Medical/Surgical Asepsis

Presented by:
Cynthia Bartlau, RN, PHN, MSN

Objectives
At the completion of this lesson the student
will be able to
Discuss concepts related to the chain of infection
Differentiate medical and surgical asepsis
Discuss equipment used for maintaining medical
and/or surgical asepsis
Identify common sources for contamination
Describe proper hand placement during aseptic
procedures
Beginning of Modern Asepsis
Previous to the discovery of asepsis many
people died due to post-operative (and other)
infection
Dr. Ignaz Semmelweis
Told doctors to wash their hands
Scottish surgeon named Joseph Lister
Inspired by Louis Pasteurs formulation of the
germ theory of disease
Used carbolic acid in operating rooms
Drastic reduction in infections
Theory of Infection Control
Microorganisms
Bacteria
Fungi
Viruses
Protozoa

Pathogenic
Disease causing
Infectious agent
Causes disease in healthy person
Opportunistic pathogen
Causes disease in susceptible person
Virulence
Communicable diseases
Non-pathogenic
Resident flora
Colonization
Can cause disease if transmitted to other areas
Infection
Local
Specific area of body is infected
Systemic
Microorganisms spread & damage other body
areas
Bacteremia when microbes enter blood stream
Septicemia when bacteremia spreads through all of
the body systems
Acute vs. chronic infection

Nosocomial infections that occur as a
result of health care delivery
Endogenous source
Exogenous sources
Iatrogenic infection directly caused by any
diagnostic or therapeutic source
Drug-Resistant Pathogens
MRSA
VRE
MDR TB

Causative Agent
Susceptible Host
Portal of Entry
Mode of
Transmission
Portal of Exit
Reservoir
Bacteria
Viruses
Fungi
Protozoa
Helminthes

People
Equipment
Water
Secretions
Excretions
Droplets
Skin
Direct-Indirect Contact/Fomite
Injection/Ingestion
Airborne/Aerosols
Broken Skin/Mucous Membrane
Gastrointestinal/Respiratory/
Urinary Tract
Neonates
Diabetics
Immunosuppressed
Cardiopulmonary Disease
Chain of
Infection
Medical Asepsis
AKA: Clean technique
Practices that inhibit the growth & spread of
pathogenic microorganisms
Handwashing
Standard precautions
Transmission based precautions
PPE


The JCAHO Sentinel Event Alert quotes Julie
Gerberding, MD, director of the CDC, as
stating
Clean hands are the single most important factor
in preventing the spread of dangerous germs
and antibiotic resistance.
Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN J ournal.
Antiseptics
Prevent or inhibit growth of pathogenic
organisms
Not effective against spores or viruses
Can be use on the skin
Alcohol
Betadine
Disinfection
Destruction of pathogens other than spores
Boiling water and chemicals
Bleach solutions
Zephirin
Irritate or damage skin
Used on objects not people


Surgical Asepsis
AKA: Sterile technique
Practices that destroy all microorganisms &
their spores
Used in specialized areas & skills
Care of surgical wounds
Catheter insertion
Invasive procedures
Surgery
Sterilization
Destruction of pathogens & non-pathogens,
including spores and viruses
Steam under pressure
Gas
Radiation
Chemicals
Autoclave is most common piece of
equipment used

CDC recommendations
Preoperative/prophylactic antibiotic
administration
No preoperative hair removal (unless hair will
interfere with operation)

Sterile Technique
Procedures that keep an object or area free
from living organisms
Sterile vs. contaminated areas
Articles must remain away from and in front
of the body and above the waist

Sterile Technique
Never reach across the sterile field
Never turn your back to the sterile field
Two inches around border is considered
contaminated
Sterile field must be kept dry
Sterile Gloving
Only touch the outside of the package with
bare hands.
The inside of the package, in which the
gloves are placed, is considered sterile.
The wrapper, when opened provides a sterile
field.
Grasp only the outside edge of the wrapper.
The inside of the glove may be touched with the bare
hand
Grasp the first glove at the top edge of the folded-
down cuff and slip in hand
Slip gloved fingers into cuff of second glove and slip
in second hand without contaminating
The outer aspect of the glove must remain sterile
Includes wrist area
Keep hands above level of waist
Sterile to sterile only
If contamination occurs, start again with new pair of gloves
Techniques to Remove Articles
from Sterile Wraps
Drop technique
For gauze pads, dressings, small items
Wrapper is partially opened , held upside down over
sterile field, dropped onto sterile field
Mitten technique
For bowls, drapes, linen
Using the wrap as a mitten, sterile supplies can be
placed on a sterile field
Transfer forceps
For cotton balls, small items, or articles
Sterile gloves or transfer forceps are used to transfer
objects to sterile field
Skills to Demo & Practice

Donning & Removing Sterile Gloves


Questions?