Chapter 57 Surgical Asepsis

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 57

Surgical Asepsis

Chapter 57

Surgical Asepsis


Asepsis, cont.Asepsis, cont.• Dirty: any object that has not been cleaned or sterilized for

removal of microorganisms

• Contaminated: anything that is not sterile

• Clean: medical asepsis

– Devoid of all gross contamination

– Free of many microorganisms

• Sterile: surgical asepsis

– Free of all microorganisms

– Many body parts are clean-not sterile:skin, mouth, GI tract, upper resp. tract

– Sterile body parts: abdominal cavity or ovary, uterus

– Areas like GU system are susceptible to infection even though bladder is sterile


Disinfection Disinfection

• Disinfection

– The process that results in the destruction of most pathogens but not necessarily their spores.

• Methods

– Use of alcohol wipes, a hexachlorophene or chlorhexidine gluconate soap scrub, or a povidone-iodine scrub, surgical hand scrub

– Phenol or chlorine is used to disinfect floors and surfaces.


SterilizationSterilization• Sterilization

– The process of exposing articles to steam heat under pressure or to chemical disinfectants long enough to kill all microorganisms and spores.

– Client usually takes home items such as washbasins, mouth care utensils, and incentive spirometers-these are not reused

• Methods

– Autoclave (uses steam at 18 pounds of pressure at a temperature of 125 C for 15 minutes), chemical disinfectants, radiation, and gas sterilization


Medical Asepsis Medical Asepsis

• Medical asepsis or clean technique

• The purpose of maintaining medical asepsis is to prevent the spread of disease from one person to another.

– Handwashing

– Standard Precautions


Surgical AsepsisSurgical Asepsis

• Surgical asepsis or sterile technique

– All microorganisms and spores are destroyed before they can enter the body.

– Used when administering parenteral medications and performing surgical and other procedures such as urinary catheterization

– Often, clean technique (medical asepsis) is performed using sterile supplies.

– Sterile to clean, dirty, or contaminated becomes contaminated.


Sterile TechniqueSterile Technique

• Sterile technique is used to prevent the spread of infection

– Supplies used for surgical and other sterile procedures

– Anything that either touches an open wound or skin break, enters a sterile body cavity, or punctures the skin

– Surgical towels or drapes are packaged, secured with special masking tape, labeled, and sterilized.

– Never touch sterile articles with unsterile articles!


Key ConceptKey Concept

• Sterile to sterile remains sterile.

• Sterile to clean or dirty becomes contaminated.

• Always think before you touch anything.

– Do not touch sterile articles with unsterile articles


Educating the ClientEducating the Client

• Client and family teaching

– Demonstrate the skill to be performed.

– Ask the client and family to demonstrate the skill before discharge.

– Explain how to recognize problems or complications.

– Describe when to seek medical care immediately.

– If indicated, make a referral for home care nursing follow-up.


Sterile Technique in NursingSterile Technique in Nursing

• Do not touch anything after sterile gloves or gown have been put on.

• Reaching over a sterile field contaminates the sterile area.

• If a sterile wrapper or mask becomes wet, they are no longer sterile.

• When wearing sterile gloves, perform a sterile procedure.

• A person’s back is not sterile. Skin can only be made clean, not sterile.

• When in doubt, consider the objects in question to be contaminated.


Sterile Technique in NursingSterile Technique in Nursing

• The inside of the gown is not sterile, someone else must tie the strings on the gown.

• Any part of the gown below the waist and above the nipple line is contaminated!

• Be sure to keep the hands between the waist and the nipple levels whenever sterile gloves are worn!


Sterile TechniqueSterile Technique

• Hair covering

• Surgical mask and eye protection

• Sterile gown

• Sterile gloves

– Open gloving

– Closed gloving

– Removal of sterile or nonsterile gloves


Procedures Requiring Sterile TechniqueProcedures Requiring Sterile Technique

• Some procedures include:

– Care of the indwelling catheter

– Surgical intervention and invasive procedures

– Sterile dressing change

– Suture and staple removal

– Administration of parenteral medications

– Venipuncture and management of IVs


Urinary CatheterizationUrinary Catheterization

• Procedure of inserting a tube (a catheter) through the urethra into the bladder to remove urine

• Sterile procedure

• Catheter sizes: 14-16 Fr. (usually)

• Insert 2-3 inches in female; 5-7 in male or until urine is visualized

• Straight catheter

– Used for one sample only and removed

• Retention catheter (eg, Foley catheter)

– Indwelling catheter (remains in the bladder)


CatheterizationCatheterization

• Coude tip catheter is used in males if there is prostate enlargement or in the female if abnormal placement of the urinary meatus is suspected

• No more than 750-1000 ml of urine can be safely removed from the bladder at any one time, particularly if the client has retention or distention for a long period.


Urinary CatheterizationUrinary Catheterization

• Self-catheterization

• Catheterizing the female client

– The side-lying position

• Catheterizing the male client

• Caring for the client after catheterization

• Removing the retention catheter


Caring for the Client After CatheterizationCaring for the Client After Catheterization

• Reposition to ensure comfort

• Signal cord within reach

• Balloon of indwelling catheter inflated

• Catheter tubing secured externally

• Patient teaching


Caring for the Client After Catheterization, cont.Caring for the Client After Catheterization, cont.

• Drainage tubing extends straight down from bed level to bag (straight drainage)

– Extra tubing placed on bed with client—allows movement

– Attach drainage apparatus to bed frame (not the side rails)

• Maintain sterility

• Removing the retention catheter


Nursing AlertNursing Alert

• A catheter is never cut for removal.

• This could cause the catheter to be pulled back into the urethra or bladder.

• In that case, surgical removal would probably be necessary.

• This would also be a source for introducing pathogenic organisms into the urinary bladder.

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Chapter 57 Surgical Asepsis