module 2 (surgical asepsis) Flashcards
define: asepsis
the process for keeping away disease-producing microorganisms
define: aseptic technique
practices designed to render an area and objects as free from microorganisms
2 types: medical & surgical
medical asepsis/ clean technique is?
procedures used to reduce and prevent spread of microorganisms
includes: hand hygiene, gloves with bodily fluids
in medical asepsis an area or object is considered contaminated when?
if it contains or is suspected of containing microorganisms
example used bedpan, floor, used dressing
surgical asepsis/ sterile technique?
requires precautions different from medical
-procedures to ELIMINATE all microorganisms including spores from an object or area
contamination- (sterile technique)
occurs when its touching by any object that is not sterile
-the slightest break in technique causes contamination
when should surgical asepsis be used?
- procedures that require intentional preforation of pts skin (insertion of IV catherer, admin of injection)
- when skin integrity is broken (trauma, surgical incision, burn)
- procedures that involve insertion of catheter or surgical instrument into sterile body cavities
- in OR (obviously)
- also at bedside (IVs, catheters, suctioning tracheaobronchial airway, reapplying sterile dressings)
in the OR nurses must:
-apply mask, protective eyewear, cap
-surgical hand scrub
-sterile gloves and gown
to prevent infection!!!!
7 principles of surgical asepsis?
- a sterile object remains sterile only when touched by another sterile object
- only sterile objects may be placed on a sterile field
- a sterile object or field out of the range of vision or an object held below a persons waist is contaminated
- a sterile object or field becomes contaminated by prolonged exposure to air
- when a sterile surface comes in contact w/ a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action
- fluid flows in the direction of gravity. a sterile object becomes contaminated if gravity causes contaminated fluid to flow over the objects surface
- the edges of a sterile field or container are considered to be contaminated
sterilization=
destroys all microorganisms and their spores
nurse performing sterile changing at bedside may only:
wash hands and apply sterile gloves
always explain the procedure to the patient and how to avoid contaminating sterile items, which includes?
-avoiding sudden body movements, refraining from touching sterile supplies, avoiding coughing or talking over sterile area
most common means in OR of sterilization?
steam sterilization
to avoid contamination during a surgical hand scrub, the nurse..?
holds their hands above their elbows and allows water to flow downward without contaminating the hands and fingers
____ border around edges of a sterile package is considered unsterile when opened?
2.5 cm border
any question of sterility?
object is considered unstable
sterile barrier that has been permeated by punctures, tears, moisture must be considered?
cotaminated
how to apply Cap/mask/eyewear?
- apply a cap (secure hair in place with pins)
- apply mask
- apply eyewear
- apply gloves
how to remove protective barriers?
gloves first
- untie bottom strings of mask, then top and remove mask from face holding ties securely
- remove eyewear, avoiding placing hands over soiled linens
- grasp outer surface of cap and lift from hair
- hand hygiene
a sterile field=
provides a sterile surface for placement of sterile equipment
- free of microorganisms
- may be inside a sterile kit, a work surface with a sterile towel, table covered with large sterile drape
important consideration when preparing a sterile field?
assess for latex allergies of patient, check sterile package integrity, anticipate number of supplies needed
implementation of preparing a sterile field
- apply PPE
- select clean, flat, dry surface above waist level
- hand hygiene
- prepare sterile work surface (sterile commercial kit/pack, linen-wrapped package, prepare sterile drape)
when liquids permeate sterile field or barrier.. it is called..
strike through! now contaminated
sterile gloving?
- helps to prevent transmission of pathogens by direct and indirect contact
- proper size glove is important and correct material
- if only sterile latex and theres a allergy don a pair of synthetic gloves first because they provide a barrier between skin and latex
- helpful to interlock the fingers and hold hands in front of body above waist level while waiting to handle sterile items
- keep hands clasped about 30cm in front of body above waist below shoulders
when do you take a throat or nose culture?
when pts have signs and symptoms of upper resp or sinus infection
antibiotics and nose/throat culture?
- obtain cultures before antibiotic therapy is initiated because antibiotics may interrupt the growth of the organisms in the lab
- if they are recevings Abs, notify lab and identify which Abs
when should you obtain a throat culture?
before meals or 1 hour after eating or drinking to decrease chance of vomiting
patients clear understanding of specimen collection minimizes?
anxiety or discomfort
you may need assistance to obtain throat cultures from..?
confused, combative, or unconscious patients
assessment for nose/throat culture?
- inspect condition of nares and drainage from nasal mucosa and sinuses
- determine if pt experiences postnasal drip, sinus headache or tenderness, nasal congestion, sore throat, or exposure to others
- apply clean gloves and assess condition of posterior pharynx
- assess patient for signs of infection
explain to patient that they may experience ….. during nose/throat culture
a tickling sensation of gagging during swabbing of throat
nasal swab may urge sneeze
position for nose/throat culture?
sitting erect in bed or chair if possible
acutely ill or young pt may lie back with head of bed riased to 45 degrees
implementation of throat culture?
- instruct pt to tilt head backwards (in bed place pillow behind shoulders)
- ask pt to open mouth and say ahhh to visualize pharynx, depress tongue with tongue blade and note inflamed areas of pharynx or tonsils, depress anterior third of tongue only and illuminate with penlight
- insert swab w/o touching lips, teeth, tongue, cheeks, or uvula
- quickly and gently swab tonsillar area from side to side (making contact with inflamed or purulent sites!)
nasal culture implementation
- encourage pt to blow nose and then check nostrils for patency with penlight
- select nostril with greatest patency
- in sitting position have pt tilt head backward (pillow if sitting)
- insert nasal speculum in one nostril (optional)
- pass swab into nostril until it reaches portion of mucosa that is inflamed or containing exudate, rotate swab quickly
- remove swab w/o touching speculum or nasal canal
- remove nasal speculum, place in basin
- insert swab into culture tube *use gauze to protect ur fingers while crushing ampule at bottom of tube to release culture medium
- place tip of swab into liquid medium and place top securely on top of tube
- label, identifiers, specimen source, date and time
- plastic biohazard bag, send to lab
unexpected outcomes of nose and throat cultures
- reveal bacterial growth
- pt experiences minor nasal bleeding
- specimen is contaminated
pediatrics and nose/throat cultures?
- allow young children to visualize speculum to decrease fear
- immobilize childs head and arms when containing specimen
- ask parent to act as a couch and that they hold child on lap
- show tongue blade to child and how to say ah to decrease anxiety
- opportunity to ask questions
- do not attempt throat culture if you suspect acute epiglottis
gerontologic considerations and nose/throat culture?
some older adults need help in keeping mouth open
- some have poor dentition
- some may need to hold patients hands due to confusion
what will you explain to patient when collecting urine from indwelling catheter?
- explain u will use syringe without the need to remove urine through catheter port and that patient will not experience discomfort
- explain u will need to clamp catheter for 10-15 minutes before obtaining urine specimen and that urine cannot be obtained from drainage bag
implementation of collecting urine from indwelling urinary catheter?
- apply clean gloves, clamp tubing with clamp or rubber band for as long as 15 minutes below site chosen for withdrawal
- position pt so catheter sampling port is easily accessible. location of port is where catheter attaches to drainage bag tube
- clean port for 15 seconds, allow to dry
- attach needleless leur-lok syringe to built-in catheter sampling port.
- withdraw 3ml for culture or 20ml for routine urinalysis
- transfer urine from syringe to clean urine container for urine analysis or sterile for culture
- unclamp catheter and allow urine to flow into drainage bag (ensure it flows freely)
collecting urine for urine analysis?
clean container, 20 mL
collecting urine for culture>
sterile container, 3mL
send specimen of urine and completed requisition to lab within?
20 minutes, refrigerate if delay cannot be avoided
attach label to container of urine and what else if female..
if they are menstruating or not
when is it okay to touch a sterile field?
only when wearing sterile gloves
true or false, always best to obtain culture samples prior to antibiotic therapy?
true!
important consideration for client about to take a throat swab for culture and sensitivity?
-collecting sample before their mealtime is best!
in both nose and throat cultures why do you crush the ampule at bottom of tube?
to release the culture medium
adding sterile items to your sterile field?
- step back from field
- open sterile item while holding outside wrapper in nondominant hand
- place item into field at an angle ensuring that arm does not reach over
adding solution to your sterile field?
- verify contents and expiration date
- place receptable for solution near table/work surface edge
- remove sterile seal and cap
- with solution bottle held away from field and bottle lip 2.5-5cm above inside of sterile receiving container, slowly pour amt needed
steps to putting on sterile gloves
- hand hygiene obvs
- remove outer glove wrapper
- open inner package, make sure to keep hands on inner surface
- glove dominant hand: use thumb and first two fingers of nondominant hand to pick up glove, only touch inside surface. carefully peel over glove, leaving cuff, making sure it doesnt roll up wrist
- then glove nondominant hand: w/ gloved dominant hand slip fingers into glove of nondominant
how do you keep your hand until procedure with sterile gloves?
interlock your hands and hold away from body above waist level
what do you do if you are exposed to a blood or body fluid?
follow the algorithm which tells you what to do according to your situation
needlestick and blood exposure protocols for VIHA?
-immediately (for needle poke or cut): wash affected area with soap and water, disinfect w alcohol swab, apply sterile dressing
(for splash with blood or body fluid w blood): rinse mucous membranes well with tepid water or saline
-go to closest emerg room for assess as soon as possible (2 hrs)
-notify manager
-report incident
