ASEPSIS AND STERILE TECHNIQUE

ANES 1501

Introduction to Anesthesia Technology

College of DuPage

HUMAN MICROBE RELATIONSHIPS

Indigenous microflora Microbes that live on the skin and inside human body “Opportunistic pathogens” Examples: bacteria, fungi, viruses, and protozoa Microflora = harmless, HOWEVER, microflora + surgical wound =

pathogen

Symbiosis Mutualism Commensalism Parasitism

PATHOGEN AND INFECTION

Pathogens Microorganisms that cause infection Commensal microbes: Opportunistic by entering through a surgical

incision Nosocomial: Urinary tract infections (UTI) Airborne viruses: Common cold

HUMAN-MICROBE RELATIONSHIPS

Mutualism: Both organisms benefit and depend on one another to a certain extent Example: Esherchia coli in the colon produces vitamin K

Synergism: Two organisms work together to achieve a result neither could obtain alone Example: Fusobacteria and spirochetes work together to cause trench mouth

Commensalism: One organism benefits but the other neither benefits nor is harmed Example: Indigenous microflora on the skin can obtain nutrients but do not

affect the skin

Parasitism: One benefits and the host is harmed Example: Intestinal worms

PATHOGENS ASSOCIATED WITH SURGICAL SITE INFECTIONS (SSI)

Bacteria Prokaryotes, binary fusion

Tuberculosis (TB) Mycobacterium tuberculosis: airborne droplet nuclei Precautions: wearing gloves, gowns, eyewear, and NIOSH-approved respirators

Viruses Non-living particles that are completely reliant on the host cell for survival Largest: 300m

Capsis: protein covering of DNA/RNA Capsomeres: the capsis is composed of protein molecules Nucleocapsid: nucleic acid-capsid combo

Smallest: 30m Poliovirus

PATHOGENS - SSI

Emerging infectious diseases Multidrug resistant strains (MDR) Strain “W” Viruses constantly mutate and evolve

Examples: ebola, dengue, Lassa

Prions Prusiner 1982 Creutzfeldt-Jakob disease (CDJ) Scrapie (“sheep disease”)

PATHOGENS – SSI

Unicellular and multicellular protozoan

Helminths: round and flat Tapeworm, flukes, and roundworms

Transmission: ingestions of contaminated food/water that contains the worm or eggs Skin, fecal-oral contamination, arthropod bite

Protozoa-unicellular eurkaryotes that are responsible for causing human diseases such as malaria and chronic sleeping sickness Amoebas, flagellates, ciliates, coccidian, and microsporidia Entamoeba histolytica: cause of amoebic dysentary

PATHOGENS – SSI: FUNGI

Mycology (study of fungi) Examples: yeast, mushrooms, and molds

Mycoses (fungal diseases) Example: Zygomycosis (bread mold) Rhinocerebral zygomycosis Increased organ transplants and immuosuppressive drugs and

antibiotics Plastic surgery and bone transplant

METHODS OF TRANSMISSION

Primary agent: bacterium, virus, fungi, or parasite

SSI: acquired at time of surgery, then after Environmental and endogenous

Personnel – WEAR PROPER ATTIRE!

Environment Fomites: inanimate objects that harbor microorganisms

Patient

FACTORS THAT INCREASE SSI

Age

Obesity

General health

Nasal carriers of S. aureus

Remote infections

Pre-op hospitalization

FACTORS AFFECTING SSI

Preexisting illness and related treatment

Pre-op hair removal

Type of procedure

Duration of procedure

SURGICAL CONSCIENCE

Surgical conscience is the practice of strict adherence to aseptic technique by ALL surgical team members, including YOU, the SURGICAL TECHNOLOGIST!

Also includes: Honesty, moral integrity, responsibility Ability to recognize and correct breaks in aseptic technique If there is hesitation and/or inability to admit = there is no place for you

in the O.R. Following all standard precautions at all times

There can be no compromise of aseptic technique

BASIC TERMINOLOGY

Antiseptic

Asepsis

Bacteriocide

Bacteriostatic

Bioburden

Contamination

Cross-contamination

BASIC TERMINOLOGY (CONT.)

Decontamination

Disinfectant

Event-related sterility

Fomite

Fungicide

Infection

Nosocomial

BASIC TERMINOLOGY (CONT.)

Pathogen

Resident flora

Sepsis

Spore

Sporicide

Sterile

Sterile field

BASIC TERMINOLOGY (CONT.)

Sterile technique

Sterilization

Strike-through contamination

Surgically clean

Terminal disinfection

Terminal sterilization

Transient flora

Vector

Virucide

PRINCIPLES OF ASEPSIS

Principle 1: sterile field is created for each procedure

Principle 2: sterile team member must be appropriately attired prior to entering sterile field

Principle 3: movement in and around the sterile field must not compromise the sterile field

PRINCIPLE 1

Time

Instrument sets, peel packs, and wrappers

Chemical indicators

Sterile edges

Opening packages

Items that fall below table edges

Questionable sterility

Causes of contamination

PRINCIPLE 2

Sterile portion of gown

Sterile portion of table

Proper technique with arms and hands

Surface for gowning and gloving

Sitting during surgery

Platform standing

PRINCIPLE 3

Sterile to sterile

Sterile individuals keep within sterile area

Nonsterile to nonsterile

CHARACTERISTICS OF BACTERIA

Morphology: size, shape and arrangements of bacteria

MORPHOLOGY

Coccobacilli

MORPHOLOGY

Bacillus- rod shape

Spirilla- spiral shape

L-Form- bacteria that lose normal shape (environmental)

GROWTH AND MOTILITY

Varies with agar medium

Rate

Flagella

Cilia

NUTRITIONAL/02 REQUIREMENTS

Classifications: ex) oxygen, carbon, nitrogen

- obligate aerobes

-microaerophiles

-obligate anaerobes

-facultative anaerobes

-aerotolerant anaerobes

-capnophiles

PATHOGENICITY

Ability to cause disease

- release of exotoxins and endotoxins

- release of enzymes

- presence of a protective capsule

- attachment to host cell

METABOLISM, PROTEINS, AND GENETICS

Metabolism is the secretion of waste products

Proteins specific to bacterial species

DNA is unique to each bacteria species

STAINING

Simple

Gram

Acid-fast

SPORE FORMING

Bacterial species capable of forming spores

Unfavorable conditions = cell is enclosed in a protein capsuleto

High survival

NOT REPRODUCTION

Difficult to destroy

DISINFECTION, DECONTAMINATION, AND STERILIZATION

Disinfection process in which most but NOT ALL the microorganisms on INANIMATE

are destroyed

Decontamination Antisepsis: process in which most but NOT ALL microorganisms on

ANIMATE surfaces are destroyed Antiseptic: solutions

Sterilization destruction of ALL microorganisms, including SPORES, on inanimate

surfaces

DISINFECTION PRINCIPLES AND DISINFECTING AGENTS

Cleaning physical removal of blood and body fluids, as well as BIOBURDEN, from inanimate objects.

Disinfection high, intermediate, and low levels

Sterilization steam, chemical agents, high velocity electron bombardment, and

ultraviolet radiation critical, semi-critical, and noncritical

DISINFECTANT EFFICIENCY FACTORS

Concentration level of disinfectant solution

Number and type of microbes present

Physical factors of the solution

- temperature

- water hardness

- pH level

- exposure time

ALWAYS FOLLOW MANUFACTURER’S INSTRUCTIONS!

HIGH LEVEL DISINFECTANT COMPOUNDS

Glutaraldehyde/Cidex pH: 7.5-6.5 Best overall disinfectant/liquid sterilant Complete immersion in liquid Endoscopes Shelf life of 14 days/28 days

HIGH LEVEL DISINFECTANT COMPOUNDS

Sodium hypochlorite Household bleach Disinfectant for surfaces, floors, and equipment CDC recommended on blood and body fluid spills

INTERMEDIATE LEVEL DISINFECTANT COMPOUND

Phenol Carbolic acid Large areas and general basis

Quaternary Ammonium Compounds “quats” Bactericidal, fungicidal, pseudomonacidal Not sporicidal or tuberculocidal Common: benzalkonium chloride, dimethyl benzyl ammonium chloride

and the newer, diakyl quat

Alcohol Isopropyl and ethyl alcohol: diluted 60-70% Bactericidal, virucidal, fungicidal, tuberculocidal, NOT sporicidal

ENVIRONMENTAL DECONTAMINATION

Role: minimize microbial counts in the OR environment

Surfaces and characteristics

Pre-op, intra-op and post-op

Standard precautions and PPE

ENVIRONMENTAL SERVICES

Decontamination practices in the OR pre, intra, post, or between

Terminal cleaning

Weekly cleaning

Dirty cases

SURGICAL INSTRUMENT DECONTAMINATION PROCESS

ALL ITEMS USED ON STERILE FIELD AND/OR ON OPEN TISSUE MUST BE STERILIZED!

Decontamination is the first step Cleaning Disinfected Lubricated (if necessary) Sorted Reassembled Wrapped Sterilized Stored properly

CLEANING

Presoaking in basin Sterile water Enzymatic solution

Proteolytic enzymatic cleaner Lipolytic enzymatic cleaner

Detergent solutions Table 7-8

Rinsed and dried Chelation, enzymatic, emulsification, and solubilization

Table 7-9

MANUAL CLEANING

1. Instruments immersed in a solution. Friction will loosen organic material. With stainless steel: back and forth motion; circular can scratch.

2. Rinse in distilled water. NO TAP WATER!

3. AVOID spotting the instruments, so DRY!

DECONTAMINATION

Washer-sterilizer

Washer decontaminator

Ultrasonic washer Considerations:

Use of tray- perforated/wire mesh Heavier instruments place on the bottom Hinges left open Disassemble any instrument Concave surfaces should be placed upside down

WASHER DECONTAMINATOR

“WD”

Purpose: allows for hands-off processing

Considered “clean” but DOES NOT INCLUDE STERILIZING PHASE

WASHER STERILIZER

“WS”

Stainless steel and heat tolerated items

MUST BE CLEAN BEFORE USE!

Stainless steel must not be placed near other metals = fusion

Use free rinsing, low sudsing, neutral pH detergent

NOT USED DIRECTLY ON PATIENTS NOT A BIOLOGICALLY MONITORED PROCESS

Types of WS machines Tunnel like chamber Horizontal/cabinet type Gravity cycle of 270 degrees

ULTRASONIC CLEANER

After instruments are placed in WD or WS, they’re place in the ultrasonic cleaner

Removes small organic particles, or places that cannot be reached Box locks, serrations, and ratchets

Cavitation High frequency sound waves Molecules are forced in a rapid motion which form bubbles Implosion occurs to create a vacuum, dislodging particles

Metal mesh trays

Each cycle last 4-5 minutes

SPECIAL CARE

Items with lumens

Rigid and flexible endoscopes

Lubrication “milking”