Pt. Care, Ch. 11 - Surgical Asepsis

medical asepsis

method of reducing pathogenic microorganisms in the environment and intervening in the process by which microorganisms are spread

surgical asepsis

the process of creating and maintaining an area that is completely free of pathogens

sterilization

the complete destruction of all organisms and spores from equipment used to perform pt care or procedures

1. chemical

2. autoclaving

3. conventional gas

4. gas plasma

4 methods of sterilization

chemical sterilization

the immersion and soaking of clean objects in a bath of germicidal solution followed by a sterile water rinse

• NOT recommended for surgical asepsis

  • control of effectiveness factors is difficult

• effective at destroying microorganisms but not spores

autoclaving

device that provides steam sterilization under pressure

• most commonly used sterilization method

• used for items that can withstand heat and moisture

conventional gas sterilization

used for items that cannot be autoclaved

• electrical, plastic, rubber items, and optical ware

very effective but has drawbacks:

• gases used are poisonous

• must be dissipated by aeration in a controlled environment

• process is time consuming

gas plasma technology

• safer than gas sterilization

  • no toxic byproducts

• able to sterilize heat/moisture sensitive items in greater volume

  • cannot completely replace gas bc it is not effective on items with long, narrow lumina

  • cannot be used on cellulose items (paper, cotton, or linen)

ionizing radiation

low temp sterilization method

• uses cobalt 60 gamma rays OR electron accelerators

  • high costs make it unfavorable - use plasma sterilization instead

sterility indicators

chemical indicators that change color when sterilization has occured

sterile field

defined as microorganism-free area prepared for the use of sterile supplies and equipment

• they are clean, dry, and have not been opened or punctured

• their expiration date has not been exceeded

• their sterility indicators have changes to a predetermined color, confirming sterilization

packages are considered sterile if they meet the following criteria:

• place pack on a clean surface within reach of physician

• just before procedure begins, break the seal and open the pack

• unfold the first corner away from you; then unfold the 2 sides

• pull the front fold down toward you and drop it; DO NOT touch the inner surface

• the inner wrap, if there is one, is opened the same way

steps to establish a sterile field

• check label

• position label toward your hand

  • prevent label from being stained & obscured

adding liquid to sterile field

tabletop, waist

a sterile field ends at the level of _____ or ______ of the sterile persons gown

shoulders, 2 inches

the only parts of sterile gown considered sterile are the front from waist to ______, and the sleeves from ________ above the elbow to the cuffs

1’’ border

a _________ at the perimeter of the sterile field is considered a ‘‘buffer zone’’ and is treated as if it were contaminated

• start in the center of the area and work outward in a circular motion

• not going back over the ‘‘cleaned’’ area with the same sponge/swab

• do not scrub harshly, as to irritate skin

  • friction is more effective than soap

skin prep using betadine or Hibiclens

• can NOT be used for lumbar punctures, mylograms, or any other procedure that might contact the meninges

• rub back and forth going over the same area several times (use friction)

skin prep using chloraprep

30 sec

prep time for chloraprep on a dry area

2 min

chloraprep prep time on a moist area

closed gloving method

used when also putting on a sterile gown

open gloving method

used when a sterile gown is not necessary