Surgical Asepsis, infection prevention and control

Question 1

Sources of contamination

Answer 1

1) Preoperative patient preparation
2) Break in principles of surgical asepsis
3) Preparation of Healthcare professionals personnel
4) Surgical environment and traffic

Question 2

1) Preoperative patient preparation

Answer 2

1) Pre-op bathing using antimicrobial soap for patient (Iodine with/without alcohol)
- Alcohol contraindication in face area, eyes, nose and open wounds
- Skin prep with dual agent solution (Iodine and another antiseptic solution eg chlorhexidine gluconate)

Surgical and antiseptic solution for skin prep:
1. Hair removal
2. Antimicrobial prep agent
3. Clean from clean to dirty
4. Heaviest bioburden cleaned last

Antiseptic solutions:
1. Cetrimide 1%
2. Chlorhexidine 0.5% with 70% alcohol
3. Chlorhexidine 0.05%
4. Methylated Spirit 70%

Question 3

2) When should surgical asepsis be indicated?

Answer 3

1. Preparation for invasive procedure
2. Preparation of sterile team
3. Creation and maintenance of sterile field
4. Sterilisation and disinfection

Question 4

AORN Recommended practices

Answer 4

1. All items used for sterile procedures must be sterile
2. Items or areas doubtful of sterility are considered unsterile
3. Gowns are considered sterile from front chest to the level of sterile field and above elbows to the cuff on the sleeves
4. Tables are sterile only at table level
5. All edges and sides are considered unsterile
6. Sterile person only touch sterile item/areas vice versa for unsterile person
7. Edges of wrappers that enclose sterile items are considered unsterile
8. Sterile drapes should be used to establish a sterile field
9. Sterile field is prepared as close as possible to time of use and constantly monitored and maintained
10. Unsterile person avoid reaching over sterile field and vice versa
11. Sterile person stay within sterile area and unsterile person avoid sterile area

Question 5

3) Preparation of healthcare professionals personnel

What are the guidelines for surgical asepsis?

Answer 5

1) Gowning and gloving:
- Proper knowledge of assisted and unassisted gowning, assisted closed and open gloving technique

2) Surgical hand scrub:
- Use of rapid and long acting antimicrobial agent with broad spectrum activity
- Follow methods according to institution protocol

Question 6

Benefit of gowning

Answer 6

Prevents microorganisms from clothing from being transferred to patient’s wound BACK OF GOWN IS NEVER STERILE

Question 7

Benefit of scrubbing

Answer 7

Scrubbing removes dirt, skin oil, transient micro organisms from nails, hands and forearms

Question 8

Benefit of gloving

Answer 8

Bacterial barrier between patient and health care worker. Decrease risk of exogenous organisms which result in surgical wound infection

Question 9

4) Surgical environment and traffic (what is the 3 zones concept)

Answer 9

1) Unrestricted area: Change room, reception area (street wear)

2) Semi-restricted area: OR corridors, storage room, recovery room (Scrub suit, cap, OT shoes)

3) Restricted area: OR, scrub room, prep room (Scrub suit, cap, OT shoes, mask)