Arreglado, Marlchiel Nathan S.

BSN 3

1. What is aseptic technique?

Aseptic technique means using practices and procedures to prevent contamination from
pathogens. It involves applying the strictest rules to minimize the risk of infection. Healthcare
workers use aseptic technique in surgery rooms, clinics, outpatient care centers, and other
health care settings.
Healthcare professionals commonly use aseptic technique when they’re:

 handling surgery equipment

 helping with a baby’s birth by vaginal delivery
 handling dialysis catheters
 performing dialysis
 inserting a chest tube
 inserting a urinary catheter
 inserting central intravenous (IV) or arterial lines
 inserting other draining devices
 performing various surgical techniques

Aseptic technique types

According to The Joint Commission, there are four chief aspects of the aseptic technique: barriers,
patient equipment and preparation, environmental controls, and contact guidelines. Each plays an
important role in infection prevention during a medical procedure.

Barriers

Barriers protect the patient from the transfer of pathogens from a healthcare worker, from the
environment, or from both. Some barriers used in aseptic technique include:

 sterile gloves

 sterile gowns

 masks for the patient and healthcare provider

 sterile drapes
Sterile barriers are those that have not touched a contaminated surface. They’re specially packaged
and cleaned items. Healthcare workers put them on or use them in specific ways that minimize
exposure to germs.
Patient and Equipment Preparation

Healthcare providers also use sterile equipment and sterile instruments. To further protect the
patient, they apply cleansing and bacteria-killing preparations to the patient’s skin before a
procedure.
Environmental controls
Maintaining a sterile environment requires keeping doors closed during an operation. Only
necessary health personnel should be at the procedure. The more people present, the more
opportunities for harmful bacteria to cause contamination.
Contact guidelines

Once healthcare providers have on sterile barriers, they should only touch other sterile items. They
should avoid touching nonsterile items at all costs.

A common procedure that carries a risk for infection is inserting a urinary catheter. These catheters
drain urine from the bladder and are associated with catheter-associated urinary tract infections
(CAUTIs). When healthcare providers insert a catheter, they demonstrate all four aseptic
techniques in action:

 Barriers: They wear sterile gloves.

 Patient and equipment preparation: They open sterile packaging that contains the sterile
catheter. They prepare the patient’s skin with a special solution.

 Environmental controls: Only one or two providers and the patient are in the room.

 Contact guidelines: Healthcare providers take great care not to touch any nonsterile surface
with the hand that advances the catheter into the patient’s urethra.

If even one part of the aseptic technique is missed during catheter insertion, the patient can easily
get an infection.
 2. What is the difference between medical and surgical asepsis?

The state of being free from disease-causing agents is defined as the asepsis. Asepsis can be
broadly divided into two main categories known as medical asepsis and surgical asepsis. The
key difference between medical asepsis and surgical asepsis lies in the way they are
defined. Medical asepsis is the reduction of the number of disease-causing agents and their
spread. On the other hand, the complete elimination of the disease-causing agents and their
spores from the surface of an object is called the surgical asepsis.

Medical asepsis is the reduction of the number of disease-causing agents and their spread.
Methods of medical asepsis:
 Isolation of the patient
 Hand washing
 Preventive vaccination
 Increasing the awareness among visitors and relatives
 Use of gloves, masks, and gowns
 Use of chemical agents

The complete elimination of the disease-causing agents and their spores from the surface of an
object is called surgical asepsis.

Surgical asepsis is a more complex process than its counterpart. The proper maintenance and
preparation of the environment, surgical equipment, personnel involved in the procedure as well
as the adequate cleaning of the surgical site are very vital factors to be taken care of when surgical
asepsis is carried out. During the procedure, all the participants are required to follow a set of
precautionary steps in order to prevent the contamination of the sterile environment. One of the
easiest and probably the most important step is to minimize the number of personnel taking part
in the procedure and keeping the conversations at a minimum as much as possible. At the same
time movements inside the theater also should be reduced. Use of non-perforating devices is
encouraged. Since both scrubbed and non-scrubbed staffs are attending the procedure, non-
scrubbed staff should maintain a fair distance away from the scrubbed staff.
3. Roles of:
a. Circulating nurse
Before Operation:
 With the help of the scrub nurse, identifies the client by checking the
following data and requirements: name, age, name of attending surgeon,
contemplated operation, date and time of surgery, signed consent,
compliance to NPO, and the presence of prosthesis, jewelry, nail polish, and
lipstick. Any inconsistency should be corrected, validated and reported to
the surgeon
 Accompanies the client when he is transferred to the OR
 Identifies and reports any potential danger in the environment or stressful
situation involving the client
 Keeps personal items of the client, such as religious articles, hearing aid,
eyeglasses, dentures, jewelry, and the like if the client is alone; otherwise,
endorses these items to the relatives.
 With the scrub nurse, sets up the operating room and positions the
equipment appropriately
 Records all the sponges, sharps, and instruments to be used during the
operation.
During Operation:
 Provides promptly any supply, instruments and equipment as needed
 Provides assistance to any member of the OR team
 Acts as a communication link between events, and between team members
in the sterile field and persons who are not in the OR but are concerned with
the outcome of the surgical procedure
 Directs or supervises the scrub nurse when necessary
 Requests for blood products when needed
 Ensures that everyone complies with the principle of asepsis
 Ensures patient safety throughout the procedure.
After Operation
 Determines the outcome of the final counts as correct or incorrect, including
the need for a radiograph to look for a lost item
 Writes an incident report on counts that remain unsolved
 Records any medications the surgeon used in the surgical site, such as
antibiotics or local anesthesia
  Makes the pathology request and conducts proper documentation and
labeling of specimens to be sent to the laboratory for safekeeping
 Gives health teachings to the client or his relatives
 Assists in transferring the patient from the OR table to the PACU
 Helps in the after care of the OR suite.
b. Scrub nurse
Before Operation:
 Validates with the surgeon his preference of sutures and surgical
instruments
 Prepares protective attire such as eye gear or apron
 Accounts for all sponges, sharps and instruments before and after the
procedure
 Checks and labels the drugs and syringes that will be used in the operation
During Operation:
 Prepares and arranges sterile instruments and supplies needed during the
surgery
 Establishes and maintains the integrity, safety, and efficiency of the sterile
field throughout the procedure
 Anticipates, plans for, and responds to the needs of the surgeon and other
team members
 Informs the surgeon of the drug used during the surgery
 If two scrub nurses are necessary, one may prepare the supplies that will be
used during the operation while the other passes instruments and supplies
to the surgeon
After Operation
 Accounts for all sponges ,sharps, and instruments after surgery
 Cleans the patient by removing unnecessary prep solution, adhesive tapes,
blood, and the like
 Assists in the transfer of the client from the OR bed to the
stretcher or hospital bed
 Assists in the after-care of the room
 Ensures that all specimens removed from the client are properly labelled.
c. Anesthesiologist
  Induces and maintains anesthesia at the required level
 Manage untoward physiologic reactions of the client throughout the
surgical procedure
 Oversees the care of the client in the PACU until the client has regained
control of his vital functions
 Participates in the hospital’s cardiopulmonary resuscitation program as
supervisor to the team members
 Acts as a consultant or manager for problems of acute and chronic
respiratory insufficiency, therapy, as well as for a variety of their fluid,
electrolyte, and metabolic disturbances
 Documents the induction of anesthesia and the response of the client
d. Surgeon
 Heads the surgical team and is regarded as the “captain of the ship”
 Makes preoperative diagnosis based on observed clinical manifestations;
selects and performs the surgical procedure to cure or alleviate a disease;
and provides preoperative, intraoperative, and postoperative care to the
client
 Assumes full responsibility for all acts of medical judgement and for the
management of the surgical client
 Determines the specific site for operation
 Determines the appropriate surgical position in consultation with the
anesthesia
4. OR equipment classification and function

Cutting and Dissecting – These instruments usually have sharp edges or tips to cut through
skin, tissue and suture material. Surgeons need to cut and dissect tissue to explore irregular
growths and to remove dangerous or damaged tissue. These instruments have single or
double razor-sharp edges or blades. Nurses and OR personnel need to be very careful to
avoid injuries, and regularly inspect these instruments before using, for re-sharpening or
replacement

Clamping and Occluding – Are used in many surgical procedures for compressing blood
vessels or hollow organs, to prevent their contents from leaking. Occlude means to close
 or shut. Therefore, these instruments are also used to control bleeding. They are either
straight, curved or angled, and have a variety of inner jaw patterns. Hemostats and
mosquito forceps are some examples of these types of instruments.

Retracting and Exposing – These surgical instruments are used to hold back, or retract
organs and tissue so the surgeon has access to the operative area. They spread open the
skin, ribs and other tissue; and are also used separate the edges of a surgical incision. Some
retracting and exposing instruments are “self-retaining,” meaning they stay open on their
own. Others manual styles need to be held open by hand.

Grasping and Holding – These instruments, as their name suggests, are used to grasp and
hold tissue or blood vessels that may be in the way during a surgical procedure. Medical
assistants must make sure these instruments are working correctly, and that their locking
mechanisms are lubricated for easy opening and closing, particularly after cleaning and
reprocessing. Forceps are a very good example of these types of instruments.
5. Layers of the human abdominal wall
Skin - is the soft outer tissue covering of vertebrates with three main functions: protection,
regulation, and sensation.
Subcutaneous tissue - The subcutaneous tissue, also called
the hypodermis, hypoderm, subcutis, or superficial fascia, is the lowermost layer of
the integumentary system in vertebrates.
Fascia - A fascia is a band or sheet of connective tissue, primarily collagen, beneath
the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.
Muscle - is a soft tissue found in most animals. Muscle cells contain protein filaments
of actin and myosin that slide past one another, producing a contraction that changes both
the length and the shape of the cell.
Peritoneum - is the serous membrane forming the lining of the abdominal
cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of
the intra-abdominal (or coelomic) organs, and is composed of a layer
of mesothelium supported by a thin layer of connective tissue.

6. What is a consent?
 In the medical field, there are two types of consent: expressed and implied. Expressed
consent is communicated either verbally or in written form. Simply put, the victim tells
you it is okay to provide assistance. In this case, the victim must be able to understand the
situation and communicate clearly in order to provide expressed consent. When an
individual is unable to provide expressed consent, the rescuer must rely on implied consent.
Implied consent happens when the rescuer is unable to communicate with the victim. This
most often happens because the victim is unconscious, but may also be a result of
intoxication, language barriers, mental disorder, or age. With implied consent, there is an
assumption that the victim would ask for help if he or she could.
If a victim is not impaired, a rescuer must receive expressed consent before physically
touching a victim. This is important for all first aid providers, but it is essential for medical
professionals and first responders, including our lifeguards and swim coaches. If a victim
isn’t able to provide expressed consent, the rescuer may rely on implied consent. Safety is
always paramount when providing first aid assistance to someone in need. Never put
yourself in harm’s way to provide help to someone who won’t take it. In all medical
emergency scenarios, calling 9-1-1 should be the first step. Additionally, it is essential to
always use personal protective equipment, such as gloves and a breathing barrier, to protect
yourself.

7. Different types of anesthesia

General anesthesia - General anaesthesia or general anesthesia is a medically induced coma
with loss of protective reflexes, resulting from the administration of one or more general
anaesthetic agents
Sedation - Sedation and analgesics usually are provided through an IV placed in a vein.
Depending on the procedure, the level of sedation may range from minimal (you’ll feel drowsy
but able to talk) to deep (you probably won’t remember the procedure). Moderate or deep
sedation may slow your breathing, and in some cases, you may be given oxygen. Analgesia
may also contribute to drowsiness. But even with deep sedation, you won’t be unconscious, as
you would be with general anesthesia.
Levels of sedation

 Minimal – Minimal sedation will help you relax, but you will likely be awake. You’ll
understand questions your doctor is asking and be able to answer as well as follow
directions. This level of sedation is typically used when your doctor needs you to be
involved in the procedure.
  Moderate – You will feel drowsy and may even fall asleep during the procedure. You may
or may not remember some of the procedure.
 Deep – You won’t actually be unconscious, but you’ll sleep through the procedure and
probably will have little or no memory of it

Regional anesthesia - This type of anesthesia, including spinal blocks and epidurals, is
often used for childbirth. In fact, an epidural is the most common type of pain control used
for labor and delivery. It allows the mother to be awake, able to push when it’s time to
deliver the baby, but numbs the pain. Another type of regional anesthesia — a spinal block
— is stronger and is used during procedures such as cesarean deliveries, also known as C-
sections. Spinal blocks and epidurals allow the doctor to surgically deliver the baby without
causing pain to the mother, and without subjecting the baby to sedating drugs that might
be harmful.

Local anesthesia - A local anesthetic is a medication that causes absence of pain sensation.
When it is used on specific nerve pathways, paralysis also can be achieved. Clinical LAs
belong to one of two classes: aminoamide and aminoester local anesthetics

8. What complications may occur after surgery?

Complications may include the following.

Shock

Shock is a severe drop in blood pressure that causes a dangerous slowing of blood flow
throughout the body. Shock may be caused by blood loss, infection, spine injury, or metabolic
problems. Treatment may include any or all of the following:

 Stopping any blood loss

 Helping with breathing. This might be with a breathing machine.
 Reducing heat loss
 Giving IV fluids or blood
 Giving extra oxygen
 Prescribing medicines. This might be raise blood pressure.

Bleeding

Rapid blood loss from the site of surgery, for example, can lead to shock. Treatment of rapid
blood loss may include:

 IV fluids or blood plasma

 Blood transfusion
 More surgery to control the bleeding
 Wound infection

When bacteria enter the site of surgery, an infection can happen. Infections can delay healing.
Wound infections can spread to nearby organs or tissue, or to distant areas through the
bloodstream. Treatment of wound infections may include:
 Antibiotics
 Surgery or procedure to clean or drain the infected area

Deep vein thrombosis

A deep vein thrombosis is a blood clot in a large vein deep inside a leg, arm, or other part of the
body. Symptoms are pain, swelling, tenderness, and skin redness in a leg, arm, or other area. If
you have these symptoms, call your healthcare provider. Compression stockings are often used
for treatment. They can also prevent DVTs.

Pulmonary embolism

The clot can break away from the vein and travel to the lungs. This clot is called a pulmonary
embolism. In the lungs, the clot can cut off the flow of blood. This is a medical emergency and
may cause death. If you have the following symptoms, call 911 or get emergency help.
Symptoms are chest pain, trouble breathing, coughing (may cough up blood), sweating, very low
blood pressure, fast heartbeat, light headedness, and fainting. Treatment depends on the location
and size of the blood clot. It may include:
 Blood-thinner medicines (anticoagulants) to prevent more clots
 Thrombolytic medicines to dissolve clots
 Surgery or other procedures

Lung problems
Sometimes lung problems happen because you don’t do deep breathing and coughing exercises
within 48 hours of surgery. They may also happen from pneumonia or from inhaling food, water,
or blood into the airways. Symptoms may include wheezing, chest pain, shortness of breath,
fever, and cough.

Urinary retention
This means you aren’t able to empty your bladder. This may be caused by the anesthesia or
certain surgeries. It is often treated by using a thin tube (catheter) to drain the bladder. This is
kept in place until you have regained bladder control. Sometimes medicines to stimulate the
bladder may be given.

Reaction to anesthesia

This is rare, but it does happen. Symptoms can range from mild to severe. Treatment of allergic
reactions includes stopping specific medicines that may be causing the reaction. You may also be
given other medicines to treat the allergy. Tell your healthcare team about any allergies you have
before the surgery to minimize this risk. If an allergic reaction does occur, ask what caused the
allergy so you can stay away from it for any future surgery