Principles of Surgical Asepsis Flashcards
What is the purpose of aseptic technique?
Practices that aim to prevent infection in the patient.
What does aseptic technique include?
They include but are not limited to…
• Sterilization of equipment, gowns, drapes, etc
• Surgical suite preparation
• Patient preparation
• Surgical team preparation
What is the history of aseptic technique?
• British surgeon that found a way to prevent infection in wounds during and after surgery
• He was the first to apply the science of Germ Theory to surgery
• Lister’s Antisepsis System is the basis of modern infection control
• His principles made surgery safe
Antisepsis is defined as the?
prevention of sepsis by exclusion, destruction, or inhibition of growth of most microorganisms on animate/living objects.
Antiseptics are used for what purpose?
• Antiseptics are used to kill most microorganisms during patient skin prep and surgical scrubbing
• Remember skin is not sterile
Asepsis is defined as ?
Absence of pathogenic microbes in living tissue that cause disease
• PREVENT wound contamination by destroying organisms before they enter the wound
Aseptic technique is defined as ?
• Aseptic technique- Principles employed to minimize degree of contamination of a surgical wound
Barrier is defined as?
A material used to reduce or inhibit the migration or transmission of microorganisms in the environment. Personnel attire and gowns, furniture and patient drapes, equipment and supply packaging, and ventilating filters.
Contaminated is defined as?
carrying or infected by microorganisms.
Cross-contamination is defined as?
Transmission of microorganisms from patient to patient or from inanimate object to patient.
Decontamination is defined as?
Cleaning and disinfecting or sterilizing processes carried out to make contaminated items safe to handle.
Disinfection is defined as ?
Chemical or mechanical (friction) destruction of pathogens.
Irreducible minimum is defined as?
The microbial burden cannot get any lower. The item is sterile to its highest degree.
Spatial relationships are defined as?
Having awareness of sterile unsterile, clean, and contaminated areas, objects, and individuals and their proximity to each other.
Standard precautions are defined as?
Procedures followed to protect personnel from contact with the blood and body fluids of patients.
Sterile is defined as ?
Free of living organisms.
Sterile field is defined as?
Area around the site of incision into tissue or the site of introduction of an instrument into a body orifice that has been prepared using sterile supplies and equipment.
Sterile technique is defined as?
The method by which contamination with microorganisms is prevented to maintain sterility through out the surgical procedure.
Terminal sterilization and disinfection is defined as?
Procedures carried out for the destruction of pathogens at the end of the surgical procedure in the operating room (OR) after the patient has been removed.
What is the purpose of asepsis?
PREVENT wound contamination by destroying organisms before they enter the wound
Antisepsis is defined as?
Destruction of most microorganisms on animate/living objects
Sterility is defined as the absence of ?
This can only be applied to?
all forms of microbial life
• Only inanimate objects
It is important to remember that complete absence of microorganisms cannot be reached in a hospital environment. How can we help reduce transmission?
Using aseptic techniques will help control pathogens and decrease risk of infection
What is the purpose of aseptic and sterile technique?
• Decrease iatrogenic infection rate
• Minimize sources of contamination
• Block transmission of microorganisms
• Reduce patients’ risk of exposure to microorganisms that cannot be removed.
Transmission of Microorganisms
How can microorganisms be transmitted in a hospital setting?
Microorganisms can be transmitted from:
Patient
Hospital Staff
Contaminated instruments
Environment
List and describe the sources of contamination
Animal Sources
• Skin - cells constantly shed;
• Hair - natural bacteria live here; secretions contain bacteria; prep patient well and shave them!
• Nasopharynx; Oral Cavity - natural bacteria; secretions
• Ear Pinnae = yeast, bacteria
• Vulva, Prepuce, Anus = yeast, bacteria
Sources of contamination from Inanimate sources include
• Fomites & Air
• Hair clipper = especially if you do not clean the clippers in between every patient
• Scrubs = e.g. parvo puppy, you can pass secretions between patients.
• Hospital structures = roof, air vents, HVAC, etc.
• Walls
• Floors
• Furniture
• Equipment
• Lights
Sources of contamination
Airborne sources
• Particles in air are responsible for about 80-90% of contamination during surgery.
• 1 cubic foot of air contains thousands of particles
• This can increase in longer procedures to more than 1 million
• Decrease foot traffic in sx room (staff, other patients, pet owners)
What is the primary aerial bacterial source?
YOU THE SURGEON
How many microbes are shed from skin/min/person?
3,000-50,000 MICROBES SHED FROM SKIN /MIN/PERSON
Describe Surgeon Preparation:
Surgical Scrubbing
• Drying of hands
• Gowning
• Gloving
Describe Patient Preparation:
Surgical site preparation
• Hair removal
• Skin preparation
• Draping
Describe Surgeon Attire
Lab Coat
• Surgical scrubs
• Surgery Cap
• Face Mask
• Shoe covers
Scrubbing removes ____ and ____, reduces ______ ________ population, ______ of skin’s resident bacterial
population, bacteria isolated in _____
dirt, oil, transient bacterial, depression, skin
How has scrubbing changed over time?
Scrub brushes are used less, alcohol rubs are much more popular now and has also decreased scrubbing time.
Scrubbing Break Down
Remove all jewelry and put on surgery cap, surgery
mask, and booties
• Nail polish?? - some studies suggest increase in microbial growth.
• Fake nails??? - harbors more bacteria than we think so remove them.
• Make way to sink and open new scrub brush
• Basic hand wash
• Clean fingernails
• Scrub
• Anatomic timed method OR Counted brush stroke method
What do we need to remember when we wash our hands?
Make sure you are not going over the same spot
Going from fingernails to finger to palm.
What do we need to remember when we are scrubbing?
See SOAP
Why did things change?
Until recently surgical hand asepsis included scrubbing hands and arms with a brush
• Studies have shown scrubbing leads to skin damage and increased bacterial counts
• Scrubbing with a brush removes epidermal layers, increases bacterial cell shedding, increases microbial counts, and changes microbial flora so we are actually introducing more bacteria and increasing risk of transmission and potential infection.
• Vigorous scrubbing is no longer recommended
Scrubbing-> Alcohol
Based (Avagard)
Remove all jewelry
• Basic hand wash
• Clean fingernails
• Apply hand antiseptic
• 3 pump application (for first surgery of the day, any surgery after that you can just do 1).
How do you dry your hands?
Pick up sterile towel from pack on table
• Unfold towel and hold lengthwise
• Use one end of towel to dry 1 hand/arm
• Bring dry hand to opposite end of towel and repeat
step 3
• Drop towel into trash or on the ground
What are the different types of gown options?
Reusable/Cloth Gowns
• Woven material (cotton)
• Loosely woven, all cotton fabric type 140 muslin
• 270 pima cloth (smaller pores than 140 muslin)
Pros and cons of reusable/cloth gowns
Disposable gowns
Disposable Gown
• Non-woven material
• Made from fibers
instead of yarn/cotton
• You will glove up before
tying waist
What do we need to remember when we are getting gowned up?
Keep in mind when using disposable gowns
Gown ties on the side
• Assistant ties the neck/collar but YOU tie
waist
• “twirl”
What to remember about Sterile Surgical Gloves
Another barrier between surgical team member and patient
• Gloves should have inner surfaces lubricated with adherent coating of hydrogel
• This is what makes them slide onto hands nicely
• Ideally gloves should not be dropped onto the opened gown pack before scrubbing and shouldn’t be placed onto sterile field until surgeon’s hands have been dried
Describe the closed technique for gloving
Closed Technique
• Most common for surgery
• Ensures hand never comes in contact with the outside of the gown or glove
Describe Open gloving
Describe Assisted gloving
To glove another team member
• Scrub person always gloves the other person’s right hand first
Describe how to remove gloves aseptically
see SOAP
What is not sterile?
Body parts:
• Back
• Neck
• Shoulders
• Axillae
• Anything below waist
• Keep hands between wait and axillae
• Anything below table height
• Wet gowns or drapes
• Anything under drapes/patient
What are the benefits of draping?
Eliminates the passage of microorganisms between
nonsterile and sterile areas
• Minimizes skin exposure
• Decreases risk of contamination
• Maintains sterile field around surgery site
• Types of drapes
• Reusable
• Huck towels
• Fenestrated cloth
• Disposable
• Paper, plastic, or combination
What are the benefits of Instrument sterilization
Process that removes microorganisms
from medical instruments
• Steam
• Chemical
• Plasma
• Peracetic acid
• Ionizing radiation
• Cold chemical sterilization
What is the purpose of sterile technique
Designed to prevent transmission of microorganisms
into the body during surgery or other invasive
procedures
• All surgical procedures ideally performed under sterile
conditions with end goal of preventing infection
Principles of sterile technique?
Only use sterile items in the sterile field
• Sterile scrubbed personnel are gowned and gloved
• Sterile personnel operate within a sterile field
• Sterile drapes are used to create a sterile field
• All items used in a sterile field must be sterile
• All items introduced onto a sterile field should be opened, dispensed, and
transferred by methods that maintain sterility and integrity
• Sterile fields are areas that are set up for procedures and are free from
microorganisms
• Usually, a tray covered with a sterile towel
• A sterile field should be maintained and monitored constantly
• Surgical staff should be trained to recognize when they have broken
technique and should know what to do next
