Sie sind auf Seite 1von 66

Principles of Asepsis

ST210
Concorde Career College

Sterile
Because sterility cannot be
assured 100% of the time
**When in doubt, throw it out!

practicing sterile technique

The goal is to keep microbes to an


irreducible minimum
Strict adherence is necessary for the
protection of the patient that is undergoing
evasive surgery
Several concepts and applications are key to
the implementation of sterile technique
Use of common sense is a must
Are there gray areas?
3

practicing sterile technique

There is no compromise in sterile technique


Sterility cannot be taken for granted; it must
constantly be checked and maintained
Surgical team members constantly monitor their
own technique, as well as that of the other team
members
Breaks are identified and corrective actions are
taken
Each team member must be expecting and be
able to accept critique from others

Keeping microbes
to an irreducible
minimum

Living tissue cannot be sterilized

The skin of the patient and surgical team


members harbors microbes that cannot be
removed via the skin prep, hand washing, or
surgical scrub
Adequate prep of some surgical sites is
impossible due to the presence of a large
number of microbes
The wound may have already been exposed to
contaminants
Infection may already be present
6

Environmental hazards are present


Environmental

decontamination may be

ineffective
Airborne contaminants may come in
contact with the sterile field
Destruction of microbial barriers results
in contamination
Movement in or around may cause
contamination
7

Sterility is not absolute and cannot


be effectively proven at all times

Chemical indicators (external and internal) only


verify exposure to the sterilization process. They
are not proof of sterility.
All types of packaging materials for sterilization
have disadvantages
Human error can effect the outcome of the
sterilization process
Handling and storage conditions may compromise
sterility
Microbes that have not yet been identified may be
a threat
8

Surgical Conscience
THE

HONESTY AND MORAL INTEGRITY


TO UPHOLD STRICT STERILE
TECHNIQUE
An STSR must be conscientious enough to
recognize and correct breaks in technique
An individual who hesitates or refuses to admit
a break in sterile technique has no place in the
operating room
9

SURGICAL CONSCIENCE

THE SURGICAL TECHNOLOGIST


MUST BE ABLE TO RECOGNIZE
AND CORRECT BREAKS IN
STERILE TECHNIQUE,
WHETHER THEY ARE
COMMITTED IN THE PRESENCE
OF OTHERS OR ALONE.
10

FUNDAMENTALS OF ASEPTIC
TECHNIQUE

11

Considered Contaminated
A situation

where one or more of the


principles of asepsis may have been
violated
The term considered means that the
situation has been thought about carefully
and a decision has been made to deem or
regard the situation in the same manner
as a blatant or gross contamination
12

PRINCIPLE # 1

A STERILE FIELD IS
CREATED FOR EACH
SURGICAL
PROCEDURE.
Must be appropriately
attired prior to entering
the sterile field
Movement in and
around the sterile field
must not compromise
the sterility of the field
13

PRINCIPLE # 1 cont.

THE STERILE FIELD CONSISTS OF a


separate, sterile area that in a larger sense
consists of the surgical site itself, the draped
portions of the patient and OR table, the
sterile portions of the gowns and gloves
and the draped ring stands, Mayo stand, and
back table.

14

PRINCIPLE # 1 cont.
AS

TIME PASSES there is a likelihood that


a sterile field has become contaminated by
error or by airborne contaminants.
Therefore, it should be created as close to
the time of use as possible. After the sterile
supplies have been opened, the room
must be monitored.
15

PRINCIPLE # 1 cont.
If

a case is switched to another OR, and


the sterile supplies and instruments have
already been opened, the back table
should NEVER be covered with a sterile
drape to be moved to another room.

16

PRINCIPLE # 1 cont.
CHEMICAL

INDICATORS- Internal or
external monitors change color when
exposed to the sterilization process. If
the indicator did not change to the
appropriate color, the items should be
considered unsterile.

17

PRINCIPLE # 1 cont.
Instruments,

such as knife blades, that


come in contact with the skin should not
be reused. The instrument should be set
in a designated area to prevent further
use on deeper tissue.

18

PRINCIPLE # 1 cont.
Personnel

should not reuse instruments


used during open bowel or dirty portions
of the procedure and scrubbed team
members should regown and reglove
before returning to use sterile
instruments from the clean setup.
setup (IF 2
SEPARTE SET UPS ARE USED)

19

PRINCIPLE # 1 cont.
When

removing instruments from the


autoclave, the sterile team member must
not touch the edge of the sterilizer with
the instrument, tray, gown, or gloves.
The inside of wrappers containing sterile
items is considered sterile except for a
1-2 perimeter around the outside edge
of the wrapper.
20

PRINCIPLE # 1 cont.
The

inner edge of a heat sealed peel


pack is considered the line between
sterile and nonsterile.
The flaps should be pulled back without
tears in the peel pack itself.
The contents must never be allowed to
slide over the edge of the peel pack.
21

PRINCIPLE # 1 cont.

When opening a sterile wrapped item, the


team member opens the (1ST) flap away from
the body. The side flaps are opened and
secured in order one at a time. The last flap is
pulled toward the body. The item is then
transferred onto the sterile field or is taken
from the package by a sterile team member.

22

PRINCIPLE # 1 cont.
The

top of a sterile table is the only part


considered sterile.
Any part of the drape extending below
the top of the sterile table is considered
nonsterile.
Any item extending beyond or falling over
the top of the sterile table edge is
considered contaminated.
23

PRINCIPLE # 1 cont.

Any portion of a hose or cord that is hanging


off of a sterile field is considered
contaminated and cannot be pulled back up
onto the sterile field. Two examples are the
Bovie cord and suction tubing.
Once sterile drapes or towels have been
placed, they cannot be repositioned.
The portion of the drape that is below the table
level is considered contaminated.
24

QUESTIONABLE STERILITY

WHEN IN

DOUBT , THROW
IT OUT.
25

INTEGRITY- COMPLETE, NO
BREAKS OR TEARS
There

must be no evidence of strikethrough, tears, or punctures; all seals


must be intact; chemical indicators must
have turned color to indicate exposure to
sterilization conditions.

26

PRINCIPLE # 1 cont.

STERILE ITEMS MUST NOT BE STORED


WITH UNSTERILE ITEMS.
STERILE ITEMS FOUND IN UNSTERILE
STORAGE AREAS SHOULD BE
CONSIDERED UNSTERILE AND SHOULD
NOT BE USED

27

PRINCIPLE # 1 cont.
IMPERVIOUS-

Not allowing moisture to


penetrate (i.e., plastic drape).
PERMEABLE- capable of allowing the
passage of fluids or substances.

28

PRINCIPLE # 1 cont.
If

a package that is wrapped in a


pervious woven material drops to the
floor, the package is considered
contaminated.
If the package is impervious and the floor
is dry, the item can be transferred to the
back table but should not be placed back
in sterile storage.
29

PRINCIPLE # 1 cont.
CUASES OF CONTAMINATION
Punctures, tears, or strike-through
compromise the sterility of packages or
drapes and is considered contaminated.
If a permeable drape covers a sterile table
or field and any liquid penetrates the drape,
the drape must be considered
contaminated.

30

PRINCIPLE # 1 cont.
Sterile

packages should be stored on


smooth, clean, dry surfaces to prevent
damage of packaging materials.
Sterile packages should be stored in a
designated sterile supply storage area.
Sterile packages should be handled
with clean, dry hands.

31

PRINCIPLE # 1 cont.
Unnecessary

pressure should not be


placed on sterile packs to prevent forcing
air outward and allowing air to be pulled
inward.
Peel packs should be stored on their
sides to prevent pressure that can
rupture the package.

32

PRINCIPLE # 1 cont.

Use non-penetrating instruments to hold


drapes and cords in place.
If towel clips used on the field puncture any
draping material, the tips of the instrument
must be considered contaminated and should
be left in place until the end of the procedure.
If a penetrating towel clip is used and is
removed for any reason, the STSR should
pass the instrument off without touching the
contaminated tips and a drape should be used
to cover the area from which it was removed.
33

PRINCIPLE # 2

STERILE

TEAM MEMBERS MUST BE


APPROPRIATELY ATTIRED PRIOR TO
ENTERING THE STERILE FIELD

34

PRINCIPLE # 2 cont.
THE ATTIRE WORN BY STERILE
TEAM MEMBERS INCLUDEs A
STERILE GOWN, STERILE GLOVES,
MASK, and HAIR COVER
Team members must don sterile gown
and gloves themselves using aseptic
technique, or be gowned and gloved by
another sterile team member
35

PRINCIPLE # 2 cont.
The surgical gown is considered sterile from
the waist to the mid-chest line in front and
2 inches PROXIMAL to the elbows on the
sleeves.
The upper chest area of the gown is
considered contaminated because it cannot
be viewed directly by the wearer and
because of the possibility of the chin coming
into contact with this part of the gown.
gown

36

PRINCIPLE # 2 cont.

When standing at a table, the gown should be


considered sterile to the top of the operating table
or the top of the back table

The arms should not be folded with the hands in the


axillary region. This region is considered
contaminated because it cannot be viewed by the
wearer and because of strike-through contamination.

37

PRINCIPLE # 2 cont.

Hands should never be allowed to fall below


waist or table level.
The team member should avoid raising the
hands above the mid-chest line or over the
head.
The back of the gown is considered
contaminated because it cannot be viewed by
the wearer.
When wearing a sterile gown, the back should
never be turned toward a sterile field.
38

PRINCIPLE # 2 cont.

The stockinette cuffs of the surgical gown are


considered nonsterile and should be covered
by the cuff of the glove.

A sterile person should sit only when the entire


procedure will be performed sitting down
and the hands must not fall into the lap.

39

PRINCIPLE # 2 cont.

A separate sterile surface should be used for


gowning and gloving to avoid contamination of
the back table.
The gown and gloves may be opened on a
mayo stand or small table prior
to the surgical scrub.
When using a platform, moving from a lower
position to a higher position should be avoided
as much as possible.
40

PRINCIPLE # 3

MOVEMENT

IN AND AROUND THE


STERILE FIELD MUST NOT
COMPROMISE THE STERILE FIELD

41

PRINCIPLE # 3 cont.
STERILE TO STERILE
Only sterile members may touch
sterile surfaces and items.
Nonsterile personnel must not touch
sterile surfaces and items.
Walking between two sterile areas
should be avoided.
42

PRINCIPLE # 3 cont.
STERILE INDIVIDUALS KEEP WITHIN THE
STERILE FIELD
Scrubbed personnel should stay close to the
sterile field throughout the procedure.

Movement within the sterile field should be


kept to a minimum to avoid airborne
contamination.
43

PRINCIPLE # 3 cont.
Sterile team members should pass each
other face to face or back to back.
A sterile person should always face the sterile
field to avoid contamination.
A sterile person should turn their back to a
nonsterile person or area when walking past.
Talking should be kept to a minimum to
prevent contamination from airborne
moisture droplets.

44

PRINCIPLE # 3 cont.

A nonsterile person should keep at least 12-18


inches from ANY sterile item, area, or sterile
field.
Additionally, equipment and furniture that is not
covered by sterile drapes must not be included
in the sterile field and must be kept a minimum
of 12-18 inches away from a sterile surface or
item.
The STSR must be conscious of these
nonsterile items and personnel and maintain
the 12-18 inch distance
45

PRINCIPLE # 3 cont.

NONSTERILE TO NONSTERILE
Nonsterile persons should never reach over a
sterile field because of contamination from
skin fallout.
While pouring solutions only the lip of the
bottle should be over the sterile basin while
maintaining 12-18 inches above the basin. To
accommodate this, a scrub could move
containers to be filled close to the edge.
46

PRINCIPLE # 3 cont.

Solutions must never be recapped or reused


because recapping contaminates the solution
within the bottle.
When draping, a sterile person should cuff
their hands in the folds of the drapes.

47

PRINCIPLE # 3 cont.
When

draping a nonsterile surface to


create a sterile field, the nonsterile
person should cuff the hands within the
underside folds of the drape or table
cover; the drape should be opened away
from the body toward the far side of the
table first, then toward them last

48

CREATING THE STERILE FIELD


The

mask must be applied prior to


creation of the sterile field and is worn by
all individuals in the presence of the
sterile field.

The

OR doors should be closed prior to


creation of the sterile field.
49

CREATING THE STERILE FIELD


A

NUMBER OF TASKS MUST BE


PERFORMED QUICKLY AND
EFFICIENTLY PRIOR TO INITIATION
OF THE SURGICAL PRODCEDURE

50

CREATING THE STERILE FIELD cont.


FURNITIRE

NEEDED TO CREATE
A STERILE FIELD

BACK TABLE- Back table pack


RING STAND- Basin set
MAYO STAND- Gown and gloves
ADDITIONAL STAND TO OPEN
INSTRUMENTS
PREP STAND

51

CREATING THE STERILE FIELD cont.

Check dates on packages before opening.


If and item is double wrapped it will be necessary to
open both wrappers at that time.
If an item is only wrapped one time or wrapped more
than twice, it must be considered contaminated.
When adding items to the sterile field, be careful not
to drop heavy items on the sterile field since they
could puncture the barrier covering the unsterile
surface.

52

CREATING THE STERILE FIELD cont.


Nonsterile

surfaces that will have sterile


drapes applied are draped first toward
the sterile person to prevent
contamination of the gown and to avoid
reaching over the nonsterile surface

53

Breach of the Sterile Field


What occurs when one of the
principles of asepsis are violated
and the goal of keeping the
microbial count within the
sterile field to an irreducible
minimum is not met

54

Breach of the Sterile Field #1


Disregard

the contamination
Only one application and is temporary the patients life is at immediate risk
Once the patient is stabilized, the
contamination must be reported and
appropriate corrective measures taken
The surgeon may want to give systemic
prophylactic antibiotics to the patient
55

Breach of the Sterile Field #2


Remove

the sterile item from the


sterile field

The most common action chosen


Appropriate for most situations
The contaminated item is removed and

replaced
Any items subsequently contaminated must
also be removed

56

Breach of the Sterile Field #3


Cover

the contaminated item or area

Due to timing or other

circumstances, the contaminated


item cannot be removed
An impervious drape should be
used to cover the item or area to
reestablish the sterile field
57

OPENING THE BACK TABLE PACK

Check integrity
Remove outer wrapper
Check inner package
Orient on back table
Break the seal
Unfold accordingly WITHOUT PULLING FLAPS
BACK ON TABLE TOP AND TOUCHING ONLY
EDGES OF BACK TABLE DRAPE

58

OPENING BASIN SET


Check

integrity
Orient basin set
Break the seal
Unfold the first flap away from you
Unfold each side flap with respective hands
Pull flaps down instead of out to avoid
hitting sterile back table

59

OPENING SMALL WRAPPED PACKAGE


(such as initial gown on mayo) ONTO
A CLEAN SURFACE
Check

integrity
Orient package
Break seal
Open first flap away from you
Unfold each side flap with respective
hands
Pull the last flap toward you
60

OPENING A PEEL PACK

Check integrity
Orient package by grasping one edge of the peel
pack in each hand
Slowly separate the sides of the peel pack (do
not change hands halfway through opening)
Balance the item to keep it between the edges of
the glue
Maintain a safe distance
Transfer the item by projecting it onto the sterile
field without dropping it below waist level or
breaking the plane of the sterile field
61

OPENING THE INSTRUMENT SET


(Rigid Container System)
Set

on suitable surface
Verify external indicators
Break the seals and release the lid
Lift the lid straight up 12-18 inches then
step back 12-18 inches from the tray
Invert the lid and inspect the inside
Remove the retainer and check the filter
62

OPENING THE INSTRUMENT SET


(Wrapped)

Set on suitable surface


Verify external indicators
Orient set where the first flap opens away from you
Break the seal
Open the first flap away from you by reaching around the
side opposite side form sterile field
Unfold each side flap with respective hands (Pull
flaps
(
down instead of out)
Pull last flap toward yourself

63

SCRUBBING, GOWNING, AND


GLOVING

Once the initial sterile filed has been established,


the STSR:

All personal needs are attended to, PPE is donned


(eyewear, lead aprons, etc.)

perform scrub, dry, gown, and then glove


Set up case
Perform the initial count
Drape the prepped area
Create sterile field
TIME OUT!
64

65

66