4.1 Asepsis and Infection Control

Question 1

Disinfection

Answer 1

(Medical Asepsis)

• Eliminates many microorganisms except bacterial spores from inanimate objects
• Used to clean surface of tables, chairs, beds
• Can be used for high level disinfection of instruments that enter non sterile environments. (Endoscopes and speculums).

Question 2

Sterilization

Answer 2

(Surgical Asepsis)

• Complete elimination of all microorganisms including spores.
• Used in operating rooms and labor delivery areas, diagnostic testing, patient bedside if invasive.
• (Dressing changes, urinary catheter insertion, tracheostomy)
• Maintaining sterile environment is also important to protect contamination during injections or surgery
• Skin can be cleaned with iodine, alcohol, or chlorhexidine.

Question 3

Maintaining Surgical Asepsis

Answer 3

• All items in sterile field must be sterile
• Sterile packages are opened as close to time of actual use as possible
• Moist areas are not sterile
• Contaminated items must be removed immediately
• Only areas that can be seen by clinician are sterile (back of clinician is not sterile)
• Gowns are only sterile in the front from chest to waist, and hands to slightly above elbow.

Question 4

Maintaining Surgical Asepsis (cont)

Answer 4

• Tables are only sterile at or above level of table
• Non-Sterile items should not cross above sterile field
• No talking, laughing, sneezing, coughing in sterile field
• Personnel with colds should avoid working or wear double mask
• Edges of sterile area or fields are not sterile
• When in doubt, discard potentially contaminated items.

Question 5

Maintaining Surgical Asepsis (cont)

Answer 5

• Safe space or margin of safety is maintained between sterile and non sterile objects/areas.
• When pouring fluids, only lip and inner cap of pouring container are sterile. Pouring container should not touch receiving container, splashing should be avoided.
• Tears in barriers are considered breaks in sterility.

Question 6

Obtaining Sterile Specimen

Answer 6

• Do not touch inside of collection container
• Do not touch sterile collection device
• If collecting from a port of a tube, clean port with alcohol before inserting needle
• Label as usual

Question 7

Opening Sterile Field

Answer 7

• Always open first opening away from you because you do not want to reach over it later
• Outer edges of sterile field (1 inch) is not sterile
• When covering sterile field with sterile drape, cover from closest to farthest.
• When setting up sterile field without kit, when setting down drape you want to start away from you then down.

Question 8

Pouring Solution on Sterile Field

Answer 8

• Outside lid of container is not considered sterile
• Put hand over label of thing you are pouring so drip does not ruin label
• Inside of cap but not lip is sterile
• Pour out a little bit to clean lip of container first
• Then pour into wherever it needs to go

Question 9

Opening things onto sterile field

Answer 9

• When using a peel back container, after peeling, hold onto the paper underneath so it doesn’t flop
• Drop items onto sterile field and leave it.
• When opening sterile solutions make sure to date and time if it is to be reused (generally 24 hours is still considered sterile)

Question 10

Donning/Doffing Sterile Glove

Answer 10

Doffing Glove

• Grab cuff only touching outside and pull off first glove
• Second glove grab inside and flip off.

Donning Glove

• Comes in package that shows which side your thumb should be on
• It will always be put on with palms facing up
• Grab cuff and put hand into first glove
• Second glove make sure gloved hand is only touching outer parts of the glove

Question 11

Brushstroke Method

Answer 11

• Remove all jewelry
• Inspect hands for any cuts or wounds and nails must not extend past fingertips
• Nail polish must be intact without any chips
• Artificial nails not aloud in operating room
• Put on head scrub (make sure neck jewelry is tucked into surgical gown)
• Donn proper eye protection and surgical mask
• Open sponge (chlorohexidine, betadine)
• Place sponge on shelf above sink with tear facing ceiling

Question 12

Brushstroke Method

Answer 12

• Prewash hands if it is first case of the day or soiled
• To prewash, use soap then nail pick under running water
• Dispose nail pick then rinse hands and forearms
• Remove sponge and run under water by squeezing and releasing
• Stroke nails back and fourth with sponge (abrasive brush side) (30 strokes)
• Abrasive side only for finger tips

Question 13

Brushstroke method

Answer 13

• Turn sponge to non abrasive side
• Fingers side by side, scrub palm of hand (10 strokes)
• Turn hand and scrub dorsal side (10 strokes)
• Scrub outside surface of thumb from wrist to tip of thumb (10 strokes) and each side of finger
• DO NOT GO BACK after scrubbing an area
• Divide forearm into thirds, from wrist up to 2 inches above elbow.
• 10 strokes to top, bottom and sides of each third
• Discard sponge by trash can next to scrub sink
• When rinsing, start with hand and work your way up to elbow
• Keep elbow at 90 degrees and hand raised above elbow. Do not move arm back and fourth when rinsing.
• Rinse one more time

Question 14

Sterile Gowning and Closed Gloving

Answer 14

• Open package in sterile manner
• Package contains gown and towel
• Add sterile gloves ensuring not to contaminate field
• If handing package to someone who is already sterile do it the same way
• After surgical scrub, pick up towel and dry 1 hand using 1 side of towel, then other side for other hand
• Start drying from fingertips to elbow
• Pickup gown and slide arms in and up shoulder
• Allow gown to drop down

Question 15

Sterile Gowning and Closed Gloving

Answer 15

• Only touch inside of Gown
• Do not slide hands through sleeves
• Ask partner to velcro neck and tie waist
• Apply sterile gloves with hands still in sleeves
• Make sure gloves cover fabric cuff