1. Chapter 42: Assisting with Minor Surgery
Lesson 1
Surgical Asepsis
© 2009 Pearson Education

2. Define and spell the terms to learn for this chapter.
Lesson Objectives
Upon completion of this lesson, students should be able to …
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.
Page 900
© 2009 Pearson Education

3. 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.
Page 902

4. 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.
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5. 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 from
Frazier/Malone MA, p. 578
Page 902

6. Categories of Surgery Elective: Emergency: Optional:
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
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7. Categories of Surgery Outpatient: Urgent:
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
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8. 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 from
PCMA 2e
Page 903

9. Medical versus Surgical Asepsis
Medical Asepsis
Surgical 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
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10. 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 42-2E
PCMA 2e
Page 903

11. 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
Page (Guidelines 42-1)
The purpose of PPE is to protect the pt & health care worker from exposure to pathogenic organisms.

12. Sterile Scrub and Hand Hygiene
Insert Figure 42-2A from PCMA 2e
Page
Is the #1 way to prevent spreading of infection.
Surgical scrub removes microorganisms more effectively than regular hand washing.

13. Steps to Surgical Hand Hygiene/Sterile Scrub
Remove jewelry and gross dirt from beneath fingernails
Assemble equipment
Stand at sink without allowing your body to touch it
Remove lab coat and roll sleeves above the elbows. Keep your hands and arms above waist
Regulate running water temperature to warm, not hot
Place hands under running water with hands pointed upward. Allow water to run from fingertips to elbows
Page (Procedure 42-1)

14. Steps to Surgical Hand Hygiene/Sterile Scrub
7. 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 from
PCMA 2e
Page (Procedure 42-1)

15. Steps to Surgical Hand Hygiene/Sterile Scrub
11. 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 from
PCMA 2e
Page (Procedure 42-1)

16. Personal Protective Equipment
Insert Figure 42-3 from PCMA 2e
Page 905
Includes: face shield, gown, & gloves.
Provides a barrier between infectious or hazardous material & the wearer.

17. Steps to Surgical Gloving
Assemble equipment and check seal and expiration date on pack
Place pack on a flat surface at waist height with cuffed end of gloves toward you
Open outside wrapper; leave opened wrapper in place
Open inner wrapper without reaching over or touching the inside of the pack
Critical Thinking
Question:
Why is it important not to reach over the pack when opening the inner wrapper?
Page (Procedure 42-2)

18. Steps to Surgical Gloving
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
Pull the glove onto the right hand using only the thumb and fingers of the left hand
Place fingers of the right-gloved hand under the cuff of left glove and pull onto left hand and up over left wrist
With gloved right hand, place fingers under the cuff of left glove and pull up over left wrist
After the gloves are in place, fingers can be adjusted with gloved hands
Page (Procedure 42-2)

19. Steps to Removing Gloves
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.
Discard the first glove into the proper biohazard waste container.
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.
Discard the gloves appropriately.
Page (Procedure 42-2)

20. Insert Figure 42-22 source of pick up from PCMA 2e
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 source of pick up from PCMA 2e
Page
To prepare you must know the names & uses of the instruments routinely used in minor surgery.

21. Steps for Opening a Sterile Packet
Insert Figure 42-5D from PCMA 2e
Page 908 (Procedure 42-3)

22. 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.
Page 908 (Procedure 42-3)

23. 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.
Page 908 (Procedure 42-3)

24. Steps for Dropping a Sterile Packet onto a Sterile Field
Insert Figure 42-6 from PCMA 2e
Page 909 (Procedure 42-4)

25. 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.
Page 909 (Procedure 42-4)

26. Steps for Transferring Sterile Objects
Insert Figure 42-7 from PCMA 2e
Page (Procedure 42-5)

27. Why is it important not to turn your back on the sterile field?
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 Thinking
Question:
Why is it important not to turn your back on the sterile field?
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28. Questions?