1. 1. Dr. Farooq Ahmed Rana MBBS, FCPS, FRCS Eng Assistant Professor Surgical unit III SIMS/SHL
2. 2. Learning objectives Explain the concepts of medical and surgical asepsis. Identify types of microorganisms causing infections. Identify types & signs of localized and systematic infections. Identify risks for nosocomial infections. Explain chain of infection.
3. 3. Identify factors influencing a microorganism's capability to produce an infectious process. Identify measures that break each link in the chain of infection. Principles of Surgical Asepsis. The OR scrub.
4. 4. Asepsis and Antiseptics Asepsis is the freedom from disease-causing microorganisms. To decrease the possibility of transferring microorganisms from one place to another, asepsis is used. Aseptic techniques are those aimed at minimising infection Asepsis usually involves The use of sterile instruments The use of a gloved no touch technique Antisepsis is the removal of transient microorganisms from the skin and a reduction in the resident flora
5. 5. History 1847 - Semmelweis identifies surgeons hands as route of spread of puerperal infection 1865 - Lister introduces hand and wound asepsis with the use of carbolic acid 1880 - von Bergmann invents the autoclave
6. 6. There are two basic types of Asepsis Medical & Surgical asepsis.
7. 7. 1. Medical Asepsis Includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganisms.
8. 8. In medical asepsis, objects are referred to as clean, which means the absence of almost all microorganisms, or dirty (soiled, contaminated), which means likely to have microorganisms, some of which may be capable of causing infection.
9. 9. Methods in Medical Asepsis Hand hygiene Carry linens away from your body No linens on floor Cover mouth when sneezing Do not raise dust Do not shake linens Clean to dirty Transmission precautions
10. 10. 2. Surgical Asepsis or Sterile Technique, refers to keep an area or object free of all microorganism, it includes practices that destroy all microorganisms and spores. Surgical asepsis is used for all procedures involving the sterile areas of the body.
11. 11. Sepsis is the state of infection and can take many forms, including septic shock.
12. 12. Types of microorganisms causing infections
13. 13. 1. Bacteria can live and be transported through air, water, food, soil, body tissues and fluids, and inanimate objects. 2. Viruses (causes the common cold) hepatitis, herpes, and human immunodeficiency virus. 3. Fungi include yeasts and molds. Candida albicans 4. Parasites They include protozoa such as the that causes malaria.
14. 14. Types of infection
15. 15. A local infection is limited to the specific part of the body where the microorganisms remain. If the microorganisms spread and damage different parts of the body, it is a systemic infection.
16. 16. When a culture of the person's blood reveals microorganisms, the condition is called bacteremia. When bacteremia results in systemic infection, it is referred to as septicemia.
17. 17. Acute infections generally appear suddenly or last a short time. A chronic infection may occur slowly, over a very long period, and may last months or years.
18. 18. Nosocomial infections Classified as infections that are associated with the delivery of health care services in a health care facility. Nosocomial infections can either develop during a client's stay in a facility or manifest after discharge.
19. 19. The incidence of nosocomial infections is significant. Major sites for these infections are the respiratory and urinary tracts, the bloodstream, and wounds.
20. 20. Factors that contribute to nosocomial infection risks are invasive procedures, medical therapies, the existence of a large number of susceptible persons, inappropriate use of antibiotics, and insufficient hand washing after client contact and after contact with body substances.
21. 21. 4. Method of transmission There are three mechanisms
22. 22. A. Direct transmission Involves immediate and direct transfer of microorganisms from person to person through touching, biting, kissing, or sexual intercourse. Droplet spread is also a form of direct transmission.
23. 23. B. Indirect transmission Material objects, such as toys, soiled clothes, cooking or eating and surgical instruments, or dressing, water, food, blood, serum, and plasma. Animal or flying.
24. 24. C. Air born transmission may involve droplets or dust.
25. 25. 5. Portal of entry Before a person can become infected, microorganisms must enter the body. The skin is a barrier to infectious agents; however, any break in the skin can readily serve as a portal of entry.
26. 26. 6. Susceptible Host A susceptible host is any person who is at risk for infection. A compromised host is a person at "increased risk.
27. 27. Factors Increasing Susceptibility to Infection 1. Age influence the risk of infection. 2. Heredity influences the development of infection. 3. The nature, number, and duration of physical and emotional stressors can influence susceptibility to infection.
28. 28. 4. Resistance to infection depends on adequate nutritional status. 5. Some medical therapies predispose a person to infection. For example, radiation treatments for cancer, some diagnostic procedures may also predispose the client to an infection.
29. 29. Cleaning, Disinfecting, and Sterilizing The first links in the chain of infection, the etiologic agent and the reservoir, are interrupted by the use of antiseptics (agents that inhibit the growth of some microorganisms) and disinfectants (agents that destroy pathogens other than spores) and by sterilization.
30. 30. Cleaning Cleanliness inhibits the growth of microorganisms. When cleaning visibly soiled objects, nurses must always wear gloves to avoid direct contact with infections microorganisms.
31. 31. Disinfecting A disinfectant is a chemical preparation, such as phenol or iodine compounds, used on inanimate objects . Disinfectants are frequently caustic and toxic to tissues. An antiseptic is a chemical preparation used on skin or tissue .
32. 32. Disinfectants and antiseptics often have similar chemical components, but the disinfectant is a more concentrated solution .
33. 33. Antiseptic Agents Rapid Action Broad Sectrum Persistent effect Safety Acceptibilty Alcohol, Chlorhexidine, Triclosan , Iodine, Iodophores Binds to Stratum Corneum.
34. 34. Alcohol > Denaturing of Protein Chlorhexidine > Disruption of Cell wall Triclosan > Disruption of cell wall Iodine/ Iodophores > Oxidation / Substitution of free Iodine
35. 35. When disinfecting articles, nurses need to follow agency protocol and consider the following:
36. 36. 1. The type and number of infectious organisms. 2. The recommended concentration of the disinfectant and the duration of contact. 3. The temperature of the environment. 4. The presence of soap. Some disinfectants are ineffective in the presence of soap or detergent.
37. 37. 5. The presence of organic materials, the presence of saliva, blood, pus can readily inactive many disinfectants. 6. The surface areas to be treated. The disinfecting agent must come into contact with all surfaces and areas.
38. 38. The basic principles of surgical asepsis
39. 39. 1. All objects used in a sterile field must be sterile. 2. Sterile objects become un-sterile when touched by un-sterile objects. 3. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.
40. 40. 4. Sterile objects can become unsterile by prolonged exposure to airborne microorganisms. 5. Fluids flow in the direction of gravity.
41. 41. 6. Moisture that passes through a sterile object draws microorganisms from un- sterile surfaces above or below to the sterile surface by capillary action.
42. 42. 7. The edges of a sterile field are considered un-sterile. 8. The skin cannot be sterilized and is un- sterile.
43. 43. Personal Protective Equipment Gloves Gown Mask Protective Eyewear
44. 44. Surgical Asepsis Precautions Sterile can touch only sterile Do not spill on a sterile field Hold objects above waist Do not reach over field Do not turn back on field Outer 1 inch is considered sterile If in doubt, treat as contaminated
45. 45. There Is No Compromise with Sterility Its Considered Sterile or Unsterile.
46. 46. The OR Scrub
47. 47. The Surgical Scrub Definition. The surgical scrub is the process of removing as many microorganisms as possible from the hands and arms by mechanical washing and chemical antisepsis before participating in a surgical procedure. Despite the mechanical action and the chemical antimicrobial component of the scrub process, skin is never sterile.
48. 48. The Methodology of the Scrub
49. 49. The Timed Method All surgical scrubs are 5 minutes in length. All are performed using a surgical scrub brush and an antimicrobial soap solution.
50. 50. Surgical Scrub Procedure 1. Wet the hands and forearms 2. Apply antiseptic agent from the dispenser to the hands. 3. Wash the hands and arms thoroughly to 2 inches above the elbows, several times. Rinse thoroughly under running water with the hands upward, allowing water to drip from the flexed elbows.
51. 51. 4. Take a sterile brush or sponge (from a package or dispenser) and apply an antiseptic agent ( if it is not impregnated in the brush). Scrub each individual finger, including the nails, and the hands, a half minute for each hand.
52. 52. 5. Hold the brush in one hand and both hands under running water, and clean under the fingernails with a disposable plastic nail cleaner. Discard the cleaner after use. 6. Again scrub each individual finger, including the nails and the hands with the brush, half a minute for each hand.
53. 53. The Final Rinse 1. Be sure to keep both arms in the upright position (careful not to touch the faucet!) so that all water flows off the elbows and not back down to the freshly scrubbed hands. Bring arm through the water once, starting with the fingers, then pull the arm straight out. Do not let water run down to hands, must drip off elbows
54. 54. 7. Rinse the hands and brush, and discard the brush. 8. Reapply the antimicrobial agent and wash the hands and arms, applying friction to the elbows, for 3 minutes. Interlace the fingers to clean between them. 9. Rinse the hands and arms as described in the previous slide.
55. 55. Drying the Hands and Arms 1. Reach down to the opened sterile package containing the gown, and pick up the towel. Be careful not to drip water onto the pack. Be sure no one is within arms reach. 2. Open the towel full- length, holding one end away from the nonsterile scrub attire. Bend slightly forward.
56. 56. 3. Dry both hands thoroughly but independently. To dry one arm, hold the towel in the opposite hand and, using the oscillating motion of the arm, draw the towel up to the elbow. 4. Carefully reverse the towel, still holding it away from the body. Dry the opposite arm on the unused end of the towel.
57. 57. Gowning and Gloving Techniques 1. Reach down to the sterile package and lift the folded gown directly upward. 2. Step back away from the table into an unobstructed area to provide a wide margin of safety while gowning. 3. Holding the folded gown, carefully locate the neckline.
58. 58. 4. Holding the inside front of the gown just below the neckline with both hands, let the gown unfold, keeping the inside of the gown toward the body. Do not touch the outside of the gown with bare hands. 5. Holding the hands at shoulder level, slip both arms into the armholes simultaneously.
59. 59. 6. The circulator brings the gown over the shoulders by reaching inside to the shoulder and arm seams. The gown is pulled on, leaving the cuffs of the sleeves extended over the hands. The back of the gown is securely tied or fastened at the neck and waist, touch the outside of the gown at the line of ties or fasteners in the back only.
60. 60. Gloving by the Closed Glove Technique 1. Using the right hand and keeping it within the cuff of the sleeve, pick up the left glove from the inner wrap of the glove package by grasping the folded cuff.
61. 61. 2. Extend the left forearm with the palm upward. Place the palm of the glove against the palm of the left hand, grasping in the left hand the top edge of the cuff, above the palm. In correct position, glove fingers are pointing toward you and the thumb of the glove is down
62. 62. 3. Grasp the back of the cuff in the left hand and turn it over the end of the left sleeve and hand. The cuff of the glove is now over the stockinette cuff of the gown, with the hand still inside the sleeve.
63. 63. 4. Grasp the top of the left glove and underlying gown sleeve with the covered right hand. Pull the glove on over the extended right fingers until it completely covers the stockinette cuff.
64. 64. 5. Glove the right hand in the same manner, reversing hands. Use the gloved left hand to pull on the right glove.
65. 65. Gloving the Right Hand
66. 66. Scrubbing, Gowning, and Gloving Complete
67. 67. Questions for Discussion 1. What would you do if, during your OR experience, you accidentally touched an unsterile object with your sterilely gloved hand? 2. What would you do if, while scrubbing, you accidentally touched the faucet? 3. Is it OK to prepare a sterile field an hour before the scheduled surgical case and leave the room to set up another OR room? Why or why not? 4. What should you do if you notice a break in sterile technique by another member of the OR team that they may/or may not be aware of?