1. Aseptic Technique: The sterile field, gloving and gowning September 2012 Innovating for life. UC201302326 EE

2. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Learning Objectives Understand Aseptic Technique –Different rooms for different procedures –Creating and Maintaining a Sterile Field –Gowning and Gloving

3. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Different Rooms for Different Procedures The Cardiac Cath Lab –Non-invasive cardiac and vascular interventions The Cardiac Hybrid OR –Fully equipped surgical suite –Blending cath lab imaging in an OR setting –Sterility of an OR

4. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. What are Aseptic Techniques? According to the organization EngenderHealth, aseptic techniques are those which: remove or kill microorganisms from hands and objects; employ sterile instruments and other items; reduce patients’ risk of exposure to microorganisms that cannot be removed.

5. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Why do we use them? FOR THE PATIENT!!

6. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. The Sterile Field A Sterile Field can be created on any flat surface in the procedure room. Respect the BLUE!

7. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. The Sterile Field The Sterile Field is 3-DIMENSIONAL - Nothing can be passed OVER a sterile field. When passing a sterile object, give at LEAST 6 to 12 inches clearance. - Be aware of loose clothing, badges, lead apron.

8. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Sterile Packaging TWO TYPES: Envelope Wrap – Object is contained within a single sterile wrapper and opened in a “four corners” technique. Peel Pack – Object contained in a bi-layer wrapper that is “peeled” open. Band-aids are in peel packs.

9. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gowning and Gloving Prepare the Gown: Open Envelope Wrap: - Away from you FIRST - Side then Side - Toward you LAST Open Gloves: - Master the peel pack “pop” - OR just hand them to Circulating Nurse.

10. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Scrubbing May be country specific –Traditional water scrub –Alcohol – based solutions Please refer to your regions standards

11. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Example of Traditional Scrubbing Technique First hand scrub of the day should be 5 minutes. Start with nails and fingertips. Divide each part of arm (fingers, hand, arm) into 4 planes. 10 scrubs per plane. Move from fingertips to elbows. When rinsing, be aware of faucet, sink, other potential contaminants. Move from fingertips to elbows. Keep arms away from body. Enter procedure room backwards.

12. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gowning after Traditional Scrub Technique Carefully pick up towel without dripping onto gown or contaminating gloves. Use half of towel to dry from hand to elbow. Flip towel over and use clean side to dry other hand from hand to elbow. Drop towel into bin or onto the floor. Note: Hand to elbow direction is critical !

13. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gowning - Self Pick up gown without contaminating gloves. Slide hands into arm pockets on either side of the gown. While grasping gown with left hand, slide right arm into sleeve of gown. Keep hand INSIDE cuff of gown. Cross right hand over chest and slide left arm into sleeve of gown. Keep hand INSIDE cuff of gown. Ask (NICELY!) if a non-sterile person can tie up the back of gown.

14. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gowning - Assisted Scrub person will open gown and hold at proper height. Walk towards them with your arms forward at a height between your chest and bellybutton (zombie style). As they pull gown over your shoulders, keep arms straight and on either side of scrub person. Do NOT allow arms to dive down! Keep hands inside cuffs until scrub person instructs you otherwise.

15. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gloving – Self: Closed Glove Technique Keep hands inside cuffs of gown (sock puppet hands). Manipulate glove wrapper so gloves are correct (L and R). Pick up Right glove and lay on palm: cuff to fingertips and thumb to thumb. Use left hand to open cuff, then wiggle Right fingers into glove. Flip glove while pulling cuff with left hand. Push, pull, and wiggle Right glove into place. Make sure glove covers all of whi te cuff on sleeve.

16. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gloving – Self: Closed Glove Technique Pick up Left glove and lay on palm: cuff to fingertips and thumb on thumb. Use gloved right hand to pull glove over Left hand. Push, pull, and wiggle Left glove into place. Adjust gloves if necessary, making sure white cuffs on gown are covered.

17. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Gloving – Assisted: Open Gloving Technique Scrub person will pull down cuffs of gown. Scrub person will hold out Right glove first with thumb towards you. Relax hand and move in a slow downward motion – do NOT dive hand into the floor! Scrub person will pull glove upwards. If glove is not on properly, just wait until both gloves are on to fix. Scrub person will hold out left glove with thumb toward you. Use two fingers of gloved right hand to help pull Left glove open. Relax hand and move in a slow downward motion. Fix gloves making sure cuffs are covered.

18. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Spinning Do a little dance... Grasp spin card in right hand, separate short tie and hold in left hand. Pass card to sterile OR unsterile person. Spin toward your LEFT. Pull long tie, allowing it to separate from card. Tie gown on left hip.

19. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Now that you are sterile... Let’s keep it that way!!!

20. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Maintaining the Sterile Field Sterile Zones: YOU: front of gown from CHEST to TABLE HEIGHT and arms up to 5cm above elbow. NEVER drop your arms! Only FRONT of gown is sterile. Pass other people back to back.

21. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Maintaining the Sterile Field Sterile Zones: Tables: avoid reaching below table height. C-arm, light handles: be careful reaching for these items as they are above shoulder height.

22. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Now what happens when...... You have contaminated OR You THINK you have contaminated something?

23. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. When in DOUBT... Throw it OUT!

24. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Quiz GOOD Aseptic Technique or BAD Aseptic Technique? BAD! Assistant is unsterile! GOOD! Cuffs of gown are covered.

25. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Quiz GOOD or BAD Aseptic Technique? BAD! You cannot tie up your own gown! BAD! Hands above chest height. BETTER….

26. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2012. All Rights Reserved. Summary Understanding aseptic technique will help you integrate into the procedure room Creating and maintaining the sterile field is essential for patient safety Proper gowning and gloving technique should be mastered prior to your first case Engager is a registered trademark of Medtronic, Inc. For more information and a complete list of adverse events, warning and contraindications reference Engager IFU.