Policies and Procedures Flashcards
Application of techniques
Application of Sterile Techniques
A set of practices that ensure an area is free of all microorganisms
Thorough hand hygiene, wearing appropriate PPE (Personal Protective Equipment) =
Sterile gloves, sterile gowns, maintaining sterile field by only touching the outer edges of sterile drapes, properly opening sterile packages without contaminating the contents and carefully handling sterile instruments to prevent contamination during invasive procedures.
USED FOR: Surgeries and catheterizations.
Involves establishing a sterile field, which includes sterilizing equipment and the surgical site. Used when the skin is broken, impaired, or accessed.
Sterile field
The designated area considered sterile during surgery is called the “sterile field,” and only sterile items should be placed within it.
Gown and glove considerations:
The front of a surgical gown is typically considered sterile, while the back and sleeves are considered non-sterile.
Created and maintained: when practitioners identify the back table that will be used, the mayo stand that will go up to the field, and finally, the patient and the surgical site itself, placing sterile surgical drapes around the patient’s surgical site and on the table where instruments are placed, ensuring all items within the field are sterile, and strictly adhering to aseptic techniques like proper hand hygiene, gowning, and gloving to prevent contamination from non-sterile sources; essentially, anything below the patient’s drape is considered outside the sterile field.
Sterile Equipment
Sterile gloves, drapes and instruments and masks.
Sterile Instruments: Surgical Scissors, Scalpels, Forceps, Needles and Pliers.
Hand Hygiene
Thoroughly scrub hands and forearms with an antiseptic soap, using a surgical brush, for a designated amount of time (usually 2-5 minutes), ensuring all surfaces are cleaned, including under fingernails, and then rinsing thoroughly with running water.
Prepare: Wear appropriate surgical attire, including gown,booties, mask, and cap.
Access scrub sink: Go to a designated surgical hand scrub sink in the operating room.
Pre-wash hands: Briefly wash hands with regular soap and water to remove visible dirt.
Apply antiseptic soap: Dispense a surgical scrub solution (like chlorhexidine or povidone-iodine) onto hands and forearms.
Scrubbing technique:
Lather thoroughly, ensuring all surfaces are covered, including between fingers, under nails, and up to the elbows.
Use a surgical brush to scrub with friction for the recommended duration.
Follow the manufacturer’s instructions for the scrub length and technique.
Rinse thoroughly: Rinse hands and forearms under running water, ensuring all soap residue is removed.
Dry with sterile towel: Use a sterile, disposable towel to dry hands and forearms
*Nail care: Keep fingernails short and clean, and remove any artificial nails before surgery.
*Jewelry removal: Remove all rings, bracelets, and watches before scrubbing.
*Water temperature: Use warm water, not hot.
*Aseptic technique: Maintain sterile practices throughout the scrubbing process.
Skin Disinfection
Common antiseptic solutions used in surgery:
Chlorhexidine gluconate (CHG): Considered a preferred choice due to its broad-spectrum activity and persistent antimicrobial effect.
Povidone-iodine (Betadine): Widely used, but may cause skin irritation in some patients.
First thoroughly clean the surgical site with soap and water, then apply the antiseptic solution with a sterile sponge, starting at the incision site and moving outwards in a circular or back-and-forth motion, ensuring complete coverage while avoiding pooling, and allowing the solution to fully dry before proceeding with surgery.
*Always follow the manufacturer’s instructions for the specific antiseptic being used, including contact time and application technique.
Gather supplies:
Select the appropriate antiseptic solution based on the surgical site and patient factors, sterile sponges or gauze pads, and a sterile towel.
Patient preparation:
Have the patient remove clothing from the surgical area.
Wash the surgical site with soap and water, removing any dirt or debris.
Dry the area thoroughly with a sterile towel.
Applying the antiseptic solution:
Start at the incision site: Begin applying the antiseptic solution directly at the intended incision site, working outward towards the periphery.
Scrubbing motion: Use a gentle back-and-forth scrubbing motion to ensure thorough coverage.
Appropriate pressure: Apply enough pressure to wet the skin completely without causing irritation.
Multiple sponges: If necessary, use a new sterile sponge for each area to avoid cross-contamination.
Contact time: Allow the antiseptic solution to remain on the skin for the manufacturer’s recommended contact time.
Drying:
Let the antiseptic solution air dry completely before draping the patient.
Avoid blotting or wiping the area, as this can disrupt the antiseptic layer.
CONSIDERATIONS:
Check for allergies:
Always check the patient’s medical history for allergies to the antiseptic solution before application.
Hair removal:
If necessary, remove excess hair from the surgical site using clippers before prepping.
Special areas:
Modify the technique depending on the surgical site, such as taking extra care around mucous membranes or eyes.
Manufacturer instructions:
Always follow the specific instructions provided by the antiseptic solution manufacturer.
Environmental Controls
Minimizing in-out traffic through OR
Maintaining proper ventilation with a high number of air changes per hour, using HEPA filters to remove particles, regulating temperature and humidity levels to minimize bacterial growth, and ensuring adequate lighting to support surgical procedures — all aimed at creating a sterile and safe environment for patients and surgical staff.
Ventilation:
High air exchange rate: Most recommendations suggest 20 air changes per hour to achieve optimal air quality.
HEPA filtration: Utilizing High-Efficiency Particulate Air (HEPA) filters to remove airborne particles and microorganisms.
Laminar flow systems: In certain surgeries like orthopedic procedures, laminar flow systems with HEPA filters may be used to create a unidirectional airflow.
Temperature and Humidity Control:
Cool temperature: Maintaining a cooler temperature range (around 68-73°F) to inhibit bacterial growth.
Moderate humidity: Keeping humidity levels within a controlled range (typically 30-60%) to prevent excessive dryness or moisture that could facilitate bacterial growth.
Lighting:
Adjustable brightness: Providing sufficient surgical light intensity with the ability to adjust based on the procedure and surgeon preference.
Noise Management:
Soundproofing: Implementing measures to minimize noise levels within the operating room.
Important considerations:
Regular monitoring:
Continuous monitoring of air quality, temperature, and humidity levels to ensure compliance with standards.
Cleaning protocols:
Strict cleaning procedures for all surfaces and equipment within the operating room to prevent microbial contamination.
Staff training:
Educating surgical team members on proper environmental control practices and infection prevention.
Sterile-to-Sterile Contact
Only sterile items or people wearing sterile attire (like gowns and gloves) can touch other sterile items or people, strictly avoiding any contact with non-sterile surfaces or individuals to maintain aseptic technique and prevent contamination during surgery; essentially, only sterile things should touch other sterile things.
Strict guidelines:
Healthcare professionals must follow strict guidelines to ensure only sterile-to-sterile contact occurs within the operating room.
Sterile field:
The designated area considered sterile during surgery is called the “sterile field,” and only sterile items should be placed within it.
Gown and glove considerations:
The front of a surgical gown is typically considered sterile, while the back and sleeves are considered non-sterile.
Examples of sterile to sterile contact:
A scrubbed surgeon passing a sterile instrument to another scrubbed surgical team member.
A sterile nurse handing a sterile drape to a surgeon.
Two scrubbed personnel passing each other face-to-face or back-to-back to maintain the sterile field.
Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas. The front of the sterile gown is sterile between the shoulders and the waist, and from the sleeves to two inches below the elbow. Non-sterile items should not cross over the sterile field.
What is not considered sterile to sterile contact:
Touching a non-sterile item like a table or chair while wearing sterile attire.
Reaching over the sterile field with a non-sterile part of your body.
A non-scrubbed person handing a sterile item directly to a scrubbed person.
Aseptic Technique
A set of practices used to prevent contamination with microorganisms by maintaining a sterile field, including wearing sterile gowns, gloves, masks, using sterile drapes, and performing thorough hand hygiene, all aimed at minimizing the risk of infection during surgery; essentially, it’s a strict method to eliminate germs and maintain a clean environment during a surgical procedure.
USED TO: Create a sterile environment
Involves wearing sterile gloves, gowns, and using sterile drapes and instruments
Used to minimize contamination from pathogens.
Used in areas where complete sterilization is unlikely, such as a hospital or physician’s waiting room.
