Unit VIISurgical Asepsis : Unit VIISurgical Asepsis Adult Health I 1 Surgical AsepsisSame as Sterile Technique : Surgical AsepsisSame as Sterile Technique Surgical asepsis requires the nurse to use different precautions than those used in medical asepsis.
Surgical asepsis includes procedures used to eliminate all microorganisms including pathogens and spores, from an object or area.
An object is sterile only when it is free of ALL microorganisms.
A sterile field is a microorganism free area.
Surgical asepsis/sterile technique refers to the practice that keeps an area or object free from ALL microorganisms. Adult Health I 2 Surgical Asepsiscontinued : Surgical Asepsiscontinued The nurse working with a sterile field or with sterile equipment must understand that the slightest break in sterile technique results in contamination to the object or the area.
There is no “in-between”--an item is either sterile or not sterile.
When in doubt,--consider the item contaminated. Adult Health I 3 Where is Surgical AsepsisUsed? : Where is Surgical AsepsisUsed? Everywhere!!!
Operating Room, Labor & Delivery, Emergency Department, Diagnostic procedure areas.
At the bedside during IV insertions or injections, Inserting Foley catheters, suctioning the airway, during wound care and assisting the physician with bedside procedures. Adult Health I 4 Indications for Using Sterile Technique : Indications for Using Sterile Technique During procedures that penetrate the skin (Insertion of IV catheters, Injections).
When the skins integrity is broken as a result of trauma, surgical incision or burn.
During procedures that involve insertion of catheters or surgical instruments into sterile body cavities. Adult Health I 5 Equipment and Supplies used during Surgical Asepsis or to perform a Sterile Technique - is accomplished by a variety of methods called Sterilization : Equipment and Supplies used during Surgical Asepsis or to perform a Sterile Technique - is accomplished by a variety of methods called Sterilization Adult Health I 6 Sterilization : Sterilization Is the complete elimination or destruction of all microorganisms, including spores.
Nurses should be familiar with agency specific policy and procedures for cleaning, handling and delivering used items for disinfection and sterilization.
Most facilities have an area called Central Processing that performs item sterilization. This area is usually located next to or within the Surgical Department. Adult Health I 7 Types of Sterilization : Types of Sterilization Moist Heat
Ethylene Oxide Gas
Boiling water Adult Health I 8 Moist Heat (Autoclave) : Moist Heat (Autoclave) Is the most widely used method of sterilization.
Supersaturated moist steam under pressure which causes the temperature to exceed that of the boiling point of water can kill pathogens and spores.
250o – 254oF for 30 minutes.
Items are wrapped in special cloth or paper
It is a nontoxic, inexpensive, sporicidal and has the ability to penetrate fabrics rapidly.
Autoclave method is used to sterilize surgical instruments, parenteral (IV) solutions and surgical dressings.
Method most commonly used in hospitals. Adult Health I 9 Autoclave Sterilization : Autoclave Sterilization Adult Health I 10 High-Speed Sterilization“Flash Autoclave” : High-Speed Sterilization“Flash Autoclave” Type of moist heat - steam under pressure.
Used in emergency situation - great for items needed quickly.
Item placed in autoclave tray.
Mixture of steam, pressure, & heat. Adult Health I 11 “Flash Autoclave”continued : “Flash Autoclave”continued Heat temperature goes up to 270oF and timed for 3 minutes.
Used in OR (Flash autoclave between each OR room).
Used to sterilize instruments quickly. Adult Health I 12 Radiation : Radiation Ionizing
used for disinfecting and sterilization
penetrates deeply into objects or packaging.
Used to sterile prepackaged items (dressings, needles, catherization trays)
Also used to sterilize foods, drugs.
Equipment that may be damaged if exposed to heat (Fiberoptic Endoscopes) equipment very expensive. Adult Health I 13 Chemical : Chemical Chemicals are effective disinfectants because they attack all types of microorganisms, act rapidly, work with water, not inactivated by organic material, are not harmful to body tissues and do not harm the item being disinfected.
Cold - solutions used.
Solutions placed in sterile basin.
Items soaked for 10 - 20 minutes.
Items must be rinsed well with sterile saline or sterile water in second basin before using.
Examples chemical solutions:
Cidex - Sporocidin - Wexcide Adult Health I 14 Antiseptics –vs-Disinfectants : Antiseptics –vs-Disinfectants Antiseptics – Are cleaning solutions that inhibit and destroy microorganisms on the skin and wounds.
Example: Isopropyl alcohol, Betadine or site preps that contains ”Surecleans”
Disinfectants – Are cleaning solutions that inhibit and destroy microorganisms on environmental surfaces.
Example: Bleach solution, Wexcide Adult Health I 15 Ethylene Oxide Gas (Autoclave) : Ethylene Oxide Gas (Autoclave) Is a method similar to steam autoclaving.
Ethylene oxide gas is released into a pressurized chamber that gives the gas increased penetrating abilities.
This gas destroys spores and pathogens by altering the cells metabolic process.
Used for products that cannot be exposed to steam sterilization due to damage or melting due to heat from steam autoclave.
Good penetrating ability, can sterilize plastic, rubber. (Endoscopes)
Items are wrapped with stripped tapes that appear when item is sterilized. Adult Health I 16 Ethylene Oxide Gas (Autoclave) : Ethylene Oxide Gas (Autoclave) Ethylene Oxide (odorless gas, which is toxic to humans).
Takes 2 to 5 hours to accomplish and is more expensive.
After items removed from autoclave….must not use for 24 hours…gas has to dissipate..larger hospitals have special machine to remove gas particles and do not have to wait 24 hours to use the articles. Adult Health I 17 Boiling Water : Boiling Water Oldest method.
Most practical and inexpensive method for home use.
Does NOT kill spores and some viruses.
Boil 212oF for at least 15 minutes.
Not used in hospital systems. Adult Health I 18 Patient Preparation : Patient Preparation The nurse needs to explain how the procedure is going to be preformed and any special activities the patient needs to do to avoid contaminating the sterile items or field.
The patient may require to be in a position which may be uncomfortable, so provide pillows and support to areas as needed.
May need to administer analgesics 30 minutes prior to the procedure. Make sure any consents are obtained prior to medicating the patient.
Assess patient’s elimination needs prior to beginning the sterile field process. Adult Health I 19 Patient Preparation : Patient Preparation The patient needs to avoid any sudden movements of body parts that are covered by a sterile drape.
The patient needs to refrain from touching the sterile drapes or supplies or sterile gloved hands.
The patient and all working in the area need to avoid coughing, sneezing or talking over a sterile field.
If needed you may need to place a facemask on the patient, yourself or others who may contaminate the sterile field. Adult Health I 20 Principles & Practices of Surgical Asepsis Maintaining Sterile Technique : Principles & Practices of Surgical Asepsis Maintaining Sterile Technique Adult Health I 21 Principles of Surgical Asepsis : Principles of Surgical Asepsis A sterile object remains sterile only when touched by another sterile object.
A sterile object can touch or be touched by another sterile object. (Sterile gloves or Sterile Forceps)
A sterile object touching a clean object causes the article to be contaminated.
Sterile touching contaminated becomes contaminated. (Irrigation syringe or gauze pad touching the patients skin).
Any item who sterility is questioned, is considered contaminated. (Improper package sealing or staining or moisture to a package) Adult Health I 22 Principles of Surgical Asepsis : Principles of Surgical Asepsis Only sterile objects can be placed on a sterile field.
The package or container containing a sterile object must be intact and dry.
A package that is torn, punctured, wet or open is considered contaminated.
Some prepackaged material are labeled with an expiration date. CHECK IT!! Adult Health I 23 Principles of Surgical Asepsis : Principles of Surgical Asepsis A sterile object or field out of the range of vision or an object below a person’s waist is contaminated.
You can NEVER turn your back to a sterile field or leave it unattended.
Contamination can occur accidentally by a dangling piece of clothing, falling hair or jewelry touching the sterile field.
ANY time your hands go below your waist, or out of your visual field they are considered contaminated.
Sterile objects must be kept in front of you with the hands as close together as possible. Adult Health I 24 Principles of Surgical Asepsis : Principles of Surgical Asepsis A sterile object or field becomes contaminated by prolonged exposure to air.
Limit air currents when a sterile field is present. Turn off any fans and do not fan linen.
No one should talk, laugh, sneeze or cough over a sterile field or when working with sterile equipment.
When opening a sterile package, the nurse holds the object as close as possible to the sterile field without touching the sterile surface.
Keep the movement or rearranging of sterile items to a minimum.
Always reach from the sides, NEVER CROSS OVER YOUR STERILE FIELD. Adult Health I 25 Principles of Surgical Asepsis : Principles of Surgical Asepsis When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action.
If moisture seeps through a sterile packages protective covering, microorganisms can travel to the sterile object or field.
When adding sterile fluids to a sterile field, any spillage of fluid into the field will cause the field to be contaminated, unless there is a nonabsorbent layer of metal or plastic under the sterile field. Adult Health I 26 Principles of Surgical Asepsis : Principles of Surgical Asepsis Fluid flows in the direction of gravity.
A sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the objects surface.
If using forceps to pick up a wet gauze pad, always hold the tip lower than the wrist.
In doing a surgical hand scrub the fingers are held higher than the elbows, so when rinsing you are going from the cleanest area to the area that may be most contaminated.
Same method for drying your hands. Adult Health I 27 Principles of Surgical Asepsis : Principles of Surgical Asepsis The edges of a sterile field or container are considered contaminated.
A margin of 1 inch around the outside border of the sterile field is considered contaminated. Any item that goes into that 1 inch margin is considered contaminated.
The lip of an open bottle of solutions also becomes contaminated.
When pouring a solution onto a sterile field from a previously opened solution container, you must first lip the bottle and discard some of the fluid over the lip.
Open Bottles must always be dated, and can only be used for 24 hours after the opening date. When in question, get a new bottle. Adult Health I 28 Performing a Sterile Procedure : Performing a Sterile Procedure You need to assemble all of the equipment that may be needed to perform a sterile procedure.
The physician may leave an order of all the supplies that he wants, or the unit may have a protocol card of the needed supplies for the procedure.
A few extra supplies may be needed during the procedure, or be replaced if they should be contaminated during the procedure.
Need to maintain hospital policy on the use of disposable supplies. Once they are taken into a patient’s room the patient generally has to be charged for the items as they cannot go back into the clean utility room. Adult Health I 29 Donning Sterile Gloves (Open Method) : Donning Sterile Gloves (Open Method) Adult Health I 30 Preparing a Sterile Field : Preparing a Sterile Field A sterile field is an area free of microorganisms and is prepared to receive the sterile items.
Gather the necessary supplies, inspecting packages for integrity, no moisture and expiration date.
Before opening any sterile items the nurse washes hands thoroughly.
You will need a flat surface such as a over-bed table or moveable table to prepare the sterile field.
Commercially packaged products are designed so that the nurse can easily tear away or separate the paper or plastic covering on the items.
The field may be prepared by using the inner surface of a sterile wrapper or by using a sterile drape. Adult Health I 31 Preparing a Sterile Field : Preparing a Sterile Field Adult Health I 32 Preparing a Sterile Field : Preparing a Sterile Field Adult Health I 33 Adding Items to a Sterile Field : Adding Items to a Sterile Field When adding items to the field, you do not want to have your arms cross over the sterile field. Need to come in from the side of the field.
Opening and adding packages to sterile field. When opening packages hold the package in the nondominant hand and open the package cover peeling it back over the nondominant hand.
Try to place items on the sterile field in the order that they will be used, to prevent crossing over the item to pick up another object.
Using Sterile forceps.
Pouring Sterile Liquids onto the field. Adult Health I 34