Principles of Asepsis

Question 1

Asepsis =

Answer 1

= absence of pathogenic microbes or their toxins in blood/tissues
> virtually impossible to eliminate ALL microbes on living tissue!

Question 2

Aseptic technique renders the site…

Answer 2

…surgically clean

Question 3

Halsted’s surgical principles (6 principles)

Answer 3

1. Asepsis
2. Hemostasis
3. Accurate anatomical dissection
4. Gentle tissue manipulation
5. Avoid excess tension on tissue during wound closure
6. Accurate tissue approximation in wound closure

Question 4

Non-Surgical methods to reduce surgical site infection

Answer 4

1. Tx existing infections
2. Minimize pre/post hospitalization time
3. Clip sx area (don’t shave)
4. Minimize # of OR personnel

Question 5

Surgical methods to reduce surgical site infection

Answer 5

1. Atraumatic surgical technique
2. Debride thoroughly
3. Minimize dead space
4. Minimize suture tension
5. Use good hemostats
6. Accurate skin closure
7. Minimize surgical time
8. Minimize sutures & use monofilament whenever possible

Question 6

The 10 Commandments of the Operating Room: 1

Answer 6

• Sterile persons stay in the sterile area

> No wandering!

Question 7

The 10 Commandments of the Operating Room: 2

Answer 7

Sterile zone:

• sx site
• draped sterile fields
• air space over sterile field
• surgeon only sterile mid-chest to waist and elbow to fingertips
• table only sterile at table height

Question 8

The 10 Commandments of the Operating Room: 3

Answer 8

Surgeons must keep hands clasped in front and above waist when not in use

Question 9

The 10 Commandments of the Operating Room: 4

Answer 9

STERILE items ONLY handled by STERILE personnel

…and vice versa w/ non-sterile items

Question 10

The 10 Commandments of the Operating Room: 5

Answer 10

• Non-sterile personnel NEVER reach over sterile field

- Keep a distance of at least 1 foot from sterile zone

Question 11

The 10 Commandments of the Operating Room: 6

Answer 11

• Always face sterile field when moving past to minimize accidental contamination
• Pass other people back-to-back

Question 12

The 10 Commandments of the Operating Room: 7

Answer 12

• Edges of instrument packs considered unsterile

- Instruments that contact these edges are contaminated

Question 13

The 10 Commandments of the Operating Room: 8

Answer 13

Damaged or wet surgical packs are considered unsterile

Question 14

The 10 Commandments of the Operating Room: 9

Answer 14

Minimize talking, movement, etc.

Question 15

The 10 Commandments of the Operating Room: 10

Answer 15

When in doubt…consider contaminated!

Question 16

Sx Prep - Scrub room

Answer 16

1. Remove all jewelry, tie up long hair
2. Put on face mask and surgeon’s cap
3. Open sx gown pack & surgical glove package
4. Timed hand scrub then pat hands dry with sterile towel (5 minute contact time - start scrub at fingers and work up towards the elbow)
5. Put on sx gown
6. Surgical gloving (open or closed [“thumb-to-thumb”] gloving techniques)

Question 17

Why scrub (surgeon)?

Answer 17

Reduce microbes on surgeon’s hands that could potentially contaminate sx field in cases of:

• punctured/torn glove
• exposed gown cuff
• sleeve soak-through

Question 18

Recent studies of hydro-alcoholic solutions…

Answer 18

• More efficient than traditional medicated soaps in pre-sx hand asepsis
• Significantly superior sustained effects

Question 19

Aesptic sx site prep in the OR

Answer 19

1. Select appropriate sol’n
   - –CHX 4% - most common
   - –PVI 10% - periocular & ortho sx - or after a timed scrub, spray site with 10% PVI
   - –Alcohol-based antiseptics
2. Timed scrub
   - –minimum of 5 mins contact time
   - –except w/ alcohol-based antiseptics

Question 20

Use of alcohol-based sol’ns in vet sx

Answer 20

• Better effects than single agents
• Improved residual effect over use of single agent
• CHG > PVI for pre-op antisepsis (40% decrease in SSI)
• CHG-Alcohol product rec. by. CDC for IVC site prep (50% decrease in IVC site infection vs. PVI)