it will help you to differentiate medical and surgical asepsis and to help in practicing it.

1. By:
Mrs. Babitha K Devu
Asstt. Professor
SMVDCoN

2. Objectives
By the end of this presentation students will;
 Differentiate medical and surgical asepsis
 Demonstrate proper hand-washing.
 Verbalize when to wash hands.
 Describe the history of hand hygiene.
 Describe the impact of hand washing on human
health.
 Demonstrate the surgical scrubbing.

3. Introduction
 Hand-washing is a first break of infection, and the
most effective and inexpensive ways to prevent
infection including nosomical infections
 The majority of HAI cases are preventable through
a combination of strategies including
environmental control and cleaning, use of
isolation precautions, and use of personal
protective equipment (PPE) when appropriate

4. History of Hand Washing
In the mid-1800s, studies by Ignaz Semmelweis in
Vienna, Austria, and Oliver Wendell Holmes in
Boston, USA, established that hospital-acquired
diseases were transmitted via the hands of HCWs.
The 1980s represented a landmark in the evolution
of concepts of hand hygiene in health care. The
first national hand hygiene guidelines were
published in the 1980s, followed by several others
in more recent years in different countries.

5. History of Hand Washing
In 1995 and 1996, the CDC/Healthcare Infection
Control Practices Advisory Committee (HICPAC) in
the USA recommended that either antimicrobial
soap or a waterless antiseptic agent be used for
cleansing hands upon leaving the rooms of patients
with multidrug-resistant pathogens. More recently,
the HICPAC guidelines issued in 2002 defined
alcohol-based hand rubbing, where available, as the
standard of care for hand hygiene practices in
health-care settings, whereas hand washing is
reserved for particular situations only.

6. Statistics & Facts
 1 in 10 person may experience nosocomial infection
(Biddle, 2009)
 At any one time, an estimated 1.4 million people suffer
from (Healthcare-associated infections) HAIs
(Landers et al., 2010)
 Global Hand-washing Day is in October 15th of each
year
 Hospital acquired infections account for 1.7 million
infections and 99,000 deaths each year (CDC.gov)

7. Definition of terms:
 Asepsis: is the absence of disease-producing organisms.
 There are two types of asepsis:
Medical and Surgical.
A.Medical asepsis (clean technique)
All practices that reduce the number, growth, transfer and
spread of pathogenic microorganisms. They include hand
washing, bathing, cleaning environment, gloving, gowning,
wearing mask, hair and shoe covers, disinfecting articles
and use of antiseptics.
B. Surgical asepsis (sterile technique);
Practices that keep an area or objects free from all
microorganisms non pathogenic and pathogenic including
spores and viruses.

8. Definition of terms:
 Disinfection:
Process of eliminating pathogenic organisms on an inanimate
object with the exception of spores.
 Disinfectant:
Is a chemical substance that is used for disinfecting only an
inanimate object e.g. (phenol, chlorine).
 Antiseptic solution:
Is a substance that is used on person's skin to inhibit the
growth and activity of microorganisms, but not necessarily
destroy them.
 Contamination:
The process by which something is rendered unclean or
unsterile
 Infection:
Is an invasion of the body tissue by pathogenic microorganism.

9. Definition of terms:
 Carriers:
Are people or animals that show no symptoms of
illness but that have pathogens on or in their bodies
that can be transferred to others.
 Nosocomial infection (Hospital acquired
infection):
It is an infection acquired from health care settings. It
may be exogenous infection when part of the client's
flora become altered and an over growth results.

10. Definition of terms:
 Resident pathogens:
These are organisms normally present on skin and are not
easily removed by hand washing unless considerable
friction is used.
 Transient pathogens;
These are microorganisms attached to the skin when a
person comes in contact another during normal activity
of living and easily removed by hand tiling.
 Concurrent disinfection;
Practices that are done, on a day to day basis in the care of
the patient, his lies, and his immediate environment to
limit or control spread of microorganisms.

11. Principles of Asepsis
Three things are extremely important in achieving
asepsis:
Time:
Longer the time taken, greater the chance of
contamination.
Trauma:
How the trauma occurred.
Trash:
It refers to contamination by bacteria or foreign matter.

13. Medical asepsis (clean technique)
 Purposes of medical asepsis;
 To prevent cross infection on hospital environment.
 To control infection.
 To ensure patient's comfort, safety and
psychological well-being.

15. CONTIN…

16. CONTIN…

21. Equipment
 Warm running water
 Antiseptic Soap Solution
 Nail brush
 Clean towel

22. Proper Hand-washing Technique
 Rub hands palm to palm
 Right palm over left dorsum with interlaced fingers and
vice versa
 Palm to palm with fingers interlaced
 Backs of fingers to opposing palms with fingers
interlocked
 Rotational rubbing of left thumb clasped in right palm
and vice versa
 Rotational rubbing, backwards and forwards with
clasped fingers of right hand in left palm and vice versa
 Rub both wrist in rotational manner

23. Hand Hygiene Technique with Soap and Water
Duration of the entire procedure: 40-60 seconds

24. CONTIN…

28. SURGICAL ASEPSIS
 Refers to the procedures used to keep the
object or areas sterile or completely free
from micro organisms.
 In surgical asepsis all practices are
directed to the elimination of both
pathogenic and nonpathogenic micro-
organisms.

29. Principles in surgical asepsis
Principles Rationale
Always face the sterile field.
Do not turn back or side on a
sterile field
Sterile objects which are out of
vision are considered
questionable and their sterility
cannot be guaranted.
Keep sterile equipment above
your waist level or above table
level.
Waist level and table level are
considered margins of safety
and will promote maximum
visibility of the sterile field.
Do not speak, sneeze and
cough over a sterile field.
To prevent or droplet infection.
Never reach across sterile
field
When a nonsterile object is held
above a sterile object, Gravity
causes micro organisms to fall
into the sterile field.

30. Principles Rationale
Keep the unsterile objects
away from the sterile field.
Micro organisms may be
transferred whenever a non
sterile object touches a
sterile field.
Keep the sterile field dry Micro organisms do not pass
easily through a dry surface.
The edge of the sterile
field is considered
unsterile.
Proximity to a contaminated
area makes sterilty doubtful.
Handle liquids cautiously
near the sterile field or
prevent drapes or wrappers
from becoming wet.
When a liquid wets it
connects a nonsterile field
with a sterile field.

31. Principles Rationale
Each sterile supply should
be clearly labeled as to its
contents, time and date of
sterilization.
To ensure sterility.
Never assume that a
object is sterile. Always
check the sterility
expiration date.
Sterility of an object
wrapped in paper or cloth
becomes doubtful after 4
weeks.
Avoid sweeping and dusting
when the sterile objects
are opened.
Micro –organisms travel in
the dust particles
Put on mask, Wash hands,
put on gowns and gloves
before handling sterile
supplies.
To prevent contamination.

32. PROCEDURES INCLUDED IN
SURGICAL ASEPSIS
Surgical hand scrub
Donning a sterile gown
Applying and removing a sterile
gloves

33. 1.Surgical hand scrub
Purpose :
Remove as many micro organisms
from the hands as possible before the
sterile procedure.

34. 1.SURGICAL HAND
SCRUB

35. Equipment
 Warm running water
 Antiseptic Soap Solution
 Hand brush stored in a sterile container
 Transferring forceps
 Sterile towel

36. Steps of the procedure
1.Makesure fingernails are short,clean,healthy.Nail
polish should be removed.
2.Remove jewelries(Rings, Bracelets).
3.Apply personal protective equipment(PPE) includes
surgical shoe covers, Cap,Facemask
and protective eyewear.

37. 4.Open disposable brush impregnated with
antimicrobial soap
5.If no disposable brush is not available/some
hospital use brush sterilized and stored in the
small bin.

38. 6.Use a transferring forceps to
pick up the brush from the
sterile bin.
7. Turn on the water and
adjust the flow so that the
water is warm. Warm
water removes less of the
protective oil of the skin
than hot water®.
8.Wet hands and arms. Keep
hands above elbows
Rationale: Movement of water
and dirt will flow from hands
to less clean areas thus
preventing contamination of
the hands during scrub.

39. 9.Wet scrub brush or apply antibacterial soap if not
already impregnated in the brush.
10.Anatomic timed scrub: Starting with fingertips, scrub
each anatomic area (Nail, fingers each side and web
space,palmar,dorsal surface and Forearm) for around 5
minutes.

40. 11.Scrub vigorously using vertical strokes in a
circular manner. Repeat with other hand.
Rationale: Ensures that all surfaces will be
systematically scrubbed to remove transient
and resident micro organisms.
12.Counted brush stroke method: Starting
finger tips, scrub each anatomic area for the
designated number of strokes. Scrub
vigorously using vertical strokes.

41. 13.Rinse hands thoroughly under warm running
water, holding hands upward. This is to allow water
to drain towards the flexed elbows.
Rationale : Prevents contamination of the hands
from dirtier areas. Remember do not touch
anything before and after rinsing hands.
Touching non sterile objects would mean the
surgical scrub need to be repeated.

42. 14.Keep hands held upward to allow water to
drip from the hands to elbow.
15.Dry hands with a sterile towel.

43. Components of PPE
 Gloves
 Gowns
 Aprons
 Masks
 Goggles
 Caps
 Theatre footwear
(Hinkin, Jayne & Cutter, 2008)

44. Selecting Appropriate PPE
 Anticipated exposure such as touch, splashes, sprays,
blood or body fluids
 Categories of isolation precautions a patient need
 Durability and appropriateness of PPE for the task
 PPE Fit the categories of exposure
(Akridge, 2011)

46. Sequence for Donning PPE
 Gown: Fully cover torso from neck to knees, arms to
end of wrists, and wrap around the back, fasten in
back of neck and waist
 Mask or respirator: Secure ties or elastic bands at
middle of head and neck, fit flexible band to nose
bridge, snug to face and below chin
 Goggles or face shield: Place over face and eyes to
adjust
 Gloves: Extend to cover wrist of isolation gown
(Transferring More than Patients, 2011)

47. Sequence of Removing PPE
 Gloves: Grasp outside of glove with opposite gloved hand
to peel off, hold removed glove in gloved hand and slide
fingers of ungloved hand under remaining glove at wrist.
Peel and discard
 Goggles or face shield: handle by head band or ear
pieces. Place in designated receptacle
 Gown: Unfasten ties. Pull away from neck and shoulders,
touching inside of gown only. Turn gown inside out, fold or
roll into a bundle and discard.
 Mask or respirator: Grasp bottom, then top ties or elastics
and remove and discard
(Transferring More than Patients, 2011)

48. 2.Donning a sterile gown

49. 2.Donning a sterile gown
Purpose :
To apply entire necessary to safely
carryout sterile procedures usually in the
operating room and delivery room.

50. Donning a sterile gown
1.Grasp folded sterile gown at the neckline
and step away from the sterile field.
Allow gown to gently unfold, being careful
that does not touch the floor. The inside of
the gown is towards the user.
Rationale: Maintains sterility of the gown
and positions it for donning.

51. 2.Holding the arms at the shoulder level, grasp
the sterile gown just below the neckband near
the shoulders and slide arms in the sleeves
until the fingers are at the end of the cuffs
but not through the cuffs.
Rationale : The finger remain in the cuffs to
protect the sterility of the gown and
prepared for closed gloving.

52. 3.Have someone tie the back of the gown
,taking care that only the ties are touched
and not the sides of the gown.
Rationale: Maintains sterility of the gown.
Gowns are considered sterile in front of
the shoulders sterile from 2 inches above
the elbow to the wrist.

54. 3.APPLYING AND REMOVING
STERILE GLOVES

55. Donning a glove
Purpose :
Prevent transfer of micro organisms
from hands to sterile objects or open
wounds.

56. A.Applying gloves
1.With fingers still within the cuff of the gown, open
the inner sterile glove package and pick up the first
glove by the cuff, using the nondominant hand.
Rationale :Maintains the sterility of the gloves.
2.Position the glove over the cuff of the gown so the
fingers are in alignment and stretch the entire glove
over the cuff of the gown, being careful not to touch
its edge. Finger remain within the cuff of the gown.

57. 3.Use the sterile gloved hand to pick up the second
glove, placing it over the cuff of the gown of the
other hand and repeat the glove application
process.
4.Adjust gloves for comfort and fit, taking care to
keep gloved hands above waist level at all times.
Rationale : If gloved hands fall below the waist
level,there are no longer Sterile.

58. B.Removing gloves:
1.Wash gloved hands first.
2.With dominant hand,grasp outer surface of non
dominat glove just below thumb. Peel off glove
insideout,without touching exposed wrist.
Rationale :After use, outer surface of gloves is
contaminated and could transfer micro organisms to
the nurse’s wrist.

59. 3.Placed ungloved hand under thumb side of second
cuff and peel off the fingers holding first glove
inside second glove. Discard into appropriate bin
Rationale: Folding contaminated glove surfaces
toward the inside minimize the chance to
transfer of micro organisms. Use glove to glove
skin to skin technique when removing gloves.
4.Wash hands before and after removing gloves to
prevent contamination of hands.

60. Impact on Health Care Workers
Excessive hand-washing and wearing occlusive gloves can
cause
 Sore and damaged skin
 Skin irritation and dryness
 In winter months some personnel may develop cracks in
their skin that cause bleeding
 Darker skin has less skin irritation than darker skin
 Dermatitis (hand washing with soap before or after alcohol
based product)
(Bissett, 2007)

61. Impact on Patients
Nosomocial infections causes
 Increase morbidity and mortality rate in patients
 Prolonged hospital stay
 Increase health care costs
(Chen & Chiang, 2007)

62. Impact on Cost
 Estimated 1.4 million people suffer from HAIs which
increased direct and indirect costs,
 prolonged hospitalization
 high rates of disability and death.
 In the US, estimated that HAIs account for direct
hospital costs of $28.4–$45 billion per year
(Landers et al. 2010)

63. Challenge and Barriers
 Skin irritation
 Time consuming (15-30 sec)
 Work load stress (too busy)
 Shortage of staff
 Availability of PPE
 Lack of knowledge
 Interfere in ability to provide care
(Hinkin, Jayne & Cutter, 2008)

64. Conclusion
 Studies show the bacteria that cause
hospital acquired infections are
frequently spread from patient to
patient by health care workers hand
 CDC and many research support
that proper hand-washing before
and after having contacts with
patients is the one most important
measure for preventing the spread
of infection in health care settings

65. Any Question???