aseptic technique Flashcards
The practice of avoiding contact with bodily fluids, by means of the wearing of nonporous articles such as gloves, goggles, and face shield. The practice was introduced in 1985
universal precautions
how should every person be treated
as though they have an infectious disease
In 1996, universal precautions was replaced with _____________. “A set of precautions designed to prevent transmission of HIV, Hepatitis B virus (HBV), and other blood borne pathogens when first aid or health care
standard precautions
what does standard precautions include
■ Hand washing
■ Appropriate personal protective equipment:
– Gloves
– Gowns
– Masks
body fluids to be careful about
■ Blood
■ Semen and vaginal secretions
■ Cerebrospinal fluid ( Cerebrospinal fluid (found in the spine)
■ Synovial fluid (found in joints)
■ Pleural fluid (found in lungs)
■ Peritoneal fluid (found in abdominal cavity)
■ Pericardial fluid
■ Amniotic fluid Amniotic fluid (pregnancy)
what can you get from body fluids
HIV, Hepatitis A, B, C, Staph and Strep infections, Gastroenteritis salmonella, and shigella, Pneumonia, Syphilis, TB, Malaria, Measles, Chicken Pox, Herpes, Urinary tract infections, and Blood infections.
The greatest risks are from HIV and Hepatitis B and C
used for infections spread in large droplets by coughing, talking, or sneezing such as influenza
droplet precautions
used for infections spread in small particles in the air such as chicken pox
airborne precautions
used for infections spread by skin to skin contact or contact with other surfaces such as herpes simplex virus
contact precautions
it is the process of destruction of disease causing microorganisms to prevent infection in patients body surface. the process may be either bactericidal or bacteriostatic
antisepsis
it is a process of killing pathogenic organisms from inanimate objects such as surgical instruments
disinfection
chemical substance used on inanimate objects to kill pathogens
disinfectant
chemical substance which kills the pathogenic organism or inhibits growth
antiseptic agent
process of destruction or removal of all microorganisms including spores from article, surface, or medium
sterilization
The skin and hair are colonized with these various organisms. The stratum corneum layer of the epidermis is colonized with a polymicrobial flora
- Staphylococcus aureus
- Staphylococcus epidermidis
- various Streptococcus species
- viruses, yeasts, and molds
what is the most common cause of wound infections
(Many of these organisms are nonpathogenic, even when placed in environments considered appropriate for infection)
S. aureus
Some species, such as__________, are pathologic only when inoculated into deeper layers of the skin and soft tissue
S. epidermidis
For most infections, a significant inoculation is required to create a critical level for microbial growth to occur._________ decreases bacterial exposure and reduces the level of potentially pathologic organisms.
Aseptic technique
is S. aureus prevalence in nasal carriage higher among male HCW or female
male
what department is s. aureus carriage rate highest
highest in orthopedics department
followed by surgery and gyn departments
all staph aureus isolates are sensitive to what drugs
vancomycin and linezolid
what is the ecological niche of S aureus
anterior nares of humans
Approximately 20% of the individuals almost always carry one type of strain and they are called
persistent carriers
A large proportion of the population (60%) harbors S. aureus intermittently, and the strains change with varying frequencies. Such persons are called
intermittent carriers
A minority of the people (20%) almost never carry S. aureus and they are called
non carriers
Routine and adequate provider disinfection in the clinical setting includes:
also how to prevent iatrogenic infections
– Hand washing
– Use of clean and disinfected personal diagnostic equipment (e.g.,
stethoscopes)
– Wearing appropriately cleaned coats and clothing
What is the right way to wash your hands?
■ Follow the five steps below to wash your hands the right way every time.
■ Wet your hands with clean, running water (warm or cold), turn off the
tap, and apply soap.
■ Lather your hands by rubbing them together with the soap. Be sure to
lather the backs of your hands, between your fingers, and under your nails.
■ Scrub your hands for at least 20 seconds. Need a timer? Hum the
“Happy Birthday” song from beginning to end twice.
■ Rinse your hands well under clean, running water.
■ Dry your hands using a clean towel or air dry them
There are very few contraindications to the maintenance of adequate clinical aseptic technique.
- Extreme clinical circumstance in which TIME does not allow proper aseptic technique, as in an emergent thoracotomy.
- Allergies and sensitivities to latex and antiseptic solutions. ALWAYS,
ALWAYS check allergies!!!
can be divided into skin disinfection and sterile technique
aseptic technique
removes any microorganisms found on the skin and decreases potential contamination during the procedure
skin disinfection
involves the application and scrubbing of a disinfectant
preparation onto the skin
disinfection
how to disinfect simple procedures, such as injections or venipunctures
little disinfection, Wipe the skin with gauze that has been impregnated with 70% isopropyl alcohol for simple
procedures. The alcohol has an antibacterial effect. The mere
force of wiping the skin reduces bacterial counts.
how to disinfect for more comprehensive skin preparation
Povidone iodine, 2% iodine tincture, and chlorhexidine are the most
commonly used skin antiseptic solutions
Povidone iodine solution is highly germicidal for
Gram-positive and Gram-negative bacteria, viruses, fungi, protozoa,
and yeasts.
Iodine rapidly reduces bacterial counts on the skin surface and these effects last up to _____ hours
3
how does iodine solution kill bacteria
Allow the iodine solution to dry and then wipe it from the skin with 70%
alcohol prior to beginning the procedure.
The iodine solutions work by oxidation and cross-linking of sulfhydryl groups, killing bacteria as the solution dries
what is used as a substitute in iodine allergic or sensitive patients
chlorhexidine or hexachlorophene
how does chlorhexidine differ from iodine
- much longer antimicrobial activity (up to 48 hours)
- more gentle on the skin
how does chlorhexidine kill bacteria
destroys cell membranes of gram-positive and gram- negative bacteria while precipitating the intracellular contents
what precedes a procedure
■ Time Out
■ Inform patient about risks and advantages of the procedure
■ Obtain consent either via the patient or the guardian
■ Preparation - Will you be performing the procedure? Attending?
■ Set up
■ Is there a study required to confirm placement?
■ Procedure note
what is a time out
■ The procedure is not started until all questions or concerns are resolved.
■ Conduct a time-out immediately before starting the invasive procedure or making the
incision.
■ A designated member of the team starts the time-out.
■ The time-out is standardized.
who is part of the time out
the immediate members of the procedure team: the individual
performing the procedure, anesthesia providers, circulating nurse, operating room technician, and other active participants who will be participating in the procedure from the beginning
During the time-out, the team members agree, at a minimum, on the following:
– Correct Patient Identity
– Correct Site
– Procedure to be done
what do you do at the end of a time out
Document the completion of the time-out. The organization determines the amount and
type of documentation
how to explain the procedure to a patient
■ Always set down and explain what you are about to do. BE HONEST!!
■ If it hurts tell the patient this will hurt!
■ Use phrases such as, “I apologize, we will make you as comfortable as possible”. Explain what analgesic you are going to use (ie. Lidocaine).
■ If no pain meds are required, such as when removing a chest tube, tell the patient “this will only take a moment, we will work together, but there is nothing I can give you to take away the pain.” The same with removing a ureter stent.
before any procedure what must you obtain
■ Informed Consent!
■ Make sure at your institution “you” can obtain consent!!!
■ Obtaining consent means obtaining the patient’s authorization for diagnosis and treatment.
■ The person consenting must be legally and actually competent and must bebinformed.
■ The burden of consent rests with the person performing the procedure.
■ Hospitals and/or hospital staff have been consistently cleared in legal proceedings when consent is concerned.
It is the responsibility of the physician or the physician’s representative to discuss what
with the patient:
– Indications for the procedure
– Risks
– Benefits
– Alternatives
how to prepare for a procedure
■ Gather all equipment necessary.
■ Place it on a small procedure stand.
■ Not having the necessary supplies may delay the procedure, make the patient more uncomfortable and can be dangerous.
how to set up for a procedure
Do not use the patient or their bed to set up supplies or equipment.
Place sterile drapes or towels to form a field wide enough to allow for a
comfortable work space.
Drape the area near the patient closest to the bedside procedure table. This will minimize inadvertent contamination in moving from the table to the patient
how to set up for a procedure
■ Make a small flat sterile area near the procedure site to allow for placement of important items that
must be immediately available.
■ Open all caps, position stopcocks, and prepare all devices prior to starting the procedure. The
likelihood of contamination increases if devices are not adequately prepared, thus requiring manipulation during the critical portion of a procedure.
■ Adhere to universal precautions guidelines. Use eye and face protection during the procedure. This
should be applied before donning gowns and gloves.
how do you set up your mayo stand
A sterile drape is used to cover your stand. Drapes come in various sizes and shapes depending upon the
procedure.
■ Drapes may be individually wrapped or come in a pre- packaged procedure kit.
■ They may be plastic, paper or cloth but are usually fluid resistant.
■ The inner surface is sterile, except for a 1 inch border around the edges. You may grasp this border to apply
the drape. Any instrument or sterile item that contacts this 1 inch border must be removed from the field, it is
not longer considered sterile.
Prior to opening a sterile item, the following should be verified:
- The integrity of the packaging material is intact, eg no perforations, tears or evidence of strike-through.
- Confirm expiration date, if present.
how to add to the sterile field for small and large objects
Small items can be
dropped 6-8 inches above
the sterile field.
Larger objects should be
set down gently on the
field
how to apply disinfectant solution
Place the disinfectant solution onto either a sterile sponge or sterile gauze if it is not supplied inside a
single-use applicator.
■ The application of disinfectant to the skin is in a circular motion, beginning with the central area of the
procedure and working out toward the periphery of the sterile field
■ repeat the application process three or four times using a new sponge, gauze square, or
applicator each time.
■ This technique ensures that the central area where the procedure is to be performed is the most sterile area of the field. The area of disinfection must be much larger than the primary area of the procedure, as the number of organisms increases toward the periphery of the prepped area
what goes into a procedure note
■ Name of the procedure
■ Indication for the procedure
■ Consent (name of person giving consent, risks, benefits, potential
complications)
■ Anesthesia
■ Details of the procedure
■ Findings
■ Complications
■ Note if X-ray pending or if has been confirmed
