Aseptic Techniques

Aseptic Techniques The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens and/or harmful microorganisms Sterile procedures

Surgical Asepsis Protection against infection before, during, and after surgery by using sterile techniques

The removal of or destruction of infected material Medical Asepsis The removal of or destruction of infected material

Establishing a Sterile Field Drape The drape is lifted out of the cover and allowed to open freely without touching anything. Another corner of the drape then is picked up carefully and laid on a clean, dry surface with the bottom farthest from the person establishing the field. Necessary sterile supplies can be added to the field using the proper package-opening techniques. FIG. 17-3 Establishing a sterile field. A, Holding the drape with one hand by the corner. B, Folding back the top to lift the cover and laying the drape on a clean, dry surface with the bottom farthest from the person establishing the field.

Dropping Sterile Contents onto a Sterile Field Drop the contents gently onto the sterile field from approximately 6 inches above the field and at a slight angle. This technique helps ensure that the package wrapping does not touch the sterile field at any time. Insert Fig 17-2 here FIG. 17-2 Opening commercially prepared sterile packs to drop sponges onto a sterile field.

Surgical Scrubbing The purposes of the surgical hand scrub are (1) to remove debris and transient microorganisms from the hands, nails, and forearms; (2) to reduce the resident microbial count to a minimum; and (3) to inhibit rapid rebound growth of microorganisms. Currently, a surgical scrub with 2% chlorhexidine gluconate or 7.5% povidone-iodine is performed before each procedure. FIG. 17-6 Drying the hands and arms after a surgical scrub. A, Pick up a sterile towel from the table, being careful not to drip water on the gown beneath it. B, Fold the towel lengthwise. C, Use one end of the towel only to dry one hand. D, Rotate the arm as you proceed to dry it, working from the wrist to the elbow. Do not allow the towel to contact the scrub suit. E and F, After the arm is dried, bring the dry hand to the opposite end of the towel and begin drying the other hand. G, Dry the arm using the blotting rotating motion. H, Proceed to the elbow. The towel must be discarded in the linen hamper or kick bucket.

Putting on a Sterile Gown Insert Fig 17-7 here Gowns and gloves are put on after the surgical scrub. Gowning can be done in two ways: self-gowning and gowning another person. After the gown is on, only the sleeves and front of the gown down to the waist are considered sterile. To maintain sterile technique once in sterile gown and gloves, persons must pass each other back to back. FIG. 17-7 Self-gowning. A, Grasp the gown firmly and bring it away from the table. It has been folded so that the outside faces away. B, Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown. C, Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside cuff of gown. D, The circulator assists by pulling the gown over the shoulders and tying it.

Gloving over a Sterile Gown FIG. 17-8 Self-gloving, closed technique. A, Lay the glove palm-down over the cuff of the gown. The fingers of the glove face toward you. B and C, Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. D and E, Unroll the glove cuff so that it covers the sleeve cuff. F through I, Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.

Gowning Another Person 1. The sterile person picks up the gown by the neckband, holds it at arm’s length, and allows it to unfold. 2. The gown is held by the shoulder seams with the outside facing the sterile person. 3. The sterile gloves are protected by placing both hands under the back panel of the gown’s shoulder. 4. The arms are slipped into the sleeves in a downward motion, sliding the gown up to the mid-upper arms. 5. A nonsterile circulator pulls the gown up and fastens the back and waistband of the gown. 6. Gently pull the cuff back over the person’s hands, being careful that your gloved hands do not touch the bare hands. FIG. 17-10 Gowning another person. A, Grasp the gown so that the outside faces toward you. Holding the gown at the shoulders, cuff your hands under the gown’s shoulders. B, The person steps forward and places his or her arms in the sleeves. Slide the gown up to the mid-upper arms. C, The circulator assists in pulling the gown up and tying it. D, Gently pull the cuffs back over the person’s hands. Be careful that your gloved hands do not touch his or her bare hands.

Two-Person Gloving FIG. 17-11 Gloving another person. A, Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so a wide opening is created. Keep thumbs under the cuff. B, The person thrusts his or her hands into the glove. Do not release the glove yet. C, Gently release the cuff (do not let the cuff snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.

Removing Sterile Gloves Insert Fig 17-12 here The procedure for removing gloves aseptically is also important to avoid contamination. FIG. 17-12 Removing contaminated gloves aseptically. A, Grasp the edge of the glove. B, Unroll the glove over the hand. Discard the glove (not shown). C, With the bare hand, grasp the opposite glove cuff on its inside surface. D, Remove the glove by inverting it over the hand. Discard the glove (not shown).

Sterile Procedures Dressing changes Tracheostomies Chest tubes Providing airway Chest tubes Urinary catheters Central venous or arterial lines Pacemakers Regulate heart rate Surgical radiography C-arm

Nonaseptic Techniques Non sterile procedures NG tube Urinals Bedpans Enema Colostomies