the sealed packet of Surgical Gloves is STERILE...... UNLESS Jose or Sharon accidentally CONTAMINATE the inner contents with germs..... Then they have to start over with a fresh pair of Sterile Gloves! We will show you the procedure used to maintain sterility in the following photos. |
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The Surgical Gloves package, has a seal at the TOP of the package, that maintains STERILITY of the GLOVES inside, even though there is a NON-STERILE pull flap on each side of the top. This allows Jose to get a grip on the packet, firmly maintaining his hand grip ONLY on the NON-STERILE outer package wraps and NOT touching anything that is inside. Jose begins pulling the 2 package flaps back away from the inner contents and downward, NOT LETTING GO. |
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Being very careful NOT to touch the inner STERILE Gloves carrier, JOSE holds the entire Surgical Gloves packet by the 2 portions of NON-STERILE outer wrapper that Jose has peeled open. He now extends the packet of Gloves toward Sharon and stops; Jose does NOT touch Sharon with the packet of Gloves. He holds the packet perfectly still, and allows Sharon to grab THE INNER STERILE GLOVES CARRIER ONLY! |
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Sharon carefully pulls the INNER STERILE GLOVES CARRIER slowly ands smoothly straight back without touching it to any outer portion of the NON-STERILE outer Surgical Gloves Packaging. |
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Without touching anything inside, Sharon begins to open the inner packet containing her STERILE Surgical Gloves. |
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Note the folded inner flaps of the package, that keeps the STERILE GLOVES from falling out. |
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Holding securely onto the STERILE pack of Surgical Gloves, Sharon begins to flatten the package out. |
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There are inner flaps on each side; Sharon now begins to unfold the Right flap, to allow her access to the Right STERILE SURGICAL GLOVE. |
Check back...tomorrow, we will put up around 100 more photos on this subject!
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SECURITY CLASSIFICATION: Cleared for Public Dissemination
