Chapter 57 Surgical Asepsis

Asepsis, cont. Dirty: any object that has not been cleaned or sterilized for removal of microorganisms Contaminated: anything that is not sterile Clean: medical asepsis Devoid of all gross contamination Free of many microorganisms Sterile: surgical asepsis Free of all microorganisms Many body parts are clean-not sterile:skin, mouth, GI tract, upper resp. tract Sterile body parts: abdominal cavity or ovary, uterus Areas like GU system are susceptible to infection even though bladder is sterile

Disinfection Disinfection The process that results in the destruction of most pathogens but not necessarily their spores. Methods Use of alcohol wipes, a hexachlorophene or chlorhexidine gluconate soap scrub, or a povidone- iodine scrub, surgical hand scrub Phenol or chlorine is used to disinfect floors and surfaces.

Sterilization Sterilization The process of exposing articles to steam heat under pressure or to chemical disinfectants long enough to kill all microorganisms and spores. Client usually takes home items such as washbasins, mouth care utensils, and incentive spirometers-these are not reused Methods Autoclave (uses steam at 18 pounds of pressure at a temperature of 125 C for 15 minutes), chemical disinfectants, radiation, and gas sterilization

Medical Asepsis Medical asepsis or clean technique The purpose of maintaining medical asepsis is to prevent the spread of disease from one person to another. Handwashing Standard Precautions

Surgical Asepsis Surgical asepsis or sterile technique All microorganisms and spores are destroyed before they can enter the body. Used when administering parenteral medications and performing surgical and other procedures such as urinary catheterization Often, clean technique (medical asepsis) is performed using sterile supplies. Sterile to clean, dirty, or contaminated becomes contaminated.

Sterile Technique Sterile technique is used to prevent the spread of infection Supplies used for surgical and other sterile procedures Anything that either touches an open wound or skin break, enters a sterile body cavity, or punctures the skin Surgical towels or drapes are packaged, secured with special masking tape, labeled, and sterilized. Never touch sterile articles with unsterile articles!

Key Concept Sterile to sterile remains sterile. Sterile to clean or dirty becomes contaminated. Always think before you touch anything. Do not touch sterile articles with unsterile articles

Educating the Client Client and family teaching Demonstrate the skill to be performed. Ask the client and family to demonstrate the skill before discharge. Explain how to recognize problems or complications. Describe when to seek medical care immediately. If indicated, make a referral for home care nursing follow-up.

Sterile Technique in Nursing Do not touch anything after sterile gloves or gown have been put on. Reaching over a sterile field contaminates the sterile area. If a sterile wrapper or mask becomes wet, they are no longer sterile. When wearing sterile gloves, perform a sterile procedure. A person’s back is not sterile. Skin can only be made clean, not sterile. When in doubt, consider the objects in question to be contaminated.

Sterile Technique in Nursing The inside of the gown is not sterile, someone else must tie the strings on the gown. Any part of the gown below the waist and above the nipple line is contaminated! Be sure to keep the hands between the waist and the nipple levels whenever sterile gloves are worn!

Sterile Technique Hair covering Surgical mask and eye protection Sterile gown Sterile gloves Open gloving Closed gloving Removal of sterile or nonsterile gloves

Procedures Requiring Sterile Technique Some procedures include: Care of the indwelling catheter Surgical intervention and invasive procedures Sterile dressing change Suture and staple removal Administration of parenteral medications Venipuncture and management of IVs

Urinary Catheterization Procedure of inserting a tube (a catheter) through the urethra into the bladder to remove urine Sterile procedure Catheter sizes: 14-16 Fr. (usually) Insert 2-3 inches in female; 5-7 in male or until urine is visualized Straight catheter Used for one sample only and removed Retention catheter (eg, Foley catheter) Indwelling catheter (remains in the bladder)

Catheterization Coude tip catheter is used in males if there is prostate enlargement or in the female if abnormal placement of the urinary meatus is suspected No more than 750-1000 ml of urine can be safely removed from the bladder at any one time, particularly if the client has retention or distention for a long period.

Urinary Catheterization Self-catheterization Catheterizing the female client The side-lying position Catheterizing the male client Caring for the client after catheterization Removing the retention catheter

Caring for the Client After Catheterization Reposition to ensure comfort Signal cord within reach Balloon of indwelling catheter inflated Catheter tubing secured externally Patient teaching

Caring for the Client After Catheterization, cont. Drainage tubing extends straight down from bed level to bag (straight drainage) Extra tubing placed on bed with client—allows movement Attach drainage apparatus to bed frame (not the side rails) Maintain sterility Removing the retention catheter

Nursing Alert A catheter is never cut for removal. This could cause the catheter to be pulled back into the urethra or bladder. In that case, surgical removal would probably be necessary. This would also be a source for introducing pathogenic organisms into the urinary bladder.