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INFECTION CONTROL
EDUCATION PROGRAM

Principles of Aseptic &


Sterile Techniques
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Important Definitions
„ A i
Antisepsis: i Prevention
P i off sepsis
i by
b the
h exclusion,
l i destruction,
d i
or inhibition of growth or multiplication of microorganisms
from bodyy tissues and fluids.
„ Antiseptics: Organic or inorganic chemical compounds that
combat sepsis by inhibiting growth of microorganism without
necessarily
il killing
killi them.
h U
Usedd on skin
ki andd tissue
i to arrest growth
h
of endogenous (resident flora) microorganisms, they must not
destroyy tissue.
„ Asepsis: Absence of microorganisms that cause disease;
freedom from infection; exclusion of microorganisms (adj.,
aseptic;
i without
ih iinfection).
f i )
„ Aseptic techniques:
techniques: Methods by which contamination with
g
microorganisms is p
prevented ((alternate term
term:: aseptic
p p practice to
maintain asepsis).
asepsis). ICC
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In spite
p of manyy variables associated with sepsis,
p
people remain the major source of
microorganisms in the environment
environment.. Everything
on or around a human being is contaminated by
him or her in some way
way.. Additionally,
Additionally the action
and interaction of personnel and patients
contributed
ib d to prevalence
l off organisms
organisms.
i .

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SOURCES OF
CONTAMINATION
„ Skin
„ H i
Hair
„ Nasopharynx
„ Fomites
„ Air
„ Human Error

Cross Infection in the OR


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Aseptic Techniques
A
Asepsis
i literally
li ll means without ih i f i . This
infection.
infection Thi implies
i li
the absence of microorganisms that cause infection
infection..
However it is impossible to exclude all microorganisms
However,
from the environment.
environment. Every effort is made to
minimize and control them for the safety of both
patients and personnel.
personnel. The methods by which
microbial contamination is p prevented in the
environment are referred to as aseptic techniques.
techniques.
These practices are the key to containment of
microorganisms..
microorganisms

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Tackling Contamination Sources
„ Skin normallyy harbors resident organisms
g below its surface that are acquired
q byy direct
contact.. Both types of flora are constantly shed into the environment.
contact environment.

Key points are mentioned here for all personnel entering the operating room.
1. Daily bathing with soap containing an antibacterial agent.
2. Donning for clean OR attire upon each entry into the OR suite. Long sleeves are worn
by unsterile team members.
3. Covering g abrasions or cuts hands and skin. Persons with infected skin lesions should
not be permitted in OR suite.
4. Thorough hand washing before initial every into restricted are of OR suite.
5. Impeccable hand washing after every direct contact with patients or items in contact
with ppatient’s blood,, bodyy fluids,, or excretions.
6. Wearing of gloves when handling blood, excreta, drainage, and secretions or items
contaminated with body substances, including tissue specimens. Hands are washed
after removing gloves.

NOTE hand washing cannot be overemphasized. This is vigorous rubbing of all surface of
well--lathered, soapy hands, followed by rinsing under a stream of water.
well

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Tackling Contamination Sources
„ H i should
Hair h ld bbe shampooed
h d ffrequently.
l C Caps or h
hoods
d
are worn to completely cover hair, including beards.
„ N
Nasopharynx
h M k are worn to cover nose and
Masks d
mouth. They should be changed after caring for each
patient Persons with respiratory infection should not
patient.
be permitted in OR suite. Coughing and sneezing
explode droplets into the environment
environment. Taking should
be kept to minimum.

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Tackling Contamination Sources
„ F it Inanimate
Fomites I i t objects
bj t collect
ll t dust,
d t lint,
li t droplets
d l t andd particles
ti l from
f the
th
air. Surfaces of furniture, equipment, and floors may be contaminated by
spills or contact with organic debris.

In addition to housekeeping practice, key points to consider are:

1. Proper packaging and storing of supplies.


supplies External shipping cartons
should be removed prior to bringing supplies beyond the unrestricted
area in the OR suite.
2. Placement of dust covers over sterile items during transport and in
prolonged storage.
3. Separation of clean and soiled items. Sterile storage areas are physically
separated
p from decontamination areas.
4. Prompt decontamination of used equipment and reusable supplies.
5. Prompt disinfection of OR surfaces, i.e., furniture and floors and disposal
y
of waste and laundry.

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Environmental Services/Housekeeping

Housekeeping practices using the most effective


supplies,
pp techniques,
q and equipment
q p available are a
most important aspect of infection control.
Housekeeping
p g procedures
p include and disinfectingg the
operating rooms and suite, handling soiled laundry and
disposing
p g of solid wastes. Theyy are carried out
according to established practices, policies and
p
procedures.

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Tackling Contamination Sources
C
Controll off Ai
Airborne
b C
Contamination
i i
„ Air currents and movement in the OR should be
k at a minimum
kept i i to prevent airborne
ib contamination.
i i
„ Viable microorganisms from the air settle on
h i
horizontall surfaces.
f P
Proper cleaning
l i off these
h surfaces
f
helps control this contamination.
„ Th ventilation
The il i system andd efforts
ff to minimize
i i i air
i
turbulence and contaminants also are important factors.

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Universal Precautions
Transmission of infection requires a source, a method, and a susceptible host.
host.
Everyy p
patient is considered a source when blood and bodyy fluids containing
g blood
will be encountered , as in invasive diagnostic or therapeutic procedures.
procedures.

Universal precautions imply treating all human blood and other bodily fluids as
though they were
infected with blood-
blood-borne pathogens.

Potentially infectious bodily fluids include:

1. Blood, blood products or components, fluid with blood in it.


2. Semen and vaginal secretions.
3. Cerebrospinal
p fluid, synovial
y fluid, p
pleural fluid, p
pericardial fluid, p
peritoneal
fluid, amniotic fluid.
4. Saliva (in dental procedures).
5. Any unfixed human organ or tissue from living or dead person.
6
6. Cell, tissue, or organ culture containing HIV.
7. Culture medium or solutions containing HIV or HBV.

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Blood--borne Pathogen Standard
Blood
Requirements
„ Employers must have a written Exposure Control
Program that explains the risks and protective measures
to be followed.

„ At--risk employees receive information and training:


At
i.i Risks of blood
blood--borne pathogens
pathogens.
ii. How to recognize tasks that could lead to exposure.
iii. How to use and dispose of personal protective equipment.
i
iv. How to identify containers for contaminated material
material.
v. What to do if exposed.
vi. Work practices and precautions to prevent exposure.

„ At-risk employees must follow procedures and use


At-
equipment
q p as trained to do.
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When to Use Universal
Precautions?
„ Universal Precautions apply to anyone in contact
with human blood or other
potentially
ll infectious
f material:
l
„ Direct contact with lab specimens.
„ D
Draw bl
bloodd or other
h fl
fluids,
id give
i iinjections
j i or other
h
invasive procedures.
„ Handle patient laundry.
laundry
„ Transport blood or contaminated materials.
„ Clean areas that could be contaminated.

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H to Protect
How P Ourselves?
O l ?

„ Personal Protective Equipment.


„ P
Personal
l Hygiene
H i (H
(Handd washing).
hi )
„ Cleaning
g and Decontamination of surfaces.
„ Handling Precautions.
Precautions.

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Universal Blood and Body Fluid Precautions

„ Routinely use barrier protection to prevent skin and mucous membrane


contamination with blood or body fluids of all patients and specimens.

„ Wear gloves when engaged in the following:


„ Touching blood and body fluids, including during routine laboratory work
and phlebotomy
phlebotomy.
„ Touching all laboratory specimens and tissues.
„ Touching mucous membranes and non- non-intact skin of all patients.
„ Handling items contaminated with blood or body fluids,
fluids including specimen
containers, laboratory instruments, counter tops, etc.
„ Performing venipuncture, arterial puncture, skin puncture, and other vascular
access procedures.

„ Note: All skin defects (cuts, abrasions, ulcers, areas of dermatitis, etc,)
should be covered with an occlusive bandage.

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Universal Blood and Body Fluid
Precautions 2
„ Change gloves between each patient.

„ Wear a mask and eye covering,


covering or preferably a face shield,
shield during
procedures that are likely to generate droplets of blood or body fluids to
prevent exposure to the mucous membranes of the mouth, nose, and eyes.

„ Wear a gown, apron, or other covering when there is a potential for


splashing or spraying blood or body fluids.

„ Wash hands or other skin surfaces thoroughly and immediately if


contaminated with blood or body fluids.

„ Wash hands immediatelyy after gloves


g are removed.

„ Take extraordinary care to avoid accidental injuries caused by needles,


scalpel blades, laboratory instruments, etc, when performing procedures,
cleaning
l i iinstruments, h handling
dli sharp
h iinstruments, and
d di
disposing
i off usedd
needles.
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Universal Blood and Body Fluid
Precautions 3
„ Place used needles, skin lances, scalpel blades, and other sharp
items into a puncture-
puncture-resistant biohazard container for
di
disposal.
l Th
The container
t i should
h ld bbe llocated
t d as close
l as possible
ibl
to the work area. Phlebotomists should carry puncture-
puncture-
resistant containers with them.

„ To prevent needle stick injuries, needles should not be


recapped, purposely bent, cut, broken, removed from
di
disposable
bl syringes,
i or otherwise
h i manipulated
i l db by h
hand.
d

„ Place large
large-
g -bore reusable needles ((e.g.,
g , bone-
bone-marrow needles
and biopsy needles) and other reusable sharps into a puncture-
puncture-
resistant container for transport to the reprocessing area.

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Universal Blood and Body Fluid
Precautions 4
„ Minimize the need for mouth-
mouth-to-
to-mouth emergency
resuscitation p
procedures. Mouth p pieces,, resuscitation
bags, or other ventilation devices should be used
routinely.

„ Take care to minimize the formation of droplets,


spatters, splashes, and spills of blood or body fluids.

„ Clean all surfaces exposed to blood and body fluids with


a detergent solution followed by decontamination with
an appropriate EPA
EPA--approved chemical germicide.

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Handling Precautions

„ Special care required for handling, storing, transporting


infectious materials
„ Use only containers that are:
i. Leak-
Leak-proof
ii. Puncture
Puncture--proof if for sharps
iii. Red or have an orange biohazard symbols
„ If outside
t id off container
t i r is
i contaminated,
t mi t d place
pl it in
i secondd
container.
„ Handling laundry:
i. Wear gloves and other PPE to handle laundry.
ii. Bag contaminated laundry where it’s used.
iii. Follow
ll allll company rules
l and
d procedures.
d
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P
Precautions
ti for
f Handling
H dli Sh
Sharps

„ Follow Universal Precautions


Precautions——assume all sharps are
contaminated.
contaminated
„ Do’s and don’ts:
i. Don t shear or break needles.
Don’t
ii. Don’t remove or bend sharps—
sharps—don’t recap needles.
iii. Don’t reach into a container that may have sharps.
iv. D ’ clean
Don’t l up b
broken
k glass
l with
ihhhands
hands—
d —use tools.
l
v. Dispose of sharps immediately in proper containers.
vi. Immediatelyy report
p anyy needle stick or other direct
exposure.

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Aseptic Techniques & their
Applications
„ Strict
S i aseptic i andd sterile
il techniques
h i are needed
d d at allll
times in places such as the operating room
room..
„ Sterile techniques prevent transfer of microorganisms
into body tissues.
tissues.
„ Intact skin and mucous membranes are the body body’ss first
line of defense against infection
infection.. Infraction of their
integrity
g y creates a p portal of entryy for microorganisms
microorganisms.
g .
Therefore, anything in contact with body tissues is
potentially dangerous.
dangerous.

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Aseptic Techniques & their
Applications
„ D
Depending
di on theirh i iintended
d d purpose and
dbbody
d contact, iitems
are classified as:
1. C
Critical.
c . Items
te s entering
e te g body tissues
t ssues underlying
u de y g skin
s and
a d mucous
ucous
membranes must be sterile, i.e., free of microorganisms, including spores.
They are handled to maintain sterility.
2. Semicritical. Sterility is less critical for items that come into contact with
intact skin or mucous membranes. These items are surgically clean, i.e.,
mechanically cleaned and disinfected to reduces microorganisms, but
unsterile. Some items are disinfected immediatelyy before use and are
handled to prevent contamination before use. Other items are terminally
sterilized, but sterility is not maintained during use.
3. Noncrtical. Items that will only come in contact with intact skin or
mucous membranes in an area remote from the operative site may be
cleaned, terminally disinfected, and stored unsterile between patient uses.

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Principles
p
„ Only sterile items are used within sterile field.
field.
„ G
Gowns are considered
id d sterile
t il only
l ini front
f t from
f
chest to level of sterile field, and the sleeves from
above elbows of cuffs
cuffs..
„ Tables are sterile only at table level
level..
„ Persons who are sterile touch only sterile items or
areas;
areas
r ; persons
p r n who h are r not
n t sterile
t ril touch
t h only
nl
unsterile items or areas.
areas.
„ Unsterile p persons avoid reaching g over a sterile
field;; sterile persons avoid leaning over an unsterile
field
area..
area
„ Edges of anything
an thing that encloses sterile contents
are considered unsterile.
unsterile.

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„ Sterile field is created as close as possible to time
of use
Degree of contamination is proportionate to length of
time sterile items are uncovered and exposedp to
environment..
environment

Precautions must be taken as follows:


1. Sterile tables are set up just before the operation.
operation
2. It is virtually impossible to uncover a table of sterile contents
without contamination.
contamination Covering sterile tables for later use
is not recommended.

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„ Sterile areas are
continuously
i l k
kept iin view
i
Inadvertent contamination of
sterile
il areas must be
b readily
dil
visible. To ensure this
principle:
1. Sterile persons face sterile
areas.
2. When sterile packs are open in
a room, or a sterile field set up,
someone must remain i in
i the
h
room to maintain vigilance.
Sterilityy cannot be
b ensured
without direct observation. An
unguarded sterile field should
b considered
be n id r d contaminated.
nt min t d
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„ Sterile persons keep well within the sterile area

They allow a wide margin of safety when passing unsterile


areas and follow these rules:

1. Sterile persons stand back at a safe distance from the operating


table when draping
p g the patient.
p
2. Sterile persons pass each other back to back at a 360 degree-
degree-turn
(Figure 7-7).
3. Sterile person turns back to non-
non-sterile person or area when
passing.
4. Sterile person faces sterile area to pass it.
5. Sterile
St ril person
p r asks
k non-
non-sterile
t ril iindividual
di id l tto step
t p aside
id rather
r th r th
than
risk contamination.
6. Sterile persons stay within the sterile field. They do not walk
aroundd or go outside
t id room.
7. Movement within and around a sterile area is kept to a minimum to
avoid contamination of sterile items or persons.

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„ Sterile persons keep contact
with sterile areas to a
minimum

Th ffollowing
The ll i rules
l are observed:
b d
1. Sterile persons do not lean on
sterile table and on the draped
p
patient.
2. Sitting or leaning against a non
non--
sterile surface is a break in
technique. If the sterile team sits
to operate, they do so without
proximity
i i to non
non--sterile
il areas.

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„ Unsterile person avoid sterile areas
They maintain an awareness of sterile, unsterile, clean
and contaminated areas and proximity to each.
each They
must be aware of their closeness to the sterile field.
A wide margin
g of safetyy must be maintained when
passing sterile areas by following these rules:
1. Unsterile persons maintain a distance of at least 1 foot ((30
30
cm) from any area of the sterile field.
field
2. Unsterile persons face and observe a sterile area when passing
it to be sure they do not touch it.
3. Unsterile persons never walk between two sterile areas, e.g.,
between sterile instrument tables.
4. Circulating nurse restricts to a minimum all activity near
sterile field.

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„ Destruction of integrity of microbial barriers
results in contamination

Integrity of a sterile package or sterile drape is


destroyed by perforation, puncture, or strike
strike--through.
through.

Strike-through is soaking of moisture through unsterile


Strike-
l ers to
layers t sterile layers
l ers orr vice
i e versa.
versa
ers .

The integrity of a sterile package,


package its expiration date,
date
and appearance of process monitor must be checked
for sterilityy jjust before opening.
opening
p g.

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To ensure sterilityy of packages:
p g

1. Sterile packages are laid on dry surfaces.


2. If sterile package wrapped in absorbent material becomes damp or wet, it
is re
re--sterilized or discarded. The package is considered non-
non-sterile if any
of it comes in contact with moisture.
3. Drapes are placed on a dry field.
4. If solution soaks through sterile drapes to non
non--sterile area, the wet area is
covered with impervious
p sterile drapes
p or towels.
5. Packages wrapped in muslin or paper are permitted to cool after removal
from the sterilizer and before being placed on cold surface to prevent
steam condensation and resultant contamination.
6. Sterile items are stored in clean dry areas.
7. Sterile packages are handled with clean dry hands.
8. Undue pressure on sterile packs is avoided to prevent forcing sterile air
out and pulling unsterile air into the pack.

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1. Skin cannot be sterilized.
sterilized. Skin is a potential source of
contamination in every operation
operation.. Inherent body defense usually
can overcome the h relatively
l i l few f organisms
i remaining
i i after
f patient’s
i ’
skin preparation
preparation..
All p
possible means are used to p prevent entrance of microorganisms
g
into wound. Preventive measure include:
a. Transient and resident floras are removed from skin around site
of ppatient and hands and arms of sterile team members byy
mechanical washing and chemical antisepsis.
b. Gowning and gloving of operating team is accomplished
without contamination of sterile exterior of gowns and gloves.
gloves
c. Sterile gloved hands do not directly touch skin and then deeper
tissues. Instruments used in contact with skin are discarded and
not reused.
reused
d. If glove is torn or punctured by needle or instrument, glove is
changed immediately. Needle or instrument is discarded from
sterile
il field.
fi ld
e. Sterile dressing should be applied before drapes are removed to
reduce risk of the incision being touched by contaminated
hands or objects.
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2. Some areas cannot be scrubbed.
scrubbed. When the operative
field includes the mouth, nose, throat, or anus, the
number of organisms present is great.
great.
The following steps may be taken to reduce number of
microorganisms present in these areas and to prevent
scattering
i them:
h
a. Surgeon makes an effort to use a sponge, only one, then
discards it.
it
b. Gastrointestinal tract, especially colon, is contaminated.
Measures are used to p prevent spreading
p g this contamination.
Infected areas are grossly contaminated. The team should
avoid disseminating the contamination by undue
manipulation.
manipulation

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3. Air is contaminated byy dust and droplets.
p

Environmental control measures are used.


used
1. Drapes over anesthesia screen or attached to IV poles
separate anesthesia area from sterile field.
2. Talking is kept to minimum in the OR. Moisture
droplets are expelled with force into mask during
process of articulating words.
3. Movement around sterile field is kept to minimum to
avoid air turbulence.
4. Drapes are not flipped, fanned, or shaken to avoid
dispersion of lint and dust.

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St ilit iis never ttaken
Sterility k ffor granted.
t d It mustt be
b
maintained and checked.

Basically, there is no compromise


with
i h sterility.
ili

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Thank you
for your
attention!

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