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Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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Presentation on theme: "Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive."— Presentation transcript:

1 Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive System Module : Infection Prevention: A- and Antiseptic Techniques in Surgical Setting

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 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 : – 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) – 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 Zone Restricted area Semi – Restricted Area SCRUB SUITSCRUB SUIT

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 1. Rules at clean zone 2. Procedures in sterile area 3. Talk as necessary 4. Restrict unnecessary movements 5. Sterile instruments, remove non sterile one 6. 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 Rinsing arms Scrubbing with antiseptic solution 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

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