Surgical asepsis

Prepared by,K.THILAGAVATHI,M.Sc(N).,Lecturer SURGICAL ASEPSIS

SURGICAL ASEPSIS

Refers to the procedures used to keep the object or areas sterile or completely free from micro organisms.In surgical asepsis all practices are directed to the elimination of both pathogenic and nonpathogenic micro-organisms.Principles in surgical asepsisPrinciples RationaleAlways face the sterile field. Do not turn back or side on a sterile fieldSterile objects which are out of vision are considered questionable and their sterility cannot be guaranted.Keep sterile equipment above your waist level or above table level.Waist level and table level are considered margins of safety and will promote maximum visibility of the sterile field.Do not speak, sneeze and cough over a sterile field.To prevent or droplet infection.Never reach across sterile fieldWhen a nonsterile object is held above a sterile object, Gravity causes micro organisms to fall into the sterile field.Principles RationaleKeep the unsterile objects away from the sterile field.Micro organisms may be transferred whenever a non sterile object touches a sterile field.Keep the sterile field dryMicro organisms do not pass easily through a dry surface.The edge of the sterile field is considered unsterile.Proximity to a contaminated area makes sterilty doubtful.Handle liquids cautiously near the sterile field or prevent drapes or wrappers from becoming wet.When a liquid wets it connects a nonsterile field with a sterile field.Principles RationaleEach sterile supply should be clearly labeled as to its contents, time and date of sterilization.To ensure sterility.Never assume that a object is sterile. Always check the sterility expiration date.Sterility of an object wrapped in paper or cloth becomes doubtful after 4 weeks.Avoid sweeping and dusting when the sterile objects are opened.Micro organisms travel in the dust particlesPut on mask, Wash hands, put on gowns and gloves before handling sterile supplies.To prevent contamination.PROCEDURES INCLUDED IN SURGICAL ASEPSISSurgical hand scrubDonning a sterile gownApplying and removing a sterile gloves1.Surgical hand scrubPurpose :Remove as many micro organisms from the hands as possible before the sterile procedure.1.SURGICAL HAND SCRUB

Equipment Warm running waterAntiseptic Soap Solution Hand brush stored in a sterile containerTransferring forcepsSterile towel

Steps of the procedure1.Makesure fingernails are short,clean,healthy.Nail polish should be removed.2.Remove jewelries(Rings, Bracelets).3.Apply personal protective equipment(PPE) includes surgical shoe covers,Cap,Facemask and protective eyewear.

4.Open disposable brush impregnated with antimicrobial soap5.If no disposable brush is not available/some hospital use brush sterilized and stored in the small bin.

6.Use a transferring forceps to pick up the brush from the sterile bin.7. Turn on the water and adjust the flow so that the water is warm. Warm water removes less of the protective oil of the skin than hot water.8.Wet hands and arms. Keep hands above elbowsRationale: Movement of water and dirt will flow from hands to less clean areas thus preventing contamination of the hands during scrub.

9.Wet scrub brush or apply antibacterial soap if not already impregnated in the brush.10.Anatomic timed scrub: Starting with fingertips, scrub each anatomic area (Nail, fingers each side and web space,palmar,dorsal surface and Forearm) for around 5 minutes.

11.Scrub vigorously using vertical strokes in a circular manner. Repeat with other hand.Rationale: Ensures that all surfaces will be systematically scrubbed to remove transient and resident micro organisms.12.Counted brush stroke method: Starting finger tips, scrub each anatomic area for the designated number of strokes. Scrub vigorously using vertical strokes.

13.Rinse hands thoroughly under warm running water, holding hands upward. This is to allow water to drain towards the flexed elbows.Rationale : Prevents contamination of the hands from dirtier areas. Remember do not touch anything before and after rinsing hands. Touching non sterile objects would mean the surgical scrub need to be repeated.14.Keep hands held upward to allow water to drip from the hands to elbow.15.Dry hands with a sterile towel.

2.Donning a sterile gown

2.Donning a sterile gownPurpose : To apply entire necessary to safely carryout sterile procedures usually in the operating room and delivery room.

Donning a sterile gown1.Grasp folded sterile gown at the neckline and step away from the sterile field. Allow gown to gently unfold, being careful that does not touch the floor. The inside of the gown is towards the user.Rationale: Maintains sterility of the gown and positions it for donning.

2.Holding the arms at the shoulder level, grasp the sterile gown just below the neckband near the shoulders and slide arms in the sleeves until the fingers are at the end of the cuffs but not through the cuffs.Rationale : The finger remain in the cuffs to protect the sterility of the gown and prepared for closed gloving.3.Have someone tie the back of the gown ,taking care that only the ties are touched and not the sides of the gown.Rationale: Maintains sterility of the gown. Gowns are considered sterile in front of the shoulders sterile from 2 inches above the elbow to the wrist.

3.APPLYING AND REMOVING STERILE GLOVES

Donning a glove

Purpose :Prevent transfer of micro organisms from hands to sterile objects or open wounds. A.Applying gloves1.With fingers still within the cuff of the gown, open the inner sterile glove package and pick up the first glove by the cuff, using the nondominant hand.Rationale :Maintains the sterility of the gloves.2.Position the glove over the cuff of the gown so the fingers are in alignment and stretch the entire glove over the cuff of the gown, being careful not to touch its edge. Finger remain within the cuff of the gown.

3.Use the sterile gloved hand to pick up the second glove, placing it over the cuff of the gown of the other hand and repeat the glove application process.4.Adjust gloves for comfort and fit, taking care to keep gloved hands above waist level at all times.Rationale : If gloved hands fall below the waist level,there are no longer Sterile.B.Removing gloves:1.Wash gloved hands first.2.With dominant hand,grasp outer surface of non dominat glove just below thumb. Peel off glove insideout,without touching exposed wrist.Rationale :After use, outer surface of gloves is contaminated and could transfer micro organisms to the nurses wrist.

3.Placed ungloved hand under thumb side of second cuff and peel off the fingers holding first glove inside second glove. Discard into appropriate binRationale: Folding contaminated glove surfaces toward the inside minimize the chance to transfer of micro organisms. Use glove to glove skin to skin technique when removing gloves. 4.Wash hands before and after removing gloves to prevent contamination of hands.