Minor surgeries

Assisting With Minor Surgeries


Types of Minor Surgeries

  • Removal of small growths

  • Removal of warts, skin tags, moles

  • Repair of a laceration

  • Irrigation and cleaning of a puncture wounds

  • Wound debridement

  • Removal of foreign bodies

  • Obtaining biopsy specimens

  • Removal of nail

  • Drainage of an abscess

  • Collection of a biopsy specimen

  • Cryosurgery

  • Laser surgery

  • Electrocauterization

  • reedcIncision and drainage (I&D)


Incision and Drainage (I&D)

  • An abscess is a collection of pus that forms due to an infection

  • Pus is composed of WBCs, bacteria, and tissue debris like dead skin cells.

  • When a protective lining forms around the abscess, it can prevent healing

  • The provider makes an incision in the lining of the abscess to allow it to drain, either on its own or by inserting a drainage tube


Biopsy Specimens

  • Biopsy: removal and examination of a tissue sample from a living body for diagnostic purposes.

  • Specimens must be placed in cups with preservative to prevent changes in the tissue

  • Most biopsies involve cutting the tissue

  • Needle biopsies: involve the use of a needle and syringe to aspirate (withdraw by suction) fluid or tissue cells


Minor surgical procedures in clinics

  • Minor surgical procedures usually involve the use of local anesthetic.

  • To be performed in a clinic, the procedure must be generally safe, and it can’t require general anesthesia.

    • Anesthesia: loss of sensation, especially pain. 

    • Anesthetic: Medication that causes anesthesia

    • Local Anesthetic: Affects only a specific area

    • General Anesthetic: Affects the whole body


Wound Types

  • A wound is any break in the skin. Wounds can be accidental, intentional, or from a surgical procedure.

    • Superficial wound: only involve the outer skin layer (epidermis), like a scrape, scratch, shallow cut

    • Deep wounds: Skin injuries that go beyond the epidermis and dermis into deeper tissues like fat, muscle, tendons, nerve, or even bone

    • Laceration: A tear or jagged cut in the skin

    • Puncture wounds: deep wounds from sharp, pointed objects piercing the skin like glass, nails, or bites.

  • All wounds, whether surgical or accidental, require specific care to prevent infection


Wound Cleaning - Irrigation

  1. First step in preventing infection in a non-surgical wound is cleaning

  2. Clean wounds with soap and water

  3. Continually flush or irrigate the wound with sterile saline or sterile water

  4. Irrigation washes out foreign debris, dead tissue, and bacteria. It also helps prevent infection and promote wound healing by keeping the area clean and moist.


Wound Cleaning - Debridement

  • Debridement: Removal of dead, damaged, or infected tissue and foreign debris from a wound to promote healing, and reduce infection risk, and prepare the wound for new tissue growth

  • Performed by physicians or licensed nurses


Wound Healing: Inflammatory Phase (Stage 1)

  • Blood vessels in the area constrict to reduce bleeding.

  • Platelets, clotting factors, and leukocytes play an important role to seal the wound, clot the blood in the area, and remove bacteria from the wound.

  • The wound contracts under the clot or scab that forms.


Wound Healing: Proliferation Phase (Stage 2)

  • New tissue forms.

  • Skin cells at the edges of the wound begin to move together to close off the wound.

  • Edges eventually come together to form a continuous layer

  • This occurs faster if the edges of a wound are approximated (brought together) so the tissue surfaces close.


Wound Healing: Maturation Phase (Stage 3)

  • Formation of scar tissue.

  • Functionally inferior to regular skin because scar tissue lacks blood vessels, sweat glands, nerves, and the resiliency of skin.

  • Scars become flatter, softer, and lighter over time.


Laser Surgery

  • A laser emits an intense beam of light that is used to cut away tissue.

  • Benefits: less damage to surrounding tissue, quicker healing, prevents infection.

  • Everyone involved needs to wear protective goggles.

  • Position, drape, and prepare the patient like you would for any surgery.

  • Laser will vaporize unwanted tissue, which is cleared away by a vacuum hose.

  • Provide normal post-op instructions on wound care.

Cryosurgery

  • Cryotherapy: Use of extreme cold to destroy unwanted tissue

  • Often used to destroy skin lesions or cervical lesions

  • Inform the patient that the initial cold sensation will be followed by a burning sensation

  • Uses liquid nitrogen (cotton-tiped applicator or spray)

  • May require multiple treatments

  • Might not require local anesthetic; cold reduces sensation

  • Some pain, swelling, and redness is normal after cryosurgery

  • If a large, painful, bloody blister forms, leave it alone. It should rupture within 2 weeks.


Electrocauterization

  • Technique where a needle, probe, or loop heated by an electrical current destroys the targeted tissue.

  • Can be used to remove warts or stop bleeding.

  • May require a grounding pad on the patient’s body to provide a safe path for electrical current and prevent thermal injury.


Cutting and dissecting instruments: Scalpel

  • Scalpel: Consists of a handle that holds a disposable blade.

  • Specific use and purpose determine blade shape and size.

  • 15 blade is the most common in minor surgeries.

  • Scalpel blades go into sharp containers after procedures.


Cutting and dissecting instruments: scissors

  • Scissors: Used for cutting tissue

  • May be straight or curved, blunt or pointed

  • Must be sharp enough to cut without damaging or ripping surrounding tissue


Cutting and Dissecting Instruments: Curettes

  • Curettes: Circular blades attached to a rod-shaped handle, used to scrape tissue

  • Available in a variety of shapes and sizes


Grasping and clamping instruments

Forceps:

  • Used to grasp or hold objects

  • May have pointed ends, serrated ends, or locking teeth

Hemostats:

  • Typically used to close blood vessels

  • Serrated jaws that taper to a point, locking handles to hold the jaws closed


Retracting, Dilating, and Probing Instruments

  • Retractors: Allow greater access to and better view of surgical sites.

  • Dilators: slender pointed instrument to enlarge body openings.

  • Probe: Slender rod with a blunt, bulb-shaped tip to explore wounds or body cavities and clear blockages.


Sutures (Stitches)

  • Sutures are chosen according to wound type/location

  • Can be natural or synthetic, absorbable or nonabsorbable

  • Swaged needles are permanently attached to suture material

  • Sutures are:

    • Sterile

    • Uniform in diameter

    • Flexible

    • Able to hold and retain knots

  • Sutures have:

    • Tensile strength (resistance to breaking under tension or pull)

    • Low incidence of tissue reactivity

  • Sizes range from 7(thickest) to 11-0 (thinnest).

  • Larger numbers without a zero are thicker

  • Larger numbers with a zero are thinner

  • MD might say something like, “Hand me a 3-0 Vicryl,” indicating the preferred suture material and size.


Asepsis

  • Asepsis: Keeping an area or objects free from disease-causing microorganisms like bacteria, viruses, and fungi, to prevent infection

  • Medical Asepsis (“Clean Technique”): Reduces microbe numbers (handwashing, PPE, disinfecting surfaces, routinely used in healthcare)

  • Surgical Asepsis (“Sterile Technique”): Eliminates all microbes, including spores, involves sterile tools for invasive procedures (surgery, cauterization) using sterile tools in a sterile environment


Sterile Field - area free of microorganisms that is used as a work area during a surgical procedure


Instrument Trays and Packs

  • Pre-assembled tray or pack containing all of the sterile surgical instruments for a specific procedure beforehand

  • Sterilized as a pack once assembled

  • Examples: Laceration repair tray, I&D tray, foreign body or growth, onychectomy (nail removal), vasectomy (male sterilization), staple remove tray






Pre-Operative MA Duties

  • Procedure scheduling

  • Insurance verification

  • Review pre-operative instructions with patients. Ex: Nothing by mouth (NPO) after midnight, no lotion on skin

  • Verify any patients who will receive sedation have a safe, designated, adult driver to take them home

  • Prepare the procedure room. Gather all needed equipment in advance. Check expiration dates and sterile packages.

  • Act as a WITNESS to the patient’s signature in the informed consent process

  • Obtain the patient’s medication history for medication reconciliation

  • Instruct the patient to use the restroom

  • Obtain vital signs

  • Check orders for any pre-op meds

  • Have the patient disrobe and change into a gown to expose the surgical site if needed


Patient Prep for Procedures

  • Skin prep includes cleaning the area, removing hair, and applying antiseptic

  • Prep at least 2’ larger than the surgical area.

  • Patients often shower in special products to reduce bacteria before true surgical procedures

  • Hair is removed with clippers, not a razor, to reduce the risk of microabrasions. Protect the integrity of the skin as much as possible


Cleaning a Procedure Site

  • Wash your hands and don gloves

  • Clean the site with the appropriate antiseptic. THis could be alcohol (before phlebotomy, iodine (betadine), or ChloraPrep (before procedures and surgeries).

  • Start at the center of the procedure/surgical site and work outwards in a firm circular motion

  • Do not go back over an area that;s already been cleaned.

  • Advise the patient not to touch prepped skin areas. If contaminated, the skin will need to be prepped again.


Intraoperative Duties

  • Apply a topical anesthetic as ordered. Topical anesthetic are used when the procedure is only mildly painful or only the upper skin layers are affected

  • Hold a vial of injectable anesthetic for a provider who is already wearing sterile gloves. The MA might also be asked to hold a vial of epinephrine, which constricts blood vessels, reducing bleeding and prolonging the action of the anesthetic. This should be used in caution for patients with cardiovascular or respiratory disease

  • Before holding any vials for the provider, triple check that you’re offering the right medication. Note the administration time.

  • Serve as a non-sterile circulator (floater) in the procedure area.

  • Non-sterile professional cannot touch the sterile field

  • Measure vital signs during the procedure if indicated. Observe and report any concerns or reactions you see to the provider

  • Record the procedure start time, intraoperative observations, and the time the procedure is complete.

  • As a circulator, you might be asked to process specimens. Most tissues are placed in 10% formalin solution to preserve them for the lab.

  • Properly label the specimens with the patient's name, date of birth, provider name, date and time of collection, and the body site where the tissue was obtained. Put your initials on the label.

  • Always make sure you have the correct patient labels

  • MAs can also function as sterile scrub assistants if they have performed surgical scrubs and are wearing sterile gloves.

  • Scrub assistants arrange instruments on the tray in the order they’ll be used or in order of provider preference.

  • Scrub assistants pass instruments to the provider during the procedure in a safe, easy to grasp manner. Special care is needed for passing sharps. The scrub assistant might also cut suture material after each stitch. Leane ⅛” of suture material above the knot


MA Duties: Post-Operative

  • Assist with dressing the wound.

  • Review post-op instructions, including wound care

  • Clean and prepare the room for the next patient

  • Medication administration within scope

  • Monitor vital signs

  • Document post-op care and the patient’s recovery

  • Incision case

  • Dressings are sterile material used to cover an incision. Gauze dressings are the most common.

  • Bandages are clean strips of gauze or elastic material. They help keep the dressing in place

  • Always verify allergies to latex or adhesives before wound care

  • Provide patients with written discharge instructions

  • Teach the patient about signs of infection, the expected timeline for wound healing, dietary restrictions, follow up appointments, etc

  • Notify the provider when the patient is ready to leave

  • Assist patients with dressing if needed, and ensure they have all of their belongings (glasses, dentures, hearing aids).

  • Providers examine surgical wounds at follow-up appointments.

  • MAs might be asked to change the dressing or remove wound closures.

  • Suture or staple removal takes 5-14 days after minor surgery.




Suture Removal

  • Only remove sutures with a provider order***

  • Wait to remove the sutures until the provider has physically assessed the wound and confirmed sutures can be removed***

  • Perform hand hygiene and wear clean gloves. Gently clean the area.

  • Use tweezers to lift the knot and scissors to snip the thread close to the skin (not through the knot)

  • Gently pull the tail (not the knot) through the skin to avoid dragging bacteria in. Pull across and towards the incision, not up or away (to avoid opening the wound)

  • Repeat for each stitch. Clean and bandage the wound

  • Stop immediately if the would starts opening.

  • Stop immediately and notify the provider if you notice: redness, swelling, warmth drainage or pus, poorly approximated wound edges, increased pain, or fever before doing the suture removal

  • Document the procedure, including the number of sutures removed.


Staple Removal

  • Perform hand hygiene. Don clean gloves.

  • Place a staple remover under the staple (two teeth on bottom), and squeeze to bend it outward.

  • Remove alternating staples if instructed.

  • Count the number of staples removed. Put them in a sharps bin, and document the procedure.


Steri-Strip Removal

  • Wash hands, and put on clean gloves

  • Verify that the wound is healed, closed, and dry

  • If needed, moisten the strips with saline or warm water to reduce skin tearing. Do NOT soak the wound.

  • Stabilize the skin with one hand

  • Gently peel the strips from each end towards the center of the wound. Pull low and slow, keeping the strip close to the skin to avoid re-opening the wound.


Integumentary System


Components

  • Skin -  Body’s largest organ, physical barrier between external environment & internal systems

  • Hair - Provides insulation and protection

  • Nails - Protect fingertips and toes

  • Glands - Sweat (cooling) and sebaceous (oil)


Functions

  • Protection: First layer of defense against pathogens, UV radiation, chemicals, and injury

  • Thermoregulation: Temperature control

    • Sweat production

    • Vasodilation to release heat (brings blood closer to the surface to cool)

    • Vasoconstriction to conserve heat (shunts blood away from the surface to body’s core)

  • Sensation: Receptors allow body to sense touch, pain, pressure, and temperature

  • Vitamin D synthesis: Produces vitamin D when exposed to sunlight (UVB light), which is necessary for calcium absorption and bone health

  • Excretion: Eliminates small amounts of metabolic waste, such as urea and salts, through perspiration (sweating)

  • Insulation, cushioning, energy storage from adipose tissue (fat layer beneath the skin)

  • Prevention of fluid loss (prevents evaporation)


Medterm Review

  • derm, dermat, cutane - skin (dermatology, subcutaneous)

  • onych, ungu - nail (onychomycosis, subungual)

  • trich, pil - hair (trichotillomania, piloerection)

  • seb - sebum or oil (sebaceous gland

  • hidr, sudor - sweat (hyperhidrosis, sudoriferous glands)

  • kerat - hard horny tissue or protein (keratin)

  • xer - dryness (xeroderma)

  • melan - dark (melanin)

  • erythem, eryth - redness or red (erythema)


Clinical Terms

  • Alopecia: Absence or loss of hair (baldness)

  • Pruitus: Severe itching

  • Diaphoresis: Profuse or excessive sweating

  • Contusion:  Bruise resulting from blunt trauma, impact, or pressure

  • Cyanosis: Bluish skin discoloration due to lack of oxygen

  • Ecchymosis: Bruise or discoloration of skin caused by bleeding underneath

  • Hematoma: Large, raised collection of clotted blood under the skin, often painful

  • Jaundice: Yellowing of skin caused by elevated bilirubin, often tied to liver disease

  • Lesion: Abnormal changes or damage to the skin like rashes, sores, or growths

  • Melanoma: Dangerous, malignant tumor of the melanocytes (pigment cells)

  • Pallor: Abnormal paleness of the skin, can result from blood loss or anemia

  • Tinea: Fungal skin infections such as ringworm or athlete's foot

  • Turgor: Elasticity of the skin, often used to assess hydration statue

  • Onycholysis: The separation of the nail from the nail bed

  • Ulcer: Open sore on skin or mucous membranes caused by tissue breakdown, often slow to heal

  • Dermatitis: Skin inflammation

  • Acne:Clogged sebaceous glands

  • Eczema: Itchy, inflamed skin with dry, red patches

  • Psoriasis: Rapid skin cell turnover, pink with silvery scales

  • Skin Cancer: Basal cell, squamous cell, melanoma

  • Desubitus Ulcers: Pressure ulcers

  • Burns:

    • First degree - epidermis only

    • Second degree - epidermis and dermis, blistering

    • Third degree - “full thickness,” extend from epidermis into fat, muscle tissue, or bone


Burn First Aid

  • For minor burns, apply cool (not cold) running water for 10-20 minutes

  • Do not apply ice, oil, butter, or ointments

  • Cover with a clean, dry, non-stick dressing

  • Do not break burn blisters

  • Remove tight clothing or jewelry near the burn. Do not forcefully peel anything off if its stuck to skin

  • For severe burns (deep, large, chemical, electric, or involving face, hands, feet, or genitals), call 911. Keep the patient warm, and monitor for shock.

  • For chemical burns, flush with large amounts of water unless otherwise directed. Dry chemicals should be dusted off.When possible burned areas should be elevated above the heart to reduce swelling and pain

  • Encourage slow deep breaths. Burns can increase the body’s oxygen demand or impair oxygen exchange


Anatomical Terms

  • Epidermis: outermost protective layer of skin

    • Thin, outermost layer of skin that serves as your body’s primary shield & barrier

    • Contains no blood vessels - cells receive nourishment from the dermis

    • Thinnest on eyelids, thickest on palms and soles

    • Contains melanin (pigment that determines skin color and protects DNA from UV radiation) and keratin (tough protein that provides structural strength and waterproofing)

  • Dermis: thick middle layer of skin containing blood vessels, nerves, and glands

    • Middle layer of skin

    • Contains connective tissues collagen (strength) and elastin (flexibility)

    • Contains blood vessels (thermoregulation) sweat glands, oil glands (lubricating, waterproof), hair follicles, and arrector pili muscle (attached to follicles ***

  • Hypodermis (Subcutaneous): Fatty bottom layer of skin that insulates the body and connects skin to muscle

    • Innermost, deepest, fatty layer of skin

    • Adipose tissue (fat) contains fat-storing cells

    • Helps with thermoregulation, energy storage in the form of triglycerides (can be used as fuel when needed), shock absorption, and anchoring of skin to underlying muscles and bones

    • Well-vascularized and lacks vital organs, so a good injection site for slow, steady adsorption into the bloodstream (subcutaneous injections like insulin)

  • Sudoriferous Glands: Sweat glands responsible for temperature regulation (2 types)

    • Eccrine - Temperature regulation

    • Apocrine - Odor-producing (armpits, groin)

    • Specialized Apocrine: mammary glands (milk production) and ceruminous glands (earwax production)

  • Sebaceous Glands: Oil glands that lubricate the hair and skin with sebum


  • Lunula: White, moon-shaped part at the base of nails


Skin Assessment

  • Color (within normal limits for race, cyanosis, pallor, jaundice)

  • Temperature (warm, cool)

  • Moisture (dry, moist, diaphoretic)

  • Turgor (hydration status)

  • Lesions or wounds


Heat Stroke

  • Heat stroke is not a skin condition, but skin changes can act as warning signs

  • Heat Rash: Mild skin irritation from blocked sweat ducts, itchy

  • Heat Exhaustion: Heavy sweating, cool/clammy skin, weakness, nausea, dizziness, a precursor to heatstroke

  • Heatstroke: Body stops cooling. Core body temp of 104 F or higher, skin is typically hot and dry, might look flushed or pale, confusion, seizures, loss of consciousness. 


Infection Control: Standard + Transmission-Based Precautions, and PPE


Standard Precautions

  • Standard precautions are infection control practices used for ALL PATIENTS, regardless of diagnosis

  • All blood and body fluids (other than sweat) are treated as potentially infectious

  • Standard precautions address protection against blood and body fluids through hand hygiene, cleaning and disinfecting, linen and waste handling, and personal protective equipment (PPE)

  • Hand Hygiene

    • #1 way to prevent spread of infection

    • Use soap and water when: hands are visibly dirty; after using the restroom; after contact with blood or body fluids; after removing gloves; and after caring for patients with C. diff or norovirus

    • Use 60% or higher alcohol based sanitizer when: hands are not visibly soiled; before and after patient contact; before donning gloves.

      • You need enough to be able to rub 15-20 seconds before it dries

    • Proper hand washing:

      • Wet your hands

      • Lather with soap

      • Scrub with friction for at least 20 seconds

      • Rinse well

      • Dry your hand

      • Use a paper towel to turn off the faucet

      • Use paper towel to open the door

  • Sharps Safety 101

    • Never recap needles

    • Never bend or break needles

    • Dispose of sharps immediately in a puncture-resistant sharps container. Sharps are considered biohazards

    • Avoid over-filling sharps containers

      • Permanently close and seal them once they are 3/4 full

    • Use safety-engineered device

  • Cough Etiquette

    • Cover coughs and sneezes

    • Cough/sneeze into your elbow, coughing into your hand spreads germs

    • Patients with respiratory symptoms should wear simple face masks to contain their droplets

    • Perform hand hygiene after exposure to respiratory secretions

  • Cleaning, Disinfecting, and Linens

    • Clean and disinfect equipment between patients

    • Use approved disinfectants

    • Promptly clean spills of blood and body fluids

    • Treat contaminated linens as infections. Do not shake.

    • Bag used linens immediately at the point of collection. Hold used linens away from your body when transporting


Biohazardous Waste

  • Biohazardous waste may contain bloodborne pathogens or infectious material

  • Includes: Blood and blood products, items saturated with blood/body fluids, specimens and specimen containers, cultures, and pathological wastes like tissues and organs

  • Wash hands immediately after handling biohazardous waste

  • Nonsharp infectious waste goes into the red, leakproof, biohazard bag with the biohazard symbol. Don’t compress bio-haz bags.

  • Do not dispose of sharps/regular waste in biohazard bags

  • Regular waste: Gloves with minimum contamination, paper towels, bandages without visible blood, empty IV bags


Gloving + PPE Selection


Gloves

  • Protect hands from contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin

  • Must be changed between patients

  • Gloves don’t replace hand hygiene


Goggles and Face Shields

  • Goggles protect the eyes from splashes, sprays, or droplets of blood/body fluids. Use when procedures may cause splashing

  • Face shields protect the entire face (eyes, nose, mouth) from splashes/sprays, providing broader coverage than goggles

    • Wear a surgical mask under the face shield

    • Worn in place of goggles


Surgical Mask

  • Protects the nose and mouth from large droplets and splashes

  • Prevents the spread of respiratory secretions from the wearer to others

  • Used for routine patient care and droplet precautions

  • Doesn’t filter airborne particles (smaller than 5 microns)


Respirator (N95)

  • Protects the wearer from airborne particles and infectious aerosols

  • Creates a tight seal around the nose and mouth

  • Requires fit testing and a proper seal check


Gown

  • Protects skin and clothing from contamination

  • Worn during procedures with a risk of splashing or soiling

  • Must be removed before leaving the patient care area


Donning PPE - Putting PPE On

Indicated PPE is put in the following order:

  1. Hand hygiene

  2. Gown

  3. Mask or Respirator

  4. Goggles/face shield

  5. Gloves- always last, pull over cuff of gowns


Doffing PPE - Taking PPE Off

  1. Gloves

  2. Goggles/face shield - remove by strap or earpiece. Don’t touch the front!

  3. Gown - Untie or break ties. Pull away from the body touching only the inside. Roll inward

  4. Mask/respirator - remove by the bottom, then top, straps, avoid touching front

  5. Hand hygiene


Removing Gloves

  1. Pinch the outside of one glove near the wrist. Do not touch your skin
    Peel the glove away from the hand, turning it inside out as you remove it

  2. Hold the removed glove in the gloved hand

  3. Slide fingers of the ungloved hand under the wrist of the remaining glove. Touch only the inside of the glove

  4. Peel the second glove off over the first, turning it inside out.

  5. Discard gloves

  6. Perform hand hygiene


Contact Precautions

  • Used for infections spread by direct or indirect contact with patients or the environment

  • Required PPE: Gloves and gown (to enter the room)

  • Dedicated equipment, like disposable blood pressure cuffs and stethoscope

  • Frequent disinfection of surfaces

  • MRSA, VRE, C. diff, scabies, norovirus, draining wounds


Droplet Precautions

  • Used for infections spread by large respiratory droplets (within 3-6 ft)

  • Required PPE: Surgical mask (to enter the room), gloves and gown (if contacting the patient or contaminated environment)

  • Patient wears a surgical face mask during transport

  • Influenza, strep pharyngitis, meningitis, pneumonia, Covid-19, pertussis, flu


Airborne Precautions

  • Used for infections spread through tiny airborne particles that stay suspended in room

  • Required PPE: N95 respirator or a powered air-purifying respirator (PAPR), gloves and gown (if contacting the patient or contaminated environment)

  • Negative air pressure room needed (airborne isolation infection room) with closed door

  • Patient wears surgical mask for transport

  • Tuberculosis (TB), measles, varicella, Covid-19


Agency Review

  • OSHA - Sets workplace safety

  • CDC - Provides infection control guidelines

  • Employers must provide PPE and training


Post-Exposure Protocol (PEP) from Blood or Potentially Infectious Body Fluids

  • Applies to needle sticks, sharps injuries, splashes, breaks in skin, and mucous membranes

  • Wash the area immediately with soap or water, or flush your eyes

  • Report the incident to a supervisor

  • Complete an incident report

  • Seek medical evaluation

  • Seek post-exposure testing for HIV, Hepatitis B, and Hepatitis C

    • Baseline testing for healthcare worker and known patient (with consent

    • Repeat testing at 6 weeks, 3 months, 6 months

    • Begin HIV prep within 72 hours if unknown patient status or clinical indication












Sterile Fields


Sound Alike Words:

  • Antiseptic: Germ-killing agent applied to the skin to limit the growth of microorganisms and help prevent infection

    • Examples: Povidone iodine (betadine), chlorahexadine, alcohol

    • Clean with a circular motion from center outwards, 2’’ beyond surgical/procedural field

  • Anesthetic: medication that blocks nerve signals, preventing the sensation of pain (numbing

    • Ex: lidocaine


Term Review

  • Asepsis: state of being free from disease-causing microorganisms (pathogens)

  • Medical Asepsis “Clean Technique”: Reducing the number of microorganisms and preventing their speed

    • Used for daily and routine care

    • Handwashing, PPE, cleaning surfaces

  • Surgical Asepsis “Sterile Technique”: elimination of all microorganisms including spores

    • Used for high-risk or invasive procedures like surgery and catheter insertion

    • Sterile gloves, sterile equipment, maintaining a sterile field


Minor Surgery Review Questions:

  1. What is the correct method for removing a patient’s body hair before surgery? Clippers

  2. What should the medical assistant encourage patients to do before being prepped for sterile procedures, both for comfort and to avoid interruptions that would jeopardize the sterile field? Going to the bathroom

  3. What is the medical assistant’s only role in the informed consent process? Witness


Sterile Fields

  • Sterile field: an area free of microorganisms that is used as a work area during a sterile or surgical procedure

  • Sterile touches sterile. Clean touches clean.

  • Often set up on Mayo stands for clinic or bedside procedures


Rules of Sterile Fields

  • Only sterile items may touch a sterile field

  • Sterile touches sterile, Non-sterile touches nonsterile. When in doubt, throw it out.

  • Keep the sterile field in sight at all times. Do not turn your back on a sterile field. Do not leave the sterile field uncovered and unattended.

  • Never reach over a sterile field.

  • Moisture contaminates a sterile field. Wet areas allow microorganisms to travel.

  • The outer 1 inch border of a sterile field is considered non-sterile

  • Objects below waist-level are considered non-sterile

  • Sterile fields should be prepared immediately before use

  • Sterile fields should not be left unattended. If they must be, cover them with a sterile drape


Adding Fluids to a Sterile Field

  • Dump first few mL of fluid into a trash receptacle

  • Pour into a container on the sterile field from 2-6’’ away

  • Avoid splashes. Avoid wetting the drape.

  • Only pour sterile solutions to avoid contamination


Sterile Surgical Scrub - 3 to 5 minutes

  • Remove jewelry

  • Don surgical mask and hair cover

  • Turn on water with foot controls

  • Wet arms and hands, holding hands above elbows for water to flow towards elbows

  • Apply antimicrobial soap

  • Scrub fingers and nails first. Clean under nails before first daily care

  • Scrubs hands and arms, working from fingertips to elbows. Scrub all surfaces of fingertips, palms, backs of hands, and arms. Follow required stroke count (usually 3-5).

  • Do not touch anything 

  • Dry with a sterile towel from fingertips to elbows. Do not go back over dried areas


Sterile Gloving

  • Perform hand hygiene or sterile scrub. Hands must be fully dry.

  • Check the sterile glove package for expiration date and integrity

  • Open the sterile glove package on a clean, dry surface

  • Pick up the first glove touching only the inside cuff with your non-dominant hand

  • Slide hand in while keeping fingers up

  • Slide the gloved fingers under the cuff of the second glove. Glove the second hand being careful to only touch sterile surfaces

  • Insert non-dominant hand

  • Adjust if needed with sterile touching sterile. Do not touch the bottom 1” of the glove cuff because it is non-sterile