ASEPTIC TECHNIQUE

SCRUBBING ,GOWNING AND GLOVING

Proper aseptic techniques is one of the most fundamental and essential principles of infection control in the clinical and surgical settings Aseptic Techniques are those which: Remove/reduce or kill microorganisms from hands and objects Employ sterile instruments and other items Reduce patients risk of exposure to microorganisms that cannot be removed

Aseptic technique also encompasses practices performed immediately before and during a surgical procedure to reduce postoperative infection: Hand washing Surgical Attire Surgical scrub, sterile gowning & gloving Patients surgical skin prep Using surgical barriers, including sterile surgical drapes and PPE Maintaining a Sterile Field Using safe operative technique Maintaining a safe environment in the OR

OPERATING ROOM ENVIRONMENT CONTROL

AIM

The surgical suite should be designed in such a way as to minimize and control the spread of infectious organisms

ACCESS CONTROL

OPERATING ROOM COMPLEX DIVIDED INTO 3 AREAS 1. 2. UNRESTRICTED AREA SEMI RESTRICTED AREA

3.

RESTRICTED AREA

1. UNRESTRICTED AREA

Areas outside the theatre complex including control point to monitor the entrance of patients, personnel, visitors, etc
RED LINE

Street clothes are permitted in the area

Traffic is not limited

2.

SEMI - RESTRICTED AREA

Peripheral support areas within theatre complex, includes corridors leading to operating rooms, work areas (storage) etc. All persons must wear scrub attire which should be made of low linting material that minimizes bacterial shedding, comfortable, clean and provides a professional appearance

3.

RESTRICTED AREA

Includes operating rooms, scrub areas and ante-rooms

Personnel must wear full surgical attire, hair coverings, masks where open sterile supplies and scrubbed persons are present
Masks are worn to reduce the dispersal of microbial droplets from the mouth and naso-pharynx of personnel high filtered Masks must cover the mouth and nose entirely, and be tied securely to prevent venting Metal strip in the top hem of the masks produces a firm contoured kit over the bridge of the nose

To provide effective barriers that prevent the dissemination of microorganisms to patients To protect personnel from contamination from blood and body fluids of patients Proper attire is a part of aseptic environmental control Protects personnel against exposure to communicable diseases and hazardous material

Proper attire must be worn within the semirestricted and restricted areas of the OR suite Clean fresh attire is donned daily on arrival to the OR and intermittently when necessary if suit becomes wet or grossly soiled-source of cross-contamination. OR attire should not be worn outdoors-this protects the OR environment from microorganisms inherent in the outdoor environment and vice-versa. Before leaving the institution everyone should change to street clothes/uniforms On occasion a cover gown may be worn over OR attire outside the suite The practice of wearing cover gowns is Not encouraged

Hair is a gross contamination Cap or hood is put on before the scrub suit to protect the garment from contamination by hair. All facial and head hair is completely covered in the semi restricted and restricted areas. Light weight caps/hoods made of disposable, lintfree fabric Reusable caps should be freshly laundered daily Skull caps do not cover the entire head, and hair can be shed from the inferior edges.

Unprotected street shoes can increase floor contamination Shoes restricted to wear in the OR are preferable in reducing microbial transfer from the outside into the OR suite Shoe covers may be worn as needed to protect from blood and body fluid Some surgeons wear plastic or rubber boots during procedures wherein extensive fluid irrigation and/or blood loss can be anticipated Shoe covers can inadvertently become soiled and harbor microorganisms and should be removed before leaving the OR

ASEPTIC TECHNIQUE

METHODS BY WHICH CONTAMINATION WITH MICROORGANISIMS IS PREVENTED (ALTERNATE TERM: ASEPTIC PRACTICE TO MAINTAIN ASEPSIS).

ASEPSIS
ABSENCE

OF MICROORGANISM THAT CAUSE DISEASE; FREEDOM FROM INFECTION.

STERILE
FREE OF MICROORGANISMS. INCLUDING ALL SPORES.

STERILISATION
THE PROCESS OF KILLING OR INACTIVATING ALL MICROORGANISMS.

UNSTERILE
INANIMATE OBJECT THAT HAS NOT BEEN SUBJECTED TO A STERILISATION PROCESS.

SURGICALLY CLEAN
MECHANICALLY CLEANED BUT NOT STERILE.

PRINCIPLES OF ASEPSIS

ARE THE EFFORTS TAKEN TO KEEP THE PATIENT AS FREE FROM HOSPITAL MICROORGANISM AS POSSIBLE. IT IS AMETHOD USED TO PREVENT CONTAMINATION OF WOUNDS AND OTHER SUSCEPTIBLE SITES BY ORGANISMS THAT COULD CAUSE INFECTION

HOW??

THROUGH ENSURING THAT ONLY STERILE EQUIPMENTS AND FLUIDS ARE USED DURING INVASIVE MEDICAL/SURGICAL PROCEDURES.

MEDICAL OR CLEAN ASEPSIS

CATEGORIES OF ASEPSIS

Aims to reduce the number of organisms and prevent their spread.

SURGICAL OR STERILE ASEPSIS

Aims to eliminate microorganisms from a given area.

FCTORS COULD INFLUENCE INFECTION PROCESS

AGE. NUTRITIONAL STATUS. DEBILITATING DISEASE. IMMUNO SUPPRESIVE DRUGS. PATIENT UNDERGOING SURGERY OR INVASIVE PROCEDURES. NUMBER OF MICROORGANISMS PRESENT. VIRULANCE OF THE MICROORGANISMS PRESENT.

THE PROCESS OF REMOVING AS MANY ORGANISMS AS POSSIBLE FROM THE HANDS AND ARMS BY MECHANICAL WASHING AND CHEMICAL ANTISEPTIC BEFORE PARTICIPATING IN AN OPERATION

Transient organisms

Resident organisms

Transient organisms

Resident organisms

PURPOSES OF HAND WASHING

To remove soil, debris, natural skin oil, hand lotions, and transient microorganisms from the hands. To reduce number of resident microorganism on skin. To suppress the growth of the resident microorganisms. To reduce the hazard of microbial contamination of the operative wound by skin flora. To reduce the risk of infection among other health care workers. To reduce the risk of transmission of infectious organisms to yourself

AGENTS FOR ANTISEPSIS

A broad-spectrum antimicrobial agent. Fast-acting and effective. Nonirritating and nonsensitizing. Prolonged-acting.

AGENTS FOR ANTISEPSIS

Chlorohexidine gluconate. Iodophors. Triclosan. Alcohol. Hexachlorophen.

PREPERATIONS BEFORE SCRUB

INSPECT HANDS FOR CUTS AND ABRASIONS. REMOVE ALL FINGER JEWELRY. BE SURE ALL HAIR IS COVERED BY HEADCAP. ADJUST THE MASK FIRMLY AND COMFORTABLY OVER NOSE AND MOUTH. CLEAN EYEGLASSES IF WORN. ADJUST WATER TO A COMFORTABLE TEMPERATURE.

DURATION OF HAND WASHING

Surgical

hand washing should not be less than 3 minutes.

Areas to which attention be paid when washing the hands

Most frequently missed

frequently missed

Areas to which attention be paid when washing the hands

Most frequently missed

frequently missed

PRINCIPLES OF ASEPSIS

All articles used for a surgical procedures are sterilized prior to surgery. Gowns are considered sterile only from waist to shoulder level in front and sleeves.

Personnel who are sterile only touch sterile articles; personnel who are not sterile only touch unsterile items.
Sterile touching sterile remaining sterile. Sterile touching unsterile contaminates all.

PRINCIPLES OF ASEPSIS

Arms not to be folded under axillae. If in doubt about the sterility of any item, consider it unsterile. Nonsterile personnel must avoid reaching over a sterile field, sterile personnel must avoid leaning over a sterile field. The area approximate 2.5cm around the edge of the sterile field is considered unsterile. Sterile personnel must be close to the sterile area, unsterile personnel must be away from the sterile area.

PRINCIPLES OF ASEPSIS

Moisture may cause contamination. Pouring should be done at the edge of the table. When passing in a sterile field, remember sterile to sterile. The sterile field must be kept insight all the time. The gloved hands must be kept insight all the time.

Once in position, drapes are never moved or shifted.

Avoid coughing, sneezing or unnecessary talking over a sterile field.

Thank you
for active listening

Laura Curtis
O.R. clinical instructor

KFMC
03\06\2006