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 Maintaining a Sterile Field Using safe operative technique Maintaining a safe environment in the OR

Common Terms used in OR:

Peri Operative Nursing

Includes all nursing activities carried out by the nurse during the pre, intra and post operative phase.

Pre Operative phase

- before the surgical procedure - begins when the decision is made to undergo surgical intervention and ends up when the patient is transferred to the operating table. - nursing assessment is done during this phase

Intra Operative phase

- during the surgical procedure - begins from the transfer of the patient to the operating table and extends to the time the patient is admitted to the recovery room.

The implementation process takes place

Post Operative phase

- after the surgical procedure - begins with the admission of the patient to the recovery room - evaluation takes place during this phase

Analgesia

lessening of or insensibility to pain/absence of pain

Anesthesia

a state characterized by loss of sensation

- absence of normal sensation

Antiseptics
an agent that inhibits the growth of some microorganisms.

Asepsis
- a condition in which living pathogenic organisms are

absent

Consent
- permission give voluntarily by a person on his own will.

Disinfection
- the act of destroying pathogenic microorganisms or to inhibit their growth and vital activity.

Homeostasis
- the process through which such body equilibrium is maintained.

Medical Asepsis
- practices that limit the transmission of microorganisms and their growth and spreading action.

Resident Bacteria
- microorganisms that usually resides on the skin, mucous membranes, respiratory and GI tract. They cling to the skin by adhesion and absorption and should be removed by a brush.

Sterile
- aseptic; without microorganisms and their spores

Sterilization
- process that destroys all microorganisms including spores - complete elimination of microorganisms accomplished by surgical, chemical or other means.

Surgery
- branch of medicine concerned with the treatment of disease, injury and deformity by manual or operative methods.

Surgical Asepsis
- is a kind of practices that keep an area or object free from all microorganisms. ( Sterile Technique)

Surgical Conscience
- an awareness which develops from knowledge based on the importance of strict adherence to the principles of aseptic and sterile technique.

Surgical Team
- is a group of highly trained individuals who must work together as coordinated team for the welfare and safety of the patient undergoing the surgery.

Transient Bacteria
- normally picked out by hands in the usual activities of daily living which are relatively few on clean and exposed areas of the skin.

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
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. IMMUNO SUPPRESIVE DRUGS. PATIENT UNDERGOING SURGERY OR INVASIVE PROCEDURES. NUMBER OF MICROORGANISMS PRESENT. VIRULANCE OF THE MICROORGANISMS PRESENT.

DEFINITION: It is the process of removing as many microorganisms as possible from the hands & arms by mechanical washing & chemical antisepsis 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

PREPARATION FOR SURGICAL SCRUB

Skin

& nails should be kept clean & in good conditions & cuticles cut. Fingernails should not reach beyond the fingertip to avoid glove puncture. Fingernail polish should not be worn. Artificial devices must not cover natural fingernails. Inspect hands for cuts & abrasions. Remove all finger jewelry.

 Be

sure all hair is covered by headgear. Pierced-ear stud must be contained by the head cover. disposable mask snugly & comfortably over nose & mouth. eyeglass if worn. Adjust eyewear or face shield comfortably in relation to mask.

Adjust

Clean

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.

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

GLOVING
1. 2.

3.

4.

Pick up one glove by the cuff using your thumb & index finger. Touching only the cuff, pull the glove onto one hand & anchor the cuff over your thumb. Slip your gloved fingers under the cuff of the other glove. Pull the glove over your fingers & hand, using a stretching sideto-side motion. Anchor the cuff on your thumb. With your fingers still under the cuff, pull the cuff up & away from your hand & over the knitted cuff of the gown.

5.

Repeat the preceding step to glove your other hand. The gloving process is complete.

5.

TO GOWN & GLOVE THE SURGEON

1.

Pick up a gown from the sterile linen pack. Step back from the sterile field & let the gown unfold infront of you. Hold the gown at the shoulder seams with the gown sleeves facing you.

2.

Offer the gown to the surgeon. Once the surgeons arms are in the sleeves, let go of the gown. Be careful not to touch anything but the sterile gown. The circulator will tie the gown.

3.

Pick up the right glove. With the thumb of the glove facing the surgeon, place your fingers & thumbs of both hands in the cuff of the glove & stretch it outward, making a circle of the cuff. Offer the glove to the surgeon. Be careful that the surgeons bare hand does not touch your gloved hands.

4.

Repeat the preceding step for the left glove.

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.

THE SPONGE & INSTRUMENT COUNT

Counting procedure is a method of accounting for items placed on a sterile table for use during operation. Sharps & instruments are counted 4 times or more. Cases that need a count:
Laparotomy Operation within the chest cavity Extraperitoneal operations Substernal thyroidectomies Deep vaginal operation Iliac bone graft Operation of the hip joint or femur Operation on the spine

RESPONSIBILITIES FOR THE COUNT

1st count:
Scrub nurse count the instruments, sponges and needles before the start of the surgery right after all the equipments has been arranged and prepared with the circulating nurse. after draping the patient and before incision.

2nd count:Counting of sponges with the surgeon right

3rd count:by the circulating nurse & scrub nurse together

with the surgeon before closure of the organ involved.

4th count: by the circulating nurse & scrub nurse together

with the surgeon before closure of the surgical wound.
sterilization.

5th count:before washing and packing the instruments for

DUTIES & RESPONSIBILITIES OF A OPERATING ROOM NURSE

General

Responsibility:

Check if the inform and surgical consent has been signed. The patient has been placed in NPO for 8hrs. Remove all jewelries, clothing, dentures and any nail polish Assess if the patient has any pacemaker Check vital signs before transporting the patient to the Operating Room ( done in the ward). Assess patient for any signs of anxiety Advise patient to take a bath before surgery (if possible) Prepare patient physically, emotionally, psychologically, spiritually and culture preferences.

DUTIES & RESPONSIBILITIES OF A SCRUB NURSE & CIRCULATING NURSE

SCRUB

NURSE:

Preoperative
Checks

the card file for surgeons special needs/requests Scrubs, gowns, & gloves & sets up sterile field. Checks for proper functioning of instruments/equipment. Performs counts with circulator.

 Preincisional
Completes

the final preparation of the sterile field. Assists surgeon with gowning/gloving. Assists surgeon with draping & passes off suction/cautery lines.

During the Procedure

Maintains

orderly sterile field. Anticipates the surgeons needs (supplies/equipment) Maintains internal count of sponges, needles & instruments Verifies tissue specimen with surgeon.

 Closing phase
Counts

with circulator at proper intervals. Organizes closing suture & dressings. Assist in applying sterile dressings. Prepares for terminal cleaning of instruments & nondisposable supplies. Reports to charge nurse for next assignment.

CIRCULATING NURSE:
Preoperative

Assists in assembling needed supplies. Opens sterile supplies. Assists scrub in gowning. Performs & records counts. Admits patient to surgical suite.

Preincisional

Transports patient to procedure room. Assists with the positioning of the patient. Assists anesthesia during induction. Performs skin prep. Assists with drapes, connects suction & cautery.

 During the procedure

Maintains orderly procedure room. Anticipates needs of surgical team. Maintains record of supplies added. Receives specimen & labels it correctly. Maintains charges & O.R records. Continually monitors aseptic technique & patients needs.

Closing Phase

Counts with scrub at proper intervals. Finalizes records & charges. Begins clean-up of procedure room. Applies tape. Assists anesthesia in preparing patient for transfer. Disposes of specimen & records. Reports to charge nurse for next assignment.

 To

provide care until the patient is fully awake, conscious, with stable vitals monitored every 15 minutes for the first two hours with no signs of hemorrhage, 30 minutes for the next hour and every hour until the patient is transported to ward
provide psychological support to the post operative patient

Responsibility of a Recovery Room Nurse

To

Peri Operative Case Conference

Is done by student(s) who are assigned in the morning shift. They will assess the patient before going to their operating room exposure and must know the following: Pre - Op Patient profile and History Anatomy and Physiology Pathophysiology Intra Op: Brief Discription of the Operation to be Performed Packs ( Laparatomy, EENT, Neurological, Orthopedic) Instuments ( ex. AP set, Lap set, craniectomy set and etc.)

continuation intra -op Suture ( Atraumatic [ATR]) ex. Vicryl 0 ( round), Chromic Gut 3-0 Silk 2-0 ( cutting), vicryl 3-0 Sutures may be absorbable or non absorbable. Once they are sutured inside the body they are consider absorbable sutures. All sutures are atraumatic sutures. Skin Preparation will always depend on what type of operation the patient will undergo. ( abdominal, neurological, orthopedic, EENT or minor surgery) Type of Anesthesia/Anesthetic Agent

Anesthetic :
General: ( induction position flat on bed) 1. Propofol 7. Isoflurane/ Sevoflurane 2. Fentanyl 8. Fentanyl 3. Succinyl Hydrochloride 9. Nitrous Oxide 4. Atracurium/Rocuronium 5. Thiopental 6. Midazolam SUB-ARACHNOID block : ( lateral position or C position) 1. Bupivacaine/ Isobaric ( through epidural catheter) 2. Tetracaine/ Bupivacaine ( Heavy by spinal needle) Side effects of SAB are: Hypotension, Spinal Headache, N &V,hypothermia

 Nursing Peri

Intervention:

Operatively

Check if the inform and surgical consent has been signed. The patient has been placed in NPO for 8hrs. Remove all jewelries, clothing, dentures and any nail polish Assess if the patient has any pacemaker Check vital signs before transporting the patient to the Operating Room ( done in the ward). Assess patient for any signs of anxiety Advise patient to take a bath before surgery (if possible) Prepare patient physically, emotionally, psychologically, spiritually and culture preferences.

Intra Operatively Transports patient to the operating room theater. Assists with the positioning of the patient. Scrubs, gowns, & gloves & sets up sterile field. Checks for proper functioning of instruments/equipment. Performs counts with circulator. Completes the final preparation of the sterile field. Assists surgeon with gowning/gloving. Assists surgeon with draping & passes off suction/cautery lines. Maintains orderly of the sterile field. Anticipates the surgeons needs (supplies/equipment) Maintains internal count of sponges, needles & instruments Verifies tissue specimen with the surgeon.

Counts with circulator at proper intervals and inform surgeon once the instruments used are complete. Organizes closing suture & dressings. Assist in applying sterile dressings. Prepares for terminal cleaning of instruments & non disposable supplies. Reports to charge nurse for next assignment. Post Operatively ( PACU) Position the patient according to what type of anesthesia General ( Semi/ High Fowlers); SAB ( Flat on bed for 6hrs.) Apply adequate oxygenation for GA patient and Thermal Blankets for SAB patient. Assess for any signs of bleeding and check patients incision site and for any attachments ( ex. Foley bag, jackson pratt) Monitor patient vital signs ( every 15 mins [2hrs]; 30 mins for next hour and every hour once stable.

 Keep

patient safety all the time Report to the surgeon and anesthesiologist for any unusualities.

THANK YOU!!!

for active listening