1. Chapter 57 Surgical Asepsis

2. Asepsis, cont.
Dirty: any object that has not been cleaned or sterilized for removal of microorganisms
Contaminated: anything that is not sterile
Clean: medical asepsis
Devoid of all gross contamination
Free of many microorganisms
Sterile: surgical asepsis
Free of all microorganisms
Many body parts are clean-not sterile:skin, mouth, GI tract, upper resp. tract
Sterile body parts: abdominal cavity or ovary, uterus
Areas like GU system are susceptible to infection even though bladder is sterile

3. Disinfection Disinfection
The process that results in the destruction of most pathogens but not necessarily their spores.
Methods
Use of alcohol wipes, a hexachlorophene or chlorhexidine gluconate soap scrub, or a povidone- iodine scrub, surgical hand scrub
Phenol or chlorine is used to disinfect floors and surfaces.

4. Sterilization Sterilization
The process of exposing articles to steam heat under pressure or to chemical disinfectants long enough to kill all microorganisms and spores.
Client usually takes home items such as washbasins, mouth care utensils, and incentive spirometers-these are not reused
Methods
Autoclave (uses steam at 18 pounds of pressure at a temperature of 125 C for 15 minutes), chemical disinfectants, radiation, and gas sterilization

5. Medical Asepsis Medical asepsis or clean technique
The purpose of maintaining medical asepsis is to prevent the spread of disease from one person to another.
Handwashing
Standard Precautions

6. Surgical Asepsis Surgical asepsis or sterile technique
All microorganisms and spores are destroyed before they can enter the body.
Used when administering parenteral medications and performing surgical and other procedures such as urinary catheterization
Often, clean technique (medical asepsis) is performed using sterile supplies.
Sterile to clean, dirty, or contaminated becomes contaminated.

7. Sterile Technique
Sterile technique is used to prevent the spread of infection
Supplies used for surgical and other sterile procedures
Anything that either touches an open wound or skin break, enters a sterile body cavity, or punctures the skin
Surgical towels or drapes are packaged, secured with special masking tape, labeled, and sterilized.
Never touch sterile articles with unsterile articles!

8. Key Concept Sterile to sterile remains sterile.
Sterile to clean or dirty becomes contaminated.
Always think before you touch anything.
Do not touch sterile articles with unsterile articles

9. Educating the Client Client and family teaching
Demonstrate the skill to be performed.
Ask the client and family to demonstrate the skill before discharge.
Explain how to recognize problems or complications.
Describe when to seek medical care immediately.
If indicated, make a referral for home care nursing follow-up.

10. Sterile Technique in Nursing
Do not touch anything after sterile gloves or gown have been put on.
Reaching over a sterile field contaminates the sterile area.
If a sterile wrapper or mask becomes wet, they are no longer sterile.
When wearing sterile gloves, perform a sterile procedure.
A person’s back is not sterile. Skin can only be made clean, not sterile.
When in doubt, consider the objects in question to be contaminated.

11. Sterile Technique in Nursing
The inside of the gown is not sterile, someone else must tie the strings on the gown.
Any part of the gown below the waist and above the nipple line is contaminated!
Be sure to keep the hands between the waist and the nipple levels whenever sterile gloves are worn!

12. Sterile Technique Hair covering Surgical mask and eye protection
Sterile gown
Sterile gloves
Open gloving
Closed gloving
Removal of sterile or nonsterile gloves

13. Procedures Requiring Sterile Technique
Some procedures include:
Care of the indwelling catheter
Surgical intervention and invasive procedures
Sterile dressing change
Suture and staple removal
Administration of parenteral medications
Venipuncture and management of IVs

14. Urinary Catheterization
Procedure of inserting a tube (a catheter) through the urethra into the bladder to remove urine
Sterile procedure
Catheter sizes: Fr. (usually)
Insert 2-3 inches in female; 5-7 in male or until urine is visualized
Straight catheter
Used for one sample only and removed
Retention catheter (eg, Foley catheter)
Indwelling catheter (remains in the bladder)

15. Catheterization
Coude tip catheter is used in males if there is prostate enlargement or in the female if abnormal placement of the urinary meatus is suspected
No more than ml of urine can be safely removed from the bladder at any one time, particularly if the client has retention or distention for a long period.

16. Urinary Catheterization
Self-catheterization
Catheterizing the female client
The side-lying position
Catheterizing the male client
Caring for the client after catheterization
Removing the retention catheter

17. Caring for the Client After Catheterization
Reposition to ensure comfort
Signal cord within reach
Balloon of indwelling catheter inflated
Catheter tubing secured externally
Patient teaching

18. Caring for the Client After Catheterization, cont.
Drainage tubing extends straight down from bed level to bag (straight drainage)
Extra tubing placed on bed with client—allows movement
Attach drainage apparatus to bed frame (not the side rails)
Maintain sterility
Removing the retention catheter

19. Nursing Alert A catheter is never cut for removal.
This could cause the catheter to be pulled back into the urethra or bladder.
In that case, surgical removal would probably be necessary.
This would also be a source for introducing pathogenic organisms into the urinary bladder.