Medical/Surgical Asepsis

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Medical/Surgical Asepsis

• Presented by
• Cynthia Bartlau, RN, PHN, MSN

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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

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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 Pasteurs formulation of the
  germ theory of disease
• Used carbolic acid in operating rooms
• Drastic reduction in infections

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Theory of Infection Control

• Microorganisms
• Bacteria
• Fungi
• Viruses
• Protozoa

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• 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

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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

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• 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

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• Drug-Resistant Pathogens
• MRSA
• VRE
• MDR TB

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Bacteria Viruses Fungi Protozoa Helminthes
People Equipment Water
Chain of Infection
Secretions Excretions Droplets Skin
Neonates Diabetics Immunosuppressed Cardiopulmonar
y Disease
Broken Skin/Mucous Membrane Gastrointestinal/Respi
ratory/ Urinary Tract
Direct-Indirect Contact/Fomite Injection/Ingestion
Airborne/Aerosols
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Medical Asepsis

• AKA Clean technique
• Practices that inhibit the growth spread of
  pathogenic microorganisms
• Handwashing
• Standard precautions
• Transmission based precautions
• PPE

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• 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.
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Antiseptics

• Prevent or inhibit growth of pathogenic organisms
• Not effective against spores or viruses
• Can be use on the skin
• Alcohol
• Betadine

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Disinfection

• Destruction of pathogens other than spores
• Boiling water and chemicals
• Bleach solutions
• Zephirin
• Irritate or damage skin
• Used on objects not people

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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

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Sterilization

• Destruction of pathogens non-pathogens,
  including spores and viruses
• Steam under pressure
• Gas
• Radiation
• Chemicals
• Autoclave is most common piece of equipment used

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• CDC recommendations
• Preoperative/prophylactic antibiotic
  administration
• No preoperative hair removal (unless hair will
  interfere with operation)

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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

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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

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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.

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• 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

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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

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Skills to Demo Practice

• Donning Removing Sterile Gloves

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Questions?