Aseptic technique

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Jump to: navigation, search Aseptic technique refers to a procedure that is performed under sterile conditions. This includes medical and laboratory techniques, such as with microbiological cultures. It includes techniques like flame sterilization. The largest example of aseptic techniques is in hospital operating theatres.

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1 Medical procedures 2 References 3 See also 4 External links

[edit] Medical procedures

Aseptic technique is the effort taken to keep patients as free from hospital micro-organisms as possible (Crow 1989). It is a method used to prevent contamination of wounds and other susceptible sites by organisms that could cause infection. This can be achieved by ensuring that only sterile equipment and fluids are used during invasive medical and nursing procedures. Ayliffe et al. (2000) suggest that there are two types of asepsis: medical and surgical asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread; surgical or sterile asepsis includes procedures to eliminate micro-organisms from an area and is practised by surgical technologists and nurses in operating theaters and treatment areas. In an operating room, while all members of the surgical team should demonstrate good aseptic technique, it is the role of the scrub nurse or surgical technologist to set up and maintain the sterile field.

[edit] References

Microbiology Techniques & Troubleshooting Methods Manual Applied Microbiology: Aseptic Technique Antiseptic Contamination control Cleanliness Body substance isolation

[edit] See also

[edit] External links

Bionique Testing Laboratories, Inc. Helpful Hints for Better Aseptic Technique Engender Health: Introduction to Aseptic Technique Hand Washing & Aseptic Technique

Retrieved from "http://en.wikipedia.org/wiki/Aseptic_technique" Categories: Medical hygiene | Microbiology techniques

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Aseptic Technique
By Katherine Hauswirth APRNThe Gale Group Inc., Gale. Gale Encyclopedia of Nursing and Allied Health, 2002more http://api.addthis.com/oexchange/0.8/forward/facebook/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://api.addthis.com/oexchange/0.8/forward/twitter/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://api.addthis.com/oexchange/0.8/forward/digg/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://addthis.com/bookmark.php? v=250&username=healthy1javascript:window.print()

Preparation
Novice and less-experienced clinicians require thorough training and supervision in the principles and practices of aseptic technique. Maintaining asepsis requires practice and vigilance.

Health care team roles

In a multidisciplinary setting, one role of the nurse or other allied health professional is to assist the doctor in caring for the patient while maintaining asepsis, i.e., by supplying equipment to the /galecontent/general-surgeryError! Hyperlink reference not valid. in a sterile fashion. Nursing staff independently practice aseptic techniques in many day-to-day procedures, such as /galecontent/urinary-catheterizationError! Hyperlink reference not valid., dressing changes, and respiratory suction. Even personnel experienced with aseptic technique must constantly monitor their own movements and practices, those of others, and the status of the overall field to prevent inadvertent breaks

in sterile or clean technique. It is expected that personnel will alert other staff when the field or objects are potentially contaminated. Health care workers can also promote asepsis by evaluating, creating, and periodically updating policies and procedures that relate to this principle.

KEY TERMS
ContaminationA breach in the preservation of a clean or sterile object or environment HostA living organism that harbors or potentially harbors infection. ImmunocompromisedLacking or deficient in defenses provided by the immune system, usually due to disease state or a side effect of treatment. InvasiveInvolving entry into the body. NosocomialOccurring in the hospital or clinical setting. PathogenA disease-causing organism. Resistant organismsOrganisms that are difficult to eradicate with antibiotics. SterileCompletely free of pathogens.

BOOKS
Beare, Patricia Gauntlet, and Judith L. Myers. Adult Health Nursing, 3rd ed., ed. Michael S. Ledbetter. St. Louis: Mosby, Inc., 1998. Potter, Patricia Ann, and Anne Griffin Perry. Fundamentals of Nursing: Concepts, Process, and Practice, 4th ed. St. Louis: Mosby-Year Book, Inc., 1997. Potter, Patricia A., and Anne Griffin Perry. Clinical Nursing Skills and Techniques, 4th ed. St Louis: Mosby-Year Book, Inc., 1998.

OTHER
Osman, Cathy. "Asepsis and Aseptic Practices in the Operating Room." Infection Control Today online. 2000. <http:/www.infectioncontroltoday.com> (March 29, 2001). Katherine Hauswirth, APRN Page: < Back 1 2 Date Published: 2002

Copyright: Gale Encyclopedia of Public Health Licensed from: /popup_galelicense.jsp/popup_galelicense.jsp

Aseptic Technique Images

/galeimage?contentId=genh_01_00074&id=genh_01_img0049/galeimage? contentId=genh_01_00074&id=genh_01_img0049 Proper removal of used gloves. (D... /galeimage?contentId=genh_01_00074&id=genh_01_img0050/galeimage? contentId=genh_01_00074&id=genh_01_img0050 Surgeons scrubbing their hands an...

TABLE OF CONTENTS
Definition Purpose Description Preparation Health care team roles KEY TERMS BOOKS OTHER

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Aseptic Technique
By Katherine Hauswirth APRNThe Gale Group Inc., Gale. Gale Encyclopedia of Nursing and Allied Health, 2002more http://api.addthis.com/oexchange/0.8/forward/facebook/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://api.addthis.com/oexchange/0.8/forward/twitter/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://api.addthis.com/oexchange/0.8/forward/digg/offer? url=http://www.healthline.com%2Fgalecontent%2Faseptictechniquehttp://addthis.com/bookmark.php? v=250&username=healthy1javascript:window.print()

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

Purpose
Aseptic technique is employed to maximize and maintain asepsis, the absence of /galecontent/pathogenic-organismsError! Hyperlink reference not valid. in the clinical setting. The goal of aseptic technique is to protect the patient from infection.

Description
All patients are potentially vulnerable to infection. Certain situations further increase vulnerability, such as disturbance of the body's natural defenses, such as occurs with extensive burns or an /adamcontent/immunodeficiencydisordersError! Hyperlink reference not valid.. Typical situations that call for aseptic measures include surgery and the insertion of intravenous lines, /adamcontent/urinary-cathetersError! Hyperlink reference not valid., and drains. The concept of asepsis can be applied in any clinical setting. Pathogens may introduce infection to the patient through contact with the environment, personnel, or equipment. The environment contains potential hazards that may spread pathogens through movement, touch, or proximity. Interventions such as controlling air flow by restricting traffic in the operating room, isolating a patient to protect airborne contamination, or using low-particle generating garb help to minimize environmental hazards. A second element requiring careful attention is equipment or supplies. Medical equipment can be sterilized by chemical treatment, radiation, gas, or heat. Personnel can take steps to ensure sterility by assessing that sterile packages are dry and intact and checking sterility indicators such as dates or colored tape that changes color when sterile.

Besides overall attention to the clinical environment and equipment, clinicians need to be attentive to their own practices and those of their peers in order to avoid inadvertent contamination. A key difference between the operating room and other clinical environments is that the operating area has high standards of sterility at all times, while most other settings are not designed to meet such standards. However, the principles of aseptic technique can be applied in other clinical settings. The application of aseptic technique in such settings is termed "medical asepsis" or "clean technique" rather than "surgical asepsis" or "sterile technique" required in the operating room. Aseptic technique is most strictly applied in the operating room because of the direct and often extensive disruption of skin and underlying tissue. Aseptic technique helps to prevent or minimize postoperative infection. The patient is prepared or prepped by shaving hair from the surgical site, cleansing with a disinfectant such as /galecontent/iodine-1Error! Hyperlink reference not valid., and applying sterile drapes. In all clinical settings, handwashing is an important step in asepsis. In general settings, hands are to be washed when visibly soiled, before and after contact with the patient, after contact with other potential sources of microorganisms, before invasive procedures, and after removal of gloves. Patients and visitors should also be encouraged to wash their hands. Proper handwashing for most clinical settings involves removal of jewelry, avoidance of clothing contact with the sink, and a minimum of 10-15 seconds scrubbing hands with soap, warm water, and vigorous friction. A surgical scrub requires use of a long-acting, powerful, antimicrobial soap, careful scrubbing of the fingernails, and a longer period of time for scrubbing. Institutional policy usually designates an acceptable minimum length of time required. Thorough drying is essential, as moist surfaces invite the presence of pathogens. Contact after handwashing with the faucet or other potential contaminants should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of foot pedals. Despite this careful scrub, bare hands are always considered potential sources of infection. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flows in the direction of gravity. With this in mind, hands are held below elbows during the surgical scrub and above elbows following the surgical scrub. Sterile surgical clothing or protective devices such as gloves, face masks, goggles, and transparent eye/face shields serve as a barrier against microorganisms and are donned to maintain asepsis in the operating room. This practice includes covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may harbor unwanted organisms. This garb must be donned with deliberate care to avoid touching external, sterile surfaces with nonsterile objects including the skin. This ensures that potentially contaminated items such as hands and clothing remain behind protective

barriers, thus prohibiting inadvertent entry of microorganisms into sterile areas. Personnel assist the /galecontent/general-surgeryError! Hyperlink reference not valid. to don gloves and garb and arrange equipment to minimize the risk of contamination. Donning sterile gloves requires specific technique so that the outer glove is not touched by the hand. A large cuff exposing the inner glove is created so that the glove may be grasped during donning. It is essential to avoid touching nonsterile items once sterile gloves are applied; the hands may be kept interlaced to avoid inadvertent contamination. Any break in the glove or touching the glove to a nonsterile surface requires immediate removal and application of new gloves. Asepsis in the operating room or for other invasive procedures is also maintained by creating sterile surgical fields with drapes. Sterile drapes are sterilized linens placed on the patient or around the field to delineate sterile areas. Drapes or wrapped kits of equipment are opened in such a way that the contents do not touch non-sterile items or surfaces. Aspects of this method include opening the furthest areas of a package first, avoiding leaning over the contents, and preventing opened flaps from falling back onto contents. Other principles that are applied to maintain asepsis include: All items in a sterile field must be sterile.

Sterile packages or fields are opened or created as close as possible to time of actual use. Moist areas are not considered sterile.

Contaminated items must be removed immediately from the sterile field. Only areas that can be seen by the clinician are considered sterile, i.e., the back of the clinician is not sterile. Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow. Tables are considered sterile only at or above the level of the table. Nonsterile items should not cross above a sterile field.

There should be no talking, laughing, coughing, or sneezing across a sterile field. Personnel with colds should avoid working while ill or apply a double mask. Edges of sterile areas or fields (generally the outer inch) are not considered sterile.

 When in doubt about sterility, discard the potentially contaminated item and begin again. A safe space or margin of safety is maintained between sterile and nonsterile objects and areas. When pouring fluids, only the lip and inner cap of the pouring container is considered sterile. The pouring container should not touch the receiving container, and splashing should be avoided. Tears in barriers are considered breaks in sterility.

In the operating room, staff have assignments so that those who have undergone surgical scrub and donning of sterile garb are positioned closer to the patient. Other "unscrubbed" staff members are assigned to the perimeter and remain on hand to obtain supplies, acquire assistance, and facilitate communication with outside personnel. Unscrubbed personnel may relay equipment to scrubbed personnel only in a way that preserves the sterile field. For example, an unscrubbed nurse may open a package of forceps in sterile fashion so that he or she never touches the sterilized inside portion, the scrubbed staff or the sterile field. The uncontaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field. Asepsis in the operating room is maintained by allowing only scrubbed personnel into the sterile field and checking all equipment and packaging for breaks in sterility, such as expired sterilization date, moisture, or torn wrappings. Clinicians observe aseptic technique by strictly avoiding practices that may introduce microorganisms. Arms of scrubbed staff are to remain within the field at all times, and reaching below the level of the patient or turning away from the sterile field are considered breaches in asepsis. Clinical areas outside of the operating room generally do not allow for the same strict level of asepsis. However, avoiding potential infection remains the goal in every clinical setting. Observation of medical aseptic practices will help to avoid nosocomial infections, or those acquired in the hospital. General habits that help to preserve a clean medical environment include: Safe removal of hazardous waste, i.e., prompt disposal of contaminated needles or blood-soaked bandages to containers reserved for such purposes. Prompt removal of wet or soiled dressings.

Prevention of accumulation of bodily fluid drainage, i.e., regular checks and emptying of receptacles such as surgical drains or /galecontent/nasogastric-suctionError! Hyperlink reference not valid. containers.

 Avoidance of backward drainage flow toward patient, i.e., keeping drainage tubing below patient level at all times. Immediate clean-up of soiled or moist areas.

Labeling of all fluid containers with date, time, and timely disposal per institutional policy. Maintaining seals on all fluids when not in use.

These general practices are important for keeping the environment as free of microorganisms as possible. In addition, specific situations outside of the operating room require a strict application of aseptic technique. Some of these situations include: /galecontent/wound-careError! Hyperlink reference not valid. drain removal and drain care intravascular procedures vaginal exams during labor insertion of urinary catheters respiratory suction

For example, a surgical dressing change at the bedside, though in a much less controlled environment than the operating room, will still involve thorough handwashing, use of gloves and other protective garb, creation of a sterile field, opening and introducing packages and fluids in such a way as to avoid contamination, and constant avoidance of contact with nonsterile items. The isolation unit is another clinical setting that requires a high level of attention to aseptic technique. Isolation is the use of physical separation and strict aseptic technique for a patient who either has a contagious disease or is immunocompromised. For the patient with a contagious disease, the goal of isolation is to prevent the spread of infection to others. In the case of respiratory infections (i.e., /galecontent/tuberculosis-4Error! Hyperlink reference not valid.), the isolation room is especially designed with a negative pressure system that prevents airborne flow of pathogens outside the room. The severely immunocompromised patient is placed in reverse isolation, where the goal is to avoid introducing any microorganisms to the patient. In these cases, attention to aseptic technique is especially important to avoid spread of infection in the hospital or injury to the patient unprotected by sufficient immune defenses. Entry and exit from the isolation unit involves careful handwashing, use of protective barriers like gowns and gloves, and care not to introduce or remove potentially contaminated items. Institutions supply specific guidelines that direct practices for different types of isolation, i.e., respiratory versus body fluid isolation precautions.

Page: 1 2 Next > Date Published: 2002 Copyright: Gale Encyclopedia of Public Health Licensed from: /popup_galelicense.jsp/popup_galelicense.jsp

Aseptic Technique Images

/galeimage? contentId=genh_01_00074&id=genh_01_img0049/galeimage? contentId=genh_01_00074&id=genh_01_img0049 Proper removal of used gloves. (D... /galeimage? contentId=genh_01_00074&id=genh_01_img0050/galeimage? contentId=genh_01_00074&id=genh_01_img0050 Surgeons scrubbing their hands an...

TABLE OF CONTENTS
Definition Purpose Description Preparation Health care team roles KEY TERMS BOOKS OTHER

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Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms in the clinical setting. The goal of aseptic technique is to protect the patient from infection.

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Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens.

Purpose
Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms in the clinical setting. The goal of aseptic technique is to protect the patient from infection.

Description
All patients are potentially vulnerable to infection. Certain situations further increase vulnerability, such as disturbance of the body's natural defenses, such as occurs with extensive burns or an immune disorder. Typical situations that call for aseptic measures include surgery and the insertion of intravenous lines, urinary catheters, and drains. The concept of asepsis can be applied in any clinical setting. Pathogens may introduce infection to the patient through contact with the environment, personnel, or equipment. The environment contains potential hazards that may spread pathogens through movement, touch, or proximity. Interventions such as controlling air flow by restricting traffic in the operating room, isolating a patient to protect airborne contamination, or using low-particle generating garb help to minimize environmental hazards. A second element requiring careful attention is equipment or supplies. Medical equipment can be sterilized by chemical treatment, radiation, gas, or heat. Personnel can take steps to ensure sterility by assessing that sterile packages are dry and intact and checking sterility indicators such as dates or colored tape that changes color when sterile. Besides overall attention to the clinical environment and equipment, clinicians need to be attentive to their own practices and those of their peers in order to avoid inadvertent contamination. A key difference between the operating room and other clinical environments is that the operating area has high standards of sterility at all times, while most other settings are not designed to meet such standards. However, the principles of aseptic technique can be applied in other clinical settings. The application of aseptic technique in such settings is termed "medical asepsis" or "clean technique" rather than "surgical asepsis" or "sterile technique" required in the operating room. Aseptic technique is most strictly applied in the operating room because of the direct and often extensive disruption of skin and underlying tissue. Aseptic technique helps to prevent or minimize postoperative infection. The patient is prepared or prepped by shaving hair from the surgical site, cleansing with a disinfectant such as iodine, and applying sterile drapes. In all clinical settings, handwashing is an important step in asepsis. In general settings, hands are to be washed when visibly soiled, before and after contact with the patient, after contact with other potential sources of microorganisms, before invasive procedures, and after removal of gloves. Patients and visitors should also be encouraged to wash their hands. Proper handwashing for most clinical settings involves removal of jewelry, avoidance of clothing contact with the sink, and a minimum of 10-15 seconds scrubbing hands with soap, warm water, and vigorous friction.

A surgical scrub requires use of a long-acting, powerful, antimicrobial soap, careful scrubbing of the fingernails, and a longer period of time for scrubbing. Institutional policy usually designates an acceptable minimum length of time required. Thorough drying is essential, as moist surfaces invite the presence of pathogens. Contact after handwashing with the faucet or other potential contaminants should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of foot pedals. Despite this careful scrub, bare hands are always considered potential sources of infection. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flows in the direction of gravity. With this in mind, hands are held below elbows during the surgical scrub and above elbows following the surgical scrub. Sterile surgical clothing or protective devices such as gloves, face masks, goggles, and transparent eye/face shields serve as a barrier against microorganisms and are donned to maintain asepsis in the operating room. This practice includes covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may harbor unwanted organisms. This garb must be donned with deliberate care to avoid touching external, sterile surfaces with nonsterile objects including the skin. This ensures that potentially contaminated items such as hands and clothing remain behind protective barriers, thus prohibiting inadvertent entry of microorganisms into sterile areas. Personnel assist the surgeon to don gloves and garb and arrange equipment to minimize the risk of contamination. Donning sterile gloves requires specific technique so that the outer glove is not touched by the hand. A large cuff exposing the inner glove is created so that the glove may be grasped during donning. It is essential to avoid touching nonsterile items once sterile gloves are applied; the hands may be kept interlaced to avoid inadvertent contamination. Any break in the glove or touching the glove to a nonsterile surface requires immediate removal and application of new gloves. Asepsis in the operating room or for other invasive procedures is also maintained by creating sterile surgical fields with drapes. Sterile drapes are sterilized linens placed on the patient or around the field to delineate sterile areas. Drapes or wrapped kits of equipment are opened in such a way that the contents do not touch non-sterile items or surfaces. Aspects of this method include opening the furthest areas of a package first, avoiding leaning over the contents, and preventing opened flaps from falling back onto contents. Other principles that are applied to maintain asepsis include:
All items in a sterile field must be sterile. Sterile packages or fields are opened or created as close as possible to time of actual use. Moist areas are not considered sterile. Contaminated items must be removed immediately from the sterile field. Only areas that can be seen by the clinician are considered sterile, i.e., the back of the clinician is not sterile. Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow. Tables are considered sterile only at or above the level of the table. Nonsterile items should not cross above a sterile field. There should be no talking, laughing, coughing, or sneezing across a sterile field. Personnel with colds should avoid working while ill or apply a double mask. Edges of sterile areas or fields (generally the outer inch) are not considered sterile. When in doubt about sterility, discard the potentially contaminated item and begin again. A safe space or margin of safety is maintained between sterile and nonsterile objects and areas.

When pouring fluids, only the lip and inner cap of the pouring container is considered sterile. The pouring container should not touch the receiving container, and splashing should be avoided. Tears in barriers are considered breaks in sterility.

In the operating room, staff have assignments so that those who have undergone surgical scrub and donning of sterile garb are positioned closer to the patient. Other "unscrubbed" staff members are assigned to the perimeter and remain on hand to obtain supplies, acquire assistance, and facilitate communication with outside personnel. Unscrubbed personnel may relay equipment to scrubbed personnel only in a way that preserves the sterile field. For example, an unscrubbed nurse may open a package of forceps in sterile fashion so that he or she never touches the sterilized inside portion, the scrubbed staff or the sterile field. The uncontaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field. Asepsis in the operating room is maintained by allowing only scrubbed personnel into the sterile field and checking all equipment and packaging for breaks in sterility, such as expired sterilization date, moisture, or torn wrappings. Clinicians observe aseptic technique by strictly avoiding practices that may introduce microorganisms. Arms of scrubbed staff are to remain within the field at all times, and reaching below the level of the patient or turning away from the sterile field are considered breaches in asepsis. Clinical areas outside of the operating room generally do not allow for the same strict level of asepsis. However, avoiding potential infection remains the goal in every clinical setting. Observation of medical aseptic practices will help to avoid nosocomial infections, or those acquired in the hospital. General habits that help to preserve a clean medical environment include:
Safe removal of hazardous waste, i.e., prompt disposal of contaminated needles or bloodsoaked bandages to containers reserved for such purposes. Prompt removal of wet or soiled dressings. Prevention of accumulation of bodily fluid drainage, i.e., regular checks and emptying of receptacles such as surgical drains or nasogastric suction containers. Avoidance of backward drainage flow toward patient, i.e., keeping drainage tubing below patient level at all times. Immediate clean-up of soiled or moist areas. Labeling of all fluid containers with date, time, and timely disposal per institutional policy. Maintaining seals on all fluids when not in use.

These general practices are important for keeping the environment as free of microorganisms as possible. In addition, specific situations outside of the operating room require a strict application of aseptic technique. Some of these situations include:
wound care drain removal and drain care intravascular procedures vaginal exams during labor insertion of urinary catheters respiratory suction

For example, a surgical dressing change at the bedside, though in a much less controlled environment than the operating room, will still involve thorough handwashing, use of gloves and other protective garb, creation of a sterile field, opening

and introducing packages and fluids in such a way as to avoid contamination, and constant avoidance of contact with nonsterile items. The isolation unit is another clinical setting that requires a high level of attention to aseptic technique. Isolation is the use of physical separation and strict aseptic technique for a patient who either has a contagious disease or is immunocompromised. For the patient with a contagious disease, the goal of isolation is to prevent the spread of infection to others. In the case of respiratory infections (i.e., tuberculosis), the isolation room is especially designed with a negative pressure system that prevents airborne flow of pathogens outside the room. The severely immunocompromised patient is placed in reverse isolation, where the goal is to avoid introducing any microorganisms to the patient. In these cases, attention to aseptic technique is especially important to avoid spread of infection in the hospital or injury to the patient unprotected by sufficient immune defenses. Entry and exit from the isolation unit involves careful handwashing, use of protective barriers like gowns and gloves, and care not to introduce or remove potentially contaminated items. Institutions supply specific guidelines that direct practices for different types of isolation, i.e., respiratory versus body fluid isolation precautions.

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Back Figure 1-11. Picking up folded hand towel. Up Scrub, Gown, and Glove Procedures Next Figure 1-15. Grasp the gown through all layers.

(17) Grasp t h e other e n d of t h e towel a n d d r y y o u r other h a n d a n d a r m in t h e same manner as above. Discard t h e towel into a linen receptacle (the circulator may take it from t h e distal end). Section V. SURGICAL GOWN TECHNIQUE 1-17. PRINCIPLES The specialist is to abide by t h e following principles whenever he dons a sterile gown: a. If t h e specialist touches t h e outside of his g o w n while donning it, t h e g o w n is contaminated. If this occurs, discard t h e gown. The specialist is to touch o n l y t h e inside of t h e g o w n while putting it o n . NOTE : Surgical gowns are folded with t h e inside facing t h e specialist. This method of folding facilitates picking up a n d donning t h e g o w n without touching t h e outside surface. b. The specialist's scrubbed hands a n d arms are contaminated if he allows t h e m to fall below waist level or to touch his body. The specialist, therefore, keeps his hands a n d arms above his waist a n d a w a y from his body a n d at an angle of about 20 to 30 degrees above t h e elbows. c. After donning t h e surgical gown, t h e o n l y parts of t h e g o w n that are considered sterile are t h e sleeves (except for t h e axillary area) a n d t h e front from waist level to a f e w inches below t h e neck opening. If t h e g o w n is touched or brushed by an unsterile object, t h e g o w n is t h e n considered contaminated. The contaminated g o w n is removed using t h e proper technique. You m u s t t h e n d o n a new sterile gown. 1-18. PROCEDURE--CLOSED CUFF METHOD a. With o n e hand, pick up t h e entire folded g o w n from t h e wrapper by grasping t h e g o w n through all layers, being careful to touch o n l y t h e inside top layer, which is exposed (see Figure 1-15). Step back from t h e table to allow other team members room to maneuver. MD0933 1-14

Back Section V. Surgical Gown Technique

Up Scrub, Gown, and Glove Procedures

Next Figure 1-17. Slide hands and arms part way into the sleeves.

Figure 1-15. Grasp t h e g o w n through all layers. b. Hold t h e g o w n in t h e manner s h o w n in Figure 1-16, near t h e gown's neck, a n d allow it to unfold, being careful that it does n o t touch either y o u r body or other unsterile objects. Figure 1-16. Unfold t h e gown. Note that t h e specialist holds t h e g o w n a w a y from him a n d at chest level to facilitate handling a n d without contaminating t h e gown. Also, no unsterile equipment is near. c. Grasp t h e inside shoulder seams a n d open t h e g o w n with t h e armholes facing y o u . d. Slide y o u r arms part way into t h e sleeves of t h e gown, keeping y o u r hands at shoulder level a w a y from t h e body (see Figure 1-17). MD0933 1-15
Back Figure 1-15. Grasp the gown through all layers. Up Scrub, Gown, and Glove Procedures Next Figure 1-19. 1 The circulator adjusts the gown over the scrub's shoulders.

Figure 1-17. Slide hands a n d arms part way into t h e sleeves. Note that hands are held high so g o w n does n o t touch t h e floor. Do n o t permit t h e outside surface of t h e g o w n to brush t h e skin. e. With t h e assistance of y o u r circulator, slide y o u r arms further into t h e g o w n sleeves; when y o u r fingertips are e v e n with t h e proximal edge of t h e cuff, grasp t h e inside seam at t h e juncture of g o w n sleeve a n d cuff using y o u r t h u m b a n d index finger. Be careful that no part of y o u r h a n d protrudes from t h e sleeve cuff (see Figure 1-18). Figure 1-18. Slide t h e arms t h e full distance that t h e y should be inserted into t h e g o w n sleeves. The specialist should grasp t h e inside seam where t h e g o w n a n d cuff join. Note that no part of his hands is protruding from t h e cuffs. MD0933 1-16

Back Figure 1-17. Slide hands and arms part way into the sleeves.

Up Scrub, Gown, and Glove Procedures

Next Figure 1-20. The circulator secures the gown at the neck with the Velcro tab.

f. The circulator m u s t continue to assist at this point. He positions t h e g o w n over y o u r shoulders (see Figure 1-19) by grasping t h e inside surface of t h e g o w n at t h e shoulder seams. Figure 1-19. 1 The circulator adjusts t h e g o w n over t h e scrub's shoulders. 2 The circulator adjusts t h e g o w n over t h e scrub's shoulders. Note that t h e circulator's hands a n d arms are in contact with o n l y t h e inside surface of t h e gown. NOTE : For t h e reusable cloth g o w n (which is rarely used), u s e t h e procedures given in steps a through f. The circulator t h e n prepares to tie t h e gown. The neck a n d back ties are tied in an up-and-down motion. He t h e n ties t h e belt by grasping t h e g o w n at t h e back as t h e scrub leans forward. The circulator leans d o w n a n d grasps t h e distal e n d of o n e belt tie; this enables t h e circulator to handle t h e belt without touching any part of t h e g o w n that should remain sterile. The circulator t h e n brings t h e belt tie to t h e back of t h e gown. The scrub t h e n swings toward t h e opposite side so that t h e circulator c a n grasp t h e other belt in t h e same manner. The circulator will t h e n tie t h e belt in an up-and-down motion; this reduces t h e area of contamination on t h e gown. The circulator will t h e n tuck t h e ends of t h e belt inside t h e g o w n at t h e back. Then t h e scrub; proceeds to t h e gloving procedure. g. The circulator t h e n prepares to secure t h e gown. The neck a n d back may be secured with a Velcro tab or ties (see Figure 1-20). The circulator t h e n ties t h e g o w n at waist level at t h e back. This technique prevents t h e contaminated surfaces at t h e back of t h e g o w n from coming into contact with t h e front of t h e gown. MD0933 1-17

The following are specific guidelines for sterilizing instruments, glassware, suture materials, and rubber latex materials. Instruments: Wash each instrument after use with an antiseptic detergent solution. When washing by hand, pay particular attention to hinged parts and serrated surfaces. Rinse all instruments, and dry them thoroughly. Use an instrument washer/sterilizer, if available, to decontaminate instruments and utensils following each surgical procedure. Following cleaning and decontamination, leave hinged instruments unclasped and wrapped singly or placed on trays for resterilization. Glassware: Inspect all reusable glassware for cracks or chips. Wash all reusable glassware with soap or detergent and water after use, and rinse it completely. When preparing reusable glass syringes match numbers or syringe parts; wrap each plunger and barrel separately in gauze; and wrap each complete syringe in a double muslin wrapper. When glassware, tubes, medicine glasses, and beakers are part of a sterile tray, wrap each glass item in gauze before placing it on the tray. Suture Material: Suture materials are available i n t w o m a j o r c a t e g o r i e s : a b s o r b a b l e a n d nonabsorbable. Absorbable suture materials can be digested by the tissues during the healing process. Absorbable sutures are made from collagen (an animal
protein derived from healthy animals) or from synthetic polymers. Nonabsorbable suture materials are those that effectively resist the enzymatic digestion

process in living tissue.

individual packages, presterilized,

These sutures are made of metal or other inorganic materials.

In both types, each strand of

specifically sized suture material is uniform in diameter and is predictable in performance. Modern manufacturing processes make all suture materials available in

with or without a surgical needle attached. Once opened, do not resterilize either the individual p a c k a g e o r a n i n d i v i d u a l s t r a n d o f s u t u r e material. NOTE: The only exception to this rule involves the use of surgical stainless steel. This material is often provided in unsterile packages or tubes. Individual strands or entire packages of surgical stainless steel must be sterilized before use. Rubber Latex Materials: Wash rubber tubing in
an antiseptic detergent solution.

Pay attention to the inside of the tubing. Rinse

all tubing well and place it flat or loosely coiled in a wrapper or container.

When packing latex surgical drains for

sterilization, place a piece of gauze in the lumen of the tray.

Never resterilize

surgical drains. Never resterilize rubber catheters bearing a disposable label. Never resterilize surgeons disposable (rubber) gloves.

These gloves are for one-time use only. Handling Sterile Articles LEARNING OBJECTIVE: Recall sterile article handling and surgical hand scrubbing techniques, donning procedure for gowning and gloving, and the steps to clean an operating/treatment room. When you are changing a dressing, removing sutures, or preparing the patient for a surgical procedure, it will be necessary to establish a sterile field from which to work. The field should be established on a stable, clean, flat, dry surface. Wrappers from sterile articles may be used as a sterile field as long as the inside of the wrapper remains sterile. If the size of the wrapper does not provide a sufficient working space for the sterile field, use a sterile towel. Once established, only those persons who have donned sterile gloves should touch the sterile 2-33

Back Rubber Latex Materials

Up Hospital Corpsman Revised Edition - Complete Navy Nursing manual for hospital training purposes

Next Gowning and Gloving

field. Additionally, the following basic rules must be adhered to: An article is either sterile or unsterile; there is no inbetween. If there is doubt about the sterility of an item, consider it unsterile. Any time the sterility of a field has been compromised, replace the contaminated field and setup. Do not open sterile articles until they are ready for use. Do not leave sterile articles unattended once they are opened and placed on a sterile field. Do not return sterile articles to a container once they have been removed from the container. Never reach over a sterile field. When pouring sterile solutions into sterile containers or basins, do not touch the sterile container with the solution bottle. Once opened and first poured, use bottles of liquid entirely. If any liquid is left in the bottle, discard it. Never use an outdated article. Unwrap it, inspect it, and, if reusable, rewrap it in a new wrapper for sterilization. Surgical Hand Scrub The purpose of the surgical hand scrub is to reduce resident and transient skin flora (bacteria)

to a minimum. Resident bacteria are often the result of organisms present in the hospital environment. Because these bacteria are firmly attached to the skin, they are difficult to remove. However, their growth is inhibited by the antiseptic action of the scrub detergent used. Transient bacteria are usually acquired by direct contact and are loosely attached to the skin. These are easily removed by the friction created by the scrubbing procedure. Proper hand scrubbing and the wearing of sterile gloves and a sterile gown provide the patient with the best possible barrier against pathogenic bacteria in the environment and against bacteria from the surgical team. The following steps comprise the generally accepted method for the surgical hand scrub. 1. Before beginning the hand scrub, don a surgical cap or hood that covers all hair, both head and facial, and a disposable mask covering your nose and mouth. 2. Using approximately 6 ml of antiseptic detergent and running water, lather your hands and arms to 2 inches above the elbow. Leave detergent on your arms and do not rinse. 3. Under running water, clean your fingernails and cuticles, using a nail cleaner. 4. Starting with your fingertips, rinse each hand and arm by passing them through the running water. Always keep your hands above the level of your elbows. 5. From a sterile container, take a sterile brush and dispense approximately 6 ml of antiseptic detergent onto the brush and begin scrubbing your hands and arms. 6. Begin with the fingertips. Bring your thumb and fingertips together and, using the brush, scrub across the fingertips using 30 strokes. 7. Now scrub all four surface planes of the thumb and all surfaces of each finger, including the webbed space between the fingers, using 20 strokes for each surface area. 8. Scrub the palm and back of the hand in a circular motion, using 20 strokes each. 9. Visually divide your forearm into two parts, lower and upper. Scrub all surfaces of each division 20 strokes each, beginning at the wrist and progressing to the elbow. 10. Scrub the elbow in a circular motion using 20 strokes. 11. Scrub in a circular motion all surfaces to approximately 2 inches above the elbow. 12. Do not rinse this arm when you have finished scrubbing. Rinse only the brush. 13. Pass the rinsed brush to the scrubbed hand and begin scrubbing your other hand and arm, using the same procedure outlined above. 14. Drop the brush into the sink when you are finished. 15. Rinse both hands and arms, keeping your hands above the level of your elbows, and allow water to drain off the elbows. 16. When rinsing, do not touch anything with your scrubbed hands and arms. 17. The total scrub procedure must include all anatomical surfaces from the fingertips to approximately 2 inches above the elbow. 2-34

Back Surgical Hand Scrub

Up Hospital Corpsman Revised Edition - Complete Navy Nursing manual for hospital training purposes

Next Figure 25.Gloving

18. Dry your hands with a sterile towel. Do not allow the towel to touch anything other than your scrubbed hands and arms. 19. Between operations, follow the same hand- scrub procedure. Gowning and Gloving If you are the scrub corpsman, you will have opened your sterile gown and glove packages in the operating room before beginning your hand scrub. Having completed the hand scrub, back through the door holding your hands up to avoid touching anything with your hands and arms. Gowning technique is shown in the steps of figure 24. Pick up the sterile towel that has been wrapped with your gown (touching only the towel) and proceed as follows: 1. Dry one hand and arm, starting with the hand and ending at the elbow, with one end of the towel. Dry the other hand and arm with the opposite end of the towel. Drop the towel. 2. Pick up the gown in such a manner that hands touch only the inside surface at the neck and shoulder seams. 3. Allow the gown to unfold downward in front of you. 2-35 Figure 24.Gowning.

Back Gowning and Gloving

Up Hospital Corpsman Revised Edition - Complete Navy Nursing manual for hospital training purposes

Next MANAGEMENT OF INFECTIOUS WASTE

4. Locate the arm holes. 5. Place both hands in the sleeves. 6. Hold your arms out and slightly up as you slip your arms into the sleeves. 7. Another person (circulatory) who is not scrubbed will pull your gown onto you as you extend your hands through the gown cuffs. Continue the process by opening the inner glove packet on the same sterile surface on which you opened the gown. The entire gloving process is shown in the steps of figure 25. 1. Pick up one glove by the cuff using your thumb and index finger. 2. Touching only the cuff, pull the glove onto one hand and anchor the cuff over your thumb. 3. Slip your gloved fingers under the cuff of the other glove. Pull the glove over your fingers and hand, using a stretching side-to-side motion. 2-36 Figure 25.Gloving.

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Medical Hand Washing Purpose: To maintain hands free of visible soiling. Steps 1. Gather the necessary supplies. Stand in front of the sink. Do not allow your clothing to touch the sink during the washing procedure. 2. Remove jewellery, if possible, and secure in as safe place or allow plain wedding band to remain in place. 3. Turn on water and adjust force. Regulate the temperature until the water is warm. (optional) 4. Wet the hands and wrist area. Keep hands lower than elbows to allow water to flow toward fingertips.

5. Use about 1 teaspoon liquid soap from dispenser or rinse bar of soap and lather thoroughly. Cover all areas of hands with the soap product. Rinse soap bar again and return to soap dish. 6.With firm rubbing and circular motions, wash the palms and backs of the hands, each finger, the areas between the fingers, the knuckles, wrists, and forearms. Wash at least 1 inch above area of contamination. If hands are not visibly soiled, was to 1 inch above wrist. 7. Continue this friction motion for at least 15 seconds. 8. Use fingernails of the opposite hand or a clean orangewood stick to clean under fingertips. 9. Rinse thoroughly with water flowing towards fingertips. 10.Pat hands dry, beginning with the fingers and moving upward towards forearms, with a paper/ hand towel and discard immediately. Use another clean towel to turn off the faucet. Discard towel immediately without touching other clean hand. Source: RLE Manual 2008 Edition Principles of Asepsis 1. Only sterile items are used within sterile fields. All articles used in an operation have been sterilized previously. 2. Persons who are sterile touch only sterile items/ areas; persons who are not sterile touch only unsterile items/ areas. 3. If in doubt about sterility of anything, consider it unsterile. 4. Nonsterile persons avoid reaching over a sterile field; sterile persons avoid leaning over unsterile area. 5. Tables are sterile only at table levels. 6. Gowns are considered sterile only from waist to shoulder level in front, and the sleeves. 7. The edge of anything that encloses sterile contents is unsterile. 8. Sterile persons keep well within sterile areas. 9. Nonsterile persons keep away from sterile areas. 10.Sterile field is created as close as possible to the time of use. 11.Sterile areas are continuously kept in view. 12.Destruction of integrity of microbial barriers results in contamination. Moisture can cause contamination. 13.When microorganisms cannot be eliminated, they must be kept to an

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Back Figure 1-15. Grasp the gown through all layers.

Up Scrub, Gown, and Glove Procedures

Next Figure 1-19. 1 The circulator adjusts the gown over the scrub's shoulders.

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PRINCIPLES OF ASEPSIS AND STERILE TECHNIQU E PRINCIPL

ES OF ASEPSIS AND STERILE TECHNIQU E

Differen ce between aseptic

and sterileDif ference between aseptic

and sterilete chniquet echniqu e

--asepsis literally means without infectiona sepsis

literally means without infectiona nd aseptic

tech is to prevent microbial and aseptic tech is to

prevent microbial contamin ation, while sterile

tech. are techconta mination, while sterile tech. are

techto create and work on a sterile fieldto

create and work on a sterile field

PRACTICES INVOLVING ASEPTIC TECHNIQU E PRACTIC ES

INVOLVING ASEPTIC TECHNIQU E

Items in use may be

sterile or unsterile (unsterileIte ms in use may be sterile or unsterile

(unsterileglo ves=bloody sponges, sterile glove=sterile fieldgloves= bloody

sponges, sterile glove=sterile field

Items are used for an individual

patient only(A disposableIte ms are used for an individual patient

only(A disposableite m should not be washed and used to other pt. it shoulditem

should not be washed and used to other pt. it shouldbe disposed)be disposed)

Items are not always used within a sterile field(the use of Items are not always

used within a sterile field(the use of surgical scrub brush is not sterile but used

before gloving)surgi cal scrub brush is not sterile but used before gloving)

Contaminatio n is contained(if oral suction tip falls, it isContaminat ion is

contained(if oral suction tip falls, it isdiscarded and a new one replaced, even though

mouth isdiscarded and a new one replaced, even though mouth isnot in the sterile

field)not in the sterile field)

R eusable items must be terminally

sterilized or R eusable items must be

terminally sterilized orhigh level disinfected before

reuse (stainless steelhigh level disinfected before

reuse (stainless steelsigmoi doscope can be sterilized)si

gmoidosco pe can be sterilized)It em is not necessarily stored in a

sterileItem is not necessarily stored in a sterilecondi tion (after

item is used, stored in anconditio n (after item is

used, stored in anunwrapp ed stage if not in a sterile

field)unwra pped stage if not in a sterile field)Asepti c tech

sometimes referred as clean techniqueA septic tech sometimes

referred as clean technique

STERILE TECHNIQU E STERILE TECHNIQU E

Items used are sterile without exceptionIt ems used are sterile

without exception

Items used have been stored in sterile

conditionsI tems used have been stored in sterile conditions

Contamina tion is avoided or remedied immediatel yContamin

ation is avoided or remedied immediatel y

Reusable items are rendered sterile before useReusabl

e items are rendered sterile before use

Principles remain the same; it is the Princi ples remain

the same; it is the degre e of adheren

ce that varies d egree of adheren

ce that varies

PRINCIPLES OF STERILE TECHNIQU E PRINCIPL ES OF STERILE

TECHNIQU E

The patient is the center of the sterile

field, whichThe patient is the center of the sterile

field, whichinclu des the areas of the patient,

the operatingin cludes the areas of the patient,

the operatingt able and furniture covered with sterile

drapes,tabl e and furniture covered with sterile drapes,and

the personnel wearing the OR attire. Strict and

the personnel wearing the OR attire. Strict adhe

rence to sound principles of sterile techniquea dherence

to sound principles of sterile techniquea nd recommen

ded practices is mandatory for theand recommen ded

practices is mandatory for thesafety of the patient.saf

ety of the patient.

The principles of sterile technique are applied in the:The

principles of sterile technique are applied in the:

1.1.

Preparation for operation by sterilizatio n

of Preparat ion for operation by sterilizatio n

of necessar y materials and suppliesne cessary materials

and supplies
2.2.

Preparation of the operating

team to handlePrep aration of the operating team to

handlesteri le supplies and intimately contact woundsteri

le supplies and intimately contact wound

3.3.

Creation and maintenan ce of the sterile field,Creati

on and maintenan ce of the sterile field,includi ng

preparatio n and draping of patient, toincluding preparatio

n and draping of patient, toprevent contaminat ion of the

surgical woundprev ent contaminat ion of the

surgical wound
4.4.

Maintenan ce of sterility

and asepsis throughout Maintenan ce of sterility

and asepsis throughout the operative proceduret

he operative procedure
5.5.

Terminal sterilizatio

n and disinfection at theTermina l sterilizatio

n and disinfection at theconclusi on of the operationc

onclusion of the operation

PRINCI PLESPR INCIPL ES

(1.) O
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em
s ar

e
not und

e
r constant o

b
s

e
r

v
ation constant o

b
s

e
r

v
ation

5.
if st

e
ril

ep
ac

k
ag

e
falls

to th

e
floor, it

m
ust

be
discard

e
d

5.
if

st

e
ril

ep
ac

k
ag

e
falls to th

e
floor,

it

m
ust

be
discard

e
d

(2.) GOW
NS

A
RE CONSIDERED STERILE ONLY

F
RO

M
THE

WA
IST TO

(2.) G
O

W
NS

A
RE CONSIDERED

STERILE ONLY

F
RO

M
THE

WA
IST TO SHOULDER LEVEL

IN

F
RONT

A
ND THE

SLEEVESSHOUL DER LEVEL IN

RONT

A
ND THE SLEEVES- - th

following

p
ractic

e
s

m
ust

be

b
s

e
rv

e
d

th

e
following

p
ractic

e
s

ust

be
o

b
s

e
rv

:1.
st

e
ril

e pe
rsons

keep

hands in sight and

at or a

b
ov

waist

1.
st

e
ril

e pe
rsons

keep

hands in sight and

at or a

b
ov

waist

2.
Hands ar

e kep
t

awa

y
from th

e
fac

e.

El

b
ows ar

e kep
t

clos

e
to

2.
Hands ar

e kep

t awa

y
from th

fac

e.
El

b
ows ar

e kep

t clos

e
to sid

.
Hands ar

e
n

e
r fold

e
d

und

e
r arms

be
caus

sid

e
s

.
Hands ar

e
v

e
r fold

d und

e
r arms

be

caus

e
of

pe
rspiration in

th

e
a

x
illar

y
ar

.
of p

e
rspiration

in th

e
a

x
illar

ar

e
a

.3.
Changing ta

e
l

e
v

e
ls

is avoid

e
d

.
If

a st

e
ril

e
p

rson must stand

3.
Changing

ta

b
l

e
l

e
v

ls is avoid

e
d

If a st

e
ril

e
rson must stand

on a platform to

e
ach th

e
op

rativ

e
fi

e
ld

,
th

ar

e
a of th

on a platform to

e
ach th

e
op

rativ

e
fi

e
ld

,
th

ar

e
a of th

gown

be
low waist must

not

b
rush against st

ril

e
ta

b
l

e
s

or gown

be
low waist

must not

b
rush against

st

e
ril

e
ta

b
l

s or drap

e
d

ar

e
as

.
drap

e
d

ar

e
as

.4.
it

e
ms

dropp

e
d

be
low waist

e
v

e
l ar

consid

e
r

e
d unst

ril

e
and

4.
it

e
ms

dropp

e
d

be
low waist

e
v

e
l ar

consid

e
r

e
d unst

ril

e
and must

be
discard

.
must

be
discard

e
d

(3.)
TABLES

ARE STERILE ONLY AT

TABLE LEVEL

(3.)
TABLES ARE

STERILE ONLY AT TABLE

LEVEL

-- the result is that:the result is that:1.

O

nly the top of the table with

sterile drape is considered1.

O

nly the top of the table with sterile drape is consideredsteril e.

E

dges and sides of drape extending below tablesterile.

E

dges and sides of drape extending

below tablelevel are considered unsterile.level are considered unsterile.2.

A

nything falling or extending

over table edge, such as piece of 2.

A

nything falling or extending over table edge, such as

piece of suture, is unsterile.

S

crub nurse does not touch the part suture, is unsterile.

S

crub nurse does not touch the part hanging below table level.hanging below table level.3.
I

n unfolding sterile drape, the part that drops below table3.

I

n unfolding sterile drape, the part that

drops below tablesurface is not brought back up to table level.surface is not brought back up to table level.

(4.)
PERSONS

W
HO ARE STERILE TOUCH

ONLY STERILE ITE

M
S

OR

(4.)
PERSONS

W
HO ARE

STERILE TOUCH ONLY STERILE

ITE

M
S OR AREAS;

PERSONS

W
HO ARE NOT

STERILE TOUCH ONLY UNSTERILE

AREAS; PERSONS

W
HO ARE

NOT STERILE TOUCH ONLY

UNSTERILE ITE

M
S OR

AREASITE

M
S OR AREAS

-- for example:for example:1.

S

terile team members maintain contact with sterile field by1.

terile team members maintain contact with sterile field bymeans of gowns and glovesmeans of

gowns and gloves2.

N

on2.
N

on--sterile circulating nurse does not directly come

intosterile circulating nurse does not directly come intocontact with the sterile fieldcontact with the sterile field3.

upplies for sterile team members reach them by means of the3.

S

upplies for sterile team

members reach them by means of thecirculating nurse who opens wrapper on sterile packagescircula ting nurse who

opens wrapper on sterile packages

(5.)
UNSTERILE

PERSONS AVOID REACHING OVER

A STERILE

F
IELD;

(5.)
UNSTERILE

PERSONS AVOID REACHING OVER

A STERILE

F
IELD; PERSONS

AVOID LEANING OVER AN

UNSTERILE AREAPERSONS AVOID LEANING

OVER AN UNSTERILE AREA

-- for example:for example:1.

U

nsterile circulating nurse never reach over a sterile field to1.

nsterile circulating nurse never reach over a sterile field totransfer sterile

items.transfer sterile items.2.

I

n pouring solutions into sterile basin, circulating nurse holds2.

I

n pouring solutions into sterile basin, circulating nurse holdsonly lip of bottle over basin to avoid reaching over a sterile

area.only lip of bottle over basin to avoid reaching over a sterile area.3.
S

crub nurse sets basin or glasses

to be filled at edge of the3.

S

crub nurse sets basin or glasses to be filled at edge of thesterile table

;

circulating nurse stands near this edge of the table to fillsterile table
;

circulating nurse stands near this edge

of the table to fillthemthem4.

C

irculating nurse stands at a distance from the sterile field to4.

C

irculating nurse stands at a distance from the sterile field toadjust light over it to avoid microbial fallout over fieldadjust light over it to

avoid microbial fallout over field5. surgeons turn away from sterile field to have permission5. surgeons turn away from

sterile field to have permissionremo ved from brow.removed from brow.6.

S

crub nurse drapes a non

sterile table toward self first to6.

S

crub nurse drapes a non sterile table toward self first toprotect

gownprotect gown7. scrub nurse stands back from non sterile table when drapping7. scrub nurse stands back

from non sterile table when drappingit to avoid leaning over an unsterile area.it to avoid leaning over an unsterile area.

(6.)
EDGES

OF ANYTHING THAT ENCLOSES

STERILE CONTENTS ARE

(6.)
EDGES

OF ANYTHING THAT ENCLOSES

STERILE CONTENTS ARE CONSIDERED

UNSTERILECON SIDERED UNSTERILE

-- for example:for example:1. edges of

wrappers on sterile packages1. edges of wrappers on sterile packages2. caps on solution

bottles2. caps on solution bottles-- the following precautions should be taken:the following precautions

should be taken:1. sterile persons lift contents from packages by reaching down1. sterile persons lift contents from

packages by reaching downand lifting them straight up, holding elbows high.and lifting them straight

up, holding elbows high.2.

I

f a sterile wrapper is used as a table cover, it should amply2.

I

f a sterile wrapper is used as a table cover, it should amplycover the entire table surface.
O

nly the interior and surface level of thecover the entire table surface.
O

nly the interior and surface

level of thecover are considered sterile.cover are considered sterile.3.

A

fter a sterile bottle is

opened, contents must be used or3.

A

fter a sterile bottle is opened, contents must

be used ordiscarded.
C

ap cannot be replaced without contaminating pouring

edges.discarde d.
C

ap cannot be replaced without contaminating pouring edges.

(7.)
STERILE

FIELD IS CREATED AS

CLOSE AS POSSIBLE TO

TI

M
E OF

(7.)
STERILE

FIELD IS CREATED AS

CLOSE AS POSSIBLE TO

TI

M
E OF USEUSE

-- degree of contamination is proportionate to length of time steriledegree of contamination is proportionate to length of

time sterileitems are uncovered and exposed to the environment.ite ms are uncovered and exposed to the environment.--

precautions must be taken as follows:precauti ons must be taken as follows:1.

S

terile tables are set up just prior to the operation1.

S

terile tables are set up just prior to the operation2.

t is difficult to uncover a table of sterile contents without 2.

I

t is difficult to uncover a table

of sterile contents without contami nation.

C

overing sterile tables for later use is not

recommended. contamination.
C

overing sterile tables for later use is not recommended. (8.)

STERILE

AREAS ARE CONTINUOSLY KEPT

IN VIE

W(8.)
STERILE AREAS

ARE CONTINUOSLY KEPT IN

VIE

W-contamination of sterile areas must be readily visiblecontamin ation of sterile areas must be

readily visible-to ensure this principle:to ensure this principle:1.

S

terile persons face sterile areas.1.

terile persons face sterile areas.2. When sterile packs are opened in a room, or a sterile field is2. When sterile

packs are opened in a room, or a sterile field isset up, someone must remain in the room to maintain

vigilanceset up, someone must remain in the room to maintain vigilance

(9.)
STERILE

PERSONS KEEP

W
ELL

W
ITHIN

THE STERILE AREAS

(9.)
STERILE

PERSONS KEEP

W
ELL

W
ITHIN

THE STERILE AREAS

-- allow a wide margin of

safety when passing unsterile areas andallow a wide margin of safety when passing unsterile areas andfollow these

rules.follow these rules.1.

S

terile persons stand back at a safe distance from the1.

S

terile persons stand back at a safe distance from theoperating table when draping the patient operatin g table when

draping the patient 2.

S

terile persons pass each other back to back2.

S

terile persons pass each other back to back3.

S

terile person turns back to non sterile person or area when3.

terile person turns back to non sterile person or area whenpassingpa ssing4.
S

terile person faces sterile area to pass it.4.

S

terile person faces sterile area to pass it.5.

terile person asks non sterile individual to step aside rather5.

S

terile person asks non sterile

individual to step aside ratherthan risk contaminationt han risk contamination6 .

S

terile persons stay within and around a sterile field.

T

hey
DO

6.

terile persons stay within and around a sterile field.

T

hey
DO

NOT

W
ALK AROUND

or go outside room

NOT

W
ALK AROUND

or go outside room7. Movement

within and around a sterile area is kept to a7. Movement within and around a sterile area is kept to aminimum to avoid

contamination of sterile items or personsminimu m to avoid contamination of sterile items or persons

(10.)
STERILE

PERSONS KEEP CONTACT

W
ITH

STERILE AREAS TO A

(10.)
STERILE PERSONS KEEP CONTACT

W
ITH STERILE AREAS TO

M
INI

M
U

MM
INI

M
U

M-- the following rules are observed:the following rules are observed:1.
S

terile persons do not lean on sterile tables and on the draped1.

S

terile persons do not lean on sterile tables

and on the drapedpatient p atient 2.

S

itting/leaning against a non sterile surface is a break in2.

S

itting/leaning against a non sterile surface is a break intechniquetech nique(11.)

UNSTERILE PERSONS

AVOID STERILE AREAS

(11.)
UNSTERILE

PERSONS AVOID STERILE AREAS

-- a wide margin of safety must be maintained when passing sterilea wide margin of safety must be maintained

when passing sterileareas by following these rules:areas by following these rules:1.

U

nsterile persons maintain at

least 1 foot distance from any1.

U

nsterile persons maintain at least 1 foot distance from anyarea of

sterile fieldarea of sterile field2.

U

nsterile persons face and observe a sterile area when passing2.

U

nsterile persons face and observe a sterile area when passingit to be sure they do not touch it.it to be sure

they do not touch it.3.

U

nsterile persons never walk between two sterile areas e.g3.

U

nsterile persons never walk between two sterile areas e.gbetween 2 sterile tablesbetween 2 sterile tables4.

irculating nurse restricts to a minimum all activity near sterile4.

C

irculating nurse restricts to a

minimum all activity near sterilefieldfield

(12.)
DESTRUCTION

OF INTEGRITY OF

M
ICROBIAL

BARRIERS RESULTS

(12.)
DESTRUCTION OF

INTEGRITY OF

M
ICROBIAL BARRIERS

RESULTS IN CONTA

M
INATIONIN

CONTA

M
INATION

-- integrity of a sterile package of a sterile drape is destroyed

byintegrity of a sterile package of a sterile drape is destroyed byperforation, puncture or strikeperforatio n, puncture or

strike-through.throug h. -- to ensure sterility:to ensure sterility:1.

S

terile packages are laid on dry surfaces.1.

S

terile packages are laid on dry surfaces.2.

I

f a sterile package becomes damp or wet, it is re2.

I

f a sterile package becomes damp or wet, it is re--

sterilized orsterilized ordiscarded.

A

package is considered non sterile if any part of it comes indiscarded.

package is considered non sterile if any part of it comes incontact with moisture.contac t with moisture.3.

rapes are placed on a dry field.3.

D

rapes are placed on a dry field.4.

I

f solution soaks through sterile drape to non sterile area the4.

I

f solution soaks through sterile drape to non

sterile area thewet area is covered with impervious sterile drape or towelswet area is covered with impervious

sterile drape or towels5.

P

ackages wrapped in muslin or paper are permitted to cool,5.

P

ackages wrapped in muslin or paper are permitted to cool,after removal from the sterilizer to avoid steam condensation

andafter removal from the sterilizer to avoid steam condensation andresultant contamination.r esultant

contamination. 6.
S

terile items are stored in clean dry areas.6.

S

terile items are stored in clean dry areas.7.

S

terile packages are handled with clean dry hands7.

S

terile packages are handled with clean dry hands8.

U

ndue pressure on sterile packs is avoided to

prevent forcing8.
U

ndue pressure on sterile packs is avoided to prevent forcingsterile air out and

pulling unsterile air into the pack.sterile air out and pulling unsterile air into the pack.

(13.) M
ICROORGANIS

MM
UST BE KEPT TO

AN IRREDUCIBLE

M
INI

M
U

M(13.) M
ICROORGANIS

MM
UST BE KEPT

TO AN IRREDUCIBLE

M
INI

M
U

M-P

e
rf

e
ct

as

e
psis in an

op

e
rativ

e
fi

e
ld

is an id

e
al

to

be
approach

e
d, it

is P

e
rf

e
ct

as

e
psis in an

op

e
rativ

e
fi

e
ld

is an id

e
al

to

be
approach

e
d, it

is not a

b
solut

e.
All microorganisms cannot

be e
liminat

e
d,

b
ut this do

e
s not not a

b
solut

e.
All microorganisms cannot

be e
liminat

e
d,

b
ut this

do

e
s not o

b
viat

e
n

e
c

e
ssity

for strict st

e
ril

e
t

e
chniqu

e.
o

b
viat

e
n

e
c

e
ssity for

strict st

e
ril

e
t

e
chniqu

e.-it is g

e
n

e
rally agr

ee
d

that:it is g

e
n

e
rally agr

ee
d that:

1.
s

k
in cannot

be
st

e
rili

ze
d

1.
s

k
in

cannot

be
st

e
rili

ze
d

2.
som

e
ar

e
as cannot

be
scru

bbe
d

2.
som

e
ar

e
as cannot

be
scru

bbe
d

3.
Inf

e
ct

e
d ar

e
as ar

e
grossly contaminat

e
d

.3.
Inf

e
ct

e
d

ar

e
as ar

e
grossly

contaminat

e
d

.4.
air is

contaminat

e
d

b
y dust

and dropl

e
ts

4.
air

is contaminat

e
d

b
y

dust and dropl

e
ts

PRIN. OF ASEPSIS and STERILE TECHNIQUE

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Principles of Sterile Technique 1. Only sterile items are used within the sterile field. 2. Sterile persons are gowned and gloved. 3. Tables are sterile only at table level. 4. Sterile person/persons touch only sterile items or areas. Unsterile persons touch only unsterile areas. 5. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over unsterile areas. 6. Edges of anything that encloses sterile content are considered unsterile. 7. Sterile field is created as close as possible time of use.

8. Sterile areas are continuously kept in view. 9. Sterile persons keep well within sterile area. 10.Sterile persons keep contact with sterile areas to a minimum. 11.Microorganisms must be kept to irreducible minimum. 12.Destruction of integrity of microbial barriers results in contamination. 13.Unsterile persons avoid sterile areas. Compliments from: University of the Visayas College of Nursing Level III-Section L Hindreich Castillo Jirylyn Traya John Hope Elison Gaudioso Uy Marfe Ornopia Anne Viacrucis

Kenmae Soria Alfonse Vidal Mark Anthony Sangre Vina Villegas Emelou Tantoy Larriz Wagwag Dr. Naomi Remolador, DDM, R.N. Clinical Instructor

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Figure 1-17. Slide hands a n d arms part way into t h e sleeves. Note that hands are held high so g o w n does n o t touch t h e floor. Do n o t permit t h e outside surface of t h e g o w n to brush t h e skin. e. With t h e assistance of y o u r circulator, slide y o u r arms further into t h e g o w n sleeves; when y o u r fingertips are e v e n with t h e proximal edge of t h e cuff, grasp t h e inside seam at t h e juncture of g o w n sleeve a n d cuff using y o u r t h u m b a n d index finger. Be careful that no part of y o u r h a n d protrudes from t h e sleeve cuff (see Figure 1-18). Figure 1-18. Slide t h e arms t h e full distance that t h e y should be inserted into t h e g o w n sleeves. The specialist should grasp t h e inside seam where t h e g o w n a n d cuff join. Note that no part of his hands is protruding from t h e cuffs. MD0933 1-16

STE RILE

TECH NIQU E ST

ERIL E TECH

NIQU E

Item s used

are steril e

witho ut exce

ption Item s

used are steril

e witho ut

exce ption

Item s used

have been store

d in steril e

condi tionsI tems

used have been

store d in steril

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Reus able item

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steril e befor

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