Sterile Precautions - Dr Imran
-
Upload
waqar-basathia -
Category
Documents
-
view
219 -
download
0
Transcript of Sterile Precautions - Dr Imran
-
8/2/2019 Sterile Precautions - Dr Imran
1/42
Sterile Precautions
-
8/2/2019 Sterile Precautions - Dr Imran
2/42
Wound infection
results from
bacterial
contamination
-
8/2/2019 Sterile Precautions - Dr Imran
3/42
What is the source of bacterialcontamination of surgical wounds?
1- Endogenous (from the patient himself):
Patients skin flora(skin preparation)
Patients viscera(colon preparation before resection)
2- Contamination from air in the O.R. :
3- Direct contamination:
Personnel circulation in the O.R.
O.R. ventilation.
Instruments, punctured gloves.
-
8/2/2019 Sterile Precautions - Dr Imran
4/42
The Theatre
The aim is to reduce the number of theorganisms in the air of the O.R. to a minimum.
-
8/2/2019 Sterile Precautions - Dr Imran
5/42
Clean and dirty areas should be separated &well demarcated.
Trafficking ofpersonnel should bekept to a minimumthrough the sterilearea.
Doors of the theatre
and the O.R. shouldbe closed.
-
8/2/2019 Sterile Precautions - Dr Imran
6/42
O.R. air quality control
Exogenous wound contamination is mainly air born.
1-Reduce
the numberof individualsin thetheatre.
Pickup other mistakes.
-
8/2/2019 Sterile Precautions - Dr Imran
7/42
O.R. air quality control
2- Avoid excess movementof individuals in thetheatre.
-
8/2/2019 Sterile Precautions - Dr Imran
8/42
O.R. air quality control
3- Doorsshould be
closed.
-
8/2/2019 Sterile Precautions - Dr Imran
9/42
O.R. air quality control
4- Air vents should not be obstructed.
-
8/2/2019 Sterile Precautions - Dr Imran
10/42
O.R. air quality control
Ideal situation:
controlled ventilation with air filters
(changing the air of the theatre 20 times / hour)
This is important in orthopedic surgerywere air is the main source of wound
contamination.
-
8/2/2019 Sterile Precautions - Dr Imran
11/42
Instruments
-
8/2/2019 Sterile Precautions - Dr Imran
12/42
Instruments
Cleaninginstruments
(removal ofcontamination)isan essential stepbeforesterilization(destroyingmicroorganisms)
-
8/2/2019 Sterile Precautions - Dr Imran
13/42
Definitions
Sterilisation Disinfection
Completedestruction of all
viablemicroorganisms
including spores &viruses.
Solid instruments
Reduces the numberof viable
microorganisms
Skin & delicateinstruments
-
8/2/2019 Sterile Precautions - Dr Imran
14/42
Sterilisation
by steam
Autoclaves
It kills vegetative bacteria (includingTB), viruses (e.g. Hepatitis)& heatresistant spores.
-
8/2/2019 Sterile Precautions - Dr Imran
15/42
Autoclaves
Organisms arekilled by thecombined effectofpressure,moist heat&time.
Temp. Press. Time
134 C 30 lb/in2 3 min.
121 C 15 lb/in2 15 min.
-
8/2/2019 Sterile Precautions - Dr Imran
16/42
Unwrapped instruments can besterilised in small autoclaveswithin
the theatre.
This is suitable to sterilise instrumentswhen accidentally dropped.
-
8/2/2019 Sterile Precautions - Dr Imran
17/42
Monitoring of adequate sterilisation
Chemical indicators
Before After
-
8/2/2019 Sterile Precautions - Dr Imran
18/42
Chemical indicators
-
8/2/2019 Sterile Precautions - Dr Imran
19/42
Sterilisation by Ethylene
Oxide Gas
For heat
sensitivematerials
includingelectricalequipments.
-
8/2/2019 Sterile Precautions - Dr Imran
20/42
Sterilisation by Ethelene Oxide Gas
Ethylene Oxide reacts
with organic debris
(serum) forming toxic
compounds, so dont use
it with contaminatedequipments (ventilator
equipments)
-
8/2/2019 Sterile Precautions - Dr Imran
21/42
Sterilisation by Hot Air
ovenCompared to moist steam sterilisation it
is less efficient.
It does not cause corrosion, so it is used
for instruments with fine cutting edges(opthalmic instruments).
-
8/2/2019 Sterile Precautions - Dr Imran
22/42
Sterilisation with
gama rays
Industrial process used to steriliselarge batches of similar products,
such as syringes, catheters andintravenous cannulas.
-
8/2/2019 Sterile Precautions - Dr Imran
23/42
Disinfection(reduce the number of the viable organisms)
Levels
High
Spores,bacteria &viruses.
Medium
Bacteria &viruses
Low
Bacteria &weak viruses.
-
8/2/2019 Sterile Precautions - Dr Imran
24/42
Disinfection
The efficacy of disinfection depends on:
The nature of the microorganism.
The load of the microorganism.
Duration of exposure to the agent.
The temperature.
-
8/2/2019 Sterile Precautions - Dr Imran
25/42
Disinfection
Boiling water(100 c for 5 minutes)
Low temperature steam(73 c for 20 minutes)
Formaldehide gas(in air tight cabinet at 50 c)
-
8/2/2019 Sterile Precautions - Dr Imran
26/42
Disinfection with
Glutaraldehyde solution (2%)Kills mostbacteria &
viruses.Used forEndoscopes
Toxic; shouldbe washed.
-
8/2/2019 Sterile Precautions - Dr Imran
27/42
Theater Staff
Personnel with infected skinlesionsor upper respiratorytract infectionmust beexcluded from the O.R. team.
-
8/2/2019 Sterile Precautions - Dr Imran
28/42
To decrease the bacterial count
in the air of the O.R.You should change your normalclothes to clean O.R. linen before
entering the theater.
Cotton gowns cannot serve as abarrier(cotton pores are 100 um insize while skin scales are 5-60 um)
-
8/2/2019 Sterile Precautions - Dr Imran
29/42
Wrong
-
8/2/2019 Sterile Precautions - Dr Imran
30/42
Wrong
-
8/2/2019 Sterile Precautions - Dr Imran
31/42
Caps & Masks
Protects the wound fromorganisms (in the oropharynx).
Offers protection to the wearer.
-
8/2/2019 Sterile Precautions - Dr Imran
32/42
Caps & Masks
Wrong Wrong
-
8/2/2019 Sterile Precautions - Dr Imran
33/42
Caps & Masks
Wrong Right
-
8/2/2019 Sterile Precautions - Dr Imran
34/42
Scrubbing
PovidoneIodine orchlorhexidine
soap, for 3-5minutes.
-
8/2/2019 Sterile Precautions - Dr Imran
35/42
Scrubbing
Use thebrushfor thenails.
-
8/2/2019 Sterile Precautions - Dr Imran
36/42
Scrubbing
Wrong
-
8/2/2019 Sterile Precautions - Dr Imran
37/42
Scrubbing
Dry your
hands
What is wrong?
Streetclothes
-
8/2/2019 Sterile Precautions - Dr Imran
38/42
Gloves
Offers atwo-way
protection
-
8/2/2019 Sterile Precautions - Dr Imran
39/42
Preoperative PatientPreparation
Short preoperative hospital stay(reduces inoculation by hospital resistantorganisms).
Preoperative showering.
Shaving (as it causes skin lacerations)should be done in the morning ofsurgery to avoid skin inoculation by
hospital organisms.
-
8/2/2019 Sterile Precautions - Dr Imran
40/42
Patients skin preparation
In the ward:
Wash the skin of the operation sitewith soap impregnated detergent(Povidone Iodine or Chlorhexidine)
Iodine may cause skin allergy. (Takehistory, Patch test)
-
8/2/2019 Sterile Precautions - Dr Imran
41/42
Patients skin preparation
Povidone Iodine or Clohexidine paint.
In the O.R.
-
8/2/2019 Sterile Precautions - Dr Imran
42/42
Patients skin preparation
Allow the
solution todry for
maximum
bacterialreduction.
Wrong