1. Infection Prevention: A- and Antiseptic Techniques in Surgical Setting
Interactive Training CD for Medical Students
Reproductive System
Module :
Infection Prevention: A- and Antiseptic Techniques
in Surgical Setting
Reproductive System, Medical School of Universitas Padjadjaran, Bandung MIR-C Corporate

2. Production Team: Director : Kiki Lukman, MD, MSc, FINACS (Dig.)
Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.)
Main contributors : Kiki Lukman, MD, MSc, FINACS (Dig.)
Yayat Ruchiyat, MD, FINACS (Dig.)
Warko Karnadihardja, MD, FINACS (Dig.)
Nurhayat Usman, dr., SpB-KBD
Lisa Hasibuan, MD
Nina K. Poetri T., SKp,
Dadang Sunarya AMK
Dedy Rusnadi AMK,
Alia Rahmi AMK,
Editorial Team : Kiki Lukman, MD, MSc, FINACS (Dig.)
Casting : Kiki Lukman, MD, MSc, FINACS (Dig.)
Artistic : MIR-C Corporate
Productions : Medical School of Universitas Padjadjaran
Bandung

3. Credits Special thanks to:
Central Operating Theatre Unit of Hasan Sadikin General Hospital

4. Infection Prevention Module
Introduction
Infection control
Antiseptic techniques
Operating Theater
Aseptic techniques

5. Description Objectives
Introduction
Description
Objectives

6. Description
Infection Prevention in Surgical Setting is one of important preventive methods in order to achieve infection control in clinical and surgical practices.

7. Objectives The aims of this method are :
To minimize surgical site infection
To protect health personnel
To improve wound healing
To minimize disability, morbidity, & mortality
To reduce the cost of hospital care

8. Specific Learning Objectives :
To describe the definition and history of sterilization, disinfection, decontamination, anti and a - septic techniques.
To describe six methods of sterilization.
To describe three categories of surgical instruments
To describe 6 rules of aseptic techniques

9. Specific Learning Objectives :
To perform aseptic techniques correctly, including (P5):
Applying surgical attire
Hand washing
Surgical scrubbing
Gloving
Surgical Gowning

10. Definition:
Sterilization : Processes by which all pathogenic & non pathogenic microorganisms, including spores, are killed.
Disinfection: Chemical or physical process of destroying all pathogenic microorganisms, except spore bearing ones; used for inanimate objects, but not on tissues.

11. Definition:
Decontamination : Process or method by which all contaminated materials that can cause diseases are removed.
Aseptic techniques : Methods by which contamination with microorganisms is prevented.
Antiseptic techniques: Prevention of sepsis by the exclusion, destruction, or inhibition of growth and multiplication of microorganisms from body tissues and fluids.

12. Infection Control

13. Why should we apply a and antiseptic techniques ?

14. Historical backgrounds :
Ignas Sammelweis ( )
Puerperal fever  increased maternal mortality
Hand scrub with chlorinated-lime solution prior to examination.
Father of nosocomial infection.
Louis Pasteur (1860)
Discover the process of fermentation by microorganisms
Germ theory: against spontaneous generation theory.

15. Historical backgrounds :
Joseph Lister (1865)
Use carbolic acid solution on surgical dressing in the operating room  mortality  (Listerization)
Father of modern surgery (Antiseptic technique)
Ernst Von Bergmann (1886)
Introduced “steam sterilizer”
Basic of sterilization  aseptic technique
Later: “pressure & vacuum steam sterilizer” was developed

16. Methods of Infection control
Anti septic techniques
Design and traffic patterns of the operating theatre
Aseptic techniques

17. Anti septic techniques

18. Sterilization The objective of modern surgery For inanimate objects
Problem :
Some items are not heat resistance

19. Techniques of Sterilization
Physical:
Heat
Radiation/ ultraviolet ray
Boiling water
Ultrasound
Chemical:
Liquid
Gas

20. Heat Sterilization Dry : Moist : Commonly cause damage
For powder, oils, and jelly
Moist :
Steam
High pressure   spores 
Vacuum  constant temperature
Autoclave

21. Chemical Sterilization
Generally as disinfection
Mechanism of action :
Protein coagulation
Enzyme denaturation in cells
Lysis
Depend on : number of microorganisms, soiling, concentration, and temperature.

22. Solutions Jodium and Jodophor Good bactericide, but irritant
Mixture : povidone-jodine 10%
Alcohol Solution of 70% or 90%
Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)
Spores are killed within 3 hours

23. Solutions Hexachloropene (Halogenated phenol) Chlorhexidine gluconate
Bacterio-static, particularly Gram (+) bacteria
For scrubbing
Chlorhexidine gluconate
Bactericide : Gram (+) & (-).
Good for antiseptic

24. Gas Sterilization
Formaldehyde
Ethilene-oxide
- propionolactone

25. Boiling Water Mild boiling Vigorous boiling
More active, if 2% sodium-carbonate or 0,1 % sodium-hydroxide being added

26. The Operating Theater Sterile core Clean Zone Transitional ZoneU B I T
Transitional
Zone
Sterile
core
Restricted area
Semi –
Restricted
Area

27. Traffic patterns of Operating Theatre
The use of aseptic principles requires regulation of traffic and flow patterns of the personnel, patient, equipment, and supplies in operating theatre
Aims : to protect the safety and privacy of patients and the cleanliness and integrity of the environment.

28. unrestricted area
Elevators
Corridors outside surgical suite

29. unrestricted area
Entrance
Reception desk
Patient suite

30. Transitional Zone (Video)
Locker room
Dressing room

31. Clean Zone (Video)
Surgical suite and corridors
Sterile core

32. Scrub Area (Video)

33. Sterile Core (Video)

34. Putting on surgical attire
In the semi & restricted area:
Scrub suit : shirt & trousers
Hair covering: surgical cap/hood
Masks : disposable/ re-useable
Goggle (optional): protective eyewear
Shoe covers
are compulsory

35. Surgical attire
Male personnel
Female personnel
Personnel with veil

37. Surgical Instruments in the Operating Theatre
Critical items :
Sterile, because of being used for penetrating skin or mucosa
Semi critical items :
In contact with skin or mucous membrane
Non critical items :

38. Aseptic techniques

39. Aseptic techniques Rules at clean zone Procedures in sterile area
Talk as necessary
Restrict unnecessary movements
Sterile instruments, remove non sterile one
Avoid & Replace wet surgical drapes/towels

41. Hand washing Indications: Between patient contacts
Before performing or assisting with invasive procedures
Before taking care of particularly susceptible patients
Before and after touching wounds
Immediately after gloves are removed

42. Hand washing Before and after performing sterile procedures
After contact with blood or body substances, mucous membranes, soiled linen, waste, or contaminated equipment.
Between tasks at different body sites on the same patient to prevent cross contamination
After taking care of infected patient
After touching contaminated inanimate sources

43. Hand washing
Preparation
The procedure

44. Surgical Scrubbing Procedure

45. Purposes:
To remove debris and transient organisms from the nails, hands, and forearms.
To reduce the resident microbial count to a minimum.
To inhibit rapid rebound growth of microorganisms.

46. Purposes:
To minimize the re-growth of microorganisms for the length of the procedure.
To reduce the numbers of microorganisms on hands
To reduce contamination of the operative site by recognized or unrecognized breaks in surgical gloves.

47. Preparation:

48. Recognizing glove sizes

49. Actual procedure: Strokes technique
Rinsing hands & arms
Scrubbing with antiseptic solution
Rinsing arms
Scrubbing with brush or sponge
Drying arms

50. Actual procedure: Five minute technique

51. Gowning
The goal:
to ensure a safe, protective, and aseptic environment to the patient and the surgical team.

52. Gowning & closed gloving techniques
Drying hands with sterile towel
Applying gown
Closed gloving technique

53. The final step of the aseptic techniques before performing surgery.
Sterile gloves are worn to permit the wearer to handle sterile supplies or tissues of the operative wound.

54. Sterile gloves establish a shield that protects the patient from contamination by flora from the hands of health care workers.

55. Open technique

56. Closed technique

57. Skin preparation The goals:
to cleanse the skin and bring both the resident and transient bacterial counts to an irreducible minimum, therefore reducing the risk of wound contamination and subsequent surgical site infection.
performed just before the surgical incision has been performed.

58. Skin preparation
Skin painting
Skin draping

59. Ready for surgery

60. Gown and gloves removal
After surgery:
Gown, Gloves removal
Simultaneous removal