Surgical Sterile

Surgical Asepsis and Sterile Technique

• Surgical asepsis, also referred to as sterile technique, is crucial in healthcare, especially in surgical environments.

• Definition of Sterile Technique:

  • Items used in a sterile environment must be completely free of microorganisms, meaning there should be zero microorganisms present.

  • This is distinct from medical asepsis which is more generalized cleaning and infection control.

Key Concepts

• Disinfection vs. Sterilization:

  • Disinfection:

  • Involves killing blood-borne pathogens.

  • Also known as germicides.

  • Sterilization:

  • A more comprehensive method that eliminates all pathogens and their spores. Different sterilization methods include:

    • Autoclaving:

    • A steam pressurized method used at temperatures of 250 to 270 degrees Fahrenheit.

    • Instruments are sterilized with heat and water under pressure.

    • Boiling:

    • Instruments are boiled in water for 10 minutes.

    • Kills non-spore forming organisms, but not spores.

    • Less effective compared to autoclaving.

    • Ionizing Radiation:

    • Used for items that cannot withstand boiling or autoclaving, based on the material composition.

    • Chemical Disinfection:

    • Used on equipment and supplies that cannot be autoclaved.

    • Gas Disinfection:

    • Specific types of gases are used for sterilization when heat is not applicable.

Indications for Sterility

• Tools like catheters and surgical instruments must maintain sterility when utilized in medical procedures.

• Sterile instruments are typically double-wrapped and placed in surgical towels or wraps.

• Common sterile settings include:

  • Operating rooms (surgery)

  • Cardiac catheterization labs (heart procedures)

  • Delivery rooms (childbirth)

  • Neonatal intensive care units (NICUs)

  • Burn units

  • Oncology units (patients have compromised immune systems requiring greater sterility)

Principles of Sterile Technique

• Contamination:

  • Occurs when a sterile item comes in contact with a non-sterile item or environment.

  • It is critical for staff to recognize and call out breaks in sterility.

• Sterile Field:

  • Defined as an area free from all microorganisms in which sterile items are placed.

  • Key principles include:

  • The skin cannot be sterilized. Sterile gloves must be worn to touch sterile items.

  • The outer inch of the sterile field is considered contaminated.

  • Ensure the workspace remains at or above waist level to avoid contamination.

  • If the sterile field becomes damp or wet, it is no longer considered sterile.

Guidelines for Maintaining Sterility

• Always check expiration dates of sterile supplies.

• Verify sterilization tape colors (where applicable).

• Ensure packages are sealed and intact without tears or moisture.

• Place sterile items on the field correctly.:

  • Open packages so that the first flap opens away from the user to avoid contamination.

• Maintain visual contact with the sterile field at all times; losing sight means it is contaminated.

• When pouring liquid onto a sterile field:

  • Hold the bottle at an angle with the label facing up.

  • Adjust the inversed edge of the cap to prevent contamination of the bottle.

  • Pour from 4 to 6 inches above the target area to ensure cleanliness.

Procedures Requiring Sterile Technique

• Any procedure that enters a sterile body cavity or utilizes invasive equipment mandates sterile technique.

• Procedures to consider include:

  • Catheter placements

  • Drawing blood from major blood vessels

  • Any insertion of tubes (e.g. tracheostomy care)

Role of Nursing Staff in Sterility

• Every nurse is responsible for maintaining sterility during procedures, including:

  • Scrub Nurse: Focuses on maintaining sterility within the operating room

  • Circulating Nurse: Ensures overall sterility in the environment

  • Surgical Technologists: Their roles often overlap with licensed practical nurses (LPNs) who may be cross-trained for surgical settings.

Understanding the Context of Sterility in Various Environments

• Sterile technique may vary between hospital and home settings:

  • Hospital settings: High patient traffic, higher exposure to multiple pathogens.

  • Home settings: Usually lower risk of contamination; however, it is still advisable to practice sterile techniques where applicable (e.g., tracheostomy suctioning).

Final Notes on Skill Development and Practice

• It is essential to practice sterile technique consistently, especially before performing clinical procedures.

• Check-offs and training will reinforce these skills.

• Prepare and practice sterile procedures repeatedly to ensure proficiency in sterile techniques before assessments.