Surgical Asepsis Fundamentals of Nursing Care, Burton & Ludwig, 2 nd ed. & accompanying workbook. Ch. 22 Objectives 1.Define various terms associated with surgical asepsis. 2.Identify guidelines for using sterile technique while opeining sterile supplies, setting up & adding items to the sterile field, opening sterile packs & working with a sterile field. 3.Determine when to use sterile technique. 4.Skills: applying sterile gloves setting up sterile field.

Terminology Related to Sterilization of Instruments Autoclaving: delivers steam under pressure Boiling: for 10 min; does not kill spores Ionizing radiation: kills pathogens on sutures, plastics, & biological materials Chemical disinfection: kills pathogens on equipment that cannot be heated Gaseous disinfection: kills pathogens on equipment that cannot be heated or get wet

Surgical Asepsis (Sterile Technique) Method used to prevent contamination during invasive procedures, or procedures that involve entering body cavities Requires the use of sterile supplies & equipment that have been treated to kill all pathogens & spores

Evidence of Sterilization Surgical instruments are often double- wrapped in a surgical towel & an outside wrapper, then sterilized in an autoclave An indicator tape is applied to the outer wrapper, showing black marks every half-inch The person who autoclaves the pack writes initials, date, expiration date on the tape A “strike-through” indicates the pack is not sterile

Restricted Areas in Hospitals Some areas of the hospital are considered restricted to help maintain surgical asepsis Staff remove street clothes & then dress in hospital-laundered scrubs Dressing in scrubs prevents contamination of the unit with lint, pet hair, or other outside pathogens

Restricted Areas in Hospitals (cont.) Surgical suites Heart catheterization laboratories Delivery rooms Neonatal intensive care units Burn units Transplant intensive care units Oncology units

Sterile Conscience Always being aware of potential or certain contamination of the sterile field or sterile objects Taking appropriate steps to correct the situation, such as replacing the contaminated object or reassembling the sterile field with new supplies

True/False Question When contamination of a sterile field might have occurred, it is up to the nurse’s discretion whether to replace the sterile items with new ones. A. True B. False

Answer B. False Rationale: When contamination occurs, you can no longer use the contaminated object or drape. It must be replaced with new sterile supplies.

Includes: Creation of a sterile environment Use of sterile equipment/supplies Sterilization of reusable supplies Surgical hand scrub Surgical attire Sterile gloves Sterile field Use of sterile technique Implementing Surgical Asepsis

Never touch anything with bare hands that comes from a body surface or cavity Gloves are to be worn for contact with Body fluids of any sort, including: Saliva, urine Feces, blood The only times gloves are not worn is for contact with intact skin or unsoiled articles. Guidelines for Patient Care Contact

Guiding Principle for Sterile Technique Sterile + sterile = sterile Sterile + unsterile = contaminated Unsterile + unsterile = contaminated

1.Consider procedure to be performed, & consult agency policy on use of gloves. 2. Inspect hands for cuts, open lesions, or abrasions. 3.Assess if pt or health care worker has a known allergy to latex. Guidelines for gloves

4. Examine glove package to ensure package is not wet, torn, or discolored. 5. Perform thorough hand washing, & determine correct glove size & type of glove material to be used. Guidelines for gloves

Know what is sterile Know what is not sterile Separate sterile from unsterile Remedy contamination immediately 4 Rules of Surgical Asepsis

1.A sterile object remains sterile only when touched by another sterile object. 2.Only sterile objects may be placed on a sterile field. 3.A sterile object or field out of the range of vision or an object held below the person’s waist is contaminated. Principles of Surgical Asepsis

4. A sterile object or field becomes contaminated by prolonged exposure to the air. 5. A sterile object or field becomes contaminated by capillary action when a sterile surface comes in contact with a wet contaminated surface. Principles of Surgical Asepsis

6.Because fluid flows in the direction of gravity, a sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object’s surface. 7. The edges of a sterile field or container are contaminated. Principles of Surgical Asepsis

Non-sterile Person Opening Peel Pack for Sterile Person The nonsterile person peels the pack apart with the opening toward the sterile person The nonsterile person peels the packaging to cover their bare hands The sterile person then grasps the item, touching only the sterile item & possibly the inside of the sterile pack

Opening Sterile Supplies to Add to Sterile Field Open the peel pack away from you Allow the item to drop onto the sterile field; don’t reach across the field Come in from the side to drop the item onto the field, being careful that it lands in the middle of the field and does not touch the outer 1 inch of drape that is considered contaminated

Safety Checks When Opening Sterile Supplies Check the expiration date for sterility Check sterilization tape, if present, for color change—the hash marks should be dark Check packaging for any holes or tears that would render the contents nonsterile

When to Use Sterile Technique When entering a sterile body cavity with a tube or other invasive equipment When caring for patients whose skin is not intact, creating exposure to pathogens During procedures that expose body cavities, or enter major blood vessels When handling needles, syringes, & lancets

Handling Needles, Syringes, Lancets Keep needles & lancing devices sterile at all times The shaft, bevel, & hub of the needle should not be touched Do not touch the sharp portion of the lancet

Handling Needles, Syringes, Lancets (cont.) After use, immediately put a used needle or lancet into a puncture-proof sharps container Do not recap a used needle, as the risk of puncturing yourself is too great