Chapter 11: Surgical Asepsis Flashcards
METHODS OF REDUCING PATHOGENIC MICROORGANISMS IN
THE ENVIRONMENT AND INTERVENING IN THE PROCESS BY
WHICH MICROORGANISMS ARE SPREAD
MEDICAL ASEPSIS
THE PROCESS OF CREATING AND MAINTAINING AN AREA THAT IS
COMPLETELY FREE OF PATHOGENS
SURGICAL ASEPSIS
THE COMPLETE DESTRUCTION OF ALL ORGANISMS AND SPORES
FROM EQUIPMENT USED TO PERFORM PATIENT CARE OR
PROCEDURES
STERILIZATION
FOUR METHODS OF STERILIZATION
- CHEMICAL
- AUTOCLAVING (STEAM)
- GAS
- GAS PLASMA
THE IMMERSION AND SOAKING OF CLEAN OBJECTS IN A
BATH OF GERMICIDAL SOLUTION FOLLOWED BY A STERILE
WATER RINSE
* NOT RECOMMENDED FOR SURGICAL ASEPSIS
* ONE OF THE LESS SATISFACTORY METHODS BECAUSE CONTROL
OF EFFECTIVENESS FACTORS (TIME, SOLUTION STRENGTH AND
TEMPERATURE, AND CONTAMINATION DETECTION) IS DIFFICULT
CHEMICAL STERILIZATION
IS A DEVICE THAT PROVIDES STEAM
STERILIZATION UNDER PRESSURE.
AUTOCLAVE
- THE MOST COMMONLY USED STERILIZATION METHOD
- QUICKEST AND MOST CONVENIENT MEANS FOR ITEMS THAT
CAN WITHSTAND HEAT AND MOISTURE
AUTOCLAVING
METHOD THAT USES A MIXTURE OF GASES HEATED TO 135°F
(57°C)
CONVENTIONAL GAS STERILIZATION
- USED FOR ITEMS THAT CANNOT BE AUTOCLAVED
- ELECTRICAL, PLASTIC, RUBBER ITEMS, AND OPTICAL WARE
- TELEPHONES, STETHOSCOPES, BLOOD-PRESSURE CUFFS, AND
OTHER EQUIPMENT USED IN ISOLATION ROOMS
CONVENTIONAL GAS STERILIZATION
WHAT ARE SOME DRAWBACKS FOR CONVENTIONAL GAS STERILIZATION
*GASES USED ARE POISONOUS.
* MUST BE DISSIPATED BY AERATION IN A CONTROLLED
ENVIRONMENT.
* PROCESS IS TIME-CONSUMING.
- SAFER THAN CONVENTIONAL GAS STERILIZATION
- NO TOXIC BY-PRODUCTS
GAS PLASMA TECHNOLOGY
ABLE TO STERILIZE HEAT/MOISTURE-SENSITIVE ITEMS IN
GREATER VOLUME
* MORE COST-EFFECTIVE THAN CONVENTIONAL GAS
* CANNOT COMPLETELY REPLACE GAS BECAUSE IT IS NOT
EFFECTIVE ON ITEMS WITH LONG, NARROW LUMINA
* CANNOT BE USED ON CELLULOSE ITEMS (LINENS, ETC.)
GAS PLASMA TECHNOLOGY
STERILITY INDICATORS
- CHEMICAL INDICATORS THAT CHANGE COLOR WHEN
STERILIZATION HAS OCCURRED - USED TO IDENTIFY WHETHER A PACK HAS BEEN STERILIZED
- PLACED INSIDE AND OUTSIDE THE PACK TO SHOW THAT THE
GAS, HEAT, STEAM, OR GAS PLASMA HAS PENETRATED TO
ALL SURFACES
- THE TAPE THAT SEALS THIS
PACK WAS ORIGINALLY A PLAIN,
LIGHT COLOR. THE STRIPES
APPEARED ON THE TAPE WHEN
CONDITIONS FOR STERILITY
WERE ACHIEVED.
STERILITY INDICATORS
DEFINED AS A MICROORGANISM-FREE AREA PREPARED FOR
THE USE OF STERILE SUPPLIES AND EQUIPMENT
STERILE FIELD
STEPS TO ESTABLISH A STERILE FIELD
*PLACE THE PACK ON A CLEAN SURFACE WITHIN REACH OF
THE PHYSICIAN.
* JUST BEFORE THE PROCEDURE BEGINS, BREAK THE SEAL
AND OPEN THE PACK.
* UNFOLD THE FIRST CORNER AWAY FROM YOU; THEN
UNFOLD THE TWO SIDES.
* PULL THE FRONT FOLD DOWN TOWARD YOU AND DROP
IT.
* DO NOT TOUCH THE INNER SURFACE.
* THE INNER WRAP, IF THERE IS ONE, IS OPENED IN THE
SAME MANNER.
* YOU HAVE NOW ESTABLISHED A STERILE FIELD.
SURGICAL ASEPSIS:
STANDARD PRINCIPLES
- ANY STERILE OBJECT OR FIELD TOUCHED BY AN UNSTERILE OBJECT OR
PERSON BECOMES CONTAMINATED. - NEVER REACH ACROSS A STERILE FIELD.
- ORGANISMS MAY FALL FROM YOUR ARM INTO THE FIELD.
- INCREASES THE RISK OF BRUSHING THE AREA WITH YOUR UNIFORM
- IF YOU SUSPECT AN ITEM IS CONTAMINATED, DISCARD IT.
- INCLUDES DAMP ITEMS, ITEMS WITH BROKEN SEAL, AND ITEMS ON WHICH
THE INDICATOR TAPE HAS NOT ASSUMED THE CORRECT COLOR - DO NOT PASS BETWEEN THE PHYSICIAN AND THE STERILE FIELD.
- NEVER LEAVE A STERILE AREA UNATTENDED.
- NO ONE WOULD KNOW IF FIELD WERE CONTAMINATED.
- A 1-INCH BORDER AT THE PERIMETER OF THE STERILE FIELD IS
CONSIDERED A “BUFFER ZONE” AND IS TREATED AS IF IT WERE
CONTAMINATED
SKIN PREPARATION FOR
STERILE PROCEDURES
steps 1 to 5
- OBTAIN A “SKIN-PREP SET” AND A BOTTLE OF ANTISEPTIC
FOR PAINTING THE SKIN. THE PREPARATION SET INCLUDES A
BASIN, LIQUID SOAP SUCH AS PHISODERM, GAUZE
SPONGES, RAZOR, TOWEL, FORCEPS, AND MEDICINE CUP. - PERFORM HAND HYGIENE.
- PLACE THE PATIENT IN A COMFORTABLE POSITION AND
ENSURE PRIVACY. - EXPLAIN WHAT IS TO BE DONE.
- EXPOSE AN AREA SLIGHTLY LARGER THAN THE
PREPARATION SITE, KEEPING THE PATIENT AS COMPLETELY
COVERED AS POSSIBLE TO PROVIDE COMFORT AND
MODESTY.
SKIN PREPARATION FOR
STERILE PROCEDURES
steps 6 to 10
NOTE: IF HAIR REMOVAL IS NOT ORDERED, OMIT STEPS 6 AND
7.
6. IF HAIR REMOVAL IS ORDERED, USE A DRY RAZOR TO SHAVE
A SMALL AREA AT A TIME. HOLD THE SKIN TAUT WITH ONE
HAND AND SHAVE WITH SHORT, FIRM STROKES IN THE
DIRECTION OF HAIR GROWTH. THE SAME CONCEPT APPLIES
IF USING AN ELECTRIC RAZOR.
7. WIPE THE AREA WITH A STERILE GAUZE SPONGE WETTED
WITH ALCOHOL, REMOVING ALL THE HAIR.
8. PERFORM HAND HYGIENE AND DON STERILE GLOVES.
9. POUR A LITTLE OF THE ANTISEPTIC INTO A WASTE
CONTAINER TO CLEANSE THE LIP OF THE BOTTLE.
10. FILL THE MEDICINE CUP WITH ANTISEPTIC.
SKIN PREPARATION FOR
STERILE PROCEDURES
steps 11-15
- GRASP SEVERAL GAUZE SPONGES WITH THE FORCEPS AND
DIP THEM INTO THE ANTISEPTIC. - PAINT THE SKIN WITH THE ANTISEPTIC, STARTING IN THE
CENTER OF THE AREA AND WORKING OUTWARD IN A
CIRCULAR PATTERN. DO NOT SCRUB HARSHLY, BUT
REMEMBER THAT FRICTION IS MORE EFFECTIVE THAN
SOAP IN CLEANSING THE SKIN. DISCARD THE SPONGE. - ALLOW THE SKIN TO DRY.
- REPEAT STEPS 12 AND 13.
- OPEN THE PACK CONTAINING THE STERILE DRAPE OR
STERILE TOWELS. THE PHYSICIAN, WEARING STERILE
GLOVES, WILL DRAPE THE AREA SURROUNDING THE
PREPARED SITE.
SURGICAL HAND SCRUB
steps 1-6
- WEAR SURGICAL ATTIRE AND APPROPRIATE PERSONAL PROTECTIVE
EQUIPMENT. - USING FOOT OR KNEE LEVER, ADJUST WATER FLOW AND TEMPERATURE.
- WET YOUR HANDS. ADD A FEW DROPS OF ANTIMICROBIAL SOAP AND MORE
WATER AS NEEDED TO MAKE A LATHER. - WASH YOUR HANDS AND FOREARMS THOROUGHLY. USE ONE BRUSH AND
SOAP TO CLEAN YOUR HANDS AND NAILS, AND CLEAN UNDER YOUR NAILS
WITH THE NAIL CLEANER UNDER RUNNING WATER. - RINSE YOUR HANDS AND ARMS THOROUGHLY, KEEPING YOUR HANDS
HIGHER THAN YOUR ELBOWS. TAKE CARE TO AVOID SPLASHING YOUR
SCRUB CLOTHES BECAUSE THE DAMPNESS MAY LATER MOISTEN YOUR
STERILE GOWN, CAUSING CONTAMINATION. - USING THE SECOND BRUSH AND MORE SOAP, THE ACTUAL SCRUB BEGINS.
THE PRESCRIBED NUMBER OF BRUSH STROKES IS USUALLY 15 STROKES TO
THE NAILS OF EACH HAND AND 10 STROKES TO EACH AREA OF THE SKIN,
WHICH USUALLY TAKES ABOUT 5 MINUTES.
SURGICAL HAND SCRUB
steps 7-13
- THE FINGERS AND HANDS SHOULD BE VISUALIZED AS HAVING FOUR SIDES, AND
EACH SIDE MUST BE EFFECTIVELY SCRUBBED. STARTING WITH THE FINGERNAILS,
SCRUB THEM VIGOROUSLY, HOLDING THE BRUSH PERPENDICULAR TO THEM. THEN
SCRUB ALL SIDES OF EACH FINGER AND THE PALMS AND BACKS OF THE HANDS.
DIVIDE EACH FOREARM INTO THIRDS AND USE A CIRCULAR MOTION TO SCRUB EACH
SIDE OF THE FOREARMS AND ELBOWS, UP TO 2 INCHES ABOVE THE ELBOWS. - KEEP YOUR HANDS ABOVE YOUR ELBOWS WHILE SCRUBBING AND ADD SMALL
AMOUNTS OF WATER AS NEEDED TO MAINTAIN A GOOD LATHER. WHEN SCRUBBING
IS COMPLETED, DISCARD THE BRUSH. - RINSE YOUR HANDS AND ARMS THOROUGHLY FROM FINGERTIPS TO ELBOWS IN ONE
MOTION, ALLOWING THE WATER TO DRAIN OFF AT THE ELBOWS. TURN OFF THE
WATER WITH THE FOOT OR KNEE CONTROL. - KEEPING YOUR HANDS ABOVE THE ELBOWS AND AWAY FROM YOUR BODY, ENTER
THE SURGICAL SUITE BY BACKING THROUGH THE DOOR. - TO DRY, GRASP THE CORNER OF A STERILE TOWEL AND STEP BACK FROM THE
FIELD, ALLOWING THE TOWEL TO FALL OPEN. BEND FORWARD AT THE WAIST AND
HOLD YOUR ARMS AWAY FROM YOUR BODY AND ABOVE YOUR WAIST. DRY YOUR
HANDS AND THEN YOUR ARMS THOROUGHLY, ROTATING THE TOWEL AS REQUIRED. - TAKE CARE NOT TO CONTAMINATE THE STERILE FIELD, THE TOWEL, OR YOUR
HANDS. - YOU ARE NOW READY TO DON A STERILE GOWN AND GLOVES.
SURGICAL SCRUB: ALCOHOL-BASED
HANDRUB METHOD
steps 1-7
- WEAR SURGICAL ATTIRE AND APPROPRIATE PERSONAL
PROTECTIVE EQUIPMENT. - USING FOOT OR KNEE LEVER, ADJUST WATER FLOW AND
TEMPERATURE. - WET HANDS AND ARMS AND LATHER WITH APPROVED NONANTIMICROBIAL AGENT.
- CLEAN FINGERNAILS UNDER RUNNING WATER USING
DISPOSABLE NAIL CLEANER; DISCARD NAIL CLEANER. - RINSE HANDS AND ARMS UNDER RUNNING WATER.
- DRY HANDS AND ARMS USING A PAPER TOWEL.
- DISPENSE OF THE MANUFACTURER’S RECOMMENDED AMOUNT
OF ALCOHOL-BASED HAND RUB INTO THE PALM OF ONE HAND.
DO NOT USE WATER WITH THE HAND PREP.
SURGICAL SCRUB: ALCOHOL-BASED
HANDRUB METHOD
steps 8-13
- DIP THE FINGERTIPS OF THE OPPOSITE HAND INTO THE
HAND PREP AND WORK IT UNDER THE NAILS. - SPREAD THE REMAINING HAND PREP EVENLY OVER THE
HAND AND FOREARM TO JUST ABOVE THE ELBOW,
COVERING ALL SURFACES. - USING ADDITIONAL HAND PREP, REPEAT STEPS 7–9 WITH
THE OTHER ARM. - REPEAT STEPS 7–10, IF RECOMMENDED.
- TO FACILITATE DRYING, CONTINUE RUBBING ANTISEPTIC
HAND PREP INTO HANDS UNTIL DRY. - KEEP SCRUBBED HANDS AND ARMS IN VIEW AND AVOID
CONTAMINATION; ALLOW TO AIR DRY COMPLETELY BEFORE
DONNING A STERILE GOWN AND GLOVES.