Asepsis in Cath Lab Flashcards
Absence of germs such as bacteria, viruses, and other microorganisms
Asepsis
Standard healthcare practice that helps prevent the transfer of germs to or from patients, staff and surrounding environment
Aseptic Technique
Sterile attire, hand hygiene and non touch technique to achieve a safe level of asepsis for technical and short procedures
Aseptic Fields
When does the Cath Lab need to meet OR standards of surgical asepsis
Planting permanent devices such as pacemakers, defibrillators, or artificial valves. Complex EP procedures as well
What is the range of infection rates in the Cardiac cath lab and EP procedures
0.1% to 0.6%
What is HAI
Healthcare Associated Infection
When should PPE be worn by all healthcare workers in the Cath Lab
Direct patient contact
What should all lab personnel entering the hybrid or procedure room wear?
Scrub attire and head coverings
What are Sterile Surfaces
Free of all living organisms including bacterial spores and viruses
Visitors entering the cath lab should don either
Clean surgical attire or single use jumpsuit (bunny suit)
When should OSHA specified respiratory protection be worn?
Person with known or suspected active tuberculosis disease
What should be adhered to follow hand hygiene
Fingernails short 1/4 inch, use hand lotion that is compatible with gloves, exclude healthcare providers from environment if they have cuts, abrasions, dermatitis, or fresh tattoos
When should cath lab personnel wash their hands
Coming in and leaving duty, before and after each contact with patient or environment, after donning and removing gloves, before and after eating/restroom, any time there has been contact with blood or other materials, after hands are visibly soiled.
What is the purpose of surgical scrubbing
Remove debris and transient microorganisms from nails, hands, and forearms.
What are the five planes for cleansing hands
two sides, back, front, and fingertips
Where should hands be held during scrubbing
above the elbows
When using a alcohol based surgical hand antiseptic, what are the following steps:
-Remove jewelry
-Don a surgical mask
-Prewash hands and forearms if soiled
-clean under fingernails with a nail pick under water
-Rinse hands and forearms under running water
-Dry hands and forearms thoroughly with disposable paper towels
-Dispense recommended amount of antisepsis product and apply it to hands and forearms
-Repeat application as directed
-Rub thoroughly until completely dry.
When using a traditional scrub-with-water product, the following steps are:
-Remove jewelry
-Don a surgical mask
-Prewash hands and forearms with soap and water if visibly soiled
-Clean under fingernails with a nail pick under water
-Dispense recommended antimicrobial product
-Apply to wet forearms and hands using a soft sponge
-Keeping hands elevated, scrub all skin surfaces with a sponge for 3-5 minutes
-Avoid splashing surgical attire
-Discard sponges in container
-Keeping hands elevated, rinse hands and forearms from fingertips to elbows under water
-In OR, dry thoroughly with a sterile surgical towel before donning gown and gloves
-Keeping hands elevated, dry hands with a sterile towel if required
When does the surgical gown be considered a sterile field
chest down to the level of the surgical field
Gowning Procedure:
1: Hold a folded sterile gown by the collar away from the body
2: Allow the gown to drop open, ensuring that no part of it touches the floor or any other object
3: Slide both arms into the sleeves, always keeping them above the waist. Flex the elbows to get the arms through the sleeves
4:Staff members will grasp the collar of the gown and fasten the tabs at the back of the neck
5: The gown can be tied at the waist after gloving
When performing closed assisted gloving, the steps are:
1: Arms are pushed only so far into the sleeve of the sterile gown that the hands are still covered by the cuff
2: The nondominant hand is used to pull the sterile glove onto the dominant hand
3: The gloved hand then applies the remaining glove to the other hand
4: Gloves are adjusted once both hands are covered
Open assisted method of applying gloves are:
1: Sterile gown is donned, with hands emerging from the cuffs
2: Using the non-dominant hand pick up the glove for the dominant hand at the cuff, using just the fingertips
3: Slide this hand into the glove until a snug fit over the thumb joint and knuckles is achieved.
4: Slide the gloved fingertips into the folded cuff of the remaining glove. Slide the ungloved hand into the glove until a snug fit is achieved
5: Unfold the cuffs of both gloves down over the gown cuffs and up the sleeves as far as they will go
When should you wear two surgial gloves on each hand?
Whenever there is a risk of exposure to blood, body fluids, and other infectious materials during the operation
What is considered the sterile field
Area surrounding the site of incision or perforation into tissue that has been prepared for a surgical or invasive procedure. Anything that is covered with sterile drapes and drape accessories as well.
When should sterile fields be prepared
As near as possible to the start time of the surgical or other invasive procedure.
How far away should non scrubbed personnel be from the sterile field
12 inches away and not pass in between two sterile fields
What should you do with a sterile item that touches an unsterile area?
Discard ad replace the item. Do not wipe the item with disinfectant.
What should you check before introducing an item to the sterile field?
-Check for an expiration date
-Check the packaging to ensure there has not ben a breach
-Check chemical sterilization indicator on package
How do you open a sterile item?
Open a wrapper flap that is farthest away from the body
Open each side flap
Open the near flap
How do you cover a sterile field?
Use two sterile cuffed drapes to cover the sterile field. First drape should be placed horizontally over the table with the cuff at the halfway point. Place a 2nd drape on the other side to cover the 1st cuff To remove, place your hand in the 1st cuff drape and remove and repeat with the 2nd cuff.
What should you do to prepare puncture site?
Assess the skin of presence of moles, warts, and rashes. Hair should be left at the surgical site unless removed by doctors orders
Where should hair removal take place
Away from the sterile field and in another room. Use a electric powered clipper with a disposable head
What is the CDC guidelines to preparing the skin
1: Prepare clean skin with an antiseptic before peripheral venous catheter insertion
2: Prepare clean skin with a 0.5% or greater chlorhexidine preperation with alcohol before central venous catheter and arterial catheter insertion and during dresing changes.
3: Antiseptics should be allowed to dry.
What is the proper preparation for central and arterial catheter insertion
0.5% or greater chlorhexidine with alcohol
If there is a contraindication to chlorhexidine, what do you use as an alternative?
Tincture of iodine and iodophor. 70% alcohol can also be used
What are the three designated areas in a cath lab suite
Unrestricted areas, Semi Restricted areas, and Restricted areas
What is in the unrestricted areas:
entrances for patients, personnel and deliveries.
Waiting and registration areas.
Break rooms
locker rooms
PACU units
What is in Semi-Restricted Rooms:
-Equipment storage and supply areas
-Sterilization Areas
-Corridors between unrestricted and restricted areas
-HVAC required areas with personnel wearing surgical attire
What is in Restricted Areas:
-Pressure positive rooms with doors closed at all times.
-Invasive procedure rooms
-Sterile items storage
What is the HVAC parameters of the ICVL environment:
-Humidity at 30-60%
-Rooms kept cool at 68-73 degrees F
-Ventilation at a rate of 20-25 room air exchanges per hour
-Filter system
Before the first procedure of the day:
-Inspect records and assess the cath lab to ensure terminal cleaning was completed the previous evening
-Wipe all horizontal surfaces with a disinfectant to remove any dust that accumulated overnight
-If no confirmation of terminal cleaning, do a full terminal clean
Cleaning between cases:
-Removal of all equipment and linens soiled with body fluids
-Spills cleaned off the floor
-Procedure table cleaned with disinfectant
-All equipment spot cleansed if soiled with body fluids
-Any patient contacted equipment cleaned between patients
-Refillable soap dispensers disassembled and cleaned before refilling
Terminal cleaning or final cleaning of the day:
-Cleaning entire floor with disinfectant
-Washing all surfaces to remove contaminants and dust
-All soiled equipment removed
-Terminal cleaning in procedure rooms, scrub areas, and utility rooms.
-Any material left in the room should be clean and free from any contamination
-All biohazardous material should be removed to the dirty utility area.
-Every surface and furniture wiped down
-Replacement of multiuse transducers
Where are gowns considered sterile
From the axilla (armpit) to the level of sterile field and sleeves from 2 inches above the elbow to the cuff
