STERILE TECHNIQUE DHO 13:7

J.J.Nelson RN,CMA

What is Surgical Asepsis?

• Procedures that maintain an area or object free of microorganisms.

• Define Sterile:

• Define Contaminated:

• No room for error!!

Sterile Procedure

• Work area must be clean, dry and uncluttered.

• Sterile items:

• Above your waist

• Always in your vision

• Held in front of your body (not touching clothing or any thing else)

What is a sterile field? Why do you need it?

• An area free of microorganisms• May be a sterile towel or a sterile tray• May be the inside of a sterile wrapWHY DO WE NEED IT ????

Sterile Field RULES:

• Never work across the sterile field

• Always keep sterile items above waist and in vision

• Never turn back to sterile tray/item

• Two inch border around tray is considered contaminated

• Move slowly and deliberately

13:7A Opening a sterile package

• Three methods of adding a sterile item to a sterile field:

• Drop technique

• Mitten technique

• Sterile gloves

• To open a sterile package:

• Ascertain the package is sterile

• Hold with sealed edge TOWARD YOU

• Only touch exterior of wrap (Tabs)

Precautions:• While performing drop technique the wrap is opened

maintaining sterility of inside of wrap and item. The item is dropped onto sterile field without touching you, exterior of wrap of the outside perimeter of sterile field. Used most commonly for gauze pads, dressings and small items.

• With mitten technique, a mitten is formed with the wrapper around the hand holding the item. Special care to maintain sterility of item and inside of wrap. DO NOT let the wrap drag onto the sterile field. Commonly used for bowls,drapes, linen and odd shaped items.

• You can also correctly open items maintaining sterility of inside of wrap and then don sterile gloves . Then you just pick up item and place on field. Caution to only touch inside of wrap.

13:7B Preparing a sterile tray• Once there is a sterile tray it must be maintained as sterile. So…..

• Contaminated items stay off the tray• Solutions are poured without touching bowl or working over

sterile field.• Drop, mitten and sterile gloves are used.• Dressings that are used last are applied to the tray first.• Follow all the “rules”• If contamination occurs….start over.

HOW???

Mayo Stand Bedside Stand Overbed Table

13:7 A & B Opening Sterile Package, Preparing Sterile Tray

• These check offs can be given by Supervisor and/or Head Nurses.

• If contamination occurs…..you start over.

• The item is either sterile or it is not sterile……there is no room for error.

Donning and Removing Sterile gloves

• How in the heck do you put two sterile gloves on two non-sterile hands and keep the exterior of the gloves sterile?????

• And why???

• Once gloves are correctly on your hands you may ONLY touch sterile items.

• What if you need to move the tray? Or get more dressings (still wrapped) ?? Or your nose itches???

• Assemble sterile glove and ascertain sterility

• Remove jewelry, wash & dry hands• Open inner wrap handling only

OUTSIDE of wrap.• Don first glove by grasping cuff

(inside of glove)• Don second glove by grasping under

cuff• Pull on second glove with extreme

care not to touch exterior of second glove. (FLY your thumb)

• Only touch sterile surfaces• If not in use keep fingers together in

“prayer position” and away from body

DHO 13:7 CHECK OFF

13:7 D Changing a Sterile Dressing

• Surgeon change the dressing the first time. After that a doctors order is necessary to change the dressing.

• If drainage is saturating the original dressing, additional dressings are added and surgeon is notified.

• Exam gloves are used to remove the dressing. Only touching the exterior of dressing. Place dressing in bio bag

• Using a prepared sterile tray and having donned sterile gloves clean the area around the wound.

• Observe wound for S&S of infection or healing, color, amount, type of drainage.

Cleaning a circular or linear wound/incision

ALWAYS WIPE CLEAN TO DIRTY

Changing a Sterile Dressing cont.

• Remember to follow the “rules”. Such as when you toss the gauze pads in the bio bag you need to keep sterile gloves above waist. Do not turn back to tray.

• If contamination occurs you start over.

• Apply tape so it runs opposite the body movement.

• Charting:• Blue or black ink• Date/military time• Procedure and location• Amount, color, type of drainage• How well patient tolerated procedure • Your first initial, last name and title• Leave no blank area

Sample Charting

10/21/2013 1440 Abdominal dressing changed. Small amount of clear serosanguineous drainage noted. Pt tolerated procedure well and states “feels much better today”.

J. Nelson RN,CMA

13:7D Changing a Sterile Dressing

• Check off can be done with supervisor and/or head nurse.

• If tray contamination occurs you start over.

• There is no room for error!!

• Charting in the charts in required with this check off.

Tube Gauze

QUESTIONS??