Surgical Asepsis and Sterility: Best Practices and Techniques

Surgical Asepsis and Sterility: Best Practices and Techniques

Chapter Overview

  • Source: Surgical Technology for the Surgical Technologist: A Positive Care Approach, 6th Edition, 2024 Cengage Learning, Inc.
  • Focus: Discusses asepsis principles and sterile techniques critical for surgical patient care and outcomes.

Objectives

  • Objective 1: Discuss the relationship between the principles of asepsis and the practice of sterile technique, focusing on the impact on surgical patient care and outcomes.
  • Objective 2: Define and discuss the concept of surgical conscience.
  • Objective 3: Discuss the principles of asepsis.
  • Objective 4: Define terms related to asepsis.
  • Objective 5: Compare and contrast sterile techniques and practices related to the principles of asepsis.
  • Objective 6: Identify the principles and procedures related to disinfection and sterilization.
  • Objective 7: Demonstrate competency and explain the standards of practice related to sterile technique.
  • Objective 8: Demonstrate competency in the procedures related to disinfection and sterilization.
  • Objective 9: Discuss the surgical environment and how to apply principles of asepsis to control potential cross-contamination.

Best Practices and Techniques

  • Goal: Enhance understanding of systematic and sequential practices necessary to prevent disease transmission in the surgical environment.

Part I: Preventing Environmental Cross-Contamination

  • Focus on methods to minimize contamination risks in the surgical environment.

Basic Terminology

Key Definitions (1 of 2)
  • Disinfection: Process by which most, but not all, microorganisms on inanimate (non-living) surfaces are destroyed.
  • Antisepsis: Destruction of most, but not all, microorganisms on animate (living) surfaces.
Key Definitions (2 of 2)
  • Decontamination: Removal, inactivation, or destruction of gross contaminants, including bioburden and pathogens, via physical or chemical means.
  • Sterilization: Complete destruction of all microorganisms, including spores, on inanimate surfaces.

Classification of Patient Care Items

  • Critical Items:
    • Used for invasive procedures.
    • High potential for causing surgical site infections (SSIs).
    • Must be sterilized (e.g., surgical instruments, needles, implantable items).
  • Semi-Critical Items:
    • Contact mucous membranes or non-intact skin (e.g., laryngoscopes, anesthesia equipment).
    • Require high-level disinfection.
  • Non-Critical Items:
    • Contact intact skin (e.g., blood pressure cuffs, pulse oximeters).
    • Require intermediate or low-level disinfection.

Disinfection Principles and Disinfecting Agents

Overview
  • Disinfection Levels:
    • Cleaning: Removal of bioburden.
    • Disinfection:
      • High-level, intermediate-level, and low-level disinfection.
    • Sterilization: Complete microbial eradication.
    • Surface cleaning: Preparation for disinfection.
Efficiency Factors for Disinfectants
  • Concentration of disinfectant solution.
  • Contact time with the surface.
  • Physical properties of the solution.
High-Level Disinfectants
  • Glutaraldehyde:
    • Has an established shelf-life.
    • Must be rinsed after use; acts within twenty minutes at room temperature.
    • Safety: Requires gloves, prevents splashing, avoid inhalation.
  • Sodium hypochlorite (Household bleach):
    • Effective for disinfecting floors and surfaces.
    • Recommended for blood and body fluid spills.
    • Safety: Requires gloves, mask, eyewear, gown, apron.
Intermediate-Level Disinfectants
  • Phenol (Carbolic acid):
    • Must be diluted with water for use on floors and countertops.
  • Quaternary Ammonium Compounds:
    • Effective against bacteria, fungi, and pseudomonas.
  • Alcohol:
    • Isopropyl and ethyl alcohol (60-70% dilution).
    • Requires PPE and to avoid pooling; should prevent direct skin contact.

Environmental Decontamination

Importance
  • Essential for maintaining asepsis by minimizing microbial counts in the surgical environment.
  • OSHA mandates hospital exposure plans including:
    • Standard precautions and PPE use.
    • Regular decontamination of the OR.
Cleaning Practices
  • Decontamination procedures include:
    • Cleaning before the first procedure of the day.
    • Concurrent cleaning during procedures.
    • Cleaning between different surgical procedures.
    • Terminal and weekly cleaning routines.
    • Specific handling procedures for dirty cases.

Part II: Instrument Decontamination and Preparation for Sterilization

Overview
  • Instrument decontamination bridges the cycle from point-of-use to point-of-use.
  • CST responsibilities include:
    • Cleaning instruments with sterile water (avoid NaCl).
    • Using a wet sponge to remove fluids/tissue post-use; soaking instruments if necessary.
Pre-Transport Care of Instruments
  • Presoaking:
    • In sterile water or enzymatic solution (proteolytic or lipolytic).
    • Use of detergent solutions.
Instrument Preparation
  • Organization before transport:
    • Place heavy instruments at the bottom of trays, smaller items on top.
    • Open ringed instruments and disassemble multi-part instruments if necessary.
    • Apply enzymatic foam as per health care facility policy.
CSPD Decontamination Methods
  • Techniques for removing organic/inorganic materials:
    • Chelation: Breaks down minerals.
    • Enzymatic cleaning: Involves chemical action to clean instruments.
    • Emulsification: Uses detergents to encase particles.
    • Solubilization: Dissolves contaminants.
Three-Sink Method
  • First Sink: Wash with water and detergent solution.
  • Second Sink: Intermediate rinse with distilled water.
  • Third Sink: Final rinse with distilled water.
Specific Instrument Care
  • Use of washer-decontaminators, washer-sterilizers, and ultrasonic cleaners.
  • Instruments needing special care: rigid and flexible endoscopes.
  • Lubrication is important for optimal functioning of instruments.

Preparation for Sterilization

  • Instruments prepped by:
    • Lubrication if needed.
    • Checking sharpness and functionality.
    • Sorting, reassembling, and organizing.
    • Use of chemical sterility indicators or integrators.
    • Wrapping or placement into rigid container systems before sterilization.

Sterilization Principles and Processes

Instrument Processing Cycle
  • Refer to Figure 7-5 for visual representations.
  • Preparation and Wrapping:
    • Packaging must meet performance standards based on material types (woven textiles, nonwoven materials, rigid containers).
  • Basic wrapping principles:
    • Techniques for wrapping (envelope fold, square fold) discussed in the text.
    • Proper labeling of instruments post-wrapping.

Part III: Methods of Sterilization

Steam Sterilization
  • Process: Uses moist heat under pressure for microbial destruction.
  • Advantages outlined in Table 7-7.
Important Factors
  • Five Factors:
    • Time, Contact, Temperature, Moisture, Pressure & Air.
  • Basic components of a steam autoclave discussed.
Types of Steam Sterilizers
  • Gravity Displacement Sterilizer: Relies on gravity to remove air.
  • Dynamic Air Removal Sterilizer: Uses a vacuum for air removal.
  • Immediate-Use Steam Sterilization (IUSS): Sterilizes unwrapped items quickly.
General Safety Precautions
  • Ensure the sterilization equipment is properly sealed before use.
  • Wait for sterilization cart to cool before handling.
Monitoring Sterilization
  • Minimum Exposure: Monitor temperatures, pressures, and times for efficacy.
  • Use mechanical, chemical, and biological methods for full monitoring compliance.

Alternative Sterilization Methods

  • Ethylene Oxide (ETO): Low temperature gas for heat-sensitive materials. Requires specialized ventilation.
  • Hydrogen Peroxide Gas Plasma: Utilizes low-temperature gas, safe for materials sensitive to heat/moisture.
  • Liquid Chemical Sterilization: Suitable for heat-sensitive but moisture-stable items based on peracetic acid and glutaraldehyde.
  • Ionizing Radiation: Utilizes gamma rays for sterilizing pre-packaged items.
  • Ozone Gas Sterilization: Converts oxygen into ozone for microbial destruction.
  • Vaporized Hydrogen Peroxide: Utilizes hydrogen peroxide in gas form for sterilization.

Administrative Controls of Sterilization Processes

  • Importance of strict documentation for sterilization results.
  • Maintain logs for preventive maintenance of sterilization equipment.

Sterile Supply Maintenance

  • Storage practices to prevent SSIs:
    • Location, shelf maintenance, item placement, stock rotation, and environmental controls influence sterilized supply integrity.

Event-Related Sterility

  • Concept that sterility is determined by handling rather than time.
  • Adoption of event-related practices due to their economical benefits for healthcare facilities.

Unifying Principles of Sterile Technique

Surgical Conscience
  • The underlying principle of sterile technique adherence by all surgical team members:
    • Involves honesty, moral integrity, and responsibility towards patients.
    • Ensures consistent delivery of quality care.
    • No compromise allowed in maintaining sterile practices.
Principles of Asepsis
  1. A sterile field is established for each surgical procedure.
  2. Sterile team members must be appropriately attired before entering sterile field.
  3. Movement around the sterile field should maintain its integrity.

Summary

  • Comprehensive overview of asepsis principles and sterile techniques essential for surgical patient care.
  • Discussion encompassing surgical conscience, principles of disinfection and sterilization, and the environmental application of aseptic principles.