ASEPTIC TECHNIQUE

ASEPSIS

The absence of disease-producing microorganism

Two Types of Asepsis

1. Medical asepsis

 Practices that limit the number of microorganisms and their growth

and spread; objects are referred to as clean or dirty.

a. Clean

 Denotes the presence of some microorganisms but the absence

of infectious agents.

b. Contaminated or dirty

 Denotes the presence of disease-producing microorganisms

2. Surgical asepsis

 Or sterile technique

 Practices that keep an area or objects free of all

microorganisms

 Includes practices that destroy all microorganisms and

spores.

PRINCIPLES AND PRACTICES OF SURGICAL ASEPSIS

PRINCIPLES PRACTICES
1. All object used in a sterile field • All articles are sterilized
must be sterile appropriately by dry or moist heat,
chemicals, or radiation before use
• Sterile articles can be stored for
only a prescribed time; after that,
they are considered unsterile
• Always check a package

2. Sterile objects become unsterile
when touched by unsterile objects
3. Sterile items that are out of vision
or below the waist level of the
nurse are considered unsterile
4. Sterile objects can become
unsterile by prolonged exposure
to airborne microorganisms
containing a sterile object for
intactness, dryness and expiration
date
• Storage areas should be clean,
dry, off the floor, and away from
sinks
• Always check chemical indicators
of sterilization before using a
package.
• Handle sterile objects that will
touch open wound or enter body
cavities only either by sterile
forceps or sterile gloved hands
• Discard or resterilize objects that
come into contact with unsterile
objects
• Whenever the sterility of an object
is questionable, assume the article
is unsterile
• Once left unattended, a sterile
field is considered unsterile
• Sterile objects are always kept in
view. Nurses do not turn their
backs on a sterile field
• Only the front part of a sterile
gown (from the waist to the
shoulder) and two inches above
the elbows to the cuff of the
sleeves are considered sterile
• Always keep sterile gloved hands
in sight and above waist level
• Sterile draped table in the OR or
elsewhere are considered sterile
only at surface level
• Doors are closed and traffic is kept
to a minimum in areas where a
sterile procedure is being
performed
• The nurse’s hair is kept clean and
short or enclosed in a net to
prevent hair from falling on sterile
objects
• Surgical caps are worn in OR, DR,
or Burn units
• Sneezing or coughing over a
sterile field can make it unsterile
because droplets containing
microorganisms from the
respiratory tract can travel 3 feet

5. Fluids flow in the direction of
gravity
6. Moisture that passes through a
sterile object draws
microorganisms from unsterile
surfaces above or below the
sterile surface by capillary action
7. The edges of a sterile field are
considered unsterile
• Anyone working over a sterile field
keeps talking to a minimum
• The nurse refrains from reaching
over a sterile filed unless sterile
gloves are worn and from moving
unsterile objects over a sterile
field because microorganisms can
fall into it
• Unless the nurse is wearing
gloves, wet forceps are always
held with the tips below the
handles. When tips are held higher
than the handles, fluid can flow
onto the handle and become
contaminated by the hands. When
the forceps are again pointed
downward, the fluid flows back
down and contaminates the tips
• During the surgical hand wash,
the hands are held higher than the
elbows to prevent contaminants
from the forearms from reaching
the hands
• Sterile waterproof barrier are used
beneath sterile objects. Liquid
(sterile saline or antiseptics) are
frequently poured into containers
on a sterile field
• The sterile covers on sterile
equipment are kept dry. Damp
surfaces can attract
microorganisms in the air
• When pouring sterile solutions into
sterile containers, care is taken to
avoid dampening the sterile field
• One must replace sterile drapes
that do not have a sterile barrier
underneath when they become
moist
• A 2.5 cm (1in.) margin at each
edge of an opened drape is
considered unsterile, since the
edges are in contact with unsterile
surfaces
• All sterile objects are placed more
than 2.5 cm inside the edges of a
sterile field
• Any article that fall outside the
edges of a sterile field is

8. The skin cannot be sterilized and
is unsterile
9. Conscientiousness, alertness, and
honesty are essential qualities in
maintaining surgical asepsis
considered unsterile
• Sterile gloves are worn and/or
sterile forceps are used to handle
sterile items
• Prior to a surgical aseptic
procedure, the hands are washed
to reduce the number of
microorganisms on them
• When a sterile object becomes
unsterile, it does not necessarily
change in appearance
• The person who see a sterile
object become contaminated must
correct or report the situation
• A sterile field should not be set up
ahead of time for future use

Point 1 - RESERVOIR
Place on which or in which organisms grow and reproduce. Examples include
man and animals

Point 2 - EXIT FROM RESERVOIR

Escape route for organisms. Examples include nose, throat, mouth, ear, eye,
intestinal tract, urinary tract, and wounds

Point 3 - VEHICLE OF TRANSMISSION

Means by which organisms are carried about. Examples include hands,
equipment (e.g. bedpan), instruments, china and silverware, linens, and
droplets

Point 4 - PORTAL OF ENTRY

Part of body where organisms enter. Examples include any break in skin or
mucous membrane, mouth, nose and genitourinary tract

Point 5 - SUSCEPTIBLE HOST

Person whose body cannot fight off organism once it enters his body and who
therefore usually becomes ill
CLASSIFICATION OF INSTRUMENTS

I. Cutting and Dissecting

• They have sharp edges; used to dissect, incise, separate or
excise tissues

1. Scalpels
• where blades are attached

a. # 10 blade – has rounded cutting edge along one side (fits # 3, 7, 9

handles)
b. # 11 blade – has a straight edge that comes to a sharp point (fit #
3, 7, 9 handles)
c. # 12 blade – shaped like a hook with the cutting edge on the inside
curvature (fits # 3, 7, 9 handles)
d. # 15 blade – has a smaller and shorter curved cutting edge (fits #
3, 7, 9 handles)
e. # 23 blade – has a curved cutting edge that comes to more of a
point than # 20, 21, 22 blades (fit # 4 handle)

2. Knives
• They usually have a blade at one end. The blade may have
one or two cutting edges; designed for very specific cases.

3. Scissors
• May be straight, angled, or curved and pointed or blunt at
the tips. Handles may be long or short.

a. Tissue or operating scissors – must have sharp blades

b. Suture scissors – have blunt points to prevent cutting structures
close to the suture being cut
c. Wire scissors – have short, heavy blades. They are used instead of
suture scissors to cut stainless steel sutures
d. Dressing or Bandage scissors - used to cut drains and dressings
and to open item such as plastic packets

4. Bone Cutters

a. Chisels
b. Osteotomes
c. Gouges
d. Files
e. Saw
 f. Rongeurs
g. Rib cutters
h. Drills
i. Rasps
j. Reamers

5. Sharp Dissectors
• to cut tissue apart or to separate tissue layers

a. Biopsy forceps and Punches

• To remove small piece of tissue may be for pathologic
examination
b. Curettes
• to scrape tissue or bone
c. Snares
• a loop of wire placed around a pedicle to direct tissue such as
tonsils

II. Grasping and Holding

• Tissues should be grasped and held in position so the
surgeon can perform the desired maneuver without injuring
surrounding tissues.

1. Tissue forceps – to pick up or hold soft tissue and vessel

2. Smooth forceps/Thumb forceps/Pick up forceps – resemble tweezers but
tapered with serrations at the tips; for delicate tissues
3. Toothed forceps – has a single tooth on one side that fits between two
teeth on the opposing side or row of multiple teeth at the tip; provides a
firm hold on tough tissues, including the skin
4. Allis forceps – each jaw curve lightly inward with a row of teeth at the end;
holds tissues gently but securely
5. Babcock forceps – the end of each jaw is rounded to fit around a structure
or to grasp tissue without injury; the rounded section is fenestrated
6. Tenaculum – has curved or angled points on the ends of the jaws
penetrate tissue to grasp firmly
7. Bone Holders – to stabilize bones (vice grips, pliers, etc.)

III. Clamping and Occluding

• To apply pressure

1. Hemostats
• To clamp blood vessels; may be straight or curved and are
fenestrated (Ochsner, Kocher, etc.)
IV. Exposing and Retracting
• Used to pull off tissues, muscles and other structure to
expose surgical sites

1. Handheld Retractors
a. Malleable – flat length of stainless steel may be bent to the desired
angle and depth for retraction
b. Hooks – with sharp points used to retract delicate structure
2. Self-retaining Retractor – holding device with two or more blades which
can be inserted to spread edges of incision and hold them apart; has
spring locks to keep the device open

V. Suturing and Stapling

1. Needle holder
• used to grasp and hold curved surgical needles
2. Staplers

VI. Viewing Instruments

• To examine the interior of body cavities, hollow organs, or
structures or operate through them

1. Speculum – enlarges and hold open a canal

2. Endoscopes – for viewing in a specific anatomic location

VII. Suctioning and Aspirating

• Used to remove blood, body fluids, tissue and irrigating
solution by mechanical suction or manual aspiration

1. Poole Abdominal tip – used in any cavity in which copious amounts of fluid
or pus are encountered; prevent adjacent tissues from being pulled into
the suction apparatus
2. Frazier tip – used when little or no fluid except capillary bleeding and
irrigating fluid is encountered; keep the field dry without the need for
sponging
3. Yankauer tip – for use in the mouth or throat
 ORGANS IN THE 9 ABDOMINAL REGIONS
Right Hypochondriac Epigastric Left Hypochondriac
Right lobe of liver Aorta Stomach
Gallbladder Pyloric end of stomach Spleen
Part of Duodenum Part of duodenum Tail of Pancreas
Hepatic flexure of colon Pancreas Splenic flexure of colon
Upper half of right kidney Part of liver Upper half of left kidney
Suprarenal gland Suprarenal gland

Right Lumbar Umbilical Left Lumbar

Ascending colon Omentum Descending colon
Lower half of right kidney Mesentery Lower half of left kidney
Part of duodenum and Lower part of duodenum Part of jejunum and ileum
jejunum Part of jejunum and ileum

Right Inguinal Hypogastric Left Inguinal

Cecum Ileum Sigmoid colon
Appendix Bladder (if enlarged) Left ureter
Lower end of ileum Uterus (if enlarged) Left spermatic cord
Right ureter Left ovary
Right spermatic cord
Right ovary

ORGANS IN THE FOUR ABDOMINAL QUADRANTS

Right Upper Quadrant
Liver
Gallbladder
Duodenum
Head of Pancreas
Right adrenal gland
Upper lobe of right kidney
Hepatic flexure of colon
Section of ascending colon
Section of transverse colon
Left Upper Quadrant
Left lower part of liver
Upper lobe of left kidney
Splenic flexure of colon
Section of transverse colon
Section of descending colon
Stomach
Spleen
Pancreas
Left adrenal gland

Right Lower Quadrant Left Lower Quadrant

Lower lobe of right kidney Lower lobe of left kidney
Section of ascending colon Section of descending colon
Right fallopian tube Left spermatic cord
Right spermatic cord Part of uterus (if enlarged)
Part of uterus (if enlarged) Sigmoid colon
Cecum Left ovary
Appendix Left fallopian tube
Right ovary Left Ureter
Right ureter

ROLES OF THE CIRCULATING NURSE

1. Organize and prepares OR before the start of surgical procedure; checks to

see that equipments work properly.

2. Gathers supplies for surgical procedure and opens sterile supplies for scrub
nurse

3. Counts sponges, sharps and instruments with scrub nurse before incision is
made, at the beginning of wound closure, and at the end of the surgical
procedure

4. Sends for client at appropriate time

5. Conducts pre-operative client assessment

6. Safely assists client to operating table and position client according to

surgeon’s preference and procedure type, using safety precautions

7. Applies conductive pad to client if electrocautery will be used; prepares

client’s skin; applies ECG electrodes if needed
8. Explains briefly to client what the circulating nurse and scrub nurse are doing

9. Assists surgical team by tying gown and arranging equipments

10.Assists anesthesia personnel during induction and extubation

11.Continuously monitors procedure for any breaks in aseptic technique and

anticipates needs of the team; opens additional sterile supplies for scrub
nurse

12.Handles surgical specimens per institutional policy

13.Document on peri operative nurse’s notes

14.Communicates to family and recovery personnel during the surgical

procedure

ROLES OF THE SCRUB NURSE

1. Assists circulating nurse in preparing OR

2. Performs surgical hand scrub, dons sterile gown and gloves

3. Prepares sterile field with procedure appropriate supplies and instruments;

checks to make sure all work properly

4. Counts sponges, sharps, and instruments with circulating nurse before

incision is made, at the beginning of wound closure, and at the end of the
surgical procedure

5. Gowns and gloves surgeons and assistants as they enter the operating room

6. Assists surgical team with sterile draping of client

7. Keeps sterile field orderly and monitors progress of procedure and any breaks
in aseptic technique

8. Passes sterile instruments and supplies to surgeon and assistants

9. Handles surgical specimens per institutional policy

10.Constantly monitors location of all sponges, sharps, and instruments in the

sterile field