Chapter 57: Surgical Asepsis

Terms That Apply to Asepsis *Dirty: any object that has not been cleaned or sterilized to remove microorganisms *Contaminated: any object that is not sterile Grossly contaminated: contains visible body fluids, discharges, or dirt *Clean: many of the most harmful microorganisms have been removed Sterile: the item or area is free of all microorganisms and spores; if a sterile item touches a nonsterile item, the sterile item becomes contaminated

Disinfection *Disinfection The process that results in the destruction of most pathogens but not necessarily their spores Methods Use of alcohol wipes, a hexachlorophene or chlorhexidine gluconate soap scrub, or a povidone- iodine scrub, surgical hand scrub *Stronger disinfectants: Phenol or chlorine is used to disinfect floors and surfaces

Sterilization *Sterilization The process of exposing articles to steam heat under pressure or to chemical disinfectants long enough to kill all microorganisms and spores Methods Autoclave, chemical disinfectants, radiation, and gas sterilization Autoclave 18 pound, at a temp of 125 C for 15 minutes*

Medical Asepsis: Clean Technique **The purpose of maintaining medical asepsis is to prevent the spread of disease from one person to another Handwashing Standard Precautions

Surgical Asepsis: Sterile Technique All microorganisms and spores are destroyed before they can enter the body. Often, clean technique (medical asepsis) is performed using sterile supplies. Sterile to clean, dirty, or contaminated becomes contaminated. *see nursing care guidelines 57-1

Sterile Technique Sterile technique is used to prevent the spread of infection Supplies used for surgical and other sterile procedures Used when administering injectable medication and performing surgical and other procedures, such as urinary catheterization* Anything that either touches an open wound or skin break, enters a sterile body cavity, or punctures the skin Surgical towels or drapes are packaged, secured with special masking tape, labeled, and sterilized

Educating the Client Client and family teaching Demonstrate the skill to be performed Ask the client and family to demonstrate the skill before discharge Explain how to recognize problems or complications Describe when to seek medical care immediately If indicated, make a referral for home care nursing follow-up

Sterile Technique in Nursing Do not touch anything after sterile gloves or gown have been put on. Reaching over a sterile field contaminates the sterile area. If a sterile wrapper or mask becomes wet, they are no longer sterile. When wearing sterile gloves, perform a sterile procedure. A person’s back is not sterile. Skin can only be made clean, not sterile. When in doubt, consider the objects in question to be contaminated.

Sterile Technique Hair covering Surgical mask and eye protection Sterile gown Sterile gloves Open gloving Closed gloving Removal of sterile or nonsterile gloves

Typical Procedures Requiring Sterile Technique Care of the indwelling catheter Surgical intervention and invasive procedures Sterile dressing change Suture and staple removal Administration of parenteral medications Venipuncture and management of IVs

Urinary Catheterization Self-catheterization Catheterizing the female client The side-lying position Catheterizing the male client *Coude tip catheter *remove no more than 750-1000ml of urine at one time Caring for the client after catheterization Removing the retention catheter

**Nursing Procedures 57-1 57-2 57-3 Use 14-16 fr catheter 57-4 57-5