Surgical Asepsis 2

8/12/2019 Surgical Asepsis 2

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Surgical Asepsis


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Surgical asepsis differs from medical asepsis. Medicalasepsis is defined as any practice that helps reduce

the number and spread of microorganisms. Surgical

asepsisis defined as the complete removal of

microorganisms and their spores from the surface of

an object.

The practice of surgical asepsis begins with cleaning

the object in question using the principles of medical

asepsis followed by a sterilization process


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Which procedures

require surgical

aseptic technique? Any medical procedure that involvespenetration of the body tissues(invasive procedure)

Major & minor surgeries

Tracheotomy care

Dressing change

Catheterization of the urinary bladder


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Myelogram (penetrat ion ofthe body t issue)

http://www.youtube.com/watch?v=GhklmYOQ5Es
http://www.youtube.com/watch?v=GhklmYOQ5Eshttp://www.youtube.com/watch?v=GhklmYOQ5Eshttp://www.youtube.com/watch?v=GhklmYOQ5Eshttp://www.youtube.com/watch?v=GhklmYOQ5Es


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Minor surgery

http://www.youtube.com/watch?v=2kM7wKLHTX8&feature=related
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http://www.youtube.com/watch?v=6lKHOtAim28&feature=related

Tracheostomy care
http://www.youtube.com/watch?v=6lKHOtAim28&feature=relatedhttp://www.youtube.com/watch?v=6lKHOtAim28&feature=relatedhttp://www.youtube.com/watch?v=6lKHOtAim28&feature=relatedhttp://www.youtube.com/watch?v=6lKHOtAim28&feature=related


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Dressing care

http://www.youtube.com/watch?v=bBa9HL4mHa4&feature=related
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The Environment and

Surgical Asepsis

Creating an environment in a surgical suite or special

procedure room, to avoid any possible infection to the

patient.

Proper attire (scrubs, cap, mask, gloves, shoe covers)

Awareness!!!!


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Proper Attire


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OSHA Protocols

Shoes must be comfortable with closed heel and toe and not clothcovered. Cloth-covered shoes may allow blood, body fluids, and other

liquids to permeate. Cloth-covered shoes will not protect the feet should a

heavy object fall on them.

Personal hygiene must be meticulous. A shower should be taken shortly

before beginning a work day in the operating room or special procedure

area.

Jewelry, long or artificial fingernails, and nail polish are prohibited.

Jewelry harbors microorganisms as do long, polished, or artificial nails.

Any body piercing jewelry must be removed as it may become loose and

fall onto the sterile field.

All persons who expect to proceed from the unrestricted zone into thesemi-restricted zone must go to the dressing area, don a scrub suit, and

tuck the blouse of the suit into the pants or wear a scrub blouse that fits

close to the body.

All hair, beards, or mustaches must be covered with a surgical cap and

mask. Hair must be confined as it sheds microorganisms with movement


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Shoe covers must be placed over shoes to reduce contamination and

to protect shoes from coming in contact with blood and body fluids.

Before proceeding into Zone 3, all persons must scrub hands and arms

for medical asepsis. It is believed that bare skin may shed

microorganisms. In many institutions, all who are not scrubbed for the

surgical procedure must wear a scrub jacket to cover bare arms.

Before entering a room where a surgical procedure is in progress, a

mask must be donned. The masks worn in the OR must be single, high-

filtration masks


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ZonesZone 1: An unrestricted zone: persons may enter in street

clothing.

Zone 2: A semi-restricted zone: only persons dressed in

scrub dress with hair covered and shoes covered may enter.

Zone 3: A restricted zone: only persons wearing scrub dress,

shoe covers, and masks are allowed to be present. If a

surgical procedure is in progress, the doors to this area are

kept closed, and only persons directly involved in the

procedure may be present. Those directly involved in theoperation are dressed in sterile gowns and sterile gloves.

They are often referred to as being scrubbed.


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The use of contaminated instruments

Contaminated gloves

Wet or damp sterile field

Microorganisms blown onto a surgical site.

os ommonCauses of

Contamination


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Ventilation ducts must have special filters.

Airflow in the OR should be unidirectional.

Air pressure in the OR should be greater than in the outside

corridors.

Humidity is to be controlled to prevent static electricity.

OR doors should remain closed as much as possible.

Special Precautions


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Surgeon

Surgical assistant

Nurses

Physician assistant (PA)

Anesthesiologist

Nurse anesthetist

Radiologic Technologist

The Surgical Team


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Anesthesiologist


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Surgical assistant

Surgical Tech Duties

Your duties as a surgical technologist will

be to always maintain a clean and sterile

environment for the doctors and nurses to

perform necessary surgeries properly. You

will be in charge of scrubbing in andkeeping instruments sterile and organized.

You may be asked to assist by handing

instruments to the physicians. You will also

have to have knowledge of surgical

machines, such as laser and suction

machines. You will be in charge of

prepping a patient before and after surgery.

All of this you will learn in the classroom as

well as hands on. Surgical technologists

play a very important role in the operating

room


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OR Nurse

For patients of operative or invasive procedures, the operating room nurse's jobs

and duties will consist of education, preparation and coordination of patient care.

O.R. or perioperative registered nurses are responsible for maintaining the sterile

conditions in the operating room and monitoring patients during the operation. They

are also responsible for continued care during and after the procedure


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X-ray in OR

http://www.youtube.com/watch?v=4LUQHq

y1ilc

http://www.youtube.com/watch?v=HFNGc_

YFmBQ&feature=related

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Removal of microorganisms and their spores must be

complete, or the article is not sterile.

Disinfection

To remove as many micoorganisms as possible from a

surface by physical or chemical means.

Articles or surfaces that cannot be sterilized in the OR or

special procedure room must be disinfected.

e o s oSterilization and

Disinfection


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Disinfectant Status UseAlcohols (70% or 90%) (intermediate-

level)bactericidal, tuberculocidal,

fungicidal, and virucidalto disinfect thermometers, medication vials, etc.

Glutaraldehyde (high-level) broad antimicrobial range,fungicidal and virucidal

to disinfect endoscopes, thermometers, and rubber

itemsChlorine Compounds (dilution of 1:50 is

high-level)concentrations of 1000 ppm

inactivate bacterial sporesto disinfect countertops, floors, other surfaces

Orthophthalaldehyde (high-level) bactericidal, virucidal,fungicidal, tuberculocidal in 12

minutes at room temperatureto clean and process endoscopes

Hydrogen Peroxide (low-level) 6% solutions effective againstsome bacteria, fungi, and

virusesmay be used to clean work surfaces, not widelyused in health care settings

Iodine and Iodophors (intermediate-

level)vegetative bactericidal, M.

tuberculosis,most viruses and

fungi, no sporicidal capabilitymay be used as disinfectant or antiseptic

Phenolics (intermediate- or low-level) most formulations aretuberculocidal, bactericidal,

virucidal, and fungicidalhave toxic effects, used as environmental notsporicidal disinfectants

Quaternary Ammonium Compounds not recommended for high-,intermediate- or low-level

disinfectioncleaning agents for noncritical surfaces


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Physical methods of disinfecting are boiling in water and

ultraviolet irradiation. Boiling may be used as a means of

disinfection if no other method is available; however, many

spores are able to resist the heat of boiling (212F or 100C)

for many hours. To increase the effectiveness of boiling,

sodium carbonate may be added to the water in quantity to

make a 2% solution. If an object is to be disinfected by boiling

and sodium carbonate is added to the water, it should be boiled

for 15 minutes. If sodium carbonate is not added, boiling time

should be 30 minutes.

http://www.youtube.com/watch?v=-

ySmmXd9CUs

http://www.youtube.com/watch?v=pZSX_x

Ollio&feature=related
http://www.youtube.com/watch?v=-ySmmXd9CUshttp://www.youtube.com/watch?v=-ySmmXd9CUshttp://www.youtube.com/watch?v=pZSX_xOllio&feature=relatedhttp://www.youtube.com/watch?v=pZSX_xOllio&feature=relatedhttp://www.youtube.com/watch?v=pZSX_xOllio&feature=relatedhttp://www.youtube.com/watch?v=pZSX_xOllio&feature=relatedhttp://www.youtube.com/watch?v=-ySmmXd9CUshttp://www.youtube.com/watch?v=-ySmmXd9CUshttp://www.youtube.com/watch?v=-ySmmXd9CUshttp://pt.wkhealth.com/pt/re/9780781771832/bookContentPane_frame.01429459-7th_Edition-4.htm;jsessionid=MfWbTGJJ00c0xrGQjmBynQThsnyTLvpxkwVX2bbwFJvT8DPCj4WN!628309595!181195628!8091!-1?bookaccessionpath=01429459-7th_Edition-4&bookmarkxpath=/CT%7b06b9ee1beed59419c428a6a1e1035d6f158a2207bfd4a8f000ab1f615ba7216d38071fa726462e9533a045d0b66e3c76%7d/OVIDBOOK%5b1%5d/TXTBKBD%5b1%5d/CHAPTER%5b5%5d


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Table 5-2 Methods of Sterilization

Steam Under Pressure:Item are double-wrapped and placed in an autoclave.Autoclavesare manufactured to sterilize bygravity displacement and dynamic air

removal.

High-speed sterilizers orflash sterilizationis an abbreviated gravity displacement

method.Chemical Sterilization:Referred to as low-temperature sterilization.A maximum

temperature of 54C to 60C of gaseous sterilization is used. An antimicrobial

and sporicidal agent must be used.Ethylene Oxide:Used for items that cannot withstand moisture and high

temperatures.

All items sterilized in this manner must be cleansed and dried since water united

with ethylene oxide forms ethylene glycol, which cannot be eliminated by aeration

and is toxic.


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http://www.youtube.com/watch?v=Z9Y9QLj

Egks&feature=related

If the sterility of an item is questionable, it

is not to be considered sterile.
http://www.youtube.com/watch?v=Z9Y9QLjEgks&feature=relatedhttp://www.youtube.com/watch?v=Z9Y9QLjEgks&feature=relatedhttp://www.youtube.com/watch?v=Z9Y9QLjEgks&feature=relatedhttp://www.youtube.com/watch?v=Z9Y9QLjEgks&feature=related


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Once a sterile field has been prepared, it must not be left unattended as it

may become contaminated and presumed to be sterile.

An unsterile person does not reach across a sterile field.

A sterile person does not lean over an unsterile area.A sterile field ends at the level of the tabletop or at the waist of the sterile

person's gown.

Anything that drops below the tabletop or sterile person's waistline is no

longer sterile and may not be brought up to the sterile tabletop. The only

parts of the sterile gown considered sterile are the areas from the waist to

the shoulders in front and the sleeves from 2 inches above the elbow to the

cuffs.

The cuffs of the sterile gown are considered non-sterile because they

collect moisture. Cuffs must always be covered by sterile gloves.

The edges of a sterile wrapper are not considered sterile and must not

touch a sterile object.Sterile drapes are placed by a sterile person. The sterile person places the

drapes on the area closest to him first to protect his sterile gown.

A sterile person must remain within the sterile area. He must not lean on

tables or against the wall.


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If one sterile person must pass another, they must pass back-to-back.

The sterile person faces the sterile field and keeps sterile gloves above

the waist in front of his chest. The sterile person must avoid touching anyarea of his body.

Any sterile material or pack that becomes damp or wet is considered

unsterile.

Any objects that are wet with disinfectant solution and are to be placed on

a sterile field must be placed on a folded sterile towel for the moisture to be

absorbed.

A wet area on a sterile field must be covered with several thicknesses of

sterile toweling or an impervious drape.

When pouring sterile solution, place the lid face upward and do not touch

the inside of the lid or the lip of the flask. Pour off a small amount of

solution before the remainder is poured into the sterile container.When a sterile solution is to be poured into a container on a sterile field,

the container is placed at the edge of the sterile field by the sterile person


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Opening sterile pack

http://www.youtube.com/watch?v=oBvLnLd

WGBE&feature=related

ass ng s er e
http://www.youtube.com/watch?v=oBvLnLdWGBE&feature=relatedhttp://www.youtube.com/watch?v=oBvLnLdWGBE&feature=relatedhttp://www.youtube.com/watch?v=oBvLnLdWGBE&feature=relatedhttp://www.youtube.com/watch?v=oBvLnLdWGBE&feature=relatedhttp://void%280%29/http://void%280%29/


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ass ng s er eobject to a sterile

person
http://void%280%29/


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Putting an object in

the sterile field
http://void%280%29/


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Transferring a sterile

object

er e scru
http://void%280%29/


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er e scru ,gowning and gloving

http://www.youtube.com/watch?v=AZVbh5iHXlE&feature=related
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The radiographer is responsible for protecting himselfand all persons in the OR and special procedure areas

from radiation. He is also expected to be

knowledgeable concerning the areas that are sterile.

He must protect sterile areas and the patient from

contamination in the process of his duties


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X-ray equipment in

OR Mobile C-arm


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Ceiling mounted C-

arm


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http://www.youtube.com/watch?v=Jz31Li9MM_E
http://www.youtube.com/watch?v=Jz31Li9MM_Ehttp://www.youtube.com/watch?v=Jz31Li9MM_Ehttp://www.youtube.com/watch?v=Jz31Li9MM_Ehttp://www.youtube.com/watch?v=Jz31Li9MM_E


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The radiographer is responsible for makingcertain that any radiographic equipment used

during a sterile procedure is clean and dust-

free before use.


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Overhead units must be cleaned with a disinfectant solution, and portable

radiographic machines and image receptors to be used must be cleaned

with a disinfectant solution.

Sterile technique must be maintained for all items and persons involved

in the invasive procedure.

If possible, place image receptors and take scout films before draping the

patient for the procedure.

If the image receptors must be placed after the procedure is begun, theradiographer may pass the image receptor to the scrub nurse who

receives the image receptor in a sterile plastic bag and places it at the

radiographer's direction.

If the radiographer places the image receptor himself, the surgical team

must make room for him. He may place the image receptor by raising thesterile drapes touching only the inside of the drape, or the circulating nurse

may lift the drapes and assist in placing the cassette into the image

receptor holder


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If multiple images are to be taken, all personnel who are not

scrubbed must leave the OR if at all possible. The scrubbed

members of the team must wear protective radiation apparel.

They may also step behind protective lead-lined screens.

When hands are directly exposed to radiation, leaded sterile

gloves as well as all other protective equipment must be worn.

Pregnant female personnel should not be present in the OR

when radiographic imaging is in progress.

The radiographer must wear his radiation detection badge on

the outside of the lead apron and under the sterile gown during

imaging procedures. The badge must be checked at prescribed

intervals.

During imaging, all unnecessary instruments must be removed

from the operative field and a sterile drape must be placed over

the open incision


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http://void%280%29/


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http://void%280%29/


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Skin prep the purpose of a skin prep is to remove as

many microorganisms as possible by mechanical and

chemical means to reduce the potential of infection. There are two aspects to skin preparation for a sterile

procedure:

Mechanical

Chemical

Skin Preparation for Sterile Procedures


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Chemical Method of Skin Preparation

The area to be penetrated should be cleaned with an

antiseptic solution.

Once you start to clean the area of interest, do this in acircular motion beginning in the center and working

outward.

Do not cross anything over the area that has been prepped.

Sterile technique is maintained during the skin prep forsterile procedures!


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http://void%280%29/http://void%280%29/


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Draping for Sterile Procedure

After the skin has been prepared, place sterile drapes

around the area of interest.

Must be handled as little as possible

They must not be flipped or fanned

Disposable sterile cloth towel are mainly used, however, a

fenestrated drape may be used.

Place them so that they are within the limits of the area

prepared They are folded so that they overlap and the folds face

the operative site.


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http://www.youtube.com/watch?v=WUbqry

DgQ40&feature=fvw
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You must not remove or reapply dressing without a

physicians order.

All dressings must be treated as if they are contaminated,because drainage from wounds may harbor pathogenic

microorganisms.

Removing and Reapplying Dressings

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UYSQ&feature=related
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Surgical Asepsis 2