ASEPTIC TECHNIQUE

[Guest Guest]

There are dozens of things we can do to help mitigate the problems we may incur during a flu pandemic, but it doesn't matter how much food or how many supplies we stock up, if we don't give equal attention to keeping ourselves as 'germ free' as possible. Aside from a healthy diet and exercise, practicing aseptic techniques may be our best chance of surviving an all out germ war.

 

The following post is basically the techniques that are taught to be used in surgical procedures. Some of the unnecessary procedures have been removed to avoid any additional confusion.

 

When cleaning for aseptic purposes, it is vital to remember that germs always fall down.

 

All of the infection prevention practices covered in this --from handwashing to waste disposal--contribute to reducing the risk of infection. This emphasizes some specific infection prevention practices that can reduce infections.

 

What is aseptic technique?

 

Aseptic means "without microorganisms." Aseptic technique refers to practices that help reduce the risk of infections by decreasing the likelihood that microorganisms will enter the body. Some of these practices are also designed to reduce risk of exposure to potentially infectious blood and and tissue.

 

Aseptic techniques are those that do the following:

 

* Remove or kill microorganisms from hands and objects.

 

* Reduce risk of exposure to microorganisms that cannot be removed.

 

Aseptic technique protects by acting as a barrier against microorganisms.

 

The usually harmless microorganisms found on the skin may cause infection when introduced into an area of the body where they are not normally found, and can also cause infection in an immunocompromised person, who is especially susceptible to infection.

 

Aseptic technique adequately protects from microorganisms in the environment and on the skin, clothes, and hair.

 

If their hands are contaminated, or if they become infected from exposure, people can spread infections to their partners, friends, or family members.

 

Infections acquired can lead to increased infections throughout the community, since these infections can continue to be passed on to others.

 

Components of aseptic technique

 

Aseptic technique refers to the practices performed to reduce infection. These include:

 

* Handwashing

* Surgical scrub

* Using barriers (surgical attire)

* Maintaining a safer environment

 

Every one of these practices is important and should be used to reduce the risk of infection.

 

Handwashing is covered in depth in this course. Detailed information on surgical scrub and the use of barriers--including information about how to put on and take off surgical gloves--can be found in the next module, Surgical Scrub and Surgical Attire.

 

* A properly gowned and gloved provider's sterile area extends from the chest to the level of the sterile field. Sleeves are sterile from 5 cm above the elbow to the cuff.

 

Only sterile items are free of potentially harmful microorganisms. Once a sterile object comes in contact with a nonsterile object or person or with dust or other airborne particles, the object is no longer sterile. If even one nonsterile object or person enters the sterile field, the field is no longer sterile. For example, sterile objects become contaminated if you touch the object with your bare hand, if the object comes in contact with dust or other airborne particles, or if the object is held below the level of the sterile field.

 

To maintain the sterile field:

* Do not contaminate sterile items when opening, dispensing, or transferring them.

* Consider items located below the level of the waist area to be unsterile.

 

* Recognize that the edges of a package containing a sterile item are considered unsterile.

* Recognize that a sterile or high-level disenfected (HLD) barrier that has been penetrated (wet, cut, or torn) is considered contaminated.

* Be conscious of where your body is at all times, and move within or around the sterile or HLD field in a way that maintains sterility or HLD status.

 

High-level disinfection (HLD)

 

HLD eliminates microorganisms (such as bacteria, viruses, fungi, and parasites), but does not reliably kill the bacterial endospores that cause diseases such as tetanus and gas gangrene. HLD is suitable for instruments and other items that will come in contact with broken skin or intact mucous membranes.

 

Remember!

When in doubt about the sterility of an item or area, consider it to be contaminated. Be conscious of where your body is and how you move around the sterile field at all times.

 

Surgical scrub

 

The warm, moist conditions inside surgical gloves provide an ideal environment for the rapid growth of microorganisms. Scrubbing with antiseptics will help prevent this rapid growth of microorganisms for a period of time and will reduce the risk of infections if the gloves develope holes, tears, or nicks during a procedure.

 

Antiseptic agents are used in surgical scrub because they inhibit the growth and development of microorganisms and are safe for use on the skin. A 3- to 5-minute surgical scrub with an antiseptic (such as chlorhexidine or an iodophor* iodine scrub or phisoderm/hex scrub) and running water is recommended before a surgical procedure.

 

If running water is not available...When performing surgical scrub, remember that:

 

* Warm water makes antiseptics and soap work more effectively, while very hot water removes more of the protective oils from the skin. Therefore, washing with very hot water should be avoided.

* Your hands--more than any other part of your arms--must be as clean as possible. Therefore, it is important to hold your hands above the level of your elbow to allow the water to flow from your hands (the area of least contamination) to your forearms (the area of most contamination). Otherwise, water may splash onto the unscrubbed portions of your arms and run down over the scrubbed portions, which would contaminate them.

* Scrubbing for at least 3-5 minutes allows adequate time to remove, inhibit, or kill as many microorganisms as possible.

 

NOTE:

Microorganisms grow and multiply in standing water. You should not scrub your hands in a basin that contains standing water, even if an antiseptic solution (such as Dettol or Savlon) is added.

 

If running water is not available...

 

When running water is not available, you can use one of the following methods:

 

1. A bucket with a tap that can be turned off to lather hands and turned on again for rinsing. Collect used water in a basin, and have the other person discard it in a latrine, if a drain is not available.

 

NOTE: If you use this method, remember that you cannot touch the tap during scrub or you will contaminate your hands. A nonsterile person should turn off the tap for you during your scrub.

 

2. A bucket and pitcher. Using the pitcher, one person pours the water over the hands of another person, who is scrubbing. Collect used water in the bucket, and have the other person discard it in a latrine, if a drain is not available.

 

NOTE:

Whether you are using running water, a bucket with a tap, or a bucket and pitcher, the water you use to scrub with must be clean.

 

How to perform surgical scrub

 

Recent studies have shown that using a brush to scrub hands during surgical scrub provides no greater reduction in the number of microorganisms on the hands than scrubbing with antiseptic alone. Surgical scrub may be performed using either a soft brush or sponge or an antiseptic alone. Avoid using a hard brush, which is not necessary and may irritate the skin.

 

Step 1

Remove all jewelry on your hands and wrists.

 

Step 2

Adjust the water to a warm temperature and wet your hands and forearms thoroughly.

 

Step 3

Clean under each fingernail with a stick or brush. It is important for all surgical staff to keep their fingernails short.

 

Step 4

Holding your hands up above the level of your elbow, apply the antiseptic. Using a circular motion, begin at the fingertips of one hand and lather and wash between the fingers, continuing from fingertip to elbow. Repeat this for the second hand and arm. Continue washing in this way for 3-5 minutes.

 

Step 5

Rinse each arm separately, fingertips first, holding your hands above the level of your elbow.

 

Step 6

Using a sterile towel, dry your arms--from fingertips to elbow--using a different side of the towel on each arm.

 

Step 7

Keep your hands above the level of your waist and do not touch anything before putting on sterile surgical gloves. Remember:

Surgical scrub may be performed using either a soft brush or sponge or an antiseptic alone. Avoid using a hard brush, which is not necessary and may irritate the skin.

Alternative methods of surgical scrub

 

Although the use of antiseptic for surgical scrub is recommended, an alternative method is necessary when:

 

* Surgical staff members are allergic to the available antiseptic solutions

* Antiseptics are not available

 

Performing surgical scrub with soap and water, followed by an alcohol handrub, can be used in place of surgical scrub in these situations. To do this:

 

Step 1

Wash your hands with plain soap and warm, running water while following the steps of normal surgical scrub.

 

Step 2

Apply 3-5 mL of alcohol (or--because using alcohol alone can dry the skin--use an alcohol handrub solution made up of 2 mL glycerine, propylene glycol, or sorbital mixed with 100 mL of 60-90% alcohol).

 

Step 3

Rub hands together until they are dry.

 

 

High-volume settings

 

Ideally, surgical handscrub should be performed before every procedure. However, to prevent skin irritation from too-frequent scrubbing in high-volume settings, use 3-5 mL of an alcohol handrub solution between clients, rubbing your hands together until the alcohol dries. Then scrub every hour or after every four clients, whichever comes first.

 

Note:

Alcohol handrub does not remove soil or organic material such as blood. If gloves are torn or punctured, or if there is blood or other body fluids on your hands after you remove your gloves, a surgical scrub should be performed.

 

Surgical gloves and other surgical attire

 

The human body is a major source of microorganisms that can cause infections. Such infections can be transmitted when bacteria are shed from hair, skin, and clothes, and when microorganisms are expelled from the nose and mouth during talking, coughing, and breathing.

 

Surgical attire acts as a barrier that protects from exposure to microorganisms that could cause infections.

 

These barriers include surgical gloves, caps, masks, gowns, protective eyewear, waterproof aprons, and sturdy footwear.

 

How different items of surgical attire protect:

 

Surgical attire, Surgical gloves

Protect clients: against microorganisms on the provider's hands.

 

Protect providers: Protect hands from contact with blood, other fluids, and tissues.

 

Masks

Protect clients: against microorganisms expelled during talking, coughing, and breathing.

 

Protect providers: Protect the nose and mouth from splashes of blood and other fluids.

 

Gowns and waterproof aprons

Protect clients: against microorganisms

Protect providers: Protect the skin and

clothes from contact with blood and other fluids.

 

Caps

Protect clients: against microorganisms in hair and skin shed from the provider's head.

 

Protect providers: No protection documented.

 

Eyecovers/Face shields

Protect clients: No protection documented.

 

Protect providers: Protect the provider's eyes from splashes of blood and other fluids.

 

Putting on sterile surgical attire

 

When you put on sterile surgical attire, it is essential that you not contaminate the sterile items. Before performing surgical scrub, you should put on any attire that will not be part of your sterile field.

 

Be sure that you know how to gown and glove without contaminating sterile attire.

 

 

Gloves

Putting on and removing sterile surgical gloves

 

Wearing sterile gloves protects the client from microorganisms on the service provider's hands and protects the service provider from infectious microorganisms in the client's blood, tissue, or other body fluids.

 

Sterile surgical gloves can become contaminated:

 

* If you touch the outside of a sterile glove with an ungloved hand

* If you touch anything that is not sterile--including your face or clothing outside the sterile field--while wearing the gloves

* If your glove becomes torn or punctured

* If your gloved hands drop below the level of your waist

 

If your gloves become contaminated:

 

* Stop whatever you are doing.

* Step away from the sterile field.

* Remove the contaminated glove.

* If your hands are soiled with blood or other matter, perform surgical scrub and put on new gloves. If not, put on a new glove, making sure not to contaminate the uncontaminated glove.

 

Tips for removing surgical gloves

 

As you remove the gloves, avoid allowing the outside surface of the gloves to come in contact with your skin, because the outer surface will have been contaminated with blood and other body fluids. Avoid letting the gloves snap, as this may cause contaminants to splash into your eyes or mouth or onto your skin or other people in the area.

 

Remove used gloves before touching anything: Countertops, faucets, and pens and pencils are frequently contaminated because health care workers touch them while wearing used gloves.

 

Rinse gloved hands in a basin with decontamination solution.

 

Grasp one of the gloves near the cuff and pull it partway off. The glove will turn inside out. It is important to keep the first glove partially on your hand before removing the second glove to protect you from touching the outside surface of either glove with your bare hands.

 

Leaving the first glove over your fingers, grasp the second glove near the cuff and pull it part of the way off. The glove will turn inside out. It is important to keep the second glove partially on your hand to protect you from touching the outside surface of the first glove with your bare hand.

 

Pull off the two gloves at the same time, being careful to touch only the inside surfaces of the gloves with your bare hands.

 

 

If the gloves are to be processed for reuse, place them in a container of decontamination solution

 

If the gloves are disposable or are not intact, dispose of them properly. If they are to be processed for reuse, place them in a container of decontamination solution. Wash hands immediately after gloves are removed, since gloves may contain tiny holes or tears that leave you at risk of exposure.

 

Putting on other attire

 

To prevent exposure to potentially infectious material, always wear the necessary attire, including eyewear, whenever you anticipate splashes, sprays, or splatters of blood or other body fluids. Appropriate attire, including a cap and mask, should be worn when sterile packs are opened and during most surgical procedures. Some minor surgical procedures can be performed safely without wearing a cap, mask, or sterile gown.

 

Only clean, intact, and dry attire will be an effective barrier against potentially infectious microorganisms. It is not necessary to sterilize caps, masks, and scrubsuits, since these garments will not have direct contact with the sterile field. Gowns, however, should be sterile.

 

Scrubsuits

There is some controversy regarding the need for operating theater staff to wear scrubsuits, including the need for members of the surgical team to wear scrubsuits under their sterile gowns. There is no scientific evidence to support the use of surgical scrubsuits as a means of reducing infections. Decisions regarding the use of scrubsuits should be made by each facility individually, after weighing the costs (purchase, replacement, laundry) and practicality (storage, availability of changing areas) against any potential benefit. If street clothes are worn in the operating theater instead of scrubsuits, they should be clean.

 

Waterproof aprons

A waterproof apron should be worn under the gown during procedures in which large amounts of blood and other body fluids are likely (e.g., cesarean delivery).

 

Footwear

Sturdy footwear must be worn in the operating theater. Footwear protects the feet from direct exposure to blood and other body fluids and from injury from instruments and other items. In addition, footwear reduces the damage caused when items accidentally fall on the feet.

 

Acceptable footwear includes rubber or leather boots or shoes. Sandals, other open shoes, and bare feet are not recommended. There is no scientific evidence to support the use of shoe covers as a means of reducing the risk of infections in clients.

 

***Note by Nana- although I'm no great authority, I disagree with this statement in the case of a pandemic, because we will be dealing with things on a different level than those in a surgical environment. If your occupation requires you to go to other's homes or places of business, or you are the care provider for someone with a highly infectious disease, shoe covers may help to eliminate the possibility of transferring infectious agents to your vehicle and home. If you have small children, think of how difficult it is to keep them from rolling around or crawling on the floor. Every extra precaution will be a bonus, and certainly won't hurt.***

 

Masks

Masks should be made of thick, sturdy cotton material to filter microorganisms. Gauze is not an acceptable material for a mask because it is too loosely woven. Masks should cover the nose and mouth, fitting snugly across the bridge of the nose, at the edge of the cheeks, and under the chin.

 

Gowns

Sterilized surgical gowns are considered sterile in front from the chest to the level of the sterile field. Sleeves are sterile from 5 cm above the elbow to the cuff. The neckline, shoulders, underarms, and back of the gown are considered to be unsterile. Gowns should be put on after surgical scrub and before gloving.

 

That's it for now. I will try to find and post other things that will help. If you have any questions, jump right in and ask!

[Mother]

Great post Nana. I just talked to my son who lives in Thailand. He works in the oil industry and he says that the company he works for (world wide company) has a flu pandemic plan already in place. He said their enphasis is on prevention. They have given information packets to all their employees about washing hands, staying away from others, and etc and have included samles of hand sanitizers. He said this has been in place for about six months already. He also said that they have plans that allow them to run the company with about ten percent of the workforce if the duration is not too long but that if it lasted months then that would be a different story. Sounds like they have really worked on this.

 

Now if all the others companies, businesses both big and small, and individuals would get on the band wagon maybe we could help prevent the spread of this.

 

I hope everyone reads your post thoroughly and takes it to heart.

 

 

[gardnmom]

Excellant post, Nana.

There is also the need for keeping the possible patient isolated from the rest of the family. It is not always possible to have a seperate room, perhaps an area curtained off with plastic?

 

[Guest Guest]

Awesome post Nana...

 

That's my girl!

[Guest Guest]

Spray bottles to put bleach water in to spray down shoes

 

 

[Lois]

BTTT