Aseptic Techniques :Aseptic Techniques By: Karina Caboverde


Brief Introduction :Brief Introduction Responsibility in radiation protection affects all members of the administrative system in a facility Affects the employing authority Affects the individual carrying out the nuclear medicine procedure In any facility using radiation, the responsibility for radiation protection should be clearly and formally defined. The Basic Safety Standards state that the main responsibility for radiation protection lies with the registrant (licensee) and the employer. It is advisable to assign an individual to oversee radiation protection matters, and be designated as the radiation protection officer (RPO).


Objectives :Objectives Discuss Standard Precautions and methods of implementation Discuss recommendations and precautions for isolation Describe transmission of infectious microorganisms Discuss the guidelines for a sterile field Describe proper procedures for donning sterile apparel Describe the proper procedures for wound care


Standard Precautions :Standard Precautions Who is responsible for implementation? When to implement Methods of implementation


Infection Control and Precautions :Infection Control and Precautions One of the biggest concerns in today’s hospitals is prevention of transmitting a disease. In order for institutions to control such an epidemic, isolation of various patients has been essential. Hospitals choose which methods of precautions fit best for them, although the CDC (Centers for Disease Control and Prevention) has recommendations for these procedures. Strict isolation Enteric Precautions Respiratory Isolation Wound and Skin Precautions Protective Isolation Discharge Precautions Blood Precautions


New CDC guidelines :New CDC guidelines These new guidelines, which were revised with the original categories, allows institutions to decide whether to use category-specific guidelines or disease-specific guidelines for disease control. The added guidelines are: Have a basis that is epidemiologically sound Emphasize the importance of all body fluids, secretions, and excretions in the transmission of nosocomial pathogens Contain adequate precautions for infections transmitted by the airborne, droplet, and contact routes of transmission Be simple to understand and use Use new terms to avoid confusion with existing systems


Hospitals and Isolation :Hospitals and Isolation There are three elements that are required in order for someone to receive an infection: Source of infection microorganisms A susceptible host Means of transmission of the microorganism Patients, personnel, and even visitors are the victims of these infecting microorganisms


Hospitals and Isolation :Hospitals and Isolation Although infection is a possibility, varying on the individual, resistance to an infectious disease can occur. Immunity to the infection Resist colonization by an infectious agent Others may become asymptomatic carriers Unfortunately development of a clinical disease may occur


Hospitals and Isolation :Hospitals and Isolation Host factors may include, but not be limited to: Age Underlying disease Certain treatments Antimicrobials Corticosteroids Or immunosuppressive agents Irradiation Breaks in defense mechanisms Surgical operations Anesthesia Indwelling catheters


Hospitals and Isolation :Hospitals and Isolation Microorganisms can be transmitted by one or more routes in a hospital. The five main routes are: 1. Contact: most important and frequent mode of nosocomial infection transmission Direct- Contact transmission: involves direct body surface-to-body surface contact Indirect- contact transmission: involves contact of a susceptible host with a contaminated intermediate object, usually inanimate. 2. Droplet transmission: it is a form of contact transmission. Considered a separate route of transmission, generated from a source person Coughing Sneezing Talking Suctioning or wound care


Hospitals and Isolation :Hospitals and Isolation 3. Airborne transmission- two modes of distribution: Airborne droplet nuclei: evaporated droplets containing microorganisms Dust particles containing the infectious agent 4. Common vehicle transmission- microorganisms contaminate: Food Water Medications Devices Equipment


Hospitals and Isolation :Hospitals and Isolation 5. Vectorborne transmission- transmitted microorganisms via: Mosquito's Flies Rats Other vermin Unlike any other region in the world, hospitals in the United States are less likely to have transmission due to this act.


Tiers of Isolation Precautions :Tiers of Isolation Precautions There are two tiers of isolation precaution: Standard Precautions: most important , implementation of Standard Precautions is the primary strategy Blood Excretions except sweat All body fluids Secretions Non-intact skin Mucous membranes Transmission-Based Precautions: avoiding infection by limiting the potential for transmission of microorganisms. Airborne Droplet Contact


Isolation Precautions :Isolation Precautions There are five areas that the CDC consider crucial for maintaining isolation precautions: 1. Administrative Controls Education: make sure patients, staff, and visitors are informed Adherence to precautions: periodically evaluate and make improvements 2. Standard Precautions Hand washing Environmental control Mask, eye protection, face shield Linen Gown Occupational (pathogens) Patient care equipment


Isolation Precautions :Isolation Precautions 3. Airborne precautions Respiratory Protection Patient Transport 4. Droplet Precautions Mask: must be worn within 3 ft. of the patient Patient Transport: limit to essential purposes only 5. Contact Precautions Gloves Hand washing Gown Patient Transport Patient Care Equipment


Apparel :Apparel Scrub Suites: not sterile Gowns: should only be worn once, and discarded appropriately Mask: used only once and discarded appropriately Should not be re worn when only taken off briefly to speak Should cover both nose and mouth Glasses: only can give barrier to front of eyes When using prescription, shields or goggles should be worn over them Shields and goggles are constructed in clear plastic Non-sterile gloves: whether using sterile or non-sterile, hand washing is required after gloves are removed Additional Apparel: Caps Beard covers Shoe Covers


Sterile Field :Sterile Field One aseptic technique is to maintain a sterile field. Most commonly in an operating room There are eight requirements for providing and maintaining a sterile field. Half of which are for creating of a sterile field, and remaining are for maintenance. Requirement : items in sterile field must be sterile. Packages are only considered to remain sterile when Initial packaging was performed properly Package was stored in a proper manner Package was not mishandled during distribution Shelf-life has not been exceeded


Sterile field :Sterile field 2. Requirement: once opened, the edges are not considered sterile. Most sterile packages have enough packaging material around the edges to keep the unsterile edges away from the sterile contents Requirement: once donned, sterile gowns are considered sterile in front, from shoulder to top table level- sleeves incl. For this reason , hands are at top table level during before and after scrubbing, gowning, and gloving 4. Requirement: at all times, the top portion of the table is considered stable. Sterile drapes cover the top of a surface and descend evenly on all sides Improperly draped surfaces are considered unsterile


Sterile Field :Sterile Field Requirement: only sterile items and personnel in sterile attire are allowed to enter the sterile field or touch items in sterile areas. Requirement: Activity in a sterile area cannot be allowed to render the area unsterile. Personnel in sterile attire should not sit on or lean against unsterile surfaces Requirement: Penetration of a sterile room covering is considered to cause contamination of a sterile field. Requirement: sterile areas are fields should be prepared as close to the time of use as feasible.


Handwashing :Handwashing Procedures Mostly, a vigorous, brief rubbing together of all surfaces of lathered hands for a minimum of 15 seconds Followed by rinsing under a stream of water is recommended When visibly soiled, more time may be required for hand washing Use of antimicrobial products should follow the manufacturer’s recommendations, ensuring that all surfaces of the hands and fingers are clean


Handwashing :Handwashing Scrubbing Must be done before entering a sterile field Scrubbing consist of specific hand washing steps with additional finger nail cleaners, soap and antibacterial products Before scrubbing, scrub suit and additional apparel are worn When facial hair is present, mask should be able to cover it


Gowning :Gowning 1. Dry one hand and arm, starting with the hand and ending at the elbow, with one end of the towel. Dry  the other hand and arm with the opposite end of the towel. Drop the towel. 2. Pick up the gown in such a manner that hands touch only the inside surface at the neck and shoulder seams. 3.  Allow the gown to unfold downward in front of you.


Gloving :Gloving Open the inner glove packet on the same sterile surface on which you opened up the gown.  Pick up one glove by the cuff using your thumb and index finger.  Touching only the cuff, pull the glove onto one hand and anchor the  cuff over your  thumb. Slip your gloved fingers under the cuff of the other glove. Pull the glove over your fingers and hand, using a stretching side-to-side motion.


Removal of Contaminated Gloves :Removal of Contaminated Gloves 1. Pull one glove near your wrist towards your fingertips until the glove folds over. 2. Carefully grab the fold and pull towards your fingertips. As you pull you are turning the inside of the glove outwards. 3. Pull the fold until the glove is almost off. To avoid contamination of your environment, continue to hold the removed glove. Completely remove your hand from the glove. 4. Slide a finger from your glove-free hand under the remaining glove. Continue to slide your finger towards your fingertips until almost half of your finger is under the glove. Step 1 Step 2 Step 3 Step 4


Removal of Contaminated Gloves :Removal of Contaminated Gloves 6. Turn you finger 180 degrees and pull the glove outwards and towards your fingertips. As you do this, the first glove will be encased in the second glove. The inside of the second glove will also be turned outwards. 7. Grab the gloves firmly, by the uncontaminated surface (the side that was originally touching your hand). Release your grasp of the first glove you removed. Pull your second hand free from its glove. Dispose of the gloves properly. Step 5 Step 6


Wound Dressings :Wound Dressings The location of a wound can dictate the type of dressing applied or the method of application. Purpose: Protect physically the site of injury Prevent contamination of a wound Prevent transmission of infection from a wound Promote healing Many institutions and heath care professionals have preferred methods of caring for specific types of wounds, and there is increasing evidence to support several methods.


Wound Dressings :Wound Dressings Evaluation of the wound is necessary in order to determine the following: The cause of the wound The location, area, and depth of the wound Whether the wound is wet or dry Whether the wound is infected; and if infected, the source, mechanism, and microorganism of infection When measuring a wound, personnel may use a clear plastic rulers- some have specialized circular rulers. Contact with the ruler should not occur. Measurements should include width, length, and depth of the wound.


Wound Dressings :Wound Dressings There are five methods of dressing applications generally used for wound management: Dry to dry- dry absorbent/nonabsorbent to cover wound Damp to damp- gauze pad moistened with normal saline Damp to dry- moistened dressing that is allowed to dry before removal Occlusive- provides a semipermeable barrier to air and moisture penetration Rigid- physical protection to a wound and the adjacent area


Wound Dressings :Wound Dressings Choice of materials for, and methods of, application of dressings may depend on: The cause of the wound Whether the wound is clean or infection; and if infected, the microorganism causing the infection The type of dressing (damp, dry) The type, if any, of antimicrobial agent to be applied The site, area, and depth of the wound Whether a trained professional, the patient, or the patient’s family will be responsible for monitoring and changing the dressing Identification of the specific microorganism responsible for infection is beneficial in treating any wound.


Wound Dressings :Wound Dressings Materials The size of the dressings, should cover a wound site, plus a portion of healthy tissue on all sides The most basic dressing is an adhesive strip with a small gauze center (Band- Aid®) Dressings with non-adhesive pads that do not stick to wounds or the exudate from wounds are also available Gauze is the most common material used for dressings, which is also available in pads and rolls. Sterile or non-sterile gauzes are available in several sizes


Wound Dressings :Wound Dressings Compression wraps are applied to control edema in a limb segment, or to provide some support of a joint. Constructed of an elastic material and are commonly known by the brand name Ace®wraps Edges of lacerations can be approximated using thin adhesive strips, commonly known by the brand name Semi-Strips™. Tape used to secure a dressing can be cloth adhesive tape or paper tape which has a hypoallergenic adhesive.


Wound Dressing :Wound Dressing Preparation Necessary supplies, such as gauze pads, roll gauze, tape, and topical agents, must be easily accessible during the procedure. Sterile fields, when required, must be prepared appropriately Protection of the wound from contamination requires the appropriate application of aseptic techniques Proper preparation of personnel (as discussed earlier), when required Tape for securing dressings may be prepared before starting the application since it requires two hands


Application of Dressings and Wraps :Application of Dressings and Wraps Depending on the depth of a wound, the wound may be: packed with gauze required to ensure that deeper layers of a wound heal before surface layers- avoiding development of an unhealed cavity. Once packed, the wound and packing are covered with additional dressing that is secured with tape. Moist Wound Dressings Dry Wound Dressings


Applying a Gauze Wrap :Applying a Gauze Wrap Gauze pads are secured by tape or gauze roll. Rolls are applied in a spiral or “figure-of-eight” wrap. Pressure of wrapping shouldn’t be excessive. Gauze- Lay the portion of the gauze roll that is unwrapping against the limb segment, with the still-rolled gauze away from the limb. Spiral Wrap- wrapping a gauze in a continuous manner around limb segment; angled slightly to accommodate for the sloping contour of the limb segment to be wrapped. When wrap is complete, the gauze is secured be tape. Removal of a gauze wrap secured with tape requires careful cutting to avoid injuring patients. Bandage scissors are used. Gauze Application


Applying a Compression Wrap :Applying a Compression Wrap The technique of applying a compression wrap is the same as for applying a gauze wrap. Frequent examination of compression wraps is necessary to ensure the amount of compression applied is appropriate and that the wrap remains in place Start with a circumferential anchoring loop around the foot Wrap from lateral to medial around the ankle Wrap from lateral to medial around the foot Wrap from lateral to medial around the ankle (second time) with an angle that will permit continuing a spiral wrap up the ankle from distal to proximal. Secure the end of the compression wrap with adhesive tape. Compression Wrap for a sprained ankle


Summary :Summary Discussed Standard Precautions and methods of implementation Discussed recommendations and precautions for isolation Described transmission of infectious microorganisms Discussed the guidelines for a sterile field Described proper procedures for donning sterile apparel Described the proper procedures for wound care


References :References Centers for Disease Control and Prevention. (2008).Aseptic Techniques. Atlanta, GA. Integrated Publishing. (2008).Hospital Corpsman-Revised Edition. The Woodlands, TX. Revolution Health Group LLC. (2008). Applying a Compression Wrap. Washington, DC.


Question 1 :Question 1 What is the most major concern in today’s hospital?


Answer 1 :Answer 1 Prevention of transmitting a disease


Question 2 :Question 2 Name a few of the CDC recommendations for disease transmission (precautions) in a health care facility


Answer 2 :Answer 2 CDC recommendations: Strict isolation Respiratory Isolation Protective Isolation Enteric Precautions Wound and Skin Precautions Discharge Precautions Blood Precautions


Question 3 :Question 3 What are the three elements required in order for someone to receive an infection?


Answer 3 :Answer 3 The three elements that are required for someone to receive an infection are: Source of infection microorganisms A susceptible host Means of transmission of the microorganism E.g. Patients, personnel, and even visitors are the victims of these infecting microorganisms


Question 4 :Question 4 Although infections occur, some individuals are resistant to infectious disease. Name a few contributing factors to this possibility.


Answer 4 :Answer 4 Immunity to the infection Resist colonization by an infectious agent Others may be asymptomatic carriers


Question 5 :Question 5 Droplet transmission is considered a “separate” form of contact transmission, generated from a source person. Name a few examples on how one can receive this from of transmission


Answer 5 :Answer 5 Coughing Sneezing Talking Suctioning or wound care


Question 6 :Question 6 What are the five areas the CDC considers crucial for maintaining isolation precautions?


Answer 6 :Answer 6 Administrative Controls Standard Precautions Airborne Precautions Droplet Precautions Contact Precautions


Question 7 :Question 7 Through vectorborne transmission, how are the microorganisms transferred?


Answer 7 :Answer 7 Mosquito's Flies Rats Other vermin


Question 8 :Question 8 What sources can microorganisms contaminate?


Answer 8 :Answer 8 Food Water Medications Devices Equipment


Question 9 :Question 9 Which personnel, in a facility, does the responsibility for radiation protection affect?


Answer 9 :Answer 9 Affects the employing authority Affects the individual carrying out the nuclear medicine procedure


Question 10 :Question 10 What are two modes of distribution for airborne transmission?


Answer 10 :Answer 10 Airborne droplet nuclei: evaporated droplets containing microorganisms Dust particles containing the infectious agent