Surgical Asepsis and Sterility

What is Asepsis

the absence of bacteria/pathogens.

proper cleaning to provide an environment to practice sterility

what’s the difference between medical and surgical asepsis?

medical is using clean technique

surgical is using sterile technique

what is disinfectant

most microorganisms on non living surfaces are destroyed

what is antisepsis

most microorganisms on a living surface are destroyed

whats the difference between inanimate and animate

inanimate: non living

animate: living

what is antiseptic

solutions and preps used to preform a surgical scrub and prep patients skin with

does a surgical scrub deem your skin sterile? why?

no

the tap water from the sink is not sterile, your skin is deemed surgically clean

what is decontamination

removal or destruction of gross contamination

what does gross mean in this context

large

what are examples of decontamination gets rid of

bioburden, blood, infectious materials

what is sterilization

deconstruction of all microorganisms on inanimate surfaces

what is bioburden

gross contamination

the amount of organic debris on an object

what is strike through

contamination of a sterile field or package with fluid

what are the classifications of patient care items

critical

semi critical

non critical

what classifies critical patient care items

items that come in contact with the inside of the body

items used in invasive surgery that carry high potential for SSI.

what are examples of critical patient care items

surgical instruments

urinary devices

probes and monitors

do critical patient care items have to be sterilized

yes, they carry high potential for SSI when not cleaned

what classifies semi critical patient care items

items that come in contact with a mucous membrane

what are examples of semi critical patient care items

respiratory and anesthesia equipment

endoscopes

nose and rectum equipment

do semi critical patient care items need to be sterilized

you can use a high level disinfectant, but sterilizing is preferred

what classifies non critical patient care items

items that come in contact with a patients skin

what are some examples of non critical patient care items

blood pressure cuffs

furniture

stretchers

do non critical patient care items need to be sterilized

no, requires intermediate/low level disinfectants

what is the Spaulding classification

the categorizing of critical, semi critical, and non critical patient care items

what is cleaning in this context

physical removal of blood, body fluids, or bioburden from inanimate objects

what is disinfection

deconstruction of pathogenic microorganisms by direct exposure to chemical or physical agents

what is sterilization

destroying of all microorganisms using steam, chemicals, electron bombardment of UV or gamma irradiation

what happens during intraoperative sterilization

sterile water should be available on sterile field'

use a wet sponge (wet with sterile water) to wipe instruments between use in a procedure

never use saline

what are some complications that can happen when intraoperative sterilization doesnt occur

dried blood can make instruments become stiff

fat can make instruments slippery

what can influence disinfectants efficiency

concentration levels

bioburden degree

temperature

water hardness

PH levels

how to practice disinfectant safety

know location of safety data sheets

PPEStores containers in ventilated areas

follow dilution manufacturers instructions

use for intended purposes only

never mix solutions

what are high level disinfectants

glutaraldehyde

sodium hypochlorite (bleach)

what is glutaraldehyde

a high level disinfectant

liquid sterilant

used for instruments that can withstand immersion

20 minute disinfectant time

10 hour sterilization time

toxic! wear PPE

what is sodium hypochlorite

high level disinfectant

household bleach

fast acting

corrosive to some metals, plastic, and rubber

good for blood and body fluids

DO NOT mix with formaldehyde or ammonia

what are some intermediate level disinfectants

phenol

alcohol

“quats”

what is phenol

an intermediate level disinfectant

carbolic acid

effective for fecal contamination

neutralize with alcohol when in contact with skin

what is alcohol

intermediate level disinfectant

corrosive to stainless steel

flammable

what is quats

an intermediate level disinfectant

mixed with water

non corrosive, safe for metal

ineffective if used with cotton wipes or mops

what are disinfectant procedures prior to first procedure of the day

dampen and dust all surfaces

what are disinfectant procedures during concurrent cleaning practices?

clean blood off non sterile surfaces

change suction

dropped items should be picked up

biohazard goes in kick bucket

what are disinfectant procedures between procedures (turnover)

removal of soiled linen and waste rags

dispose of sharps

removal of used suction containers

wipe everything down

mop floors

instruments sent to centrile processing

what is terminal cleaning?

more thorough cleaning at the end of the day

what do you do for terminal cleaning

all furniture is wiped down

ceilings, walls, and lights are wiped

floor is mopped

OR table is thoroughly wiped

clean all other equipment and horizontal surfaces cleaned

what does a surg tech do for decontamination

presoaks contaminated instruments'

soiled instruments should be isolated in a different container to transport to decontam

what happens to instruments when they arrive to decontamination

they are cleaned, disinfected or preliminary sterilized.

why is decontamination so important

critical in prevention of transmission of microbes

what is an ultrasonic cleaner

uses cavitation

cleans areas of instruments that other methods cant reach

what is cavitation

high frequency sound waves form microscopic bubbles to clean instruments

what are lumens and how do you clean them

theyre like straws kinda, usually suction instruments

you use a long brush to clean

what steps are used for instrument preparation for sterilizing

inspect: integrity and function must be checked

packaging: maintain sterility of items

easy to open

must allow sterilization to penetrate

what are common packaging’s

woven wrap

non woven wrap (kimgaurd)

paper (peel pack)

rigid pans/ containers

What is steam sterilization?

Uses high pressure, temperature, and steam to kill microbes.

What happens during steam sterilization?

• Exposes each item to direct steam contact

• Requires time, temperature, and pressure

• Microbes are killed by moisture and heat

• Pressure is increased to further increase temperature

What temperature does a pre-vac steam sterilizer hit?

270 degrees Fahrenheit - for 4 minutes

What temperature must a gravity steam sterilizer hit?

250 degrees Fahrenheit - for 30 minutes

What does a gravity displacement sterilizer do?

Steam enters the top and pushes the air out.

What does a pre-vac sterilizer do?

Air is removed via vacuum, then steam enters.

What does IUSS stand for?

Immediate Use Steam Sterilization

Things to keep in mind when using an IUSS

• Instruments should be unwrapped

• You should avoid as much as possible

• Don’t flash implants

• Save indicators for charting

What do chemical indicators do?

Only verifies that the autoclave met correct parameters - it doesn’t prove microorganisms were killed

What does the Bowie Dick test do?

Used to see if a sterilizer is effectively removing air from the chamber.

What microorganisms do biological indicators contain?

Geobacillus Stearothermophilus, a SPORE

How long do you incubate a biological indicator for?

1-24 hours

Where do you place biological indicators?

The bottom and front of a load.

What do you do when a load has an implant in it?

Must be monitored with a biological implant, and test must be read before using the implant.

What is an ETO?

Ethylene Oxide Sterilizer

Why use an ETO?

• Doesn’t corrode metal

• Passes through woven material

• Good for heat sensitive devices, plastic tubing and endoscopes

Why would you not use an ETO?

• Health risks

• Expensive

• Can take up to 16 hours

What is a STERRAD Sterilizer?

A hydrogen peroxide gas plasma sterilizer

What is the biological indicator spore for a STERRAD Sterilizer?

Bacillus Atrophaus

What are some things to keep in mind when using a STERRAD Sterilizer?

• Used for narrow lumen instruments

• Runs for 28-30 minutes

• Use non-woven packaging

• TYVEK peel packs

• Used on batteries and cameras

• Uses plasma to sterilize

Who uses ionizing radiation for sterilizing?

A manufacturer’s

How does ionizing radiation sterilization work?

Thermal and chemical energy cause death of all microbes and spores.