Medical/Surgical Asepsis

Presented by: Cynthia Bartlau, RN, PHN, MSN

Objectives

At the completion of this lesson the student will be able to

Discuss concepts related to the chain of infection Differentiate medical and surgical asepsis Discuss equipment used for maintaining medical and/or surgical asepsis Identify common sources for contamination Describe proper hand placement during aseptic procedures

Beginning of Modern Asepsis

Previous to the discovery of asepsis many people died due to post-operative (and other) infection Dr. Ignaz Semmelweis

Told doctors to wash their hands

Scottish surgeon named Joseph Lister

Inspired by Louis Pasteurs formulation of the germ theory of disease Used carbolic acid in operating rooms

Drastic reduction in infections

Theory of Infection Control

Microorganisms
Bacteria Fungi Viruses Protozoa

Pathogenic
Disease

causing Infectious agent Causes disease in healthy person Opportunistic pathogen

Causes disease in susceptible person

Virulence Communicable

diseases

Non-pathogenic
Resident

flora Colonization Can cause disease if transmitted to other areas

Infection

Local

Specific area of body is infected Microorganisms spread & damage other body areas
Bacteremia

Systemic

when microbes enter blood stream Septicemia when bacteremia spreads through all of the body systems

Acute vs. chronic infection

Nosocomial infections that occur as a result of health care delivery

Endogenous source Exogenous sources

Iatrogenic infection directly caused by any diagnostic or therapeutic source

Drug-Resistant Pathogens
MRSA VRE MDR TB

Causative Agent Bacteria Viruses Fungi Protozoa Helminthes Susceptible Host Neonates Diabetics Immunosuppressed Cardiopulmonary Disease

Reservoir People Equipment Water

Chain of Infection

Portal of Exit Secretions Excretions Droplets Skin

Portal of Entry Broken Skin/Mucous Membrane Gastrointestinal/Respiratory/ Urinary Tract

Mode of Transmission Direct-Indirect Contact/Fomite Injection/Ingestion Airborne/Aerosols

Medical Asepsis
AKA: Clean technique Practices that inhibit the growth & spread of pathogenic microorganisms

Handwashing Standard precautions Transmission based precautions PPE

The JCAHO Sentinel Event Alert quotes Julie Gerberding, MD, director of the CDC, as stating

Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance.

Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.

Antiseptics
Prevent or inhibit growth of pathogenic organisms Not effective against spores or viruses Can be use on the skin

Alcohol Betadine

Disinfection
Destruction of pathogens other than spores Boiling water and chemicals

Bleach solutions Zephirin

Irritate or damage skin Used on objects not people

Surgical Asepsis
AKA: Sterile technique Practices that destroy all microorganisms & their spores Used in specialized areas & skills

Care of surgical wounds Catheter insertion Invasive procedures Surgery

Sterilization

Destruction of pathogens & non-pathogens, including spores and viruses

Steam under pressure Gas Radiation Chemicals

Autoclave is most common piece of equipment used

CDC recommendations
Preoperative/prophylactic antibiotic administration No preoperative hair removal (unless hair will interfere with operation)

Sterile Technique
Procedures that keep an object or area free from living organisms Sterile vs. contaminated areas Articles must remain away from and in front of the body and above the waist

Sterile Technique
Never reach across the sterile field Never turn your back to the sterile field Two inches around border is considered contaminated Sterile field must be kept dry

Sterile Gloving
Only touch the outside of the package with bare hands. The inside of the package, in which the gloves are placed, is considered sterile. The wrapper, when opened provides a sterile field. Grasp only the outside edge of the wrapper.

The inside of the glove may be touched with the bare hand Grasp the first glove at the top edge of the foldeddown cuff and slip in hand Slip gloved fingers into cuff of second glove and slip in second hand without contaminating The outer aspect of the glove must remain sterile

Includes wrist area Keep hands above level of waist Sterile to sterile only If contamination occurs, start again with new pair of gloves

Techniques to Remove Articles from Sterile Wraps

Drop technique

For gauze pads, dressings, small items Wrapper is partially opened , held upside down over sterile field, dropped onto sterile field
For bowls, drapes, linen Using the wrap as a mitten, sterile supplies can be placed on a sterile field For cotton balls, small items, or articles Sterile gloves or transfer forceps are used to transfer objects to sterile field

Mitten technique

Transfer forceps

Skills to Demo & Practice

Donning & Removing Sterile Gloves

Questions?