Medical/Surgical Asepsis Presented by: Cynthia Bartlau, RN, PHN, MSN

Objectives At the completion of this lesson the student will be able to Discuss concepts related to the chain of infection Differentiate medical and surgical asepsis Discuss equipment used for maintaining medical and/or surgical asepsis Identify common sources for contamination Describe proper hand placement during aseptic procedures

Beginning of Modern Asepsis Previous to the discovery of asepsis many people died due to post-operative (and other) infection Dr. Ignaz Semmelweis Told doctors to wash their hands Scottish surgeon named Joseph Lister Inspired by Louis Pasteur’s formulation of the germ theory of disease Used carbolic acid in operating rooms Drastic reduction in infections

Theory of Infection Control Microorganisms Bacteria Fungi Viruses Protozoa

Pathogenic Disease causing Infectious agent Causes disease in healthy person Opportunistic pathogen Causes disease in susceptible person Virulence Communicable diseases Non-pathogenic Resident flora Colonization Can cause disease if transmitted to other areas

Infection Local Specific area of body is infected Systemic Microorganisms spread & damage other body areas Bacteremia when microbes enter blood stream Septicemia – when bacteremia spreads through all of the body systems Acute vs. chronic infection

Nosocomial – infections that occur as a result of health care delivery Endogenous source Exogenous sources Iatrogenic – infection directly caused by any diagnostic or therapeutic source

Drug-Resistant Pathogens MRSA VRE MDR TB

Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host Causative Agent Bacteria Viruses Fungi Protozoa Helminthes People Equipment Water Secretions Excretions Droplets Skin Direct-Indirect Contact/Fomite Injection/Ingestion Airborne/Aerosols Broken Skin/Mucous Membrane Gastrointestinal/Respiratory/ Urinary Tract Neonates Diabetics Immunosuppressed Cardiopulmonary Disease Chain of Infection

Medical Asepsis AKA: Clean technique Practices that inhibit the growth & spread of pathogenic microorganisms Handwashing Standard precautions Transmission based precautions PPE

The JCAHO Sentinel Event Alert quotes Julie Gerberding, MD, director of the CDC, as stating Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance. Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.

Antiseptics Prevent or inhibit growth of pathogenic organisms Not effective against spores or viruses Can be use on the skin Alcohol Betadine

Disinfection Destruction of pathogens other than spores Boiling water and chemicals Bleach solutions Zephirin Irritate or damage skin Used on objects not people

Surgical Asepsis AKA: Sterile technique Practices that destroy all microorganisms & their spores Used in specialized areas & skills Care of surgical wounds Catheter insertion Invasive procedures Surgery

Sterilization Destruction of pathogens & non-pathogens, including spores and viruses Steam under pressure Gas Radiation Chemicals Autoclave is most common piece of equipment used

CDC recommendations Preoperative/prophylactic antibiotic administration No preoperative hair removal (unless hair will interfere with operation)

Sterile Technique Procedures that keep an object or area free from living organisms Sterile vs. contaminated areas Articles must remain away from and in front of the body and above the waist

Sterile Technique Never reach across the sterile field Never turn your back to the sterile field Two inches around border is considered contaminated Sterile field must be kept dry

Sterile Gloving Only touch the outside of the package with bare hands. The inside of the package, in which the gloves are placed, is considered sterile. The wrapper, when opened provides a sterile field. Grasp only the outside edge of the wrapper.

The inside of the glove may be touched with the bare hand Grasp the first glove at the top edge of the folded- down cuff and slip in hand Slip gloved fingers into cuff of second glove and slip in second hand without contaminating The outer aspect of the glove must remain sterile Includes wrist area Keep hands above level of waist Sterile to sterile only If contamination occurs, start again with new pair of gloves

Techniques to Remove Articles from Sterile Wraps Drop technique For gauze pads, dressings, small items Wrapper is partially opened, held upside down over sterile field, dropped onto sterile field Mitten technique For bowls, drapes, linen… Using the wrap as a mitten, sterile supplies can be placed on a sterile field Transfer forceps For cotton balls, small items, or articles Sterile gloves or transfer forceps are used to transfer objects to sterile field

Skills to Demo & Practice Donning & Removing Sterile Gloves

Questions?