Surgical Asepsis 2

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					Surgical Asepsis
Surgical asepsis differs from medical asepsis. Medical
asepsis is defined as any practice that helps reduce
the number and spread of microorganisms. Surgical
asepsis is defined as the complete removal of
microorganisms and their spores from the surface of
an object.

The practice of surgical asepsis begins with cleaning
the object in question using the principles of medical
asepsis followed by a sterilization process
Which procedures require surgical aseptic
• Any medical procedure that involves penetration of the
  body tissues (invasive procedure)

• Major & minor surgeries

• Tracheotomy care

• Dressing change

• Catheterization of the urinary bladder
Myelogram (penetration of the body tissue)

Minor surgery

Tracheostomy care

Dressing care

The Environment and Surgical Asepsis

• Creating an environment in a surgical suite or special
  procedure room, to avoid any possible infection to the

• Proper attire (scrubs, cap, mask, gloves, shoe covers)

• Awareness!!!!
Proper Attire
  OSHA Protocols
• Shoes must be comfortable with closed heel and toe and not cloth
covered. Cloth-covered shoes may allow blood, body fluids, and other
liquids to permeate. Cloth-covered shoes will not protect the feet should a
heavy object fall on them.
• Personal hygiene must be meticulous. A shower should be taken shortly
before beginning a work day in the operating room or special procedure
• Jewelry, long or artificial fingernails, and nail polish are prohibited.
Jewelry harbors microorganisms as do long, polished, or artificial nails.
• Any body piercing jewelry must be removed as it may become loose and
fall onto the sterile field.
• All persons who expect to proceed from the unrestricted zone into the
semi-restricted zone must go to the dressing area, don a scrub suit, and
tuck the blouse of the suit into the pants or wear a scrub blouse that fits
close to the body.
• All hair, beards, or mustaches must be covered with a surgical cap and
mask. Hair must be confined as it sheds microorganisms with movement
• Shoe covers must be placed over shoes to reduce contamination and
to protect shoes from coming in contact with blood and body fluids.

• Before proceeding into Zone 3, all persons must scrub hands and arms
for medical asepsis. It is believed that bare skin may shed
microorganisms. In many institutions, all who are not scrubbed for the
surgical procedure must wear a scrub jacket to cover bare arms.

• Before entering a room where a surgical procedure is in progress, a
mask must be donned. The masks worn in the OR must be single, high-
filtration masks
•Zone 1: An unrestricted zone: persons may enter in street

•Zone 2: A semi-restricted zone: only persons dressed in
scrub dress with hair covered and shoes covered may enter.

•Zone 3: A restricted zone: only persons wearing scrub dress,
shoe covers, and masks are allowed to be present. If a
surgical procedure is in progress, the doors to this area are
kept closed, and only persons directly involved in the
procedure may be present. Those directly involved in the
operation are dressed in sterile gowns and sterile gloves.
They are often referred to as “being scrubbed.”
    Most Common Causes of Contamination

•    The use of contaminated instruments
•    Contaminated gloves
•    Wet or damp sterile field
•    Microorganisms blown onto a surgical site.
Special Precautions

• Ventilation ducts must have special filters.
• Airflow in the OR should be unidirectional.
• Air pressure in the OR should be greater than in the outside
• Humidity is to be controlled to prevent static electricity.
• OR doors should remain closed as much as possible.
    The Surgical Team

•    Surgeon
•    Surgical assistant
•    Nurses
•    Physician assistant (PA)
•    Anesthesiologist
•    Nurse anesthetist
•    Radiologic Technologist
 Surgical assistant
Surgical Tech Duties
Your duties as a surgical technologist will
be to always maintain a clean and sterile
environment for the doctors and nurses to
perform necessary surgeries properly. You
will be in charge of scrubbing in and
keeping instruments sterile and organized.
You may be asked to assist by handing
instruments to the physicians. You will also
have to have knowledge of surgical
machines, such as laser and suction
machines. You will be in charge of
prepping a patient before and after surgery.
All of this you will learn in the classroom as
well as hands on. Surgical technologists
play a very important role in the operating
  OR Nurse

For patients of operative or invasive procedures, the operating room nurse's jobs
and duties will consist of education, preparation and coordination of patient care.
O.R. or perioperative registered nurses are responsible for maintaining the sterile
conditions in the operating room and monitoring patients during the operation. They
are also responsible for continued care during and after the procedure
X-ray in OR
Methods of Sterilization and Disinfection

• Removal of microorganisms and their spores must be
  complete, or the article is not sterile.
• Disinfection
   • To remove as many micoorganisms as possible from a
     surface by physical or chemical means.
   • Articles or surfaces that cannot be sterilized in the OR or
     special procedure room must be disinfected.
Disinfectant                                Status                               Use

  Alcohols (70% or 90%) (intermediate-        bactericidal, tuberculocidal,       to disinfect thermometers, medication vials, etc.
  level)                                      fungicidal, and virucidal

  Glutaraldehyde (high-level)                 broad antimicrobial range,          to disinfect endoscopes, thermometers, and rubber
                                              fungicidal and virucidal            items

  Chlorine Compounds (dilution of 1:50 is     concentrations of 1000 ppm          to disinfect countertops, floors, other surfaces
  high-level)                                 inactivate bacterial spores

  Orthophthalaldehyde (high-level)            bactericidal, virucidal,            to clean and process endoscopes
                                              fungicidal, tuberculocidal in 12
                                              minutes at room temperature

  Hydrogen Peroxide (low-level)               6% solutions effective against      may be used to clean work surfaces, not widely
                                              some bacteria, fungi, and           used in health care settings

  Iodine and Iodophors (intermediate-         vegetative bactericidal, M.         may be used as disinfectant or antiseptic
  level)                                      tuberculosis, most viruses and
                                              fungi, no sporicidal capability

  Phenolics (intermediate- or low-level)      most formulations are               have toxic effects, used as environmental not
                                              tuberculocidal, bactericidal,       sporicidal disinfectants
                                              virucidal, and fungicidal

  Quaternary Ammonium Compounds               not recommended for high-,          cleaning agents for noncritical surfaces
                                              intermediate- or low-level
Physical methods of disinfecting are boiling in water and
ultraviolet irradiation. Boiling may be used as a means of
disinfection if no other method is available; however, many
spores are able to resist the heat of boiling (212°F or 100°C)
for many hours. To increase the effectiveness of boiling,
sodium carbonate may be added to the water in quantity to
make a 2% solution. If an object is to be disinfected by boiling
and sodium carbonate is added to the water, it should be boiled
for 15 minutes. If sodium carbonate is not added, boiling time
should be 30 minutes.
                                     Table 5-2 Methods of Sterilization

Steam Under Pressure: Item are double-wrapped and placed in an autoclave.
Autoclaves are manufactured to sterilize by gravity displacement and dynamic air
High-speed sterilizers or flash sterilization is an abbreviated gravity displacement
Chemical Sterilization: Referred to as low-temperature sterilization. A maximum
temperature of 54° C to 60° C of gaseous sterilization is used. An antimicrobial
and sporicidal agent must be used.
Ethylene Oxide: Used for items that cannot withstand moisture and high
All items sterilized in this manner must be cleansed and dried since water united
with ethylene oxide forms ethylene glycol, which cannot be eliminated by aeration
and is toxic.

If the sterility of an item is questionable, it
is not to be considered sterile.
•Once a sterile field has been prepared, it must not be left unattended as it
may become contaminated and presumed to be sterile.
•An unsterile person does not reach across a sterile field.
•A sterile person does not lean over an unsterile area.
•A sterile field ends at the level of the tabletop or at the waist of the sterile
person's gown.
•Anything that drops below the tabletop or sterile person's waistline is no
longer sterile and may not be brought up to the sterile tabletop. The only
parts of the sterile gown considered sterile are the areas from the waist to
the shoulders in front and the sleeves from 2 inches above the elbow to the
•The cuffs of the sterile gown are considered non-sterile because they
collect moisture. Cuffs must always be covered by sterile gloves.
•The edges of a sterile wrapper are not considered sterile and must not
touch a sterile object.
•Sterile drapes are placed by a sterile person. The sterile person places the
drapes on the area closest to him first to protect his sterile gown.
•A sterile person must remain within the sterile area. He must not lean on
tables or against the wall.
•If one sterile person must pass another, they must pass back-to-back.
•The sterile person faces the sterile field and keeps sterile gloves above
the waist in front of his chest. The sterile person must avoid touching any
area of his body.
•Any sterile material or pack that becomes damp or wet is considered
•Any objects that are wet with disinfectant solution and are to be placed on
a sterile field must be placed on a folded sterile towel for the moisture to be
•A wet area on a sterile field must be covered with several thicknesses of
sterile toweling or an impervious drape.
•When pouring sterile solution, place the lid face upward and do not touch
the inside of the lid or the lip of the flask. Pour off a small amount of
solution before the remainder is poured into the sterile container.
When a sterile solution is to be poured into a container on a sterile field,
the container is placed at the edge of the sterile field by the sterile person
Opening sterile pack

Passing sterile object to a sterile person
Putting an object in the sterile field
Transferring a sterile object
Sterile scrub, gowning and gloving

The radiographer is responsible for protecting himself and
all persons in the OR and special procedure areas from
radiation. He is also expected to be knowledgeable
concerning the areas that are sterile. He must protect
sterile areas and the patient from contamination in the
process of his duties
X-ray equipment in OR
• Mobile C-arm
Ceiling mounted C-arm
The radiographer is responsible for making
certain that any radiographic equipment used
during a sterile procedure is clean and dust-
free before use.
• Overhead units must be cleaned with a disinfectant solution, and portable
radiographic machines and image receptors to be used must be cleaned
with a disinfectant solution.
• Sterile technique must be maintained for all items and persons involved
in the invasive procedure.
• If possible, place image receptors and take scout films before draping the
patient for the procedure.
• If the image receptors must be placed after the procedure is begun, the
radiographer may pass the image receptor to the scrub nurse who
receives the image receptor in a sterile plastic bag and places it at the
radiographer's direction.
• If the radiographer places the image receptor himself, the surgical team
must make room for him. He may place the image receptor by raising the
sterile drapes touching only the inside of the drape, or the circulating nurse
may lift the drapes and assist in placing the cassette into the image
receptor holder
•If multiple images are to be taken, all personnel who are not
scrubbed must leave the OR if at all possible. The scrubbed
members of the team must wear protective radiation apparel.
They may also step behind protective lead-lined screens.

•When hands are directly exposed to radiation, leaded sterile
gloves as well as all other protective equipment must be worn.

•Pregnant female personnel should not be present in the OR
when radiographic imaging is in progress.

•The radiographer must wear his radiation detection badge on
the outside of the lead apron and under the sterile gown during
imaging procedures. The badge must be checked at prescribed

•During imaging, all unnecessary instruments must be removed
from the operative field and a sterile drape must be placed over
the open incision
Skin Preparation for Sterile Procedures
• Skin prep – the purpose of a skin prep is to remove as
  many microorganisms as possible by mechanical and
  chemical means to reduce the potential of infection.
• There are two aspects to skin preparation for a sterile
   • Mechanical
   • Chemical
Chemical Method of Skin Preparation

• The area to be penetrated should be cleaned with an
  antiseptic solution.
• Once you start to clean the area of interest, do this in a
  circular motion beginning in the center and working
• Do not cross anything over the area that has been prepped.
• Sterile technique is maintained during the skin prep for
  sterile procedures!
Draping for Sterile Procedure

• After the skin has been prepared, place sterile drapes
  around the area of interest.
   • Must be handled as little as possible
   • They must not be flipped or fanned
• Disposable sterile cloth towel are mainly used, however, a
  fenestrated drape may be used.
   • Place them so that they are within the limits of the area
   • They are folded so that they overlap and the folds face
     the operative site.
Removing and Reapplying Dressings

• You must not remove or reapply dressing without a
  physicians order.
• All dressings must be treated as if they are contaminated,
  because drainage from wounds may harbor pathogenic


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