The correct answer is C. The first scrub of the day should take 5 minutes. The first scrub of the day is the longest because your hands and arms carry the most contaminants at this point. This answer may be center dependent, so please check with your institutional guidelines.

The correct answer is A. When performing a water-based scrub, the correct order of steps is to scrub the nails, fingers, front of hands, back of hands, and from wrist to elbow. It is important to follow this order to ensure that contaminated water does not travel down from your forearms to your hands.

The correct answer is: C. If your hands or arms become contaminated at any point in the scrub process, you must start over. This is key to preventing surgical site infections.

The correct answer is B. It is important to tilt your forearms upward and allow the water to run from hand to elbow while rinsing. If you tilted your arms downward or kept them parallel, contaminated water from your unclean upper arms could run down and contaminate your forearms and hands.

The correct answer is D. You should scrub to 2 inches above the elbow. The more you clean, the less chance you have of spreading any possible contaminants to your patients. This answer may be center dependent, so please check with your institutional guidelines.

The correct answer is C. You must wear a clean pair of scrubs at the start of your shift. You should change your scrubs anytime they are soiled or contaminated but you do not need to change them after each operation, so E is incorrect. Answers A and D are incorrect because you must put on your surgical mask before you have scrubbed in and anytime a sterile field is established. Answer B is incorrect because you are never allowed to wear jewelry on your hands or wrists when you are in the OR.

The correct answer is D. The first water-based scrub of the day should last 5 minutes. All subsequent scrubs should last 3 minutes. This answer may be center dependent so please check with your institutional guidelines.

The correct answer is C. All of these options are frequent causes of unplanned readmission following surgery, but the leading cause is surgical site infection. See Merkow et al. JAMA (2015) for a paper on the topic.

The correct answer is D. When using a waterless scrub, rub the product in until completely dry so the solution has enough time to take effect and you can get your gown and gloves on easily afterwards. It may be tempting to dry off your hands with a towel, but doing so will remove the scrub solution you have just worked into your skin. Do not wave your hands and arms in the air to dry them as this creates air currents that can disturb dust particles that may stick to your wet skin.

The correct answer is E. None of these items are permitted into the OR except your hospital ID. In order to limit the spread of contaminants in the OR, we must minimize the number of unnecessary items we bring into the room. Drinks and snacks are also prohibited for the same reason and because spills can damage equipment.

The correct answer is D. All of these are steps are appropriate except for ii, because the ties at the back of the gown are unsterile. Always ask an unsterile member of the team to help you do up these ties. This eliminates choices A, C, and E. The correct order is: i. enter the OR with your forearms tilted up, making sure not to touch anything, iii. place your arms into the sleeves of the surgical gown, v. put on gloves, and iv. untie the knot at your front, hand the right end to the scrub nurse, turn, and tie the knot to secure your gown.

The correct answer is B. A is incorrect because you should not touch the front of the mask; infectious material may be transferred onto the front of the mask during an operation. C is incorrect because it is not necessary to have someone else remove your mask. D is incorrect because you must use a fresh mask for each operation.

The correct answer is B. When removing your gloves after a procedure, never touch the outsides of the gloves with your bare hands. This is because the gloves are contaminated from the operation. Answer A is incorrect because when you are gowning on your own, you must only touch the inside of the gown with your bare hands. Answers C and D are incorrect since gloves are not a substitute for hand washing. Answer E is incorrect because it is important to maintain hand hygiene regardless of whether or not you are participating in an operation. It is everyone’s duty to maintain a clean operating room environment.

The correct answer is D. Label A is incorrect because the cuffs are not sterile once gloves are worn over them. Label E is incorrect because this portion of the gown is above the axilla and therefore outside of the sterile portion of the gown. Labels B, C, and D are all sterile.

The correct answer is A. B is incorrect because the gown is always donned before the gloves. C is incorrect because the gloves are the last item to be donned. D and E are incorrect because the sterile field is limited to the front of the sleeves below the axilla (excluding the cuffs) and the front of the gown from the level of axilla to the level of the working surface.

The correct answer is E. After an operation, your gown, gloves, and mask carry possible sources of infection so it is important to remove them in this particular order. By removing your gown first, while your gloves are still on, your skin does not make contact with the outside of the gown. By removing your gloves prior to your mask, you prevent the spread of contaminants from your gloves to your head and neck.

The correct answer is A. After an operation, you should untie the tie at the front of your gown with your gloves on and have an unsterile member of the team untie the ties at the back of your gown. B and C are incorrect because the ties at your back are very difficult to untie without touching your skin or clothing underneath the gown, and you thus would not want to do so with dirty gloves. D is incorrect because your gown is contaminated and must be removed with your gloves still on.

The correct answer is E. If you contaminate your hand or arm, you must re-scrub.

The correct answer is B. Placing the gloves on your sleeve-wrapped hands with the glove’s fingers facing your elbows will allow you to easily put the gloves on by yourself. A is incorrect because the packaging is not sterile. D is correct only if someone is assisting you while gowning. When gowning alone, you need to keep your hands completely inside the cuffs so you can handle the gloves. E is incorrect because you cannot tie the tie your back without becoming unsterile.

The correct answer is C. When gowning, shrug your arms into the gown until your hands are down into the ends of the sleeves and your fingertips are peeking out of the cuffs. A is incorrect because you cannot touch the outside of the gown with your bare hands, so you don’t want to push them all the way through. If you were to push your hands all the way through the gown, you would also be increasing skin and microbe shedding from your skin. B is incorrect because it would be very hard to glove with assistance if your hands were completely within the cuff. D and E are incorrect because you cannot touch the sterile gown with your bare hands. E is also incorrect because the unsterile cuffs of the gown must remain underneath the gloves.

The correct answer is C. In order to make this movement, you need to ensure that your sterile front will not be contaminated by anything and that your unsterile back will not contaminate anything. A is incorrect because your sterile front would be in close proximity to the surgeon’s unsterile back and you could become contaminated. D and E are incorrect because your unsterile back would be in close proximity to the surgeon’s sterile front and the operating table, which could cause contamination.

The correct answer is A. Wearing a sterile back cover if you think your back might come into contact with a sterile object will proactively prevent contamination. Although some centres do not have sterile back covers, this concept remains true. B is false because you must always wear a mask in the OR during an operation. C is false because you do not need to wear surgical gloves unless you are performing a sterile procedure. D is false because you must always change your gloves if they become contaminated. If you are wearing only a single glove you should always ask the scrub nurse for help when degloving to prevent contaminating yourself. E is incorrect because you must always wash your hands after a procedure.

The correct answer is A. If your arm becomes contaminated during a procedure, it needs to be made sterile again. This can be accomplished by wearing a sterile sleeve cover, or alternatively, re-scrubbing and re-gowning. C and D are incorrect because you could not do so without contaminating your sterile gloves.

The correct answer is A. You should always inform someone if you break surgical sterility. This is called surgical conscience. B and C are incorrect because a surgical mask and cap must be worn as soon as a sterile field is established. D is incorrect because glasses are not a substitute for eye protection. E is incorrect because it is everyone’s responsibility to help maintain a sterile field.

The correct answer is B. You should always remain at least 2 feet away from sterile equipment/people when you are in the OR and are not scrubbed in.

The correct answer is C. In this photo the surgeon, OR table, and surgical equipment table are all sterile. If you are in the OR but not scrubbed in, you must not touch these things and remain at least 2 feet away from them at all times.

The correct answer is A. In this situation, you may only rest your hands on a sterile surface such as the draped operating table or the sterile portion of your gown. B is incorrect because your hands would fall below the level of the sterile working surface. C is incorrect because placing your hands on the instrument table places you at risk of a sharps injury. D is incorrect because your back is not sterile.

The correct answer is B. Everyone in the OR is a team. If you see someone break the sterile field without realizing it, let that person or the team leader know right away so they can correct the issue. C and E are incorrect because waiting to report the incident after the operation does not solve the problem and thus puts the patient at risk. D is incorrect because the matter can be handled within the surgical team.

The correct answer is B. When something soaks through your gown, it breaches the layer of sterility that the gown provides. A is incorrect because this only holds true for the front of the gown. C is incorrect because draped tables are only sterile at the level of the table top. This is because the area below the table top is not monitored. D is incorrect because you should always wash your hands when going into an operating room. E is incorrect because only the front tie is sterile when a surgical gown is worn.

The correct answer is C. You must wear a mask whenever a sterile field has been established (i.e. whenever sterile objects or persons are present in the operating room). The mask prevents the spread of infection from you to your patient, and from your patient to you.