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2 Principles of Asepsis & Sterile Technique.ppt
• Knowledge of causative microorganisms including their modes of
transmission, life cycles, and methods of control is the basis of prevention
of infection
MICROORGANISM
NON PATHOGENS PATHOGENS
• Natural resident florae found
in the reproductive tract secretions,
gastrointestinal tract, nasopharyngeal
mucus, respiratory passages & any
superficial ductal opening such as
sweat & oil glands
INFECTION
• when non resident florae
invade a susceptible area;out
balance cause a pathogenic
condition - SEPSIS
• Accurate identification of the microorganism is critical to the selection of
the appropriate therapy
• Changes in temperature, moisture, illumination, nutrients & pH can
influence the rate at which any microbe passes through doubling time
THREE LINES OF DEFENSE
•First line of defense: involves generalized good health & incorporates
Natural biochemical, mechanical & anatomic protection through the ff:
 Skin
 Mucous membranes
 Reflexes
 Sneeze
 Genitourinary / reproductive tracts
 Eyes
 Cellular Level
 Stomach Acid
 Muscular closure of orifices
• Second line of defense: involves the collaborative effort of several body
systems to prevent the proliferation of pathogenic microorganism;it includes
the following:
 Inflammatory response
 Antibody production
 Temperature elevation
THREE LINES OF DEFENSE
• Third line of defense: can be acquired naturally or induced therapeutically
it requires actual exposure to the pathogen in some form during which
temporary or quasi-permanent resistance is attained. Methods include the
following:
 Passive immunity
 Active immunity
PATHOGENIC
INVASION
Local: surface of the wound, necrosis of tissue,
diminished inflammatory response, & absence of
anatomic barrier
Body orifice, duct, lumen of a broken vessel
Central nervous system
Lymphatic system
Major organ systems
Any body fluid or substance
 Knowledge of how the cycle of infection works is the most important
element of prevention;Considerations include but are not limited to the
following:
• Identifying the reservoir of the pathogen
• Identifying the portal of exit of the pathogen from the reservoir
• Identifying how pathogens are transmitted
• Identifying the portal of entry into a susceptible host
• Identifying the invasion of the susceptible host
INFECTIOUS PROCESSES IN THE BODY
1. Localized infection: inflammatory response
2. Regional infection: if localization is inadequate & does not contain the
infectious process, spreading & extension occur
3. Systemic infection: or septic shock is a multiple infection sites;Diagnosis
of systemic infection may include any 2 of the following:
• Temperature more than 38C (100.4F) or less than 36C (96.8F)
INFECTIOUS PROCESSES IN THE BODY
• changes in Vital signs
• lab tests
• clinical manifestations
RISK FOR EXPOSURE
Surgeon,assistants & scrub person have higher risk by role & proximity
because of incidence of needle sticks & puncture wound
Circulator, environmental services personnel & instrument processors are
also at increased risk for body substance exposure because of specimen
handling, cleaning processes & other contaminants in the environment
RISK FOR EXPOSURE
 Patients is also at risk to include immunosuppression, an immature
immune system, radiation therapy, burns, diabetes, nutritional depletion,
smoking, chemotherapy for cancer, older patients, steroid use, sickle
cell disease, alcoholism, liver & kidney disease & preexisting infection
being treated with antibiotic therapy
TYPES OF PATHOGENIC MICROORGANISMS
 infections may be caused by one or several combinations of
microorganisms;each of the five main main types is described according to
structure, life cycle & mode of transmission
COMMON MICROORGANISMS IN AN
OPERATING ROOM ENVIRONMENT
Microorganism Usual Environment Mode of Transmission
Staphylococci Skin, hair, upper respiratory Direct contact
tract Airborne
Escherichia coli Intestinal tract Feces, urine
urinary tract Direct contact
Streptococci Oronasopharynx Airborne
Skin, perianal area Direct contact
Mycobacterium Respiratory tract Airborne, droplet
tuberculosis urinary tract Direct contact
Pseudomonas Intestinal tract Direct contact
Respiratory tract Urine, feces,water
Serratia marcesens Urinary tract Direct contact,water
Respiratory tract
Clostridium Intestinal tract Direct contact
Fungi Dust,soil,inanimate objects Airborne, Direct contact
Hepatitis virus Blood, body fluids Bloodborne,direct
contact
ASEPTIC & STERILE TECHNIQUE
 are based on sound scientific principles & are carried out
primarily to prevent the transmission of microorganism that
can cause infection
Break in sterile technique
Post operative infection
Prevention is the knowledge of causative agents & their control
As well as the principles of aseptic & sterile technique
ASEPSIS: A state of being free from disease causing contaminants or
preventing contact with microorganisms
ASEPTIC TECHNIQUE: Methods or ways by which microbial contamination is
prevented in the sterile environment
MEDICAL SURGICAL
ASEPSIS
 Ignaz Semmelweis advocated the value of handwashing
 Louis Pasteur taught his germ theory that physicians begin to study the cause
of infections and means of controlling them
 Robert Koch isolated the tubercle bacillus, advocated the use of bichloride of
mercury as an antiseptic
 Joseph Lister pursued the work of Pasteur;first to use carbolic solution on
dressings that reduce the mortality of his patients; He believed infections were
borne
 In Amsterdam, Lister’s antiseptic principles of surgery were truly accepted by the
medical profession
 German surgeons played a role in the transition from antisepsis to asepsis
 Gustav Adolf Neuber introduced mercuric chloride to clean his apron; he advocate
scrubbing the furniture with disinfectant, wearing gowns, boots & caps and
sterilized everything that came in contact with wounds
 Surgical team is the most common source of transmission followed
followed by contaminated instrumentation
 Transmission-Based Precautions (Box 15-2)should be implemented in the
perioperative environment and in any area with the potential to transmit potentially
pathogenic microorganisms
 Areas critical for the introduction & spread of microorganisms: semirestricted
And restricted areas
 Considering how microorganism proliferate fast certain advances in aseptic
technique & infection control were introduced that include the following:
• Operating Room ventilation
• Sterilization & disinfection methods
• Improved barriers between sterile, clean & contaminated surfaces
• Surgical technique
• Antimicrobial prophylaxis
 Despite advances, surgical-site infections (SSI) continue to cause significant
Morbidity & mortality in surgical patients (Table 15-1)
 Factors to consider when evaluating the reasons for the emergence of resistant
Microorganisms include the following:
• Inadequate doses of antibiotic
• Improper selection of antibiotic
• Previous use of ineffective antibiotic
• Sequestered infectious site or retained foreign body
• Inadequate infection control practices
HUMAN-BORNE SOURCES OF
CONTAMINATION
• Skin
• Hair
• Nasopharynx
• Human Error
• Cross infection
NONHUMAN FACTORS IN CONTAMINATION
1. Fomites
 contaminated particles are present in the dust that rests on inanimate objects
such as furniture, OR surfaces, equipment, supplies and fabrics
 in maintaining an aseptic environment, the following key points should be
considered:
• prompt decontamination of used equipment & reusable supplies
• prompt disinfection of OR surfaces
• separation of clean and soiled items
• proper packaging & storing of supplies
• placement of dust covers over sterile items during transport and while in
prolonged storage
2. Air
 microorganisms have an affinity for horizontal surfaces –floor; from the floor
microorganisms are projected into the air
 an effective ventilation system is essential to prevent patients and personnel
From breathing potentially contaminated air which can predispose them to infection
• Community –Acquired Infection
• Communicable Infection
• Spontaneous Infection
• Nosocomial Infection
STANDARD PRECAUTIONS
 established by the CDC (Center for Disease Control & Prevention) and
enforced by OSHA
 formerly referred to as Universal Precautions
 protect health care workers from contact with blood and body fluids of all
patients
 it include considerations for the following:
 All body fluids
• Handwashing
• Barrier clothing
• Handling of used patient care equipment
• Occupational exposure to bloodborne pathogens
• Patient placement
1. Protective barriers & personal protective equipment (PPE)
 appropriate barriers prevent contact of the skin & mucous membranes
with blood and body substances
 other barriers materials must prevent blood & other fluids from passing
through or reaching the wearer’s clothing or body
 include gloves, eyewear, gowns, hair covers & masks
a. GLOVES: reduce contamination of hands; Latex, vinyl & other materials
are used in manufacturing of these gloves
(1) Sterile gloves are worn for procedures that involve the invasion of
body tissues when sterile field is created; double gloving does not
prevent puncture wounds but may be appropriate for procedures in
which the risk of glove tears is high
(2) Unsterile latex or vinyl examination gloves are worn for procedures
That do not require a sterile field such as handling specimens
(3) General-purpose utility gloves are worn for cleaning instruments
& for decontaminating & housekeeping procedures involving potential
blood contact
(4) Gloves are changed after every contact with patients or contaminated
Items; washing gloves between patient contacts is not an acceptable
practice
(5) The hands are washed immediately after glove removal
b. MASKS: protect personnel from aerosols and patients from droplets;they
are worn for all invasive procedures;specialty masks to filter laser
plume;should be changed immediately if grossly contaminated by a
splash of blood or body fluid
c. EYEWEAR: with shields protects the mucous membranes of the eyes, &
full face shields protect the mucous membranes of the eyes, nose and
mouth;they are worn for procedures in which blood, bone chips,
amniotic fluid,and the aerosol of other body fluids may splash or be
projected into the eyes;Googles with enclosed sides & chin-length face
offer better protection than do simple eyeglasses
d. GOWNS/APRON: made of fluid-resistant material protect the wearer from
a splash with blood & body fluids; a plastic apron may be worn under a
woven fabric gown
e. SHOE COVERS / BOOTS: protect the wearer when gross contamination
on the floor can be anticipated;grossly soiled shoe covers or knee
high disposable boots are removed before the wearer leaves the
room
2. Prevention of puncture injuries
 needles, knife blades, and sharp instruments present a potential hazard
for the handler and user
 skin may be punctured or cut if caution is not taken
a. Do not manipulate sharps by hand;
b. use an instrument, such as a heavy hemostat, to attach and remove
the scalpel blade;
c. arm the needle directly from the suture packet when possible
d. do not bend or break an injection needle
e. Pass needles in a needle holder or use a “neutral zone” to transfer sharps
on field
f. Remove instruments from the surgical field after use and return them to
mayo stand or instrument promptly
g. Do not recap used injection needles except with a recapping safety device
h. Do not remove the needle from disposable syringe by hand after use;if a
needle must be change use hemostat or other instrument to exchange a
hypodermic needle
i. Place all used sharps in a puncture-resistant container for disposal
3. Management of puncture injuries
 if a glove is torn or punctured, removed the puncturing sharp or instrument
from the sterile field immediately and change the glove promptly using the
open glove method
 squeeze the skin to release the blood & wash out contaminants under
running water with an antiseptic then irrigate the wound with a virucidal
disinfectant such as an iodophor, bleach or peroxide
 report the incident immediately & document all actions on the appropriate
forms and baseline testing may be necessary for the punctured individual
and the patient
4. Oral procedures
 blood contaminated saliva and gingival fluid is expected during dental &
surgical procedures in the oropharyngeal cavity
 mouth protection, Ambu bags and/or other ventilation devices should be
available for emergency airway resuscitation
 respiratory secretions coughed up during endotracheal procedures are
often infectious
5. Care of specimens
 all specimens of blood, body fluids and tissues should be contained to
prevent leaking during transport to the laboratory
 the outside of the container should be clean
 the circulator while wearing gloves needs to disinfects the outside of the
culture tube handed from the sterile field or a container if it has been
contaminated
6. Decontamination
 all instruments are thoroughly cleaned before sterilization or high level
disinfection;gloves, masks and eyewear are worn fro cleaning procedures
7. Laundry
 soiled woven fabrics should be handled as little as possible and are
transported to the laundry in leak proof bags
 all laundry is considered contaminated and should be handled only by
glove hands
8. Waste
 blood suctioned fluids may be safely poured down a drain that is
Connected to a sanitary sewer
 a solidifying agent can be added to disposable suction containers to
Disinfect the produce and convert it into solid waste
 trash is disposed of by incineration or sent to a sanitary landfill in sealed
Containers as required by local ordinances or state regulations
 trash bags must be leak proof and of sufficient thickness and strength to
Ensure integrity during transport
 waste segregation should be observed
9. Handwashing
 thorough handwashing with an improved antimicrobial agent after every
contact with a patient, contaminated items or suspected contamination
protects both patient and personnel
10. No touching of mucous membranes
 eating and drinking is prohibited in any area where there is a risk for
exposure
 applying lip balm or cosmetics or adjusting contact lenses in the
perioperative environment significantly increases the risk of exposure
 hand to mouth and hand to eye contact can contribute to microbial
transmission
11. Prophylaxis
 perioperative personnel are encouraged to know their HIV, HBV, HCV
Antibody status
 personnel who participate in invasive procedures are at risk for bloodborne
Exposure and should have the HBV immunization series
 is the foundation of modern surgery
 the patient is the center of the sterile field, which includes the personnel
wearing sterile attire and the areas of the patient, operating bed & furniture
that are covered with sterile drapes
 strict adherence to the recommended practices of sterile technique
reflects the surgical conscience of the perioperative team and is mandatory
for the safety of the patient and personnel in the environment
 principles of sterile technique are applied under the following conditions:
• In preparation for an invasive procedure by sterilization of necessary
Materials & supplies
 In preparation of the sterile team to handle sterile supplies & intimately
Contact the surgical site by scrubbing, gowning and gloving
 In the creation and maintenance of the sterile field including skin
Preparation and draping of the patient
 In the maintenance of sterility throughout the entire surgical procedure
 In terminal sterilization & disinfection at the conclusion of the surgical procedure
14 COMMANDMENTS IN THE OPERATING ROOM
ONLY STERILE ITEMS ARE USED
WITHIN THE STERILE FIELD
1.
2.
STERILE PERSONS ARE GOWNED
AND GLOVED
14 COMMANDMENTS IN THE OPERATING ROOM
3. TABLES ARE STERILE ONLY
AT TABLE LEVEL
4.
STERILE PERSONS TOUCH ONLY STERILE ITEMS
OR AREAS, WHILE UNSTERILE PERSONS TOUCH
ONLY UNSTERILE ITEMS OR AREAS
14 COMMANDMENTS IN THE OPERATING ROOM
5.
UNSTERILE PERSONS AVOID REACHING OVER
THE STERILE FIELD WHILE STERILE PERSONS
AVOID LEANING OVER AN UNSTERILE ITEMS OR
AREAS
6.
THE EDGES OF ANYTHING THAT ENCLOSES
STERILE CONTENTS ARE CONSIDERED
UNSTERILE
14 COMMANDMENTS IN THE OPERATING ROOM
7. WHEN IN DOUBT, DISCARD!
8.
THE STERILE FIELD IS CREATED AS
CLOSE AS POSSIBLE TO THE TIME OF USE
14 COMMANDMENTS IN THE OPERATING ROOM
9. STERILE AREAS ARE CONTINUOUSLY
KEPT IN VIEW
10.
STERILE PERSONS KEEP WELL WITHIN
THE STERILE AREA
14 COMMANDMENTS IN THE OPERATING ROOM
11. STERILE PERSONS KEEP CONTACT
WITH STERILE AREAS TO A MINIMUM
12.
UNSTERILE PERSONS AVOID
STERILE AREAS
14 COMMANDMENTS IN THE OPERATING ROOM
13.
DESTRUCTION OF THE INTEGRITY OF
MICROBIAL BARRIERS RESULTS IN
CONTAMINATION
14.
MICROORGANISMS MUST BE KEPT TO
AN IRREDUCIBLE MINIMUM
1. The sterile team wears sterile attire
2. When in doubt, discard!
3. Gowns are considered sterile only from waist to shoulder level and in front
4. Sterile to sterile; unsterile to unsterile
5. Once opened, use at once and do not reuse
6. Sterile person should pass each other back to back
7. Sterile person faces the sterile area when passing it
8. Sterile person turn his back to a non-sterile person or area when passing
9. A sterile table is created as close as possible to the scheduled time of use
10. Sterile areas must be constantly kept in sight
11. Unsterile persons avoid sterile areas or reaching over a sterile field
12. Once the sterile pack or drape is damaged, it becomes contaminated and unsterile
13. Surgeons makes an effort in sponge only once for mopping, then discard it into a pail
14. Sterile packages are laid on dry areas
15. The skin cannot be sterilized
16. Infected areas are grossly contaminated, avoid scattering the contamination
17. The GIT more especially the colon is contaminated.
Please remember the PRINCIPLES!
Principles of sterile technique are applied in the following
conditions:
1.Prior the operation, materials and supplies to be used must be
sterilized
2.Prior the operation, the number of bacteria in the skin must be
minimized through surgical scrub and skin prep
3.Before surgery, the sterile field should be established by draping the
client with sterile drapes.
4.During the surgery, sterilitty should be observed while handling the
sterile supplies and when in contact with the incision.
5.At the end of the operation, the room should be disinfected.
2 Principles of Asepsis & Sterile Technique.ppt
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2 Principles of Asepsis & Sterile Technique.ppt

  • 2. • Knowledge of causative microorganisms including their modes of transmission, life cycles, and methods of control is the basis of prevention of infection MICROORGANISM NON PATHOGENS PATHOGENS • Natural resident florae found in the reproductive tract secretions, gastrointestinal tract, nasopharyngeal mucus, respiratory passages & any superficial ductal opening such as sweat & oil glands INFECTION • when non resident florae invade a susceptible area;out balance cause a pathogenic condition - SEPSIS • Accurate identification of the microorganism is critical to the selection of the appropriate therapy • Changes in temperature, moisture, illumination, nutrients & pH can influence the rate at which any microbe passes through doubling time
  • 3. THREE LINES OF DEFENSE •First line of defense: involves generalized good health & incorporates Natural biochemical, mechanical & anatomic protection through the ff:  Skin  Mucous membranes  Reflexes  Sneeze  Genitourinary / reproductive tracts  Eyes  Cellular Level  Stomach Acid  Muscular closure of orifices • Second line of defense: involves the collaborative effort of several body systems to prevent the proliferation of pathogenic microorganism;it includes the following:  Inflammatory response  Antibody production  Temperature elevation
  • 4. THREE LINES OF DEFENSE • Third line of defense: can be acquired naturally or induced therapeutically it requires actual exposure to the pathogen in some form during which temporary or quasi-permanent resistance is attained. Methods include the following:  Passive immunity  Active immunity PATHOGENIC INVASION Local: surface of the wound, necrosis of tissue, diminished inflammatory response, & absence of anatomic barrier Body orifice, duct, lumen of a broken vessel Central nervous system Lymphatic system Major organ systems Any body fluid or substance
  • 5.  Knowledge of how the cycle of infection works is the most important element of prevention;Considerations include but are not limited to the following: • Identifying the reservoir of the pathogen • Identifying the portal of exit of the pathogen from the reservoir • Identifying how pathogens are transmitted • Identifying the portal of entry into a susceptible host • Identifying the invasion of the susceptible host INFECTIOUS PROCESSES IN THE BODY 1. Localized infection: inflammatory response 2. Regional infection: if localization is inadequate & does not contain the infectious process, spreading & extension occur 3. Systemic infection: or septic shock is a multiple infection sites;Diagnosis of systemic infection may include any 2 of the following: • Temperature more than 38C (100.4F) or less than 36C (96.8F)
  • 6. INFECTIOUS PROCESSES IN THE BODY • changes in Vital signs • lab tests • clinical manifestations RISK FOR EXPOSURE Surgeon,assistants & scrub person have higher risk by role & proximity because of incidence of needle sticks & puncture wound Circulator, environmental services personnel & instrument processors are also at increased risk for body substance exposure because of specimen handling, cleaning processes & other contaminants in the environment
  • 7. RISK FOR EXPOSURE  Patients is also at risk to include immunosuppression, an immature immune system, radiation therapy, burns, diabetes, nutritional depletion, smoking, chemotherapy for cancer, older patients, steroid use, sickle cell disease, alcoholism, liver & kidney disease & preexisting infection being treated with antibiotic therapy TYPES OF PATHOGENIC MICROORGANISMS  infections may be caused by one or several combinations of microorganisms;each of the five main main types is described according to structure, life cycle & mode of transmission
  • 8. COMMON MICROORGANISMS IN AN OPERATING ROOM ENVIRONMENT Microorganism Usual Environment Mode of Transmission Staphylococci Skin, hair, upper respiratory Direct contact tract Airborne Escherichia coli Intestinal tract Feces, urine urinary tract Direct contact Streptococci Oronasopharynx Airborne Skin, perianal area Direct contact Mycobacterium Respiratory tract Airborne, droplet tuberculosis urinary tract Direct contact Pseudomonas Intestinal tract Direct contact Respiratory tract Urine, feces,water Serratia marcesens Urinary tract Direct contact,water Respiratory tract Clostridium Intestinal tract Direct contact Fungi Dust,soil,inanimate objects Airborne, Direct contact Hepatitis virus Blood, body fluids Bloodborne,direct contact
  • 9. ASEPTIC & STERILE TECHNIQUE  are based on sound scientific principles & are carried out primarily to prevent the transmission of microorganism that can cause infection Break in sterile technique Post operative infection Prevention is the knowledge of causative agents & their control As well as the principles of aseptic & sterile technique
  • 10. ASEPSIS: A state of being free from disease causing contaminants or preventing contact with microorganisms ASEPTIC TECHNIQUE: Methods or ways by which microbial contamination is prevented in the sterile environment
  • 12.  Ignaz Semmelweis advocated the value of handwashing  Louis Pasteur taught his germ theory that physicians begin to study the cause of infections and means of controlling them  Robert Koch isolated the tubercle bacillus, advocated the use of bichloride of mercury as an antiseptic  Joseph Lister pursued the work of Pasteur;first to use carbolic solution on dressings that reduce the mortality of his patients; He believed infections were borne  In Amsterdam, Lister’s antiseptic principles of surgery were truly accepted by the medical profession  German surgeons played a role in the transition from antisepsis to asepsis  Gustav Adolf Neuber introduced mercuric chloride to clean his apron; he advocate scrubbing the furniture with disinfectant, wearing gowns, boots & caps and sterilized everything that came in contact with wounds
  • 13.  Surgical team is the most common source of transmission followed followed by contaminated instrumentation  Transmission-Based Precautions (Box 15-2)should be implemented in the perioperative environment and in any area with the potential to transmit potentially pathogenic microorganisms  Areas critical for the introduction & spread of microorganisms: semirestricted And restricted areas  Considering how microorganism proliferate fast certain advances in aseptic technique & infection control were introduced that include the following: • Operating Room ventilation • Sterilization & disinfection methods • Improved barriers between sterile, clean & contaminated surfaces • Surgical technique • Antimicrobial prophylaxis  Despite advances, surgical-site infections (SSI) continue to cause significant Morbidity & mortality in surgical patients (Table 15-1)
  • 14.  Factors to consider when evaluating the reasons for the emergence of resistant Microorganisms include the following: • Inadequate doses of antibiotic • Improper selection of antibiotic • Previous use of ineffective antibiotic • Sequestered infectious site or retained foreign body • Inadequate infection control practices HUMAN-BORNE SOURCES OF CONTAMINATION • Skin • Hair • Nasopharynx • Human Error • Cross infection
  • 15. NONHUMAN FACTORS IN CONTAMINATION 1. Fomites  contaminated particles are present in the dust that rests on inanimate objects such as furniture, OR surfaces, equipment, supplies and fabrics  in maintaining an aseptic environment, the following key points should be considered: • prompt decontamination of used equipment & reusable supplies • prompt disinfection of OR surfaces • separation of clean and soiled items • proper packaging & storing of supplies • placement of dust covers over sterile items during transport and while in prolonged storage 2. Air  microorganisms have an affinity for horizontal surfaces –floor; from the floor microorganisms are projected into the air  an effective ventilation system is essential to prevent patients and personnel From breathing potentially contaminated air which can predispose them to infection
  • 16. • Community –Acquired Infection • Communicable Infection • Spontaneous Infection • Nosocomial Infection STANDARD PRECAUTIONS  established by the CDC (Center for Disease Control & Prevention) and enforced by OSHA  formerly referred to as Universal Precautions  protect health care workers from contact with blood and body fluids of all patients  it include considerations for the following:  All body fluids • Handwashing • Barrier clothing • Handling of used patient care equipment • Occupational exposure to bloodborne pathogens • Patient placement
  • 17. 1. Protective barriers & personal protective equipment (PPE)  appropriate barriers prevent contact of the skin & mucous membranes with blood and body substances  other barriers materials must prevent blood & other fluids from passing through or reaching the wearer’s clothing or body  include gloves, eyewear, gowns, hair covers & masks a. GLOVES: reduce contamination of hands; Latex, vinyl & other materials are used in manufacturing of these gloves (1) Sterile gloves are worn for procedures that involve the invasion of body tissues when sterile field is created; double gloving does not prevent puncture wounds but may be appropriate for procedures in which the risk of glove tears is high (2) Unsterile latex or vinyl examination gloves are worn for procedures That do not require a sterile field such as handling specimens (3) General-purpose utility gloves are worn for cleaning instruments & for decontaminating & housekeeping procedures involving potential blood contact
  • 18. (4) Gloves are changed after every contact with patients or contaminated Items; washing gloves between patient contacts is not an acceptable practice (5) The hands are washed immediately after glove removal b. MASKS: protect personnel from aerosols and patients from droplets;they are worn for all invasive procedures;specialty masks to filter laser plume;should be changed immediately if grossly contaminated by a splash of blood or body fluid c. EYEWEAR: with shields protects the mucous membranes of the eyes, & full face shields protect the mucous membranes of the eyes, nose and mouth;they are worn for procedures in which blood, bone chips, amniotic fluid,and the aerosol of other body fluids may splash or be projected into the eyes;Googles with enclosed sides & chin-length face offer better protection than do simple eyeglasses d. GOWNS/APRON: made of fluid-resistant material protect the wearer from a splash with blood & body fluids; a plastic apron may be worn under a woven fabric gown
  • 19. e. SHOE COVERS / BOOTS: protect the wearer when gross contamination on the floor can be anticipated;grossly soiled shoe covers or knee high disposable boots are removed before the wearer leaves the room 2. Prevention of puncture injuries  needles, knife blades, and sharp instruments present a potential hazard for the handler and user  skin may be punctured or cut if caution is not taken a. Do not manipulate sharps by hand; b. use an instrument, such as a heavy hemostat, to attach and remove the scalpel blade; c. arm the needle directly from the suture packet when possible d. do not bend or break an injection needle e. Pass needles in a needle holder or use a “neutral zone” to transfer sharps on field f. Remove instruments from the surgical field after use and return them to mayo stand or instrument promptly
  • 20. g. Do not recap used injection needles except with a recapping safety device h. Do not remove the needle from disposable syringe by hand after use;if a needle must be change use hemostat or other instrument to exchange a hypodermic needle i. Place all used sharps in a puncture-resistant container for disposal 3. Management of puncture injuries  if a glove is torn or punctured, removed the puncturing sharp or instrument from the sterile field immediately and change the glove promptly using the open glove method  squeeze the skin to release the blood & wash out contaminants under running water with an antiseptic then irrigate the wound with a virucidal disinfectant such as an iodophor, bleach or peroxide  report the incident immediately & document all actions on the appropriate forms and baseline testing may be necessary for the punctured individual and the patient
  • 21. 4. Oral procedures  blood contaminated saliva and gingival fluid is expected during dental & surgical procedures in the oropharyngeal cavity  mouth protection, Ambu bags and/or other ventilation devices should be available for emergency airway resuscitation  respiratory secretions coughed up during endotracheal procedures are often infectious 5. Care of specimens  all specimens of blood, body fluids and tissues should be contained to prevent leaking during transport to the laboratory  the outside of the container should be clean  the circulator while wearing gloves needs to disinfects the outside of the culture tube handed from the sterile field or a container if it has been contaminated 6. Decontamination  all instruments are thoroughly cleaned before sterilization or high level disinfection;gloves, masks and eyewear are worn fro cleaning procedures
  • 22. 7. Laundry  soiled woven fabrics should be handled as little as possible and are transported to the laundry in leak proof bags  all laundry is considered contaminated and should be handled only by glove hands 8. Waste  blood suctioned fluids may be safely poured down a drain that is Connected to a sanitary sewer  a solidifying agent can be added to disposable suction containers to Disinfect the produce and convert it into solid waste  trash is disposed of by incineration or sent to a sanitary landfill in sealed Containers as required by local ordinances or state regulations  trash bags must be leak proof and of sufficient thickness and strength to Ensure integrity during transport  waste segregation should be observed
  • 23. 9. Handwashing  thorough handwashing with an improved antimicrobial agent after every contact with a patient, contaminated items or suspected contamination protects both patient and personnel 10. No touching of mucous membranes  eating and drinking is prohibited in any area where there is a risk for exposure  applying lip balm or cosmetics or adjusting contact lenses in the perioperative environment significantly increases the risk of exposure  hand to mouth and hand to eye contact can contribute to microbial transmission 11. Prophylaxis  perioperative personnel are encouraged to know their HIV, HBV, HCV Antibody status  personnel who participate in invasive procedures are at risk for bloodborne Exposure and should have the HBV immunization series
  • 24.  is the foundation of modern surgery  the patient is the center of the sterile field, which includes the personnel wearing sterile attire and the areas of the patient, operating bed & furniture that are covered with sterile drapes  strict adherence to the recommended practices of sterile technique reflects the surgical conscience of the perioperative team and is mandatory for the safety of the patient and personnel in the environment  principles of sterile technique are applied under the following conditions: • In preparation for an invasive procedure by sterilization of necessary Materials & supplies  In preparation of the sterile team to handle sterile supplies & intimately Contact the surgical site by scrubbing, gowning and gloving  In the creation and maintenance of the sterile field including skin Preparation and draping of the patient  In the maintenance of sterility throughout the entire surgical procedure  In terminal sterilization & disinfection at the conclusion of the surgical procedure
  • 25. 14 COMMANDMENTS IN THE OPERATING ROOM ONLY STERILE ITEMS ARE USED WITHIN THE STERILE FIELD 1. 2. STERILE PERSONS ARE GOWNED AND GLOVED
  • 26. 14 COMMANDMENTS IN THE OPERATING ROOM 3. TABLES ARE STERILE ONLY AT TABLE LEVEL 4. STERILE PERSONS TOUCH ONLY STERILE ITEMS OR AREAS, WHILE UNSTERILE PERSONS TOUCH ONLY UNSTERILE ITEMS OR AREAS
  • 27. 14 COMMANDMENTS IN THE OPERATING ROOM 5. UNSTERILE PERSONS AVOID REACHING OVER THE STERILE FIELD WHILE STERILE PERSONS AVOID LEANING OVER AN UNSTERILE ITEMS OR AREAS 6. THE EDGES OF ANYTHING THAT ENCLOSES STERILE CONTENTS ARE CONSIDERED UNSTERILE
  • 28. 14 COMMANDMENTS IN THE OPERATING ROOM 7. WHEN IN DOUBT, DISCARD! 8. THE STERILE FIELD IS CREATED AS CLOSE AS POSSIBLE TO THE TIME OF USE
  • 29. 14 COMMANDMENTS IN THE OPERATING ROOM 9. STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW 10. STERILE PERSONS KEEP WELL WITHIN THE STERILE AREA
  • 30. 14 COMMANDMENTS IN THE OPERATING ROOM 11. STERILE PERSONS KEEP CONTACT WITH STERILE AREAS TO A MINIMUM 12. UNSTERILE PERSONS AVOID STERILE AREAS
  • 31. 14 COMMANDMENTS IN THE OPERATING ROOM 13. DESTRUCTION OF THE INTEGRITY OF MICROBIAL BARRIERS RESULTS IN CONTAMINATION 14. MICROORGANISMS MUST BE KEPT TO AN IRREDUCIBLE MINIMUM
  • 32. 1. The sterile team wears sterile attire 2. When in doubt, discard! 3. Gowns are considered sterile only from waist to shoulder level and in front 4. Sterile to sterile; unsterile to unsterile 5. Once opened, use at once and do not reuse 6. Sterile person should pass each other back to back 7. Sterile person faces the sterile area when passing it 8. Sterile person turn his back to a non-sterile person or area when passing 9. A sterile table is created as close as possible to the scheduled time of use 10. Sterile areas must be constantly kept in sight 11. Unsterile persons avoid sterile areas or reaching over a sterile field 12. Once the sterile pack or drape is damaged, it becomes contaminated and unsterile 13. Surgeons makes an effort in sponge only once for mopping, then discard it into a pail 14. Sterile packages are laid on dry areas 15. The skin cannot be sterilized 16. Infected areas are grossly contaminated, avoid scattering the contamination 17. The GIT more especially the colon is contaminated. Please remember the PRINCIPLES!
  • 33. Principles of sterile technique are applied in the following conditions: 1.Prior the operation, materials and supplies to be used must be sterilized 2.Prior the operation, the number of bacteria in the skin must be minimized through surgical scrub and skin prep 3.Before surgery, the sterile field should be established by draping the client with sterile drapes. 4.During the surgery, sterilitty should be observed while handling the sterile supplies and when in contact with the incision. 5.At the end of the operation, the room should be disinfected.