Medical/Surgical AsepsisPresented by:

Cynthia Bartlau, RN, PHN, MSN

Objectives

At the completion of this lesson the student will be able to Discuss concepts related to the chain of infection Differentiate medical and surgical asepsis Discuss equipment used for maintaining medical

and/or surgical asepsis Identify common sources for contamination Describe proper hand placement during aseptic

procedures

Beginning of Modern Asepsis

Previous to the discovery of asepsis many people died due to post-operative (and other) infection

Dr. Ignaz Semmelweis Told doctors to wash their hands

Scottish surgeon named Joseph Lister Inspired by Louis Pasteur’s formulation of the

germ theory of disease Used carbolic acid in operating rooms

Drastic reduction in infections

Theory of Infection Control

Microorganisms Bacteria Fungi Viruses Protozoa

Pathogenic Disease causing Infectious agent Causes disease in healthy person Opportunistic pathogen

Causes disease in susceptible person Virulence Communicable diseases

Non-pathogenic Resident flora Colonization Can cause disease if transmitted to other areas

Infection

Local Specific area of body is infected

Systemic Microorganisms spread & damage other body

areas Bacteremia when microbes enter blood stream Septicemia – when bacteremia spreads through all of

the body systems

Acute vs. chronic infection

Nosocomial – infections that occur as a result of health care delivery Endogenous source Exogenous sources

Iatrogenic – infection directly caused by any diagnostic or therapeutic source

Drug-Resistant Pathogens MRSA VRE MDR TB

Causative Agent

Susceptible Host

Portal of EntryMode of

Transmission

Portal of Exit

Reservoir

Bacteria

Viruses

Fungi

Protozoa

Helminthes

People

Equipment

Water

Secretions

Excretions

Droplets

Skin

Direct-Indirect Contact/Fomite

Injection/Ingestion

Airborne/Aerosols

Broken Skin/Mucous Membrane

Gastrointestinal/Respiratory/ Urinary Tract

Neonates

Diabetics

Immunosuppressed

Cardiopulmonary Disease

Chain of

Infection

Medical Asepsis

AKA: Clean technique Practices that inhibit the growth & spread of

pathogenic microorganisms Handwashing Standard precautions Transmission based precautions PPE

The JCAHO Sentinel Event Alert quotes Julie Gerberding, MD, director of the CDC, as stating Clean hands are the single most important factor

in preventing the spread of dangerous germs and antibiotic resistance.

Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.

Antiseptics

Prevent or inhibit growth of pathogenic organisms

Not effective against spores or viruses Can be use on the skin

Alcohol Betadine

Disinfection

Destruction of pathogens other than spores Boiling water and chemicals

Bleach solutions Zephirin

Irritate or damage skin Used on objects not people

Surgical Asepsis

AKA: Sterile technique Practices that destroy all microorganisms &

their spores Used in specialized areas & skills

Care of surgical wounds Catheter insertion Invasive procedures Surgery

Sterilization

Destruction of pathogens & non-pathogens, including spores and viruses Steam under pressure Gas Radiation Chemicals

Autoclave is most common piece of equipment used

CDC recommendations Preoperative/prophylactic antibiotic

administration No preoperative hair removal (unless hair will

interfere with operation)

Sterile Technique

Procedures that keep an object or area free from living organisms

Sterile vs. contaminated areas Articles must remain away from and in front

of the body and above the waist

Sterile Technique

Never reach across the sterile field Never turn your back to the sterile field Two inches around border is considered

contaminated Sterile field must be kept dry

Sterile Gloving

Only touch the outside of the package with bare hands.

The inside of the package, in which the gloves are placed, is considered sterile.

The wrapper, when opened provides a sterile field.

Grasp only the outside edge of the wrapper.

The inside of the glove may be touched with the bare hand

Grasp the first glove at the top edge of the folded-down cuff and slip in hand

Slip gloved fingers into cuff of second glove and slip in second hand without contaminating

The outer aspect of the glove must remain sterile Includes wrist area Keep hands above level of waist Sterile to sterile only If contamination occurs, start again with new pair of gloves

Techniques to Remove Articles from Sterile Wraps Drop technique

For gauze pads, dressings, small items Wrapper is partially opened , held upside down over

sterile field, dropped onto sterile field Mitten technique

For bowls, drapes, linen… Using the wrap as a mitten, sterile supplies can be

placed on a sterile field Transfer forceps

For cotton balls, small items, or articles Sterile gloves or transfer forceps are used to transfer

objects to sterile field

Skills to Demo & Practice

Donning & Removing Sterile Gloves

Questions?