Infection control: Surgical Asepsis Flashcards
What is the key principle regarding sterile objects in surgical asepsis?
- A sterile object remains sterile only when touched by another sterile object
- This guides how nurses place and handle sterile objects
What happens when sterile objects touch sterile objects?
- They remain sterile
- Examples: Sterile gloves, forceps used on sterile field
What happens when a sterile object touches a clean (non-sterile) object?
- The sterile object becomes contaminated
- Example: Sterile syringe tip touching clean disposable glove
What is the objective of surgical asepsis or aseptic technique?
- Prevent microorganisms from being introduced to a susceptible site
- Prevent transmission of microorganisms to other patients or staff
What should be done to prepare for a sterile procedure?
- Gather all required supplies
- Ensure a clear and dry field
How should movement around a sterile field be done?
- In a manner that does not contaminate the sterile field
When should sterile fields be prepared?
- As close to time of use as possible to minimize environmental contamination
What should be minimized in a sterile field?
- Conversation to reduce contamination from respiratory droplets
What should be done prior to setting up a sterile field?
- Perform hand hygiene
How should the sterile barrier be checked?
- Ensure it is intact with no punctures or moisture damage
ow should questionable sterility be handled?
- The item must be considered unsterile
How should sterile packs be opened?
- Carefully to prevent contamination of contents
What is required for items in a sterile field?
- All items must be sterile
What area is considered unsterile once a package is opened?
- A 2.5 cm border around the edges
How should solutions be poured into sterile receptacles?
- Slowly to avoid splashing and contamination
When is an object considered no longer sterile?
- If below waist level or out of vision range
Why should sterile gloves be worn?
- Prevent introducing microorganisms to site
- Protect wearer from body fluids
What happens when a sterile object touches a contaminated object?
- The sterile object becomes contaminated
- Example: Touching a sterile object with an ungloved hand
How should questionable sterile objects be handled?
- Considered contaminated and discarded
- Example: Torn/broken packaging, even if object appears untouched
What can be placed on a sterile field?
- Only properly sterilized objects
- Stored in clean, dry areas with intact packaging
When is a sterile object or field considered contaminated?
- Out of nurse’s vision range
- Held below waist level
- Unattended and could be accidentally touched
How does prolonged air exposure contaminate sterile objects/fields?
- Air currents from movements can carry microorganisms
- Talking/coughing/sneezing over sterile area
- Reaching over sterile area
How does contact with a wet, contaminated surface affect sterility?
- Sterile object/field becomes contaminated by capillary action
- If moisture seeps through sterile packaging, object is contaminated
- Wet sterile packages must be discarded or re-sterilized
How can spills contaminate a sterile field?
- Any spill can contaminate unless field rests on moisture-proof sterile surface
- Example: Spill in sterile catheter tray container won’t contaminate contents
When is a sterile object at risk of gravity contamination?
- If gravity causes a contaminated liquid to flow over object’s surface
- Hands held above elbows during scrub to prevent this
What areas of a sterile field are considered contaminated?
- 2.5 cm border around edges where field touches unsterile surface
- Open container edges exposed to air
- Sterile objects must avoid touching these areas
What should be done before starting a sterile procedure?
- Have extra supplies available in case of accidental contamination
Why should each step be explained before the procedure?
- To ensure patient can cooperate fully
What should be done if an object becomes contaminated during the procedure?
- Discard the contaminated object immediately
What protective equipment may nurses wear for sterile procedures on a general nursing unit?
- Surgical mask
- Eyewear (if risk of fluid/blood splashing)
- No cap required
For sterile surgical procedures, what is the proper order for donning protective equipment?
- Apply clean cap covering all hair first
- Then put on surgical mask
- Then put on eyewear
How should the surgical mask fit?
- Snugly around face and nose
- To prevent droplet nuclei contamination
When should a surgical mask be changed?
- If it becomes moist, as moisture promotes microorganism spread
How should protective eyewear fit?
- Snugly around forehead and face
- To fully protect eyes
When is eyewear needed?
- For procedures with risk of body fluid splashing into eyes
What should be removed first before taking off mask, eyewear and cap?
- Remove gloves first
- To prevent contamination of hair, neck and face
How should a used mask be removed and discarded?
- Untie mask, hold by ties and discard with cap
- Do not wear hanging from neck after removal
What should be done after removing all protective equipment?
- Perform hand hygiene
How are sterile items packaged?
- In paper or plastic containers impervious to microorganisms when dry and intact
- Some reusable supplies wrapped in permeable paper/linen for steam autoclaving
How are sterile items stored?
- In clean, enclosed storage cabinets
- Separated from non-sterile equipment
What indicates an item has been sterilized?
- Chemical tapes that change color during sterilization process
- If tapes don’t change color, item is not sterile
When should a sterile item not be used?
- If packaging integrity is compromised
How do facilities indicate expiration of sterile items?
- “Event-related expiration” with date processed and lot number
- “Date-related expiration” with expiration date applied
What should be done before opening sterile packages?
- Perform thorough hand hygiene
- Inspect supplies for package integrity and sterility indicators
Where should sterile packages be opened?
- On a cleaned work area above waist level
- Not in confined spaces where dirty objects could fall on them
How should commercially packaged sterile items be opened?
- Hold item in one hand, pull away paper/plastic cover with other hand
- Take care to keep inner contents sterile before use
What are the steps to open facility-packaged sterile items?
- Place item flat in center of work surface
- Remove sterilization tape/seal
- Grasp and open outer flap away from body, arm outstretched
- Open side flaps one at a time, allowing to lie flat
- Stand away and open innermost flap, letting it fall flat
- Use inner package surface as sterile field, avoiding 2.5cm border
How can a sterile package be closed if not for immediate use?
- Touch only outside wrapper surface
- Reverse order of opening
- Do not touch inner contents or reach over field
How should a small sterile item be opened when held?
- Hold package in non-dominant hand
- Use dominant hand to carefully open side/top flaps away from item
- Open so item can be handed to person with sterile gloves or transferred
What is a sterile field?
- An area free of microorganisms
- Prepared to receive sterile items
- Created using inner sterile wrapper surface, sterile drape, or dressing tray
How are sterile items added to the field?
- Carefully placed directly on field
- Transferred using sterile forceps
- Any contact with 2.5cm border requires discarding item
What precautions are taken when wearing sterile gloves on the field?
- Can touch entire drape area
- Sterile items must be handed over by assistant
- Gloves cannot touch wrappers of sterile items
hat parts of a bottle containing sterile solution are considered sterile?
- Inside of the bottle
- Inside of the bottle cap
How should the bottle cap be handled after removal?
- Held in hand or placed sterile side up on clean surface
- Never rested on sterile surface to avoid contamination
What should be checked before pouring the solution?
- Check label to ensure it is the correct solution
How should the bottle be held when pouring?
- Hold with label in palm to prevent wetting/fading
- Keep bottle edge away from receiving container edge/inside
How should the solution be poured?
- Pour slowly to avoid splashing sterile field
- Hold bottle outside edge of sterile field
How many times can solution be poured from container?
- Pour solution from container once only
- Discard remaining fluids after procedure
Why must nurses decontaminate their hands when working in operating rooms?
- To decrease and suppress growth of skin microorganisms
- In case glove tears during procedure
What areas should be scrubbed during surgical hand antisepsis?
- Scrub from fingertips to elbows with antiseptic soap
What products can be used for surgical hand antisepsis?
- Antimicrobial surgical scrub agent intended for surgical hand antisepsis
- Alcohol-based antiseptic surgical hand rub with persistent/cumulative activity
How long should a traditional surgical scrub last?
- 3-5 minutes to allow adequate contact time
- Follow manufacturer’s instructions and facility policy
What should be removed for maximum bacteria elimination?
- All jewelry including watches
- Keep nails clean and short
What should not be worn on fingernails?
- Artificial nails or enhancements as they harbor more bacteria
- Nail polish as it conceals soil and chipped polish increases bacterial load
Who should be excluded from the surgical team?
- Nurses with active skin infections, open lesions/cuts
- Nurses with respiratory infections
What are sterile gloves used for?
- An additional barrier to bacterial transfer
- Used by nurses for procedures like dressing changes and catheter insertions
What is open gloving?
- Technique used by nurses on general nursing units
- For procedures like dressing changes and catheter insertions
What is closed gloving?
- Performed after applying sterile gown in operating room
- Used for surgical procedures
How is the sterile drape opened?
- Place pack on surface and open as shown in Figure 34.4
- Ensures sterility of packaged drape
How is the sterile drape lifted?
- Use fingertips of one hand on 2.5cm unsterile border
- Gently lift and unfold without touching objects
How is the drape positioned on surface?
- Hold adjacent corners up and away from body
- First lay bottom half, then top half over surface
What is the purpose of laying drape this way?
- Prevents reaching over sterile field
- Creates flat sterile work surface
How should the sterile drape be positioned on the work surface?
- First lay bottom half of drape over work surface
- Then place top half of drape over work surface last
How should sterile items be opened?
- Open according to package directions
- Hold outer wrapper in non-dominant hand
How should wrapper be removed?
- Carefully peel onto non-dominant hand
- Do not shake item onto sterile field
How should item be placed on field?
- Place at an angle, not holding arm over field
- Prevents contaminating sterile surface
Why dispose of outer wrapper?
- Prevents accidental contamination of sterile field
Why use sterile technique?
- Prevents transmission of infection to patient
