SURGICAL ASEPSIS

SURGICAL ASEPSIS
 Purpose:
To prevent the introduction of microorganisms.  Surgical Asepsis is required in the following

situations:

Surgical procedures. All procedures that invade the bloodstream. Procedures causing break in a skin or mucous membrane (e.g. IM)

Cont
 Surgical Asepsis is required in the following

situations:
Complex dressing changes and wound care. Insertion of tubes, catheters, or devices into the sterile body cavities (e.g. urinary bladder) Care of high risk groups (e.g. transplant recipients, burn clients, client with cancer)

PRICIPLES OF SURGICAL ASEPSIS

 Moisture causes contamination.
Prevent splashing of liquids in the sterile fields. Place wet objects on sterile, water-impermeable surfaces, such as sterile basin.  Never assume that an object is sterile.
Ensure that it is labeled as sterile. Always check the integrity of the packaging. Always verify the expiration date on the package. Whenever in doubt of the sterility of an object, consider it unsterile.

Cont
 Always face the sterile field.  Sterile articles may touch only sterile articles

or surfaces if they are to maintain their sterility.  Sterile areas or equipment must be kept above the waist level and on top of the sterile field.
Drapes hanging over the edge of the table are not considered sterile.

Cont
 Prevent unnecessary traffic or air currents

around the sterile area.

Close doors. Unfold drapes or wrappers slowly. Do not sneeze, cough or talk excessively over the sterile field. Do not reach across sterile fields. Move around a sterile field to reach for an object, if necessary.

Cont
 Open, unused sterile articles are no longer

sterile after the procedure.  A person who is considered sterile who becomes contaminated must reestablish sterility.  Surgical technique is a team effort.
A collective and individual sterile conscience is the best method of enhancing sterile technique.

SURGICAL HAND SCRUB

 Purpose:
To remove as many microorganisms from hands as possible before the sterile procedure.

 Equipments:
Sink with knee or foot controls (ideally) Antimicrobial soap Surgical scrub brush Plastic nail stick or sterile nail cleaner (ideally) Sterile towel for drying

Cont
 Steps: 1. Be sure fingernails are short, clean, and

healthy. Nail polish should be removed. 2. Remove rings. Apply surgical shoe covers, cap, face mask, and protective eye wear. 3. Wash and rinse hands for initial wash. 4. Open disposable brush impregnated with antimicrobial soap, adjust water temperature to warm using knee or foot control lever.

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5. Wet hands and arms. Keep hands above elbows. 6. Use nail stick or cleaner to clean under nails of both hands. 7. Wet scrub brush or apply antimicrobial soap if not already impregnated in the brush. 8. Scrub according to the preferred method.

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 2 Methods of Surgical Hand Scrub
ANATOMIC TIMED SCRUB METHOD
Start with fingertips, scrub each anatomic area (nails, fingers each side and web space, palmar surface, dorsal surface and forearm) for 5 minutes. Scrub vigorously using vertical strokes. Repeat with the other hand.

COUNTED BRUSH STROKE METHOD Starting with fingertips, scrub each anatomic area (same as Anatomic Timed Scrub Method) for the designated number of strokes according to agency policy. Scrub vigorously using vertical strokes.

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9. Rinse hands thoroughly under warm running water, holding hands upward. This is to allow water to drain towards the flexed elbows. 10. Keep hands held upward to allow water to drip from the hands to the elbow. Dry hands with sterile towel.

Special Consideration
 Do not touch anything before and after rinsing

hands. Touching non-sterile objects would mean the surgical scrub would need to be repeated.

APPLYING AND REMOVING STERILE GLOVES

 Purpose:
Prevent transfer of microorganisms from hands to sterile objects or open wounds.

 Equipments:
Packaged sterile gloves in correct size Flat working surface.

Applying Gloves
 Steps:

1. Wash hands. 2. Peel off outside wrapper as directed by manufacturer (peel sides apart). 3. Lay inner package on clean, flat surface about waist level. Open wrapper from outside, keeping gloves on inside surface.

Cont
4. Grasp first glove by inside edge of cuff with thumb and first two fingers of the dominant hand. Hold hands above waist, insert nondominant hand into glove. Adjust fingers inside glove after both gloves are on. 5. Slip gloved hand (four fingers with thumb up) underneath second gloved cuff and pull over the dominant hand. 6. Keeping hands above waist, adjust glove fit, touching only sterile areas.

Special Consideration
 Put on gloves on the non-dominant hand first,

then on the dominant hand.

Removing Gloves
 Steps: 1. Wash gloved hands first. 2. With the dominant hand, grasp outer

surface of non dominant glove just below thumb. Peel off glove inside out, without touching exposed wrist. 3. Place ungloved hand under thumb side of second glove. Discard into appropriate receptacle. 4. Wash hands.

Special Consideration
 Use glove-glove and skin-skin technique

when removing gloves.

 Safety Alert: Wash hand before and after

removing gloves to prevent contamination of hands.

DONNING A STERILE GOWN AND CLOSED GLOVING

 Purpose:
To apply attire necessary to safely carry out sterile procedures usually in the operating room and deliver room.

 Equipments:
Sterile gown Sterile gloves Mayo stand or flat surface area above waist level

Donning a Sterile Gown

 Steps:

1. Wear shoe covers, cap that covers all hair, face mask and protective eye wear (ideally) and perform the surgical scrub. 2. Grasp folded sterile gown at the neckline and step away from the sterile field. Allow gown to gently unfold, being careful that it does not touch the floor. The inside of the gown is toward the user.

Cont
3. Holding the arms at shoulder level, grasp the sterile gown just below the neckband near the shoulders and slide arms in the sleeves until the fingers area at the end of the cuffs but not through the cuffs. 4. Have someone tie the back of the gown, taking care that only the ties are touched and not the sides or the front of the gown.

Closed Gloving
 Steps:

5. With fingers still within the cuff of the gown, open the inner sterile glove package and pick up the first glove by cuff, using the nondominant hand. 6. Position the glove over cuff of the gown so the fingers are in alignment, and stretch the entire glove over the cuff of the gown, being careful not to touch its edge. Fingers remain within the cuff of the gown.

Cont
7. Work the fingers into the glove and pull the glove up over wrist with the non-dominant hand that still remains within the cuff of the gown. 8. Use the sterile gloved hand to pick up the second glove, placing it over the cuff of the gown of the other hand and repeat the glove application process.

Cont
9. Adjust gloves for comfort and fit, taking care to keep gloved hands above waist level at all times.

DONNING AND REMOVING GLOVES, MASKS, GOWNS AND EYE WEAR

 For sterile procedures on a general nursing

division, the nurse may wear surgical mask and gloves without a cap. Eye wear is ideally worn it there is risk of fluid or blood splashing into the nurse s eyes.  For sterile procedures, the nurse first applies a clean cap that covers all of the hair and then the surgical mask, eye wear and shoe cover.  A mask must fit snugly around the face and nose to prevent contamination by droplet nuclei.

Cont
 To remove protective devices:

Glove

Mask

Gown

Others

Removing the gloves first prevents contamination of the hair, neck, and facial area.

Thank you for listening!