UNIT 1 ASEPSIS AND STERILIZATION Flashcards
What is the crucial responsibility of a surgical tech?
Preventing surgical site infection is one of the crucial responsibility of a surgical technologist
3 COMPONENTS OF AN INFECTION
Source of causative organism (pathogen)
Mode of transmission
Susceptible host
Mode of transmission
Direct contact-human-to-human without intermediate carrier
Indirect contact-human-to-object-to-human
Droplet
Airborne spread such as sneezing
Example of an indirect contact
Occurs in surgery, when the instruments are not properly sterilized
example of an airborne spread
Not wearing mask properly can spread bacteria from our nasopharynx into the air
3 CATEGORIES OF SOURCES OF PATHOGENS IN SURGERY
Personnel
Environment
Patient
2 CONTROL MEASURES FOR personnel PATHOGENS
handwashing, surgical scrub
good oral hygiene prevents you from having URI
2 CONTROL MEASURES FOR environment PATHOGENS
sterilize instruments
Disinfect surfaces to kill fomites
Keep the OR door closed to maintain the positive pressure air flow; this keeps the cleanest air flowing over the patient and out rather than allowing less-filtered hallway air to flow into the OR
2 CONTROL MEASURES FOR patients PATHOGENS
wash skin with an antiseptic
If there is an infection do not operate on patient until resolved (unless it’s urgent or emergent)
Control measures to block personnel pathogens include:
Sterile gown and double gloves
Keep hair restrained and covered
Proper use and fit of mask
What is the proper way to wear a mask?
The mask need to be tied at crown of head, snug nicely at neck and secured properly against the cheek and chin
Susceptible host
Everyone can become a susceptible host for pathogens, unfortunately it is not possible to eliminate the patient or eliminate personnel in the case of blood borne pathogens
3 HOST FACTORS THAT INCREASE THE RISK OF SURGICAL SITE INFECTION
Age- geriatric/pediatric patients often have reduced immune response due to failing system or immature system
We need a strong immune response but if malnutrition occurs it causes immune response to decrease making us more susceptible to pathogens.
Hospitalization will exposure the patient to numerous microorganisms as a result it will put additional stress on their immune system
Duration of procedure-The longer the skin is open, the more chances for bacteria to invade the site
Key points to remember:
Our knowledge and safe practices help prevent SSI
There are several means to reduce or block the transmission of pathogens.
5 KEY POINTS THAT ARE PART OF THE CONCEPT OF THE SURGICAL (STERILE) CONSCIENCE.
Honesty
No reluctance to admit an error
Moral and ethical integrity
Responsibility
Hesitation or lack of follow through unacceptable
Consistency
EVERY situation
EVERY patient
Recognize and correct errors in asepsisWhat is the “Golden Rule”?
Treat others as you would have them treat you
Safety and well-being of the patient comes first!
Be aware of other team members and help them!
To develop a strong sterile conscience, we must:
Know correct practices and WHY those are correct
Be able to physically carry out the correct practices
And decide to do the correct practices
PRINCIPLES OF ASEPSIS
A sterile field is created for each surgical procedure
Sterile team members must be appropriately attired prior to entering the sterile field
Movement in and around the sterile field must not compromise the sterile field.
Purpose of OR attire
2 way barrier to protect the patient from us and protect us from the patient
Protect patient from unsterile staff to sterile wound
Protect us from the patient who may carry blood borne pathogens
Components of OR attire
Scrub suit, mask, hair cover, shoe covers
PLUS:
Eye protection
Radiation protection PRN
Hats – OSHA opinion
to provide protection to the patient from any organisms that may shed from the hair or scalp of surgical staff.
may be necessary to prevent splashes of blood or other potentially infectious material (OPIM) from the surgical site onto the surgeon(s) and/or others in the operating room.
the contaminated surgical caps must be laundered by the employer at no cost to the employee
dures are being followed and because contamination could migrate to the homes of employees
3 important facts that support double gloving
Fat degrades latex
Barrier decreases over time
Lattice structure fills with fluid
Protect yourself and the patient!
State required aspects of personal hygiene
Daily bath or shower
Shampoo hair properly
All hair must be completely contained in the cap
Short, clean nails (no polish); intact skin
Brush teeth daily, use mouthwash
No cologne or makeup
5 guidelines for the proper use of masks.
Fit snuggly over nose, mouth, and to cheeks to prevent leaks
Improper tying prevents snug fit
Masks are either on or off
Handle by strings only when removing
Change mask after each case or when it is wet
What is the purpose of the surgical scrub.
Remove as many microbes and skin debris as possible from hands and arms, rendering them surgically clean
It also suppress the growth of resident bacteria that may rise to the skin surface
3 methods for a surgical scrub.o
Timed (5 minute, 3 minute)
Counted brush stroke
Alcohol-based waterless/brushless (Wipe on and air dry)
Other agents include:
Chlorhexidine gluconate (CHG)
Parachlorometaxylenol (PCMX)
Iodophors (Betadine)
Alcohol (“brushless scrub”, Avaguard, etc.)What is the purpose for using a sterile sleeve
To cover a small-well defined area of contamination on the gown sleeve.
It slips over the existing sleeve and covers the contaminated area, saving an entire change of gown and gloves during an operation
4 options for replacing contaminated glove/s from best to least optimal technique.
Best: replace gown and gloves
Circulator removes glove; other sterile team member re-gloves you
Circulator removes glove; ST re-gloves using open technique
Least: don glove over contaminated glove
we are double-gloved, so the contaminated outer glove is simply removed and replaced with a new outer glove.
4 recommendations for the STSR to follow when preparing instruments for decontamination.
Place heavy items at the bottom of a tray; protect the delicate items
Disassemble instruments with multiple parts
Soak instruments or spray with enzymatic foam
3 advantages and 2 disadvantages of the 3 types of packaging used for sterilization.
Nonwoven (synthetic material) wrappers
Advantages-no lint; impervious and tear-resistant
Disadvantages-expensive and single use only
Paper/plastic and Tyvek pouches
Advantages-Inexpensive; plentiful supply; porous
Disadvantages-fragile; turns brittle in dry conditions, tears and punctures easily
Woven
Advantages-reusable and easily penetrated by sterilants
Disadvantages-least effective at providing a barrier, cannot be used with EtO
Rigid instrument containers
Advantages-Perfect solid barrier, no tears possible, easy open
Disadvantage-expensive, but last for many years
5 practice guidelines for pouch packaging.
Peel off strip and seal carefully and completely
Place item inside, cut roll, heat-seal ends
Do NOT use staples to close package!•Do NOT use rubber bands, paperclips or tape
Protect sharp edges with permeable tip protectors
Orient item when placing in pouch for easier delivery/grasp
Use correct size pouch for item
recommended weight limit for instrument sets and explain the reason for the weight limit.
Instrument sets should not exceed 25 pounds
Because the density of contents affects the ability of the sterilizing agent to contact all parts
5 tips for preparing and loading items for sterilization.
Use special trays for micro-instruments
Place instruments in a mesh-bottom tray with a towel lining the bottom
Heavy items on bottom or side of tray to prevent damage to more delicate items
Tilt reusable light handles to prevent condensation
Instrument trays placed flat on sterilizer cart
5 practice guidelines for immediate-use (flash) sterilization.
Immediate-use sterilization is defined as an urgent process for sterilizing unwrapped items
Don’t misuse to compensate for lack of inventory
Should not be used for implantable items
270° F; no drying time needed because there are no wrappers
Composition of item determines exposure time
Reserved for items needed immediately
Items must be decontaminated and disassembled first
3 major types of monitoring for the sterilization process
Mechanical
Chemical
Biological
Example of mechanical monitoring
Older type of monitors include chart recorders, thermometers, pressure gauges
Modern monitors provides digital printout provides a record of those parameters
Example of chemical monitoring
External
Autoclave tape
Dots on paper side of peel packs
Locking devices (plastic tags) with dots for canisters
Internal
Paper strips (aka. “OK” strips)Example of biological monitoring
Uses a known number and type of microbe
Only type that assures kill conditions were met
If one shows growth, all items from that load must be pulled from shelves
Steam sterilization uses: Geobacillus stearothermophilus
Hydrogen peroxide gas plasma sterilization uses: Bacillus atropheous
EtO sterilization uses: Bacillus atropheous
Principles of sterile technique
If in doubt about the sterility of an item, consider it non sterile and do not use.
The integrity of sterile packages must be checked before opening
Sterile packages found in storage areas commonly used for storage of non sterile items must not be used.
Hands should not be allowed to fall table level
The back of the sterile gown is considered non sterile
A separate sterile surface should be used for owning and glowing to avoid contamination of the back table.
Only sterile items and sterilely attired individuals may contact sterile areas.
Non-sterile items and individuals may only contact non sterile areas.
