ASEPTIC TECHNIQUE

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ASEPTIC TECHNIQUE

• Laura Curtis-
• Clinical Instructor -OR

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Introduction

• Proper aseptic techniques is one of the most
  fundamental and essential principles of infection
  control in the clinical and surgical settings
• Aseptic Techniques are those practices which
• Standard Precautions
• Remove or kill microorganisms from hands and
  objects
• Employ sterile instruments and other items
• Reduce patients risk of exposure to
  microorganisms that cannot be removed

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OBJECTIVES

• Describe aseptic technique
• Explain the rules of asepsis
• Describe the technique used to maintain asepsis
  in the operating room
• Practice aseptic technique properly
• Describe Standard Precautions as practiced during
  surgery

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Cont

• Aseptic technique is vital in reducing the
  morbidity and mortality associated with surgical
  infections.-SSI.
• Therefore aseptic measures include surgery and
  the insertion of intravenous lines, urinary
  catheters, and drains.

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Asepsis In The Operating Room

• Aseptic technique is most strictly applied in the
  operating room because of the direct and often
  extensive disruption of skin and underlying
  tissue.
• Aseptic technique helps to prevent or minimize
  postoperative infection.

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Asepsis In The Operating Room(Before Entering
the OR and Procedures)
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Introduction

• Aseptic technique also encompasses practices
  performed immediately before and during a
  surgical procedure to reduce postoperative
  infection
• Hand washing
• Surgical Attire
• Surgical scrub, sterile gowning gloving
• Patients surgical skin prep
• Using surgical barriers, including sterile
  surgical drapes and PPE
• Maintaining a Sterile Field
• Using safe operative technique
• Maintaining a safe environment in the OR

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OPERATING ROOM ENVIRONMENT CONTROL
The surgical suite should be designed in such a
way as to minimize and control the spread of
infectious organisms
AIM
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ACCESS CONTROL
OPERATING ROOM COMPLEX DIVIDED INTO 3 AREAS

• UNRESTRICTED AREA
• SEMI RESTRICTED AREA
• RESTRICTED AREA

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1. UNRESTRICTED AREA

• Areas outside the theatre complex including
  control point to monitor the entrance of
  patients, personnel, visitors, etc
• Street clothes are permitted in the area
• Traffic is not limited

RED LINE
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1. SEMI - RESTRICTED AREA

• Peripheral support areas within theatre complex,
  includes corridors leading to operating rooms,
  work areas (storage) etc.
• All persons must wear scrub attire which should
  be made of low linting material that minimizes
  bacterial shedding, comfortable, clean and
  provides a professional appearance

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1. RESTRICTED AREA

• Includes operating rooms, scrub areas and
  ante-rooms
• Personnel must wear full surgical attire, hair
  coverings, masks where open sterile supplies and
  scrubbed persons are present
• Masks are worn to reduce the dispersal of
  microbial droplets from the mouth and
  naso-pharynx of personnel high filtered
• Masks must cover the mouth and nose entirely, and
  be tied securely to prevent venting
• Metal strip in the top hem of the masks produces
  a firm contoured kit over the bridge of the nose

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Surgical Attire
To provide effective barriers that prevent the
dissemination of microorganisms to patients To
protect personnel from contamination from blood
and body fluids of patients Proper attire is a
part of aseptic environmental control Protects
personnel against exposure to communicable
diseases and hazardous material
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Surgical Attire Considerations

• Proper attire must be worn within the
  semirestricted and restricted areas of the OR
  suite
• Clean fresh attire is donned daily on arrival to
  the OR and intermittently when necessary if suit
  becomes wet or grossly soiled-source of
  cross-contamination.
• OR attire should not be worn outdoors-this
  protects the OR environment from microorganisms
  inherent in the outdoor environment and
  vice-versa.
• Before leaving the institution everyone should
  change to street clothes/uniforms
• On occasion a cover gown may be worn over OR
  attire outside the suite
• The practice of wearing cover gowns is Not
  encouraged

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Head Cover

• Hair is a gross contamination
• Cap or hood is put on before the scrub suit to
  protect the garment from contamination by hair.
• All facial and head hair is completely covered in
  the semi restricted and restricted areas.
• Light weight caps/hoods made of disposable,
  lint-free fabric
• Reusable caps should be freshly laundered daily
• Skull caps do not cover the entire head, and hair
  can be shed from the inferior edges.

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Shoe Cover

• Unprotected street shoes can increase floor
  contamination
• Shoes restricted to wear in the OR are preferable
  in reducing microbial transfer from the outside
  into the OR suite
• Shoe covers may be worn as needed to protect from
  blood and body fluid
• Some surgeons wear plastic or rubber boots during
  procedures wherein extensive fluid irrigation
  and/or blood loss can be anticipated
• Shoe covers can inadvertently become soiled and
  harbor microorganisms and should be removed
  before leaving the OR

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ASEPTIC TECHNIQUE

• METHODS BY WHICH CONTAMINATION WITH
  MICROORGANISIMS IS PREVENTED (ALTERNATE TERM
  ASEPTIC PRACTICE TO MAINTAIN ASEPSIS).

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PRINCIPLES OF ASEPSIS

• ARE THE EFFORTS TAKEN TO KEEP THE PATIENT AS FREE
  FROM HOSPITAL MICROORGANISM AS POSSIBLE.
• IT IS AMETHOD USED TO PREVENT CONTAMINATION OF
  WOUNDS AND OTHER SUSCEPTIBLE SITES BY ORGANISMS
  THAT COULD CAUSE INFECTION

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Proper Surgical Hand Scrub
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THE PROCESS OF REMOVING AS MANY ORGANISMS AS
POSSIBLE FROM THE HANDS AND ARMS BY MECHANICAL
WASHING AND CHEMICAL ANTISEPTIC BEFORE
PARTICIPATING IN AN OPERATION
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before hand washing
Transient organisms
Resident organisms
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after hand washing
Transient organisms
Resident organisms
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SURGICAL HAND WASHING
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AGENTS FOR ANTISEPSIS

• A broad-spectrum antimicrobial agent.
• Fast-acting and effective.
• Nonirritating and nonsensitizing.
• Prolonged-acting.

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AGENTS FOR ANTISEPSIS

• Chlorohexidine gluconate.
• Iodophors.
• Triclosan.
• Alcohol.
• Hexachlorophen.

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PREPERATIONS BEFORE SCRUB

• INSPECT HANDS FOR CUTS AND ABRASIONS.
• REMOVE ALL FINGER JEWELRY.
• BE SURE ALL HAIR IS COVERED BY HEADCAP.
• ADJUST THE MASK FIRMLY AND COMFORTABLY OVER NOSE
  AND MOUTH.
• CLEAN EYEGLASSES IF WORN.
• ADJUST WATER TO A COMFORTABLE TEMPERATURE.

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DURATION OF HAND WASHING

• Surgical hand washing should not be less than 3
  minutes.

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1).SURGICAL HAND SCRUB

• APPLY ANTIMICROBIAL AGENT

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(No Transcript)
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GOWNING AND GLOVING
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Assissted Gloving
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All members of the sterile team are required to
perform a surgical hand scrub and don sterile
gown and gloves before touching sterile equipment
or the sterile field.
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Rules Wearing Sterile Gown and Glove

• Rules to observe while wearing sterile gown and
  gloves.
• NEVER drop his hands below the level of the
  sterile area at which he is working.
• NEVER touch his surgical gown above the level of
  the axilla or below the level of the sterile area
  where he is working.
• NEVER put his hands behind his back he must
  keep them within his full view at all times.
• NEVER tuck his gloved hands under his armpits, as
  the axillary region of his gown is contaminated.
• NEVER reach across an unsterile area for an item.
  

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Asepsis In The Operating Room

• Patient surgical prep
• Maintaining a sterile field
• Using safe operative techniques
• Maintaining a safe environment in the operating
  room

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PRINCIPLES OF ASEPSIS

• All articles used for a surgical procedures are
  sterilized prior to surgery.
• Gowns are considered sterile only from waist to
  shoulder level in front and sleeves.
• Personnel who are sterile only touch sterile
  articles personnel who are not sterile only
  touch unsterile items.
• Sterile touching sterile remaining sterile.
• Sterile touching unsterile contaminates all.

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PRINCIPLES OF ASEPSIS

• Arms not to be folded under axillae.
• If in doubt about the sterility of any item,
  consider it unsterile.
• Nonsterile personnel must avoid reaching over a
  sterile field, sterile personnel must avoid
  leaning over a sterile field.
• The area approximate 2.5cm around the edge of the
  sterile field is considered unsterile.
• Sterile personnel must be close to the sterile
  area, unsterile personnel must be away from the
  sterile area.

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PRINCIPLES OF ASEPSIS

• Moisture may cause contamination.
• Pouring should be done at the edge of the table.
• When passing in a sterile field, remember sterile
  to sterile.
• The sterile field must be kept insight all the
  time.
• The gloved hands must be kept insight all the
  time.
• Once in position, drapes are never moved or
  shifted.
• Avoid coughing, sneezing or unnecessary talking
  over a sterile field.

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Principles of Sterile TechniqueSterile persons
pass each other back to back or front to front
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Principles of Sterile Technique

• Destruction Of The Integrity Of Microbial
  Barriers Results In Contamination
• The integrity of a sterile package or sterile
  drape is destroyed by perforation puncture or
  strike through.
• Strike-through is the soaking of moisture through
  unsterile layers to sterile layers or vice versa.
• The integrity of a sterile package and its
  expiration date for sterility must be checked
  just prior to opening it.

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REMOVING GOWN AND GLOVES
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Conclusion

• STERILITY IS NEVER TAKEN FOR GRANTED. IT MUST BE
  MAINTAINED AND CHECKED.
• BASICALLY THERE IS NO COMPROMISE WITH STERILITY
• OR PERSONNEL MUST MAINTAIN THE HIGH STANDARDS OF
  STERILE TECHNIQUE THEY KNOW ARE ESSENTIAL.

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Thank you for active listening
Laura Curtis O.R. clinical instructor
KFMC
03\06\2006