Aseptic Awareness in the Operating Room Michael Janeski ST Vanessa Seidell PA

The Importance of Aseptic Technique Surgical site infection are the third most common nosocomial infections longer hospital stays Increased costs to patients and hospital Increased morbidity and mortality

Principal 1: What’s makes a surgical team member sterile? A proper surgical scrub Proper surgical attire Sterile surgical gown Gown Mask Eye protection Sterile gloves A scrubbed member works within the sterile field.

Who is a Non-sterile Surgical team member. Anesthesiologist Circulator Any vendor or Rep’s Non sterile members work in the periphery of the sterile field.

What is sterile, what isn’t? Only the top surface of draped table Front of gown from 2” below neck of gown to sterile field level Sleeves of gown are sterile 2” above the elbow to the cuff Lines or sutures falling over the edge of table should be discarded. Sterile members should not touch the part hanging below the table level DO NOT place hands in axillary region or below level of table. Minimize placing hands above level of sterile gown. Once draped item is sterile, It should not be re-adjusted.

Principle 2: Draping and opening sterile items Sterile drapes should be placed on the patient, furniture, and equipment to be included in the sterile field, leaving only the incisional site exposed Once draped item is positioned it should not be re-adjusted. Again, after the operating room tables are draped, only the top surface of the draped area is considered sterile.

Principle 3: Opening Sterile Items To ensure sterility, all sterile items need to be inspected for package integrity and sterilization process indicators, such as indicator tape and internal chemical indicators, prior to introduction onto the sterile field. IF YOU ARE IN DOUBT ABOUT THE STERILITY OF A CERTAIN OBJECT, CONSIDER IT UNSTERILE! If a package has been compromised, it should be considered contaminated and not be used. The integrity of a sterile package or sterile drape is destroyed by perforation, puncture or strike through Strike-through is the soaking of moisture through non-sterile layers to sterile layers or vice-versa Package expiration date for sterility must be checked just prior to opening it

Principle 4: Opening Sterile Items The circulating nurse, must use good judgment when dispensing sterile items onto the sterile field When opening wrapped supplies, the nonsterile person should open the top wrapper flap away from them first, then open the flaps to each side. The last wrapper flap is pulled toward the nonsterile person opening the package When opening a peel package, the nonsterile person opens the package by rolling the wrapper over his or her hands and presenting the inner contents of the package to the scrubbed person either by presenting them directly to the scrubbed person or placing them securely on the sterile field. Sterile items that are tossed onto the sterile field may displace other sterile items, penetrate the drape, or roll off the sterile field causing contamination to occur This technique of opening a wrapped package ensures that the nonsterile person does not reach over the sterile item inside.

Principle 5: Movement in Operating Room Use “margin of Safety” (min 12”) when you have to move around. Unsterile member should NEVER pass between two sterile areas! Unsterile members should face sterile field when passing it. Unsterile members should notify a sterile member when they are passing behind them. “sterile” team members should stay near the sterile table. They should not wonder about the room nor go out into the corridor. When scrubbed personnel change positions, they should maintain a safe distance from each other and always pass each other by turning back-to-back or face-to-face. Once a case begins, entering and exiting the operating room should only be through the sub-sterile door.

Principle 6: The sterile field should be maintained and monitored constantly It is the responsibility of the operating room staff to monitor and maintain the sterile field When a breach of sterility occurs, team members must take immediate and appropriate action to correct the break in technique to reduce further risk of contamination. The sterile field should be prepared as close as possible to the time of use. Once set up, the sterile field needs to be monitored constantly. Remember, if there is doubt regarding an item's sterility, consider it not sterile.3