2. Prevention of infection in operating theatre
• The infection prevention (IP) practices are planned for use in all
types of health care facilities – from large urban hospitals to
small rural clinics.
• The IP principles are based on the guideline issued by Centers
for Disease Control and Prevention, CDC (Atlanta, Georgia
1996).
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3. IP principles
• Consider every person potentially infectious and susceptible to
infection.
• Washing hands before and after any procedure
• Donning gloves before touching anything potentially infectious
and wet such as
broken skin
mucous membrane,
body fluids , secretions & excretions,
soiled instruments and other items
before performing invasive procedures.
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4. c..
• Using personal protective equipment (PPE) to provide barriers, if
splashes or spills of any blood, body fluids, secretions or
excretions are anticipated.
• Using antiseptic agents for cleansing the skin or mucous
membrane prior to surgery, cleaning wounds
• Using safe work practices, such as no recapping or bending
needles, safely passing sharp instruments , and disposing sharps in
puncture resistant containers.
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5. C..
• Processing instruments and other items that come in contact
with blood, body fluids, secretions and excretions.
• Routinely cleaning and disinfecting equipment and furniture in
patient care areas.
• Disposing contaminated materials and waste properly.
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6. Personal Protective Equipment(PPE )
-are protective barriers and clothing
provides a physical barrier b/n m/o and the wearer, thereby
preventing m/o from contaminating hands, eyes, clothing, hair,
and shoes.
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7. PPE
• reduces, but does not completely eliminate, the risk of acquiring
an infection.
• must be used effectively, correctly, and whenever there is a risk
of contact with blood and body fluids.
• Making PPE available and training HCWs to use it properly
are essential.
NB: Use of PPE does not replace the need to follow basic IP
measures such as hand hygiene.
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8. Principles for Using PPE
• Assess the risk of exposure to blood, body fluids, excretions, or secretions
and choose items of PPE accordingly.
• Use the right PPE for the right purpose.
• Avoid any contact between contaminated (used) PPE and surfaces, clothing,
• Discard used PPE appropriately in designated disposal bags.
• Do not share PPE.
• Change PPE completely and thoroughly wash hands each time
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9. individuals should use PPE:
- HCW who provide direct care to patients
- who work in situations in which they might have contact with:
• blood , body fluids
• excretions or secretions
- Support staff:
waste handlers , cleaners, laundry staff,
- Laboratory staff who handle pt specimens
- Family members who provide care
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10. Types of PPE and their recommended uses.
• Gloves :should be worn:
• When there is a reasonable chance of hands coming in contact with:
blood or other body fluids,
mucous membranes, or no intact skin.
• Before -performing invasive procedures,
- handling contaminated waste items /
touching contaminated surfaces.
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11. types of gloves con….
A. Sterile surgical gloves .
B. Disposable (single-use)/ examination gloves
C. Utility or heavy-duty gloves (for use in cleaning
instruments, equipment, contaminated surfaces, and while
handling or disposing of contaminated waste)
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12. Caps
Use it :
• during surgery to prevent flake of skin and hair from shedding
into a patient's wound.
• In scrub suits
• when handling immunocompromised patients
• When handling patients with infectious disease
• When performing invasive procedures
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13. Aprons (Mackintoshes, plastic or rubber )
• Used in which splashing of blood, body fluids, secretions,
or excretions are likely
- Footwear (Closed boots or shoes )
Wear closed shoes to protect your feet from
injury by sharps
contact with blood or body fluids.
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14. Surgical Masks
should be worn in circumstances where
- splashes of blood, body fluids, secretions, and excretions are
likely, the patient has a communicable disease that is spread via
the droplet route.
• It protect the mucous membranes of the nose and mouth during
procedures and patient care activities.
• should be large enough to cover the HCW‟s nose, lower face,
jaw, and all facial hair.
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15. c..
The purpose of the mask is:
• to protect the patient from moisture droplets that are expelled as
HCWs speak, cough, or sneeze;
• to protect the HCW by preventing accidental splashes of patient's
blood or other contaminated body fluids from entering the HCW,s
nose or mouth.
• Unless the mask is made of fluid-resistant materials, it is not
effective in preventing either of these.
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16. c..
• There are two types of surgical masks:
• The tie-back mask, which has four ties to fasten the mask
around the mouth and nose.
• The flexible metal tab is placed above the bridge of the nose to
help secure the mask and minimize air escape from the sides
• The ear-loop mask is similar to the tie-back mask except that it
has two elastic bands used for hooking behind the ears.
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17. Protective Eyewear
• includes clear plastic goggles, safety goggles, and face shields.
• used to protect the mucous membranes of eyes during
procedures and patient care activities that could generate
splashes or sprays of blood, body fluids, secretions, and
excretions.
• .
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18. c..
The following guidelines apply:
• Use protective eyewear that is appropriate for the particular
procedure.
• Discard disposable eyewear appropriately.
• If they are reusable, decontaminate them according to the
manufacturers‟ instructions.
• Masks and eyewear should be worn when performing any task
where an accidental splash into the face is likely to occur.
• If face shields are not available, goggles or glasses and a mask
can be used together
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19. Gowns
• Wear to protect uncovered skin
• to prevent soiling of clothing during procedures and patient care
activities that are likely to generate splashes or sprays of blood,
body fluids, secretions, or excretions.
• should not be worn outside of the area for which they are intended,
• soiled or wet gowns should be removed as soon as possible.
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20. Personal hygiene and health
• Strict personal hygiene is necessary for OR workers.
• Daily baths and frequent shampooing aid in the maintenance of a
healthy surgical environment.
• Fingernails must be kept short, since bacteria are easily trapped
• Nail polish is strictly forbidden because it serves as a barrier to
effective hand cleaning and scrubbing.
• Excessive make-up should be avoided because minute particles
can be shed onto sterile surfaces.
• Any employee with a respiratory condition, open sores or
wounds, infections of the eyes, nose, or throat must not work in
the operating room.
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21. Hand hygiene
• Hand washing a separate activity from the surgical scrub, should
be a routine practice during the course of a workday
• Research has shown that hand washing has a dramatic effect on
the reduction of disease transmission in the hospital setting.
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22. Hand hygiene Procedure
1. Use an antimicrobial soap, not plain soap.
2. Use 3 to 5 mL of soap per hand wash.
3. For the antimicrobial action to take effect, the soap must be in
contact with the skin for at least 10 seconds.
4. When washing hands, pay particular attention to the subungual
area. Most of the hand bacteria are found in this area. Fingernails
must always be kept short for this reason.
5. Always remove rings before washing . The skin under rings can
harbor dangerous amounts and kinds of bacteria.
.
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23. C ..
6. Health care workers who wash or scrub their hands frequently
are subject to cracked or dry skin.
• Breaks in the surface of the skin, even when very small, can
allow the entry of bacteria.
• SO, Use lotion to prevent this.
• However, do not use skin lotion immediately before or after hand
washing. Because Lotions can inhibit the residual action of the
antimicrobial soap.
• When lotions are used they must be dispensed in such a way that
the user cannot contaminate the lotion remaining in the container
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25. Techniques that maintain asepsis
The Surgical Scrub
- is the process of removing as many m/o s as possible from the hands
and arms by mechanical washing and chemical antisepsis before
participating in a surgical procedure.
. Despite the mechanical action and the chemical
antimicrobial component of the scrub process, skin is never
sterile.
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26. Preparations before scrub
• Inspect hands for cuts and abrasions.
• Remove all finger jewelry.
• Be sure all hair is covered by head cap.
• Adjust the mask firmly and comfortably over nose and mouth.
• Clean eyeglasses if worn.
• Adjust water to a comfortable temperature
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27. Scrubbing
• All sterile team members perform the hand and arm scrub before entering the
surgical suite.
• There are two methods of scrub procedure.
• One is a numbered stroke method in which a certain number of brush strokes are
designated for each finger, palm, back of hand and arm.
• Second , is the timed scrub method
• All surgical scrubs are 5 minutes in length.
• All are performed using a surgical scrub brush and an antimicrobial soap solution
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28. c…
• The procedure for the timed 5-minute scrub consists of
the following:
1. Position scrub brushes, antimicrobial soap, and nail
cleaners which are available at each scrub station.
2. Remove watch and rings.
3. Wash hands and arms with antimicrobial soap.
4. Clean subungual areas with a nail file.
5. Start timing. Scrub each side of each finger, between
the fingers and the back and front of the hand for
2minutes.
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29. c…
6. Proceed to scrub the arms keeping the hand higher than the arm
at all times.
This prevents bacteria-loaded soap and water from contaminating
the hand.
7. Wash each side of the arm to 3 inches above the elbow for 1
minute.
8. Repeat the process on the other hand and arm keeping hands
above elbows at all times. If at any time the hand touches
anything except the brush, the scrub must be lengthened by 1
minute for the area that has been contaminated.
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30. C…
9. Rinse hands and arms by passing them through the water in one
direction only, from finger tips to elbow.
Do not move the arm back and forth through the water. Proceed to the
operating room suite holding hands above elbows.
• If the hands and arms are grossly soiled (dirt is visible) the scrub time
should be lengthened. However, vigorous scrubbing that causes the
skin to become abraded should be avoided
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36. The Final Rinse
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1. Be sure to keep both
arms in the upright
position
2. all water flows off the
elbows and not back
down to the freshly
scrubbed hands.
3. Bring arm through the
water once, starting with
the fingers, then pull the
arm straight out.
37. Drying the Hands and Arms
• After scrubbing, the hands and the arms should be thoroughly
dried before the sterile gown is donned to prevent contamination
of the gown by strike-through organisms from wet skin.
• A reusable or disposable towel for drying the hands is placed on
top of the gown during packaging.
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38. Drying the Hands and Arms
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1. Reach down to the opened sterile package
containing the gown, and pick up the towel.
Be careful not to drip water onto the pack.
Be sure no one is within arm’s reach.
2.Open the towel full-length, holding one end away
from the no sterile scrub attire. Bend slightly forward
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3. Carefully reverse the towel, still holding it
away from the body. Dry the opposite arm on
the unused end of the towel.
4. Dry both hands thoroughly but independently.
To dry one arm, hold the towel in the opposite
hand and, using the oscillating motion of the
arm, draw the towel up to the elbow.
40. Gowning and Gloving Techniques
1. Reach down to the sterile package and lift the
folded gown directly upward.
2. Step back away from the table into an
unobstructed area to provide a wide margin
of safety while gowning.
3. Holding the folded gown, carefully locate the
neckline
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41. C..
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4. Holding the inside, front of the gown just
below the neckline with both hands, let the
gown unfold, keeping the inside of the
gown toward the body. Do not touch the
outside of the gown with bare hands.
5. Holding the hands at shoulder level, slip
both arms into the armholes
simultaneously.
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6. The circulator brings the gown over the shoulders
by reaching inside to the shoulder and arm seams.
The gown is pulled on, leaving the cuffs of the
sleeves extended over the hands.
The back of the gown is securely tied or fastened at
the neck and waist, touch the outside of the gown at
the line of ties or fasteners in the back only.
43. Gloving
• Hand hygiene coupled with the use of protective gloves, is a key
component in minimizing the spread of disease-producing m/o &
maintaining an infection-free environment
• Sterile gloves may be put on in two ways:
- By the closed gloving technique
- By the open gloving technique
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44. Closed Gloving Technique
• Using the right hand and keeping it within the cuff of
the sleeve, pick up the left glove from the inner wrap
of the glove package by grasping the folded cuff.
• Extend the left forearm with the palm upward.
• Place the palm of the glove against the palm of the
left hand, grasping in the left hand the top edge of
the cuff, above the palm. In correct position, glove
fingers are pointing toward you and the thumb of the
glove is down
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45. c…
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Grasp the back of the cuff in the left hand and turn
it over the end of the left sleeve and hand.
The cuff of the glove is now over the
stockinette cuff of the gown, with the hand
still inside the sleeve.
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Glove the right hand in the same
manner, reversing hands.
Use the gloved left hand to pull on
the right glove
50. Open gloving Technique
1. Pick up the glove by its inside cuff with one hand.
2. Do not touch the glove wrapper with the bare hand
3. Slide the glove onto the opposite hand.
4. Using the practically gloved hand, slide the fingers
into the outer side of the opposite glove cuff.
5. Slide the hand into the glove and unroll the cuff.
6. Do not touch the bare arm as the cuff is unrolled.
7. With the gloved hand, slide the fingers under the
outside edge of the opposite cuff and unroll it gently,
using the same technique.
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51. Techniques of Removing the Gown and Gloves
• The gown is always removed before the gloves .
• Removing the Gown.
1. Grasp the right shoulder of the loosened gown with the
left hand and pull the gown downward from the shoulder
and off the right arm turning the sleeves inside out
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52. c…
2. Turn the outside of the gown away from the body
with flexed elbows
3. Grasp the left shoulder with the right hand and
remove the gown entirely, pulling it off inside out
4. Discard the gown in a laundry hamper or in a trash
receptacle (if disposable)
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53. Removing the Gloves
• The cuffs of the gloves usually turn down
• The gloves should be removed so that the bare skin does not
come into contact with the outside of the soiled gloves.
• Procedure
1. Grasp the cuff of the left glove with the gloved fingers of the
right hand and pull it off inside out.
2. Slip the ungloved fingers of the left hand under the cuff of
the right glove and slip it off inside out.
3. Discard the gloves in an appropriate receptacle.
4. Wash hands.
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