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SurgTech 1509 t1

Asepsis Without infection. Implies the absence of microorganisms that cause infection.
Aseptic Technique methods by which microbial contamination is prevented in the environment
Sterile Free of microorganisms, including all spores.
Sterile Technique Creating and working within the sterile field.
Transmission Skin, Hair, Nasopharynx, Fomites, Air, Human Error.
Standard Precautions PPE, Prevention of puncture injuries, Management of puncture injuries, Oral Procedures, Care of specimens, Decontamination, Laundry, Waste, Hand Washing, Avoid touching mucous membranes Prophylaxis.
Critical item entering the body tissues underlying the skin and mucous membrane must be sterile
Semicritical item that comes in contact with intact skin or mucous membranes are surgically clean. May be sterilzied but are not maintained sterile.
Noncritical item will come into contact with intact skin or mucous membrane. Cleaned, disinfected and stored unsterile.
Surgical Conscience A surgical conscience involves self inspection coupled with moral obligation. Involving both scientific and intellectual honesty, it is self regulation in practice according to deep personal commitment to the highest values.
Conscience dictates that appropriate action be taken, whether the person is with others or is alone and unobserved.
We are sterile where? only in front from axilla level to table level and two inched above elbows to cuffs
Edges of anything that encloses sterile contents are considered unsterile (1 inch margin)
Disinfection the process of inhibiting the growth of most forms of pathogenic micro-organisms (except bacterial spores and prions) on inanimate objects or surfaces
Disinfectant Any agent that destroys or inhibits the growth of most forms of pathogenic micro-organisms (except bacterial spores and prions) of inanimate objects or surfaces. Disinfectants are registered with the EPA.
Levels of Disinfection High Level - kills all bacteria, viruses & fungi but not prions. Intermediate Level - kills most bacteria, viruses and fungi. Will not kill endospores, mycobacteria, prions. Low level - Kills most vegetative bacteria, fungi, least resistant viruses.
Spauldings Classification of Patient Care Items CRITICAL Items - must be sterile: surgical instruments, implants SEMICRITICAL Items - contact with nonintact skin and mucous membranes, high level disinfection or sterile: Respiratory equipment, endoscopes NONCRITICAL Items - BP cuffs, linens
Chemical Agents used as Disinfectants Alcohol,Chlorine compounds,Formaldehyde,Glutataldehyde, Iodophors, Phenolic compounds, Other Agents
Alcohol disinfects only, denatures cell proteins. excellent disinfectant except spores, limited use due to flammability.
Chlorine compounds usually used as a room disinfectant. excellent inexpensive way to disinfect room surface.
Formaldehyde bactericidal, fungicidal, psudomonicidal, tubercolocidal and virucidal in 10 in alcohol solution and 15 in aquous sporicidal in 12 hours.
Gluteraldehyde used to disinfect and sterilize, may be used on items too sensitive to steam sterilize, has nasty odor, irritates skin, eyes, and mucous membranes, items must be fully submersible in liquid for 20-30 minutes or 10 hours - must rinse
Iodophors for surgical skin prep and for disinfection; not for sterilizing; may cause allergic skin reaction, corrosive to metal - stains surfaces.
Phenolic compounds disinfect only, irritates skin and should be used only with proper PPE.
Physical disinfectants Boiling / Pasteurization / Ultraviolet / Radiation
Decontamination process by which chemical or physical agents are used to clean non-critical inanimate objects or surfaces combining cleaning and disinfection. In OR we usually talk of decontamination with regard to instrumentation used during surgical procedures.
Process for Decontamination Combination of manual and chemical cleaning - Prerinsing/presoaking - Manual cleaning - Ultrasonic cleaning - Washer-sterilizer
Prerinsing/Presoaking Triple proteolytic enzymatic detergent. Usually spray on in OR or in processing. Makes further processing more efficient. Instruments should be transported to the processing dept with a cover.
Manual Cleaning Apply enzyme solution in OR. Must wear appropriate PPE, use brushes, detergents and compressed air. Purpose of manual cleaning is to remove residual blood and debris before terminal sterilization or high level disinfection. Best practice is one sink with
Ultrasonic cleaning Uses high-frequency sound waves, cleans by process of cavitation. Cavitation is the formation of bubbles which expand and then implode which can pull small debris out of tiny crevices. Lid should be shut.
Effective steam sterilization Five (5) factors TIME / TEMPERATURE / PRESSURE / MOISTURE / PROPER CONTACT
Sterilization Cycle - Heat up or penetration of the agent - Kill time - Bioburden - Evacuation or dissipation of agent
Method of sterilization CHEMICAL Solutions: used for endoscopic scopes and lenses (doesn't damage lenses and penetrates well into crevices - Gluteraldehyde (Cidex) - Peracetic acid (Steris) - Hydrogen peroxide 6% (Sterrad)
Method of sterilization RADIATON microwave and gamma radiation. This is used in the commercial or industrial settings.
Method of sterilization ELECTROMAGNETIC WAVES penetrate at 10-20 hours exposure.
Method of sterilization IONIZING RADIATION the most effective - no residue.
Washer sterilizer Usually positioned with one end accessible from the dirty decontam areas and the other to clean processing area. Before touching, instruments may or may not be fully sterilized. No sterility monitor is put on machines. Assumed high level decontamination.
Method of Disinfection / Room Decontamination Always use gloves. Always use a new mop head. Clean and Disinfect: - All patient areas. - All surfaces which supported a sterile field. - The entire floor. When done cleaning room all towels must be removed from the room also.
Sterilization The process by which ALL pathogenic and non-pathogenic micro-organisms, including spores, are killed. A process capable of destroying all forms of microbial life, including spores.
Sterilizer A piece of equipment used to attain either physical or chemical sterilization. The agent used must be capable of killing all micro-organisms. Procedures are in place to assure that sterility occurs and that sterilization cycles are complete.
Monitors that validate sterility Mechanical indicators, Chemical Indicators, Biological indicators
Mechanical indicators (Sterility) Gauges, thermometers, alarms, and “test pack”
Chemical indicators (Sterility External sterilization tape, labels, internal tape or strips
Biological indicators (Sterility) The only method that positively ensures sterility, living spores (BACILLUS STEAROTHERMOPHILUS) are sent through the sterilization process and then incubated.
Methods of sterilization Thermal (physical) -> Steam under pressure/moist heat: Most reliable and commonly used method. The moisture hastens action of heat. The pressure increases temp, destroys the micro-organism denaturing proteins. Dry heat hot air -> powder, petrol.
Types of steam autoclaves Moist Heat Gravity Displacement, Pre-vacuum sterilizer, Flash Pressure (high speed).
Moist Heat Gravity Displacement (Steam Autoclave) Pressurized steam displaces air in chamber and pushes it out the bottom and back of autoclave. Biological test pack is performed daily to check for proper function.
Pre-vacuum sterilizer (Steam Autoclave) faster evacuation of air from autoclave chamber through use of vacuum before filling the chamber with steam. Biological test done daily.
Flash Pressure (high speed) (Steam Autoclave) are usually adjacent to the OR so the item can be transported to the sterile field in a sterile manner. Biological test done daily.
Effective Steam Sterilization (5 Factors Time, Temperature, Pressure, Moisture, Proper Contact
Sterilization Cycle Heat up or penetration of the agent / Kill time / Bioburden / Evacuation or dissipation of agent
Chemical (Gas) Sterilization to sterilize items sensitive to steam or heat. Ethylene Oxide (ETO) (bad for ozone and carcinogenic)/ Formaldehyde gas.
Chemical Sterilization to sterilize endoscopic scopes and lenses Gluteraldehyde (Cidex) [not used much], Peracetic Acid (Steris) [needs to be rinsed], Hydrogen Peroxide 6% (Sterrad) [for plastic and rubber] - 122 degrees for 12 minutes -> Urology, cystoscopy, EGD
Packaging Materials and Methods Nonwoven Fabrics Woven Fabrics Peel Packs or Pouches Sealants and Labeling Wrapped Trays Rigid Closed Containers
Woven fabrics Not moisture resistant May create lint in the OR Discarded after 50 to 75 washes
Nonwoven Fabrics Excellent barrier against microorganisms and moisture Lint free Disposable
Peel packs Paper on one side clear plastic on the other Single instruments Odd shaped items Small items
Assembly of Instrument Sets (1 of 2) Instruments are dry with a towel in bottom of pan. Use a count sheet that is placed inside of pan. Organize instruments with heavy on bottom. Open the hinges and box locks on all hinged instruments.
Assembly of Instrument Sets (2 of 2) Ring handled instruments placed on stringer. Concave or cupped instruments placed with curve down. Disassemble all detachable parts.
Cleaning the physical removal of soil, debris, blood and body fluids from an area or item.
Disinfection chemical or physical process of destroying most forms of pathogenic microorganisms.
Decontamination process by which chemical or physical agents are used to clean and disinfect inanimate, noncritical sources.
Restricted area: Requires the wearing of scrubs, scrub cap and a mask. This includes the OR, central core and when removing items from the autoclave
Semi-restricted area: This is an area of the OR that requires the wearing of scrubs and a scrub cap, but a mask is not required. This is the area of the OR beyond the “Red Line”. These areas are the holding and recovery rooms, the lab, hallway, break room and other depts.
Unrestricted area: This is an area of the OR located near the entrance to the OR. This includes the dressing rooms, offices, and main desk of the OR. (also called the back desk). Street clothes are allowed in this area.
The surgical scrub is: the process of removing as many micro-organisms as possible from the hands and arms by mechanical washing and chemical antisepsis before participating in a surgical procedure.
You are unable to sterilize your hands and arms, but you can get them “surgically clean”
Transient Organisms (flora) flora acquired by direct contact and are attached loosely to the skin’s surface. Mechanical action of scrub kills these organisms.
Resident Organisms (flora) flora beneath the skin’s surface in hair follicles and sweat glands. They are resistant to removal. Chemical action of the scrub kills these organisms.
Purpose of Scrub •To decrease the number of resident flora to an irreducible minimum. •To keep population of micro-organisms minimal during the procedure by suppression of growth. •To reduce hazard of microbial contamination of wound by transient and resident flora.
Surgical Scrub Processes •Mechanical –the actual friction of the scrub brush against the skin •Chemical –inactivation of micro-organisms with microbial or antiseptic agents, reducing the resident flora.
Surgical Scrub Methods •Timed –scrub is performed in sections with timed intervals •Brush Stroke –scrub is performed in sections with counted brush strokes for each area sectioned off
Equipment Needed for Scrubbing •Scrub Sinks –various types available •Disposable scrub brush –various types available •Soap Dispenser –located at sinks with foot control dispenser
General rules for the scrubber •Short, clean fingernails with cuticles in good condition •Good skin integrity of the hands and arms •NO fingernail polish •NO artificial nails •No jewelry on hands and arms
Anti-microbial Agents for Scrubbing •Broad-spectrum anti-microbial agent •Fast-acting and effective •Non-irritating and non-sensitizing •Prolonged-acting (leaves an antimicrobial residue on the skin to temporarily prevent growth of micro-organisms on the skin) •Independent of cum. actio
Common Scrubbing Agents •Iodophors–Betadine; tincture of iodine; povidone-iodine •Parachlorometaxylenol(PCMX) •ChlorohexidineGluconate(CHG) aka: hibiclens •Alcohol
Waterless “Scrub” •Most brushless, waterless cleansing agents have an alcohol base with an antimicrobial agent such as CHG or triclosan. –Avagard
Before you scrub •Before scrubbing –Bladder emptied –Open gown and gloves on mayo tray in your assigned area. –Be sure you are properly attired (all hair covered, goggles on, mask on, etc)
Fingertips - scrub for: 30 seconds total
Fingers (all sides and webs) scrub for: 30 seconds total
Palm 30 seconds total
Dorsal hand 30 seconds total
arms from wrist to 2 inches above elbow 3 sections - 10 seconds each
Fixing a contamination during scrub rescrub the area with a scrub brush for 10 seconds. If you have already dropped your brush, you will have to find a friendly body that will open a new brush for you or you will have to start over. DO NOT reach into the sink to retrieve your brush!
P OF A T 1. Only Sterile Items Are Used... Within A Sterile Field
P OF A T 2. Sterile Persons Are... Gowned And Gloved
P OF A T 3. Tables Are Sterile... Only At Table Level
P OF A T 4.Sterile Persons Touch Only Sterile Items Or Areas... Unsterile Persons Touch Only Unsterile Items Or Areas
P OF A T 5. Unsterile Persons Avoid Reaching Over A Sterile Field... Sterile Persons Avoid Leaning Over An Unsterile Area
P OF A T 6. Edges Of Anything That Encloses Sterile Contents... Are Considered Unsterile
P OF A T 7. Sterile Field Is Created As Close... As Possible To The Time Of Use
P OF A T 8. Sterile Areas Are Continuously Kept In View
P OF A T 9. Sterile Persons Keep... Well Within The Sterile Area
P OF A T 10. Sterile Persons Keep Contact With Sterile Areas To A Minimum
P OF A T 11. Unsterile Persons Avoid Sterile Areas
P OF A T 12. Destruction Of The Integrity Of Microbial Barrier... Results In Contamination
P OF A T 13. Microorganisms Must Be Kept... To An Irreducible Minimum
Created by: frovan
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