Transcript Surgical Asepsis in the OR

Surgical Asepsis in the OR
Principles of Sterile Technique
Becky Ellis, MN RN
Nurse Educator N230
Course Information
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You are about to begin learning about
Surgical Asepsis. Part of this module
is devoted to the theory of asepsis
as it is used in the operating room.
The second half of this module is
devoted to teaching you the skills
needed for your OR experience,
particularly those of scrubbing,
gowning, and gloving.
Purpose
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The purpose of this module is to acquaint the nursing
student with surgical asepsis, surgical scrubbing and the
gowning and gloving techniques that will be used during
their OR rotation. This module is meant to be on overview
and a module to be studied at the student’s convenience.
The student must successfully complete this module prior
their OR check off in the skills lab and prior to their OR
rotation at their health care facility.
Learning Objectives
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After completing this self study
course the student will be able to:
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Describe the fundamental principles of
safe conduct and the basic rules for
aseptic technique in the operating
room.
Demonstrate the correct technique of
the surgical scrub and the correct
gowning and gloving technique.
Pretest Instructions
The next 5 questions compose a
pretest to gauge your knowledge and
ability prior to starting this module.
Select the best answer, then double
click with your mouse.
Now here we go
Pretest
1. The Definition of Asepsis is:
A. Soiled or infected with
organisms
B. Capable of producing disease
C. Absence of microorganisms
2. Cross-contamination is defined as:
A. Producing or capable of producing
disease.
B. Transmission of microorganisms
from patient to patient and from
inanimate objects to patients.
C. Severe toxic state resulting from
infection with pyogenic organisms.
Correct!!
Cross-contamination is the
Transmission of
microorganisms
3. Which task or function during a
surgical procedure is designed as
being within the scope of the
practice of the scrub nurse?
A. Closing the surgical wound
B. Setting up the sterile field
C. Administering blood products
Right Again!!
The Scrub nurse
prepares the sterile
field
4. For which member of the surgical
team is a “surgical scrub”
unnecessary?
A. Anesthetist/anesthesiologist
B. Surgical technologist
C. Scrub nurse
WOW!
You are doing great. Another
Right answer!
Proceed onto the next
question, please
5. Which is the best technique for you to use when
rinsing your hands and forearms after a surgical
scrub?
A. Rinsing is not performed after a surgical
scrub because it will reduce the antimicrobial
activity of the cleansing solution.
B. Rinsing should start at the elbow with the
water running down back down to the hand.
C. Rinsing should start with the hand
positioned such that water runs off the elbow
rather than down to the hands.
Correct Answer!!
You have completed your
pretest so it’s time to
continue on with the
module.
Answers to Pretest
1.
2.
3.
4.
5.
Correct answer is (a.) Absence of microorganisms.
Correct answer is (b.) Transmission of microorganisms
from patient to patient and from inanimate objects to
patients.
Correct answer is (b.) Setting up the sterile field.
Correct answer is (a.) Anesthetist/anesthesiologist.
Correct answer is (c.) Rinsing should start with the hand
positioned such that water runs off the elbow rather than
down to the hands.
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1. Only sterile items are used within the sterile
field
2. Sterile persons are gowned and gloved
3. Tables are sterile only at table level
4. Sterile persons touch only sterile items or
areas
5. Unsterile persons avoid reaching over the
sterile field
6. The edges of anything that encloses sterile
contents are considered unsterile
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7. The sterile field is created as close as
possible to the time of use
8. Sterile areas are continuously kept in view
9. Sterile persons keep well within the sterile
area
10. Sterile persons keep contact with sterile
areas to a minimum
11. Unsterile persons avoid sterile areas
12. Destruction of the integrity of microbial
barriers results in contamination
1. Only Sterile Items Are Used Within
A Sterile Field
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Discard any contaminated items:
 If a sterile package is found in a
contaminated area.
 If uncertain about the actual timing or
operation of the sterilizer.
 If an unsterile person comes into close
contact with a sterile table.
 If a sterile table or unwrapped sterile items
are not under constant supervision.
Only Sterile Items Are Used Within the
Sterile Field (Continued)
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Discard any contaminated items:
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If the integrity of the packaging material is
not intact.
If a sterile package wrapped in a material
other than plastic or another moistureresistant barrier becomes damp or wet.
If a sterile package wrapped in a pervious
woven material drops on the floor or other
areas of questionable cleanliness.
2. Sterile Persons are Gowned and Gloved
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Observed gowning practices.
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Self-gowning and gloving should be done from
a separate sterile surface to avoid dripping
water onto sterile supplies or a sterile table.
The stockinette cuffs of the gown are
enclosed beneath sterile gloves. The
stockinette is absorbent and retains
moisture, and doesn’t provide a microbial
border.
Sterile persons keep their hands in sight at
all times and at or above waist level or the
level of the sterile field.
Sterile Persons are Gowned and Gloved
(Continued)
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Observed gowning practices (con’t).
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Hands are kept away from the face,
and the elbows are kept close to the
sides.
The back of the gown is considered
contaminated.
The gown is considered sterile only to
the highest level of the sterile tables.
3. Tables Are Sterile Only At The
Table Level
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Sterile table.
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Only the top of a sterile, draped table is
considered sterile. The edges and sides of
the drape extending below table level are
considered unsterile.
Anything falling or extending over the table
edge, such as a piece of suture, is unsterile.
When unfolding a sterile drape, the part that
drops below the table surface is not brought
back up to table level.
4. Sterile Persons Tough Only Sterile
Items or Areas
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Sterile team members maintain contact
with the sterile field by means of
sterile gowns and gloves.
The unsterile circulator does not
directly contact the sterile field.
Supplies are brought to sterile team
members by the circulator, who opens
the wrappers on sterile packages.
5. Unsterile Persons Avoid Reaching
Over the Sterile Field
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The unsterile circulator never reaches over a
sterile field to transfer sterile items.
The circulator holds only the lip of the bottle
over the basin when pouring solution into a
sterile basin in order to avoid reaching over
the sterile area.
The scrub person sets basins or glasses to be
filled at the edge of the sterile table.
6. Edges of Anything That
Encloses Sterile Contents
Are Considered Unsterile
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The inside of a wrapper is considered sterile to
within 1 inch of the edges. The circulator opens
top flap away from self. Then turns the sides
under. The ends of the flaps are secured in the
hand so they do not dangle loosely. The last flap
is pulled toward the person opening the package,
thereby exposing the package contents away
from the unsterile hand.
Edges of Anything That Encloses
Sterile Contents Are
Considered Unsterile (Con’t)
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Sterile persons lift contents from packages
by reaching down and lifting them straight up,
holding their elbows high.
The flaps on peel-open packages should be
pulled back, not torn, to expose the sterile
contents. The contents should not be
permitted to slide over the edges.
Edges of Anything That Encloses
Sterile Contents Are
Considered Unsterile (Con’t)
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After a sterile bottle is opened, the
contents are either used or discarded.
The cap cannot be replaced without
contaminating the pouring edges.
7. The Sterile Field Is Created
As Close As Possible to the
Time of Use
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Sterile tables are set up just prior to
the surgical procedure.
It is virtually impossible to uncover a
table of sterile contents without
contamination. Covering sterile tables
for later use is not recommended.
A covered table is not under
observation at all times.
8. Sterile Areas Are Continuously Kept
in View
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Sterile persons face sterile areas.
Someone must remain in the room to
maintain vigilance when sterile packs
are opened in a room or a sterile field
is set up. Sterility cannot by ensured
without direct observation. An
unguarded sterile field should be
considered contaminated.
9. Sterile Persons Keep Well Within
the Sterile Area
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Sterile persons stand back at a safe distance
from operating bed when draping the patient.
Sterile persons pass each other back to back
at a 360-degree turn.
Sterile persons turn their backs to an
unsterile person or area when passing.
Sterile persons face a sterile area to pass it.
Sterile Persons Keep Well Within the
Sterile Area (Con’t)
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Sterile persons ask an unsterile individual to
step aside rather than risk contamination.
Sterile persons stay within the sterile field.
They do not walk around or go outside the
room.
Movement within and around a sterile area is
kept to a minimum to avoid contamination of
sterile items or persons.
10. Sterile Persons Keep Contact With
Sterile Areas to a Minimum
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Sterile persons do not lean on sterile
tables or on the draped patient.
Sitting or leaning against an unsterile
surface is a break in technique.
11. Unsterile Persons Avoid Sterile
Areas
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Unsterile persons maintain a distance of at
least 1 foot from any area of the sterile field.
Unsterile persons face and observe a sterile
area when passing to be sure they do not
touch it.
Unsterile persons never walk between two
sterile areas.
The circulator restricts to a minimum all
activity near the sterile field.
12. Destruction of the Integrity of
Microbial Barriers Results in
Contamination
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Sterile packages are laid on dry surfaces
only.
If a sterile package wrapped in absorbent
material becomes damp or wet, it is
discarded. The package is considered
unsterile if any part of it comes in contact
with moisture.
Drapes are placed on a dry field.
Destruction of the Integrity of
Microbial Barriers Results in
Contamination (Con’t)
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If solutions soak through a sterile drape to
an unsterile area, the wet area is covered
with impervious sterile drapes or towels.
Sterile items are stored in clean, dry areas.
Sterile packages are handled with clean, dry
hands.
Setting Up An Unsterile Table As A
Sterile Field
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The scrub person
drapes an unsterile
table toward self
first to protect the
gown. Gloved hands
are protected by
cuffing a drape
over them.
The scrub person
stands back from
the unsterile table
when draping it in
order avoid leaning
over an unsterile
are.
There Is No Compromise with
Sterility
It’s Considered Sterile or
Unsterile.
The OR Scrub
The Surgical Scrub
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Definition.
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The surgical scrub is the process of removing
as many microorganisms as possible from the
hands and arms by mechanical washing and
chemical antisepsis before participating in a
surgical procedure.
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Despite the mechanical action and the
chemical antimicrobial component of the scrub
process, skin is never sterile.
The Methodology of the Scrub
The Timed Method
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All surgical scrubs are 5 minutes in
length.
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All are performed using a surgical
scrub brush and an antimicrobial soap
solution.
Surgical Scrub Procedure
1.
2.
3.
Wet the hands and
forearms
Apply antiseptic agent
from the dispenser to
the hands.
Wash the hands and
arms thoroughly to 2
inches above the elbows,
several times. Rinse
thoroughly under running
water with the hands
upward, allowing water to
drip from the flexed
elbows.
4.
Take a sterile brush or
sponge (from a package
or dispenser) and apply
an antiseptic agent ( if it
is not impregnated in the
brush). Scrub each
individual finger,
including the nails, and
the hands, a half minute
for each hand.
5.
6.
Hold the brush in one
hand and both hands
under running water, and
clean under the
fingernails with a
disposable plastic nail
cleaner. Discard the
cleaner after use.
Again scrub each
individual finger,
including the nails and
the hands with the
brush, half a minute for
each hand.
The Final Rinse
1.
Be sure to keep both
arms in the upright
position (careful not to
touch the faucet!) so that
all water flows off the
elbows and not back down
to the freshly scrubbed
hands. Bring arm through
the water once, starting
with the fingers, then
pull the arm straight out.
Do not let water run
down to hands, must
drip off elbows
7.
8.
9.
Rinse the hands and brush, and discard
the brush.
Reapply the antimicrobial agent and wash
the hands and arms, applying friction to
the elbows, for 3 minutes. Interlace the
fingers to clean between them.
Rinse the hands and arms as described in
the previous slide.
Drying the Hands and Arms
1.
2.
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.
Open the towel fulllength, holding one end
away from the nonsterile
scrub attire. Bend
slightly forward.
3.
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.
Carefully reverse the
towel, still holding it
away from the body. Dry
the opposite arm on the
unused end of the towel.
Gowning and Gloving Techniques
1.
2.
3.
Reach down to the
sterile package and lift
the folded gown directly
upward.
Step back away from the
table into an
unobstructed area to
provide a wide margin of
safety while gowning.
Holding the folded gown,
carefully locate the
neckline.
4.
5.
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.
Holding the hands at
shoulder level, slip both
arms into the armholes
simultaneously.
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.
Gloving by the Closed Glove
Technique
1.
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.
2.
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
3.
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.
4.
Grasp the top of
the left glove and
underlying gown
sleeve with the
covered right
hand. Pull the
glove on over the
extended right
fingers until it
completely covers
the stockinette
cuff.
5.
Glove the right
hand in the same
manner, reversing
hands. Use the
gloved left hand
to pull on the
right glove.
Gloving the Right Hand
Scrubbing, Gowning, and Gloving
Complete
Group Discussion
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Now visit your Blackboard Course site and
go the discussion board section. Discuss
the following questions (on the next slide)
with your other class members, be sure to
share any previous experiences you may
have had using Aseptic Technique along
with any insights that you may have
related to this topic.
Questions for Discussion
1.
2.
3.
4.
What would you do if, during your OR experience, you
accidentally touched an unsterile object with your
sterilely gloved hand?
What would you do if, while scrubbing, you accidentally
touched the faucet?
Is it OK to prepare a sterile field an hour before the
scheduled surgical case and leave the room to set up
another OR room? Why or why not?
What should you do if you notice a break in sterile
technique by another member of the OR team that they
may/or may not be aware of?
I would like to express thanks to
Karen Steinke, RN, MN for
graciously helping with the photos
used in this presentation.