Lesson 1

Surgical Asepsis

Chapter 42: Assisting with Minor Surgery

© 2009 Pearson Education

Define and spell the terms to learn for this chapter.

List and differentiate between the types of ambulatory surgery.

Discuss all guidelines for surgical aseptic technique.

Describe the differences between medical asepsis and surgical asepsis.

© 2009 Pearson Education

Lesson Objectives

Upon completion of this lesson, students should be able to …

© 2007 Pearson Education

MEDB152 Health and Safety/Intro to Microbiology

Introduction

Aseptic technique is also known as sterile technique. Some procedures that require sterile technique are:

• Minor surgical procedures• Suture insertion & removal• Breat biopsy (bx)• Incision & drainage (I&D)• Removal of growths• Wound treatment (tx)

If there is any doubt that something is sterile or not; assume that it is non-sterile.

Ambulatory Surgery

Method for performing surgical procedures Patient is admitted and discharged from a surgical

facility on the same day Includes outpatient surgery in a hospital setting, a

surgicenter, or medical office. Hospitalization is not required unless unexpected

complications occur. Disadvantage is the short time the health care team has

for assessing the patient’s postoperative condition. Important for outpatient facility to develop a follow-up

procedure to track the patient’s condition after leaving.

Outpatient Surgery

Generally limited to procedures requiring less than 60 minutes to perform.

Many surgeries are performed in free-standing surgicenters or surgical centers that are part of a hospital complex.

Insert Figure 29-10 fromFrazier/Malone MA, p. 578

Categories of Surgery

Elective: • Considered medically necessary, but can be

performed when the patient wishes

Emergency:• Required immediately to save a life or

prevent further injury or infection

Optional:• May not be medically necessary, but the

patient wishes to have it performed

Categories of Surgery

Outpatient: • does not require an overnight stay in a

hospital

Urgent:• to be performed as soon as possible, but is

not an immediate or acute emergency

Medical versus Surgical Asepsis Medical asepsis—the

elimination of organisms that have left the body

Surgical asepsis—the practice of creating and maintaining a sterile environment, in which organisms are destroyed before entering the body

Insert Figure 42-1 fromPCMA 2e

Medical versus Surgical Asepsis

Medical AsepsisMedical Asepsis Surgical AsepsisSurgical Asepsis

Clean technique used Sterile technique used

Controls microorganisms Absence of microorganisms

Basic hand hygiene used Surgical scrub performed

Clean equipment and supplies

Sterile equipment and supplies

Clean field Sterile field

Principles of Surgical Asepsis

Surgical asepsis is necessary for any invasive procedure

Requires:• Sterile scrub• Sterile gloves• Sterile technique when

handling material

“Clean for clean” and “sterile for sterile”

Insert Figure 42-2EPCMA 2e

Guidelines for Surgical Asepsis

A sterile item can only touch another sterile item A sterile item on a sterile field must be within your

field of vision and above your waist Airborne microorganisms contaminate sterile fields The edges of a sterile field are contaminated Sterile gloves must only touch sterile items Sterile packets may be touched on the outside with

bare hands Be honest if you make an error or suspect you

have made an error

Sterile Scrub and Hand Hygiene

Insert Figure 42-2A from PCMA 2e

Insert Figure 42-2A from PCMA 2e

Steps to Surgical Hand Hygiene/Sterile Scrub1. Remove jewelry and gross dirt from beneath

fingernails

2. Assemble equipment

3. Stand at sink without allowing your body to touch it

4. Remove lab coat and roll sleeves above the elbows. Keep your hands and arms above waist

5. Regulate running water temperature to warm, not hot

6. Place hands under running water with hands pointed upward. Allow water to run from fingertips to elbows

Steps to Surgical Hand Hygiene/Sterile Scrub7. Apply a circle of soap and

lather well

8. Vigorously scrub hands and wrists with scrub brush (5 minutes per hand)

9. Raise hands, bending at elbows, and rinse off soap, fingertips to elbows

10. If performing a second lather, use 3 minutes per hand

Insert Figure 42-2C fromPCMA 2e

Steps to Surgical Hand Hygiene/Sterile Scrub11. Use sterile towel to pat

hands dry, from finger-tips to wrists to elbows

12. Turn off faucet with fresh towel or foot lever

13. Glove immediately. Keep hands above waist and folded together until procedure begins

Insert Figure 42-2F fromPCMA 2e

Personal Protective Equipment

Insert Figure 42-3 from PCMA 2e

Insert Figure 42-3 from PCMA 2e

Steps to Surgical Gloving1. Assemble equipment and check

seal and expiration date on pack

2. Place pack on a flat surface at waist height with cuffed end of gloves toward you

3. Open outside wrapper; leave opened wrapper in place

4. Open inner wrapper without reaching over or touching the inside of the pack

Critical ThinkingCritical ThinkingQuestion:Question:

Why is it important Why is it important not to reach over not to reach over the pack when the pack when

opening the inner opening the inner wrapper?wrapper?

Critical ThinkingCritical ThinkingQuestion:Question:

Why is it important Why is it important not to reach over not to reach over the pack when the pack when

opening the inner opening the inner wrapper?wrapper?

Steps to Surgical Gloving5. Using the thumb and fingers of the left hand, pick up

the glove on the right side of the pack by grasping the folded inside edge of the cuff

6. Pull the glove onto the right hand using only the thumb and fingers of the left hand

7. Place fingers of the right-gloved hand under the cuff of left glove and pull onto left hand and up over left wrist

8. With gloved right hand, place fingers under the cuff of left glove and pull up over left wrist

9. After the gloves are in place, fingers can be adjusted with gloved hands

Steps to Removing Gloves1. Remove the first glove by grasping the edge of that

glove (with fingers of the other gloved hand) and pull the first glove over the hand inside out.

2. Discard the first glove into the proper biohazard waste container.

3. Remove the other glove by grasping the edge of the cuff with your fingers (from the ungloved hand) and pull the second glove down over the hand, inside out.

4. Discard the gloves appropriately.

Sterile Packaging

Each autoclaved pack may contain one or more items

Packs are set up on Mayo stand

The inside of the packet’s wrapper is the sterile field

Insert Figure 42-22 source of pick up from PCMA 2e

Insert Figure 42-22 source of pick up from PCMA 2e

Steps for Opening a Sterile Packet

Insert Figure 42-5D from PCMA 2e

Insert Figure 42-5D from PCMA 2e

Steps for Opening a Sterile Pack

Perform hand hygiene. Assemble equipment. Adjust the Mayo stand to correct height. Place packet on the Mayo stand with the folded edge

on top. Position the packet on the stand so that the top flap will

fold away from you. Remove the tape or fastener and check the sterilization

indicator and date. Discard in a waste container. Pull the corner of the pack that is tucked under and lay

this flap away from you.

Steps for Opening a Sterile Pack

With both hands, pull the next two flaps to each side. Grasp the corner of the last flap, without reaching over

the sterile field, and open the flap toward your body without touching it.

The inside of this outer wrapper is now your sterile field. If you need to arrange items within this field, use sterile forceps.

If an inner packet needs to be opened with an instrument setup, then someone wearing sterile gloves must open it.

Steps for Dropping a Sterile Packet onto a Sterile Field

Insert Figure 42-6 from PCMA 2e Insert Figure 42-6 from PCMA 2e

Steps for Dropping a Sterile Packet onto a Sterile Field Assemble equipment; check expiration date and sealed

condition of packet. Locate the edge on the prepackaged item and pull apart

by using the thumb and forefinger of each hand. Do not let your fingers touch the inside of the packet. Pull the packet apart by securely placing the remaining

three fingers of each hand against the outside of the packet on each side.

Holding the item securely about eight to ten inches from the sterile field, gently drop the packet contents inside the sterile field.

Steps for Transferring Sterile Objects

Insert Figure 42-7 from PCMA 2eInsert Figure 42-7 from PCMA 2e

Sterile Transfer Used to move items around

on the sterile field or to place instruments onto a sterile field

Must put on sterile gloves or use transfer forceps

Do not reach across or turn your back on the sterile field unless it is covered with a sterile towel

Critical Critical ThinkingThinkingQuestion:Question:Why is it Why is it

important not to important not to turn your back turn your back on the sterile on the sterile

field?field?

Critical Critical ThinkingThinkingQuestion:Question:Why is it Why is it

important not to important not to turn your back turn your back on the sterile on the sterile

field?field?

Questions?