aseptic technique and sterilization methods ctvt pgs 1158-1168 objectives: understand aseptic...
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ASEPTIC TECHNIQUE AND STERILIZATION METHODS
CTVT PGS 1158-1168
Objectives:
Understand aseptic technique and it’s importance in surgery.
Learn how to properly sterilize instruments and equipment.
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Asepsis- condition of sterility where no living organisms are present
Aseptic technique- all steps taken to prevent contamination of surgical site by infectious agents
Goal: to “maintain asepsis“ and watch for “breaks” in aseptic technique
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Where do contaminants come from?
Exogenous sources:o You, patient’s fur/skin, instruments, air
Endogenous:o Inside the patient reach the incision
through blood stream
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Ways to Maintain Aseptic Technique
Disinfection - destruction of pathogens on inanimate objects (Kennel Care, Accel)o Doesn’t effect bacteria spores
Sanitization - acceptable level of contaminants present
Antiseptic – inhibits growth of infectious agents on living tissue (Chlorhexidine)
Sterilization - complete destruction or elimination of all living organismso Including viruses and bacterial spores o Always inorganic material
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When does aseptic technique begin?
It’s always happening!o Cleaning of instrumentso Surgery suite sanitation/disinfectiono Patient prepo Sx team scrubo Surgical suite etiquette
Contamination cannot always be avoidedo Skin abscess, dental disease
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Contamination Risk of contamination doubles every hour under Ax
Contamination does not mean infection
Infection is dependent on:
o Patient health
o Tissue damage
o Virulence and quantity of agent
The level of contamination determines:
o Use of perioperative antimicrobials
o Degree of asepsis required
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Classification of Surgical Procedures
Clean = non-contaminated, routine, placement of hardware
o Ex. permanent implants (IM pins), benign laparotomy
Clean-contaminated = entering a hollow organ
o Ex. enterotomy, cystotomy
Contaminated = leakage during Sx or major breach of aseptic technique
o Ex. enterotomy, cystotomy
Dirty = previously ruptured hollow organ or abscess
o Ex. cutaneous abscess, septic peritonitis, ruptured pyo
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Methods of Sterilization
1. Physical Sterilization Filtration Radiation Heat
2. Chemical Sterilization Liquid Gas
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Filtration Sterilization
Filtration – microorganisms separated from liquid materials o Pharmaceuticalso Can be placed on IV line or syringe
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Radiation Sterilization
Radiation - destruction of microorganism without significant increase in temperature o Gloves and suture material
*Filtration and radiation are typically performed by the manufacturer before shipments
- anything that comes pre-sterilized
- a lot of “one time use” products
- items which cannot be heat sterilized
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Heat Sterilization
Most common sterilization technique Destroys bacteria by denaturing their proteins
1. Dry Heat Sterilizationo High temperatures for a long period of time
2. Wet Heat Sterilizationo Creating steam under pressure at high
temperatures o Ex. Autoclave
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Dry Heat Sterilization Does not involve moisture (no rust, no corrosion)
Takes longer than wet heat and requires higher temperatures
(no steam to achieve the higher temperature)
Ex. 300°f for 2 ½ hours
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Wet Heat: Autoclave Sterilization
Pack must be able to withstand heat AND moisture!
1. Pre-vacuum sterilizer A pump evacuates the air before the steam enterso More even penetration of steamo Shorter duration
2. Gravity Displacement Sterilizer Steam enters the top and forces air to bottom Most commonly used type
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Autoclave Sterilization (Gravity Displacement)
Used most commonly for “packs”
Heat = 250 °F minimum
Pressure = 20 PSI
Time = 13 minutes at temp (exposure time)o Total cycle =Heat-up + exposure + dry timeo Usually 30 - 45 minute cycle
Always use distilled water!*Every machine is different, refer to the operator's manual
(usually have pre-set buttons to use)
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There should be space between each pack!
Steam should be allowed to flow around every surface of each pack
Use multiple racks if sterilizing a lot of packs
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Pack Preparation
Proper pack preparation is critical Instruments must be clean and dry All locking instruments should be unlocked Wrap materials must be steam permeable
1. Woven = double thickness muslino Reusable
2. Non-woven =crepe paper or plastic poucho One time use …(mostly)
Many practices double wrap (AAHA)
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Pouch Preparation
Peel packs – clear plastic pouches
made of plastic and paper
o Self-sealing or heat sealedo Instrument is placed into pouch with
the handles toward the closed ino Plastic side should face downo Pack will be opened from the closed end
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Labeling of Packs
Three requirements: What is in it Initials of who prepared it Date it was sterilized
*VTI- which patient it is for
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Sterility Indicators1. Tape – outside of pack was exposed to steam
2. Chemical Indicator Strips- change color when exposed to steam for adequate time
Examples:
o Peel packs – indicator on the outside of the paper
o OK Strip - can be placed in the center of the pack
o Stickers- can be placed anywhere (mostly for gas)
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Sterility Indicators
3. Pellet glass – glass ampule containing a temperature sensitive pellet that melts between 244-250 °F
4. Biological/Culture tests – contain a spore population of bacteria (usually Bacillus sp.)
o Takes minimum of 24 hours for resultso Confirms that microorganisms
were in fact killed if the sample does
not grow anything
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Autoclave Quality Control
Performed by technicians- ensures proper technique Sterility Indicators
Must be used in combination, as not just one will cover all requirements
Temperature graphs Autoclave maintenance - autoclave cleaner
o Ex. Speed-Clean – mixed in the water
o Ex. Chamber Brite – powder is sprinkled on the bottom of cold chamber; cycle is ran without drying
o Both require a “rinse” cycle to be ran after use
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After the Autoclave Cycle Packs must cool slowly to prevent condensation which could:o Wick bacteriao Rust metalo Tear paper
Let the dry cycle finish completely!
Door should be cracked to vent slowly ~ 10-20 minuteso Opening door wide causes steam to condense inside
the pack becomes wet wicks bacteria
Don’t leave paper packs in autoclave longer than needed (makes paper more brittle, easy to tear)
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Maintaining Sterile Packs
The outside is not sterile
Storage: dust free, dry, well-ventilated, away from contaminated areas - closed cabinet is safer than open
Broken sterility: dropped on floor, wet, broken outer wrap (instruments penetrates paper)
o Never assume sterility - autoclave again
o Error on the side of caution
Monitor dates for expired sterility
(clinic protocol)
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Length of Sterility Table on page 1163 in CTVT
1. Date related practice: Which one lasts longer? Double vs. single wrapped Non-woven vs. Woven Closed vs. open cabinet Heat sealed vs. Self-sealed
2. Event related practice: item is sterile until an event in which the sterility is broken
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Flash Sterilization (Emergency situation)
Instruments are placed unwrapped in a perforated metal tray
270°F for 3 minute exposure time
Removed with detachable metal handles and carried straight to surgery (or huck towel)
Instruments must cool before use
Some machines have a preset for this