Medical/Surgical Asepsis

1. Medical/Surgical Asepsis Presented by: Cynthia Bartlau, RN, PHN, MSN

2. Objectives • At the completion of this lesson the student will be able to • Discuss concepts related to the chain of infection • Differentiate medical and surgical asepsis • Discuss equipment used for maintaining medical and/or surgical asepsis • Identify common sources for contamination • Describe proper hand placement during aseptic procedures

3. Beginning of Modern Asepsis • Previous to the discovery of asepsis many people died due to post-operative (and other) infection • Dr. Ignaz Semmelweis • Told doctors to wash their hands • Scottish surgeon named Joseph Lister • Inspired by Louis Pasteur’s formulation of the germ theory of disease • Used carbolic acid in operating rooms • Drastic reduction in infections

4. Theory of Infection Control • Microorganisms • Bacteria • Fungi • Viruses • Protozoa

5. Pathogenic • Disease causing • Infectious agent • Causes disease in healthy person • Opportunistic pathogen • Causes disease in susceptible person • Virulence • Communicable diseases • Non-pathogenic • Resident flora • Colonization • Can cause disease if transmitted to other areas

6. Infection • Local • Specific area of body is infected • Systemic • Microorganisms spread & damage other body areas • Bacteremia when microbes enter blood stream • Septicemia – when bacteremia spreads through all of the body systems • Acute vs. chronic infection

7. Nosocomial – infections that occur as a result of health care delivery • Endogenous source • Exogenous sources • Iatrogenic – infection directly caused by any diagnostic or therapeutic source

8. Drug-Resistant Pathogens • MRSA • VRE • MDR TB

9. Bacteria Viruses Fungi Protozoa Helminthes People Equipment Water Chain of Infection Neonates Diabetics Immunosuppressed Cardiopulmonary Disease Secretions Excretions Droplets Skin Broken Skin/Mucous Membrane Gastrointestinal/Respiratory/ Urinary Tract Direct-Indirect Contact/Fomite Injection/Ingestion Airborne/Aerosols

10. Medical Asepsis • AKA: Clean technique • Practices that inhibit the growth & spread of pathogenic microorganisms • Handwashing • Standard precautions • Transmission based precautions • PPE

11. The JCAHO Sentinel Event Alert quotes Julie Gerberding, MD, director of the CDC, as stating • Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance. Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.

12. Antiseptics • Prevent or inhibit growth of pathogenic organisms • Not effective against spores or viruses • Can be use on the skin • Alcohol • Betadine

13. Disinfection • Destruction of pathogens other than spores • Boiling water and chemicals • Bleach solutions • Zephirin • Irritate or damage skin • Used on objects not people

14. Surgical Asepsis • AKA: Sterile technique • Practices that destroy all microorganisms & their spores • Used in specialized areas & skills • Care of surgical wounds • Catheter insertion • Invasive procedures • Surgery

15. Sterilization • Destruction of pathogens & non-pathogens, including spores and viruses • Steam under pressure • Gas • Radiation • Chemicals • Autoclave is most common piece of equipment used

16. CDC recommendations • Preoperative/prophylactic antibiotic administration • No preoperative hair removal (unless hair will interfere with operation)

17. Sterile Technique • Procedures that keep an object or area free from living organisms • Sterile vs. contaminated areas • Articles must remain away from and in front of the body and above the waist

18. Sterile Technique • Never reach across the sterile field • Never turn your back to the sterile field • Two inches around border is considered contaminated • Sterile field must be kept dry

19. Sterile Gloving • Only touch the outside of the package with bare hands. • The inside of the package, in which the gloves are placed, is considered sterile. • The wrapper, when opened provides a sterile field. • Grasp only the outside edge of the wrapper.

20. The inside of the glove may be touched with the bare hand • Grasp the first glove at the top edge of the folded-down cuff and slip in hand • Slip gloved fingers into cuff of second glove and slip in second hand without contaminating • The outer aspect of the glove must remain sterile • Includes wrist area • Keep hands above level of waist • Sterile to sterile only • If contamination occurs, start again with new pair of gloves

21. Techniques to Remove Articles from Sterile Wraps • Drop technique • For gauze pads, dressings, small items • Wrapper is partially opened , held upside down over sterile field, dropped onto sterile field • Mitten technique • For bowls, drapes, linen… • Using the wrap as a mitten, sterile supplies can be placed on a sterile field • Transfer forceps • For cotton balls, small items, or articles • Sterile gloves or transfer forceps are used to transfer objects to sterile field

22. Skills to Demo & Practice • Donning & Removing Sterile Gloves

23. Questions?