1. Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies CHAPTER Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved THIRD EDITION Infection Control Lesson 3: Surgical Asepsis 34

2. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Lesson Objectives Upon completion of this lesson, students should be able to: 1.Define and spell the terms to learn for this chapter. 2.Define surgical asepsis. 3.Explain the difference between sanitization, disinfection, and sterilization. 4.Discuss two methods for sterilizing instruments.

3. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Critical Thinking Questions 1.When might you use medical asepsis versus surgical asepsis? 2.What is the difference?

4. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Surgical Asepsis  Techniques practiced to maintain a sterile environment  Destruction of organisms before they enter the body Sanitization Disinfection Sterilization

5. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sanitization  Cleaning process that inhibits or inactivates pathogens through careful cleaning of equipment and instruments to remove debris  Accomplished by rinsing and scrubbing the instruments with a brush and a detergent with a neutral pH, such as a low-sudsing soap

6. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sanitization  After debris has been removed, items rinsed in hot water and air dried  Wear thick utility gloves

7. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sanitization  Cleans items, but does not destroy microorganisms and bacteria  Used for supplies and equipment that do not come into direct contact with patient or that touch only the skin surface

8. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Sanitizing Instruments Apply both disposable and rubber gloves Place low-sudsing (low pH) detergent or germicidal agent in large container with water Rinse instruments in clear water in either sink or container

9. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Sanitizing Instruments Delicate and sharp instruments should be separated from general instruments Scrub each instrument individually with a brush and detergent under running water

10. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-5 Sanitizing Instruments FIGURE A Delicate and sharp instruments should be kept separated from others.

11. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-5 Sanitizing Instruments FIGURE B Take extra care to scrub the hinges and screws of equipment as necessary.

12. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Sanitizing Instruments Open instruments to thoroughly scrub all serrated edges, crevices, and hinge areas Rinse instruments thoroughly under hot water After thoroughly rinsing cleaned instruments, roll them in a towel and hand dry them

13. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Sanitizing Instruments Check the condition of all instruments for defects or any remaining soil Discard disposable towels and disposable instruments in biohazard waste container

14. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Sanitizing Instruments Remove utility gloves and disposable gloves and perform hand hygiene Place sanitized instruments in appropriate area for storage or wrap instrument(s) for sterilization or place them in an ultrasonic cleaner If necessary, perform quality assurance reporting in necessary log books regarding sanitization practices

15. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Critical Thinking Question 1.What process is used for instruments that break the surface of the skin?

16. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Disinfection  Destroys or inhibits activity of disease- causing organisms  Does not always kill spores or certain viruses  Involves soaking items and/or wiping items  Disinfecting agents: chemical germicides, flowing steam, boiling water

17. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Disinfection  Chemical disinfection process referred to as a "cold" process  Heat neither used nor generated  Chemical disinfectants: soap, alcohol, phenol, acid, alkalines (such as bleach), and formaldehyde

18. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved TABLE 34-6 Disinfection Methods

19. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Disinfection Methods Alcohol (70% Isopropyl)  Used for skin surfaces, equipment such as stethoscopes and thermometers, and table surfaces  Causes damage to rubber products, lenses, and plastic  Flammable

20. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Disinfection Methods Chlorine (Sodium Hypochlorite or Bleach)  Use in dilution of 1:10 (1 part bleach to 10 parts water)  Used to eliminate a broad spectrum of microorganisms

21. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Disinfection Methods Chlorine (Sodium Hypochlorite or Bleach)  Has corrosive effect on instruments, rubber, and plastic products  Can cause skin irritation  Inexpensive

22. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Disinfection Methods Formaldehyde  Used to disinfect and sterilize  Dangerous product regulated by OSHA—must have clearly marked labels Hydrogen Peroxide  Effective disinfectant for use only on nonhuman surfaces and products  May damage rubber, plastics, metals

23. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Disinfection Methods Glutaraldehyde  Effective against viruses, bacteria, fungi, and some spores  Regulated by OSHA—must have clearly marked labels and be used only in well- ventilated area  Must wear gloves and masks when using

24. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Disinfection  Completely immerse contaminated instruments and equipment in germicidal solution for period of time stated in manufacturer's instructions  Then rinse in water and dry them  Objects that come into contact with mucous membranes, such as vaginal speculums, laryngoscopes, or thermometers, must be disinfected

25. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Disinfection  Instruments and equipment that cannot be soaked, such as scopes, computers, and electrical instruments, should be wiped thoroughly with a germicidal solution  Germicidal solutions changed frequently  Boiling water can be used as means of disinfection

26. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Disinfection  Antiseptics inhibit growth of microorganisms on skin surfaces  Most commonly used antiseptic is 70% isopropyl alcohol  Other antiseptics, such as povidone- iodine solution (Betadine), are safe and more effective

27. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sterilization  Process that kills all microorganisms, both pathogenic and nonpathogenic  Heat sterilization can kill spores, bacteria, and other microorganisms

28. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sterilization  Dry heat used for sterilizing dense ointments, such as petroleum jelly  All supplies (dressings, needles, instruments that come into contact with internal body tissue or open wound) must be sterile

29. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Sterilization  Once sterile article touched by hands or another unsterile object, it is considered contaminated  Sterile gloves must be used when touching sterilized items  Procedure for applying sterile and nonsterile gloves sometimes referred to as donning

30. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Steam under pressure  Dry heat (320°F for 1 hour)  Dry gas  Radiation  High heat and moisture caused by steam causes the cells of the microorganisms to explode and thus killing the microorganisms

31. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved FIGURE 34-7 An autoclave.

32. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Requires 15 pounds of pressure per square inch (PSI) and temperature of 250°F to 270°F  Heat transferred to items by way of the steam condensation through use of distilled water

33. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Consists of outer chamber (jacket) that creates a buildup of steam that is forced into an inner chamber; items to be sterilized placed inside inner chamber

34. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Jacket pressure gauge to indicate pressure in outer chamber  Chamber pressure gauge to indicate steam pressure in inner chamber  Temperature gauge to indicate temperature in inner chamber in which items are placed

35. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Critical Thinking Question 1.Why must you clean the autoclave?

36. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave Maintenance  Read and follow manufacturer's instructions  Cleansed on a regular basis  Regulated checks to ensure proper functioning

37. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Critical Thinking Question 1.What could be the result of a malfunctioning autoclave?

38. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Wrappings in which instruments and materials are sterilized must be permeable and strong enough to hold together during steam process

39. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Wrapping materials: heavy paper, muslin, plastic, and stainless steel containers  All items completely covered with wrapping material and fastened with autoclave tape

40. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-6 Wrapping and Labeling Instruments for Autoclaving FIGURE A Place items (with hinges open) in the center of wrapping material. Fold the bottom up and over the instruments.

41. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-6 Wrapping and Labeling Instruments for Autoclaving FIGURE B Fold the right side of the paper until it covers the item and make a small flap. Proceed in the same way with the left side.

42. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Autoclave indicator tape used to fasten autoclave package securely  Lines on tape change color during autoclaving process and indicate that exposure to the high temperature has occurred  Not necessarily indication that proper time and temperature for sterilization reached

43. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-6 Wrapping and Labeling Instruments for Autoclaving FIGURE C Fold the bottom of the package up toward the top until the top corner remains.

44. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-6 Wrapping and Labeling Instruments for Autoclaving FIGURE D Use a piece of autoclave tape to secure the package.

45. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Sterilization indicators (strips) used to signify proper and complete sterilization  Strip placed inside wrapper of packages or in chamber when using open trays

46. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-7 Sterilizing Instruments in an Autoclave FIGURE A Check the water level in the autoclave and add distilled water as necessary.

47. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-7 Sterilizing Instruments in an Autoclave FIGURE B Properly set the autoclave controls according to the manufacturer’s instructions.

48. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved PROCEDURE 34-7 Sterilizing Instruments in an Autoclave FIGURE C Remove instruments and packages to a clean container using sterile transfer forceps.

49. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Color changes or dots appear on an indicator denote inner contents exposed to required conditions necessary for sterility: Correct temperature, correct time, exposure to moisture

50. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Critical Thinking Question 1.When and why should you use a sterilization bag?

51. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Sterilization pouches or bags often used to hold individual instruments  Each package labeled with date of sterilization, items within packet, and initials of individual who prepared the pack

52. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Instruments with hinges in open position  Tubing free of any kinks  Syringes unassembled before wrapping

53. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Instruments used immediately can be placed in open perforated trays and left unwrapped  Lid immediately placed over instruments after sterilization

54. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Containers and jars of supplies placed on their sides in order for full sterilization to occur  Solutions autoclaved separately

55. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  After autoclave process complete, drying process takes place  Almost as important as achieving correct temperature and pressure during autoclaving

56. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Wetness on items ("wet packs") can cause a break in sterility  Autoclaved packages stored in dry and dust-free shelves or drawers

57. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Infection Control: Physical and Chemical Barriers Autoclave  Autoclave packs organized according to date and type of item(s) visible  Instruments considered sterile for 21 to 30 days  Autoclaved items cannot be reautoclaved in the same packages without washing, rinsing, drying, and rewrapping each item

58. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 3/e Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Questions?