1. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Chapter 22 Surgical Asepsis

2. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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, and 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

3. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Medical Asepsis (Clean Technique)  Medical asepsis: practices performed to prevent the spread of infection  Standard precautions: measures to prevent the transmission of pathogens in the blood and body fluids  Performing hand hygiene, wearing appropriate protective equipment, and using cough etiquette

4. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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 and equipment that have been treated to kill all pathogens and spores

5. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Evidence of Sterilization  Surgical instruments are often double- wrapped in a surgical towel and 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, and expiration date on the tape  A “strike-through” indicates the pack is not sterile

6. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company

7. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Restricted Areas in Hospitals  Some areas of the hospital are considered restricted to help maintain surgical asepsis  Staff remove street clothes and then dress in hospital-laundered scrubs  Dressing in scrubs prevents contamination of the unit with lint, pet hair, or other outside pathogens

8. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Restricted Areas in Hospitals (cont.)  Surgical suites  Heart catheterization laboratories  Delivery rooms  Neonatal intensive care units  Burn units  Transplant intensive care units  Oncology units

9. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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, and lancets

10. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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

11. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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

12. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Opening Sterile Pack  Place package on a clean, dry, non-clutter surface at waist level  Position package so that the first flap will open away from you  Open flap away from you first, then open each side flap, then open flap towards you last  If double wrapped—open both layers the same

13. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Sterile Field  An area that is free of all microorganisms  Additional sterile items can be placed  Skin can not be sterilized  Sterile gloves

14. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Sterile Field  Outer 1 inch considered contaminated  Anything below waist level or out of eye sight considered contaminated  Only sterile items can be placed on the sterile field  If sterile field becomes damp or wet— contaminated—unless drape has moisture- proof back

15. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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

16. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company

17. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Adding Sterile Items  Drop sterile item onto field—6” above field  Do not let wrapper touch sterile item  Do not drop in outer 1 inch border  Pour liquid 4 to 6 inches above basin  Pour solution slowly to prevent splashing  Properly applied sterile gloves to touch sterile items on sterile field

18. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Rules for Sterile Field  NEVER reach across a sterile field  Keep sterile field in view at all times  Never turn your back on a sterile field  Once apply sterile gloves—hands must stay in safety zone—above waist level, below eye level, and in front of body at all times

19. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Rules for Sterile Field  Out of safety zone—contaminated  Discard items by dropping—keep hands in safety zone  Prepare sterile field just prior to use— exposure to air for long period of time— contaminated

20. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 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

21. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company True/False Question Procedures requiring sterile technique can be delegated to assistive personnel. A. True B. False

22. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guiding Principle for Sterile Technique  Sterile touches non-sterile  CONTAMINATED  Sterile touches sterile  STERILE

23. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Sterile Gloving  Wash hands  Proper size  Clean, dry surface—waist level—free of clutter  Keep hands 12 inches away from body, above waist  Secure any loose objects or clothing

24. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Sterile Gloving  Apply glove to dominant hand first  Maintain sterility throughout procedure  Only sterile can touch sterile