GTJ 205/4

Nursing Foundation III

Therapeutic interventions

Introduction
Concept to Surgical Asepsis
Nursing Year 2
1

Objectives

state the definition of surgical asepsis

state the indication for surgical asepsis
discuss the principles of surgical asepsis
differentiate between disinfection and sterilization
demonstrate proper surgical aseptic techniques
Open sterile packages
Open sterile item on a flat surface
Open sterile item while holding it
Preparing sterile field
Pouring sterile solution
surgical handwash technique
don and remove sterile gloves
appreciate the importance of practicing correct asepsis
technique during nursing care.

Definition Surgical Asepsis

O A sterile technique prevents

contamination of an open wounds,

serves to isolate the operative area
from the unsterile environment, and
maintains a sterile field for surgery
(Potter & Perry, 2009)

Indication for Surgical Asepsis

O Operating room

O Labor room
O Major diagnostic areas
O At clients bedside
Inserting IV catheters
Urinary catheters
Suctioning tracheobronchial airway
Dressing wounds
Injections
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Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched

by another sterile object

Sterile touching sterile remains sterile
Sterile touching clean becomes contaminated
Sterile touching contaminated becomes contaminated

Sterile state is questionable

2. Only sterile objects may be placed on a sterile

field
3. A sterile object held below a persons waist is
contaminated
4. A sterile object or field becomes contaminated by
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prolonged exposure to air

Principles of Surgical Asepsis

5. When a sterile surface comes in contact with a
wet, contaminated surface, the sterile object/filed
becomes contaminated by capillary reaction

6. Fluid flow in the direction of gravity

7. The edges (I inch or 2.5 cm)of a sterile field or
container are considered to be contaminated
8. Hold sterile objects above the level of the waist
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Principles of Surgical Asepsis

9. Avoid talking, coughing, sneezing, or reaching
over a sterile field or object
10. Never walk away from or turn your back on a
sterile field
11. Use dry, sterile forceps when necessary
12. All items brought into contact with broken skin
or used to penetrate the skin in order to inject
substances into the body, or to enter normally
sterile body cavities, should be sterile
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Disinfection and Sterilization

Disinfection
is a chemical preparation on inanimate the
objects to destroys most pathogens but not
necessarily their spores.
Sterilization
is a process that destroys all microorganisms
including spores and viruses

Antiseptic and Disinfectants

Antiseptic
agents that inhibit the growth of some
microorganism
O is a chemical preparation used on skin or
tissue
Disinfectants
agent that destroy pathogen other than
spores
O caustic and toxic to tissue
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Sterilization
O only level of asepsis that kills all
microbes both pathogenic &
nonpathogenic.
O Method used are the use of gas,
chemicals, steam under pressure and
radiation.
O Mainly used on medical instruments and
equipment, surgical dressings, gowns
etc.
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Methods of Sterilization
1. Thermal (Physical)

1.1 Steam or Moist Heat

O steam under pressure
O temperature higher than boiling point
O denaturation & coagulant enzyme protein

microorganism
O e.g. using autoclave

1.2 Boiling water boil item for at least 15mins

1.3 Dry heat
O Form hot air
O Slow process of heat absorption by conduction
O Slow burning process involves coagulating the protein

in cells

2. Chemical(Chemosterilizer)
2. 1 Chemical solutions
O agent used for instruments and equipment
disinfection and sterilization
O e.g.Glutaraldehyde (Cidex), Peracetic acid 35%,
O 10 hours sterilization
O 10 20 minutes disinfection
2.2. Gas
O interfering with metabolic process in cells
O Effective against spores
O Effective for heat sensitive items
O e.g Ethylene oxide gas (EO)

3. Radiation (Physical) X-ray

O Gamma ray
O disrupting the DNA molecule

pharmaceutical, food, plastic, and

other heat-sensitive items

Procedures
1.

2.
3.
4.
5.
6.
7.

Opening sterile packages and set

Handling sterile transfer with Cheathle forceps
Adding wrapped sterile supplies to a sterile field
Adding commercially packaged gauze to a
sterile field
Pouring sterile solution into sterile container
Surgical hand washing
Donning sterile glove (open method)

Opening a wrapped sterile

package on a surface
1.
2.
3.
4.

5.

1 Layer Package/Set
Place package in the center of work area so top
flap of wrapper opens away from you.
Pinch first flap on the outsides of wrapper
between thumb and index finger.
Pull flap open, laying it flat on the far surface.
Repeat for side flaps, opening the top one first.
Use right hand for right flap and left hand for left
flap.
Pull fourth flap toward you by grasping the
corner that is turned down.

For Two layers package/Set

1.
2.

Use sterile Cheatle forceps

Use your hand after surgical hand wash (dried)
and donning sterile glove

Opening sterile packages

while holding it
1.
2.

3.

Hold the package in one hand with top flap

opening away from you
Using the other hand open the package as
described above pulling the corners of the
flaps well back. Hands are contaminated,
and should not touch contents of package.
Tuck each of the corners into the hand
holding the package so that they do not
flutter and contaminate sterile field

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Opening commercially
prepared packages
1.

If the flap of the package has an unsealed

corner, hold the container in one hand and pull
back on the flap with the other hand

2.

If the package has a partially sealed edge,

grasp both sides of the edge, one with each
hand and pull apart gently

Adding items to a Sterile Field

1.
2.

3.

4.

Open each wrapped package as described in the

preceding steps
With the free hand, grasp the corners of the
wrappers and hold them against the wrist of the
other hand. The sterile wrapper now covers the
unsterile hand
Place the sterile item on the field by approaching
from an angle rather than holding the arm over
the field
Discard the wrapper

Adding commercially packed

items to a sterile field

1.
2.

3.

Open each package as previously

described
Hold the package 15 cm above the field
and allow the contents to drop on the field.
(At this height the outside of the package
is not likely to touch and contaminate the
sterile field).
Keep in mind 2.5 cm (1) around the edge
of the field is considered contaminated

Adding solution to a sterile container

Read the label three times to make sure you have
the correct solution and strength.
2. Remove the cap from the bottle
3. Invert the cap before placing it on a surface that is
not sterile. Inverting the cap maintains the sterility
of the inside surface because it is not allowed to
touch an unsterile surface.
4. Hold the bottle at the a slight angle so that the
label is upper most . Any solution that flow down
the outside of the bottle during pouring will not
damage the label.
1.

Adding solution to a sterile container

5. Hold the bottle of fluid at a length of 10-15 cm over
the bowl and to the side of the sterile field.
6. Pour the solution gently to avoid splashing the
liquid.
7. Tilt the neck of the bottle back to vertical quickly
when done pouring.
8. Write on the label the date and time of opening if
the bottle will be used again,
*. A sterile container of solution that is opened may be
used only once and is then discarded or may
permit recapped bottles to be reused within 24
hours.

Preparing a sterile field using

a sterile drape
1.
2.
3.
4.
5.

Establish clean, dry, flat work area at waist level.

Check expiry date on supplies and check for
integrity of all packages
Set up a drape on a surface at least 2 inches
border on all sides
Add dry sterile supplies
Add sterile liquids

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Handling sterile transfer with

Cheatle forceps

Surgical hand washing

Purpose
To remove and kill the transient flora
To decrease the resident flora in order to
reduce the risk of wound
contamination.
Indications
Before doing sterile procedures
Steps: refer manual IT/asepsis1

Donning and removing

sterile glove
Purpose
Maintains asepsis
Prevent cross infection
Indications
Before doing sterile procedures
Steps: refer manual procedures IT

Lecture Demo

Open sterile packages

Open sterile item on a flat surface
Open sterile item while holding it
Preparing sterile field
Pouring sterile solution
Surgical handwash technique
don and remove sterile gloves

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