Reproductive System,Reproductive System,Medical School of Universitas Padjadjaran, Medical School of Universitas Padjadjaran, BandungBandung20052005
MIR-C CorporateMIR-C Corporate
Interactive Training CD for Medical StudentsInteractive Training CD for Medical StudentsReproductive SystemReproductive System
Module : Module :
Infection Prevention: A- and Antiseptic TechniquesInfection Prevention: A- and Antiseptic Techniques
in Surgical Settingin Surgical Setting
Production Team:Production Team:
Director : Kiki Lukman, MD, MSc, FINACS (Dig.) Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.) Main contributors : Kiki Lukman, MD, MSc, FINACS (Dig.)
Yayat Ruchiyat, MD, FINACS (Dig.) Warko Karnadihardja, MD, FINACS (Dig.) Nurhayat Usman, dr., SpB-KBD
Lisa Hasibuan, MD Nina K. Poetri T., SKp, Dadang Sunarya AMK Dedy Rusnadi AMK, Alia Rahmi AMK,
Editorial Team : Kiki Lukman, MD, MSc, FINACS (Dig.) Casting : Kiki Lukman, MD, MSc, FINACS (Dig.) Artistic : MIR-C Corporate Productions : Medical School of Universitas Padjadjaran
Bandung
CreditsCredits
Special thanks to:Central Operating Theatre Unit of
Hasan Sadikin General Hospital
Infection Prevention Module Infection Prevention Module
Introduction
Infection control
Antiseptic techniques
Operating Theater
Aseptic techniques
IntroductionIntroduction
Description Objectives
DescriptionDescription
Infection Prevention in Surgical Setting is one of important preventive methods in order to achieve infection control in clinical and surgical practices.
ObjectivesObjectives
The aims of this method are :
– To minimize surgical site infection– To protect health personnel– To improve wound healing– To minimize disability, morbidity, &
mortality– To reduce the cost of hospital care
Specific Learning Objectives :Specific Learning Objectives :
To describe the definition and history of sterilization, disinfection, decontamination, anti and a - septic techniques.
To describe six methods of sterilization.To describe three categories of surgical
instrumentsTo describe 6 rules of aseptic techniques
Specific Learning Specific Learning Objectives :Objectives :
To perform aseptic techniques correctly, including (P5):
– Applying surgical attire– Hand washing– Surgical scrubbing– Gloving– Surgical Gowning
Definition:Definition:
– Sterilization : Processes by which all pathogenic & non pathogenic microorganisms, including spores, are killed.
– Disinfection: Chemical or physical process of destroying all pathogenic microorganisms, except spore bearing ones; used for inanimate objects, but not on tissues.
Definition:Definition:
– Decontamination : Process or method by which all contaminated materials that can cause diseases are removed.
– Aseptic techniques : Methods by which contamination with microorganisms is prevented.
– Antiseptic techniques: Prevention of sepsis by the exclusion, destruction, or inhibition of growth and multiplication of microorganisms from body tissues and fluids.
Infection ControlInfection Control
Why should we apply a and antiseptic techniques ?
Historical backgrounds :Historical backgrounds :
Ignas Sammelweis (1818 - 1865)– Puerperal fever increased maternal mortality– Hand scrub with chlorinated-lime solution prior to
examination.– Father of nosocomial infection.
Louis Pasteur (1860)– Discover the process of fermentation by microorganisms– Germ theory: against spontaneous generation theory.
Historical backgrounds :Historical backgrounds :
Joseph Lister (1865)– Use carbolic acid solution on surgical dressing in
the operating room mortality (Listerization)– Father of modern surgery (Antiseptic technique)
Ernst Von Bergmann (1886)– Introduced “steam sterilizer”– Basic of sterilization aseptic technique– Later: “pressure & vacuum steam sterilizer” was developed
Methods of Infection Methods of Infection controlcontrol
Anti septic techniques
Design and traffic patterns of the operating theatre
Aseptic techniques
Anti septic techniquesAnti septic techniques
SterilizationSterilization
The objective of modern surgeryFor inanimate objectsProblem :
– Some items are not heat resistance
Techniques of Techniques of SterilizationSterilization
Physical:– Heat– Radiation/ ultraviolet ray– Boiling water– Ultrasound
Chemical:– Liquid– Gas
Heat SterilizationHeat Sterilization
Dry : – Commonly cause damage– For powder, oils, and jelly
Moist :– Steam– High pressure spores – Vacuum constant temperature– Autoclave
Chemical SterilizationChemical Sterilization
Generally as disinfection Mechanism of action :
– Protein coagulation– Enzyme denaturation in cells– Lysis
Depend on : number of microorganisms, soiling, concentration, and temperature.
Solutions Solutions
Jodium and Jodophor– Good bactericide, but irritant– Mixture : povidone-jodine 10%
Alcohol Solution of 70% or 90%
Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)– Spores are killed within 3 hours
SolutionsSolutions
Hexachloropene (Halogenated phenol)– Bacterio-static, particularly Gram (+) bacteria– For scrubbing
Chlorhexidine gluconate– Bactericide : Gram (+) & (-).– Good for antiseptic
Gas SterilizationGas Sterilization
FormaldehydeEthilene-oxide- propionolactone
Boiling WaterBoiling Water
Mild boiling Vigorous boiling
More active, if 2% sodium-carbonate or 0,1 % sodium-hydroxide being added
The Operating Theater The Operating Theater
Sterilecore
Clean Zone
Transitional Zone Restricted area
Semi – Restricted Area
SCRUB SUIT
Traffic patterns of Operating Traffic patterns of Operating TheatreTheatre
The use of aseptic principles requires regulation of traffic and flow patterns of the personnel, patient, equipment, and supplies in operating theatre
Aims : to protect the safety and privacy of patients and the cleanliness and integrity of the environment.
unrestricted areaunrestricted area
Elevators
Corridors outside surgical suite
unrestricted areaunrestricted area
Entrance
Reception desk
Patient suite
Transitional Zone Transitional Zone (Video)(Video)
Locker room
Dressing room
Clean Zone (Video)Clean Zone (Video)
Surgical suite and corridors
Sterile core
Scrub Area (Video)Scrub Area (Video)
Sterile Core (Video)Sterile Core (Video)
Putting on surgical Putting on surgical attireattire
In the semi & restricted area:
– Scrub suit : shirt & trousers– Hair covering: surgical cap/hood– Masks : disposable/ re-useable– Goggle (optional): protective eyewear– Shoe covers
are compulsory
Surgical attireSurgical attire
Male personnel
Female personnel
Personnel with veil
Surgical Instruments in the Operating Surgical Instruments in the Operating TheatreTheatre
Critical items :– Sterile, because of being used for penetrating
skin or mucosa
Semi critical items :– In contact with skin or mucous membrane
Non critical items :
Aseptic techniquesAseptic techniques
Aseptic techniquesAseptic techniques
1. Rules at clean zone
2. Procedures in sterile area
3. Talk as necessary
4. Restrict unnecessary movements
5. Sterile instruments, remove non sterile one
6. Avoid & Replace wet surgical drapes/towels
Hand washingHand washing
Indications:
– Between patient contacts– Before performing or assisting with invasive
procedures– Before taking care of particularly susceptible
patients– Before and after touching wounds– Immediately after gloves are removed
Hand washingHand washing
– Before and after performing sterile procedures
– After contact with blood or body substances, mucous membranes, soiled linen, waste, or contaminated equipment.
– Between tasks at different body sites on the same patient to prevent cross contamination
– After taking care of infected patient
– After touching contaminated inanimate sources
Hand washingHand washing
Preparation The procedure
Surgical Scrubbing Surgical Scrubbing ProcedureProcedure
Purposes:Purposes:
– To remove debris and transient organisms from the nails, hands, and forearms.
– To reduce the resident microbial count to a minimum.
– To inhibit rapid rebound growth of microorganisms.
Purposes:Purposes:
– To minimize the re-growth of microorganisms for the length of the procedure.
– To reduce the numbers of microorganisms on hands
– To reduce contamination of the operative site by recognized or unrecognized breaks in surgical gloves.
Preparation:Preparation:
Recognizing glove sizesRecognizing glove sizes
Actual procedure: Actual procedure: Strokes techniqueStrokes technique
Rinsing hands & arms
Scrubbing with antiseptic solution
Rinsing arms Scrubbing with
brush or sponge Rinsing arms Scrubbing with
antiseptic solution Drying arms
Actual procedure: Actual procedure: Five minute techniqueFive minute technique
GowningGowning
The goal:
– to ensure a safe, protective, and aseptic environment to the patient and the surgical team.
Gowning & closed gloving Gowning & closed gloving techniquestechniques
Drying hands with sterile towel
Applying gown
Closed gloving technique
– The final step of the aseptic techniques before performing surgery.
– Sterile gloves are worn to permit the
wearer to handle sterile supplies or tissues of the operative wound.
– Sterile gloves establish a shield that protects the patient from contamination by flora from the hands of health care workers.
Open technique
Closed techniqueClosed technique
Skin preparationSkin preparation
The goals: – to cleanse the skin and bring both the
resident and transient bacterial counts to an irreducible minimum, therefore reducing the risk of wound contamination and subsequent surgical site infection.
performed just before the surgical incision has been performed.
Skin preparationSkin preparation
Skin painting
Skin draping
Ready for surgeryReady for surgery
Gown and gloves Gown and gloves removalremoval
After surgery:
Gown, Gloves removal
Simultaneous removal