Aseptic Techniques (free One)

Aseptic Techniques (procedures)

Aseptic Techniques (procedures) • Definition • Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens

Aseptic Techniques • Prerequisite Knowledge •

Principles of asepsis

•

Surgical scrub

Aseptic Techniques • Principles of aseptic technique Aseptic: The complete absence of lining microorganisms

Methods to achieve sterility or asepsis: • •

Chemical methods (e.g. gas sterilization) Physical methods (e.g. autoclaving)

Aseptic Techniques • Aseptic technique is based on the fundamental principle that the infection is introduced into the body from the outside • Therefore, perform all procedures using a method that prevents the introduction of bacteria into a surgical wound

Aseptic Techniques

• Operating Room The operating room (OR) should provide an environment that is free of bacterial contamination as possible

The minimum size recommended for an OR is usually20 by 20 feet, which allow space for: ► Gowning of the operative team ► Draping the patient ► And movement of the other personals, without contaminating of sterile areas

Aseptic Techniques • Operating Room

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The concept of separating clean traffic to dirty traffic is theoretically sound but has not been shown to lower wound infection rates

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Studies suggest that the redispersal of bacteria from the OR floor into the air is very low

• Appropriate ventilation rapidly clears bacteria from the air, • and the degree of floor contamination should not increase infection rates

• Operating Room The very low concentrations of airborne particulate matter and bacterial in most OR are achieved by changing room air 20 to 25 time each hour.►►►► ► And passing inflow air through a high-efficiency particulate air (HEPA) filter which efficiently remove pathogens

Aseptic Techniques • Patients • Wound infections that occur in clean operations are often caused by staphylococci or other bacteria form a source in the patient such as: • the skin or • nares Preparation of the patient’s skin before an incision is one of the most important methods of decreasing infection

Aseptic Techniques • Patients • It is effective to have the shower with antibacterial preparation the night before elective procedures

• Hair removal should be employed only when the hair may interfere with the performance of the procedure

• Shaving the patient with razor the night before operation has been associated with a relative high wound infection rate

Aseptic Techniques

• Patients • The risk of infection is decreased by shaving the patient in the operating room immediately before the procedure or in the setting by using a depilatory cream or electric clippers

• The most commonly used antimicrobial agents for intact antisepsis are iodophors (e.g. Betadine)

Aseptic Techniques • Patients • Skin Cleansing • The most commonly accepted technique in cleansing the patient’s skin is to begin with the area where the incision is to be made and to consider this as the cleanest portion of the area of operation • The contaminated sponge stick should never be returned to the cleansing solution

Aseptic Techniques

• Remember • 1. The procedure

must be done in a sterile field from which all bacteria have been excluded, if possible

• The inadvertent use of unsterile items may introduce contaminants into the wound • Items of uncertain sterility must be considered unsterile

Aseptic Techniques • The circulating nurse should check: • the package integrity • the expiration date and • the chemical process indicator •

before dispensing a sterile item

2. Gown worn by the surgical team are considered sterile at the front, from chest to the level of the sterile field

• The sleeves are also considered sterile from to inches above the elbow to the stockinet cuff • The cuff should be considered unsterile because it tends to collect moistures and is not an effective bacterial barrier • Therefore, the sleeve cuffs should always be covered by sterile gloves

Aseptic Techniques • Other areas of gown that should be considered unsterile are the: • neck • shoulders • areas under the arms and • back

• These areas may become contaminated by perspiration or by collar and shoulder surfaces rubbing together during head and neck movement • The back of the gown is not sterile it cannot be observed by the scrubbed person and protected from contamination

Aseptic Techniques • 3. Sterile drapes are used to create sterile field • Only the top surface of the draped table is considered sterile

Aseptic Techniques • Any item that extends beyond the sterile boundary is considered contaminated and cannot brought back onto the sterile field • A contaminated item must be lifted clear of the operative field without contacting the sterile surface and must be dropped with minimum handling to an unsterile area, or receptacle

Aseptic Techniques • 4 After a sterile package or container is opened, the edges are considered unsterile

• ► the edge of bottle cap is considered contaminated once the cap has been removed from the bottle

• ► The sterility of the contents cannot be ensured if the cap is replaced on the bottle

Aseptic Techniques • 5.

Whether a sterile barrier is permeated, it must be

considered contaminated

• Obvious contamination occurs from direct contact between sterile and unsterile objects

Aseptic Techniques Other less apparent modes of contamination are the:

* filtration of airborn microorganisms through materials * The passage of liquid materials * The undetected perforations in materials 6. Sterile fields should be prepared as close as possible to the scheduled time of use

Aseptic Techniques

• Patient Position • Patient position should: • Ensure optimum exposure

and access of the operative

site

• • •

Sustain body alignment Maximize circulatory and respiratory function Not compromise neuromuscular structure

Aseptic Techniques • Surgeon • Operating Room Attire • Comfortable closed in shoes (preferably operating room dedicated) • Eat breakfast , and use restroom before the session begins!

Aseptic Techniques • Surgeon • Operating Room Attire • No jewellery or nail polish • Short, clean nails

Aseptic Techniques

• Surgeon • Operating Room Attire Protective eyewear/ Face shields Hat/ Cap: hair tucked in Mask facing out, tied securely

• Remember: ► Masks should cover the nose and mouth ► Fitting snugly across the bridge of the nose ► At the edge of the cheeks under the chin • Footwear: If available ►► Now Ready for operating room

• Surgeon • Review of surgical scrub

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Scrub time: 5 min for the first scrub of the day, and 3 min for each subsequent scrub

• Hand and forearms are to be held out from scrub clothes • Hand to be at higher level than elbows at all the time • Scrub solution is applied to hands * Each nail is cleaned under running water with nail stick *

Aseptic Techniques • Surgeon • Review of surgical scrub Each nail is scrubbed against palm of opposite hand • Each finger is then scrubbed in all 4 sides * Back of the hand and palm is scrubbed from base of fingers to wrist

Aseptic Techniques • Surgeon • Review of surgical scrub Small overlapping circles are used to scrub from wrist to 2 -3 cm above elbow Hand and forearms are rinsed from finger-tip to elbow

Hand drying • Drying towel is lifted up away from the sterile field without dripping water into that field • Bent forward at the waist, fingers and hand are dried thoroughly, then the same part of towel is used to dry remainder of forearm • The other end of the towel is then used to dry the other hand and forearm

Aseptic Techniques

• Gowning • The sterile gown is lifted out of it sterile wrapper without contamination • The individual then moves into an area where the gown may be opened without contamination of gown • The gown is held away from the body and unfolded so that the inside is toward the wearer

• Gowning • The hands are slipped into the gown while keeping them away from the body at and shoulder level • The hand are advanced up the sleeves of the gown to the proximal end of the cuffs • Gloving is performed by the closed or opened method

• Gowning • The surgeon then hands the sterile right tab of the gown the scrub nurse, turns left 280º and then takes back this tab •

He/Her then ties this to the other sterile tab to wrap the gown

Aseptic Techniques

• Gloving • Closed method • In this technique the scrubbed nurse assists the scrubbed individual with gloving

Aseptic Techniques • Gloving • Open method

Aseptic Techniques • Removal of dirty gown and gloves • This is recommended to prevent contact with the soiled outer layer of gloves and gown and mask • The waist tie is untied by the surgeon • The surgeon turn away from the circulating nurse to allow him/her to undo the back closure of the gown • The surgeon then grasps a shoulder of the gown and pulls it inside out off one gloved arm • pulls that sleeve off leaving the glove on, but with the cuff now everted

Aseptic Techniques

• Removal of dirty gown and gloves • This step is repeated with the other arm • The gown is pulled off completely, held away from the body, and placed into the appropriated linen container • The gloved finger of one hand are placed under the everted cuff of the cotrolateral glove. The glove is pulled off and inverted at the same time • The everted cuff on the remaining glove is then grasped the bare free fingers of the other hand and is pulled off in the same way

Aseptic Techniques • Removal of dirty gown and gloves • The surgeon then goes back to the scrub area and removes his/her mask, taking care to touch only the ties at the back (A new mask should be worn for each case) • The arms should then be watched carefully • •

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