SUR 111 Lecture 2

Terminology Related to Asepsis and Sterile Technique  Review and learn the terms in table 7-1 page 143  You must be familiar with these terms

Pathogens & Infection  Pathogen  Any microorganism that is capable of causing an infection  Infection  Microorganism in a particular place  Presence of or multiplication of microorganisms  NOT necessarily causing problems  Disease  Showing signs or symptoms due to microorganisms ARE causing problems

Infection  Nosocomial Infection  Hospital acquired infection  Surgical Site Infection (SSI)  Infection that is the direct result of surgery  Primarily caused by patient’s own normal flora (endogenous)  Can be caused by breaks in aseptic technique  Is a type of nosocomial infection  25% of all nosocomial infection  Typically do not become evident until after patient is discharged from hospital  Note table 7-3 page 134 for pathogens associated with SSIs and their percentage rates

Sources of Microbial Transmission  Personnel  Environment  Patient

Pathogens associated with SSIs  Bacteria  Escherichia coli  Resides normally in lumen of intestines = resident flora  If gets outside of intestinal lumen will cause infection (peritonitis) that is life threatening  Staphylococcus aureus  Resides on your skin = resident flora  Can reside in your nares (nostrils)  Most commonly transmitted pathogen in the operating room  Mycobacterium tuberculosis  Causes disease tuberculosis  Airborne pathogen transmitted by droplet nuclei (you can breath it)  Known affected surgical patients require special masks

Spore Producing Bacteria  Bacillus and Clostridium genuses  Are spore producers  Highly resistant  Bacillus stearothermophilus and Bacillus subtilis are the biological indicators utilized in sterization to test that autoclaves and ethylene oxide sterilization techniques are working to destroy all microorganisms and their spores (sterilization)  B. stearothermophilus (steam sterilization)  Notice stea beginning in stearothermophius to help remember it’s for steam autoclaves  B. subtilis (ethylene oxide or EtO)

Viruses  Reliant on host cell for survival  Viruses are the biggest risk health care workers face  Note table 7-4 page 145 for viral pathogens

Prevention of Staff Imposed SSIs  Human error/breaks in sterile technique  Must be documented if occur  Failure to recognize and correct a breach in sterile technique is wrong as it is negligence  Surgical conscience  Basis for practice of strict adherence to sterile technique that involves honesty and moral integrity and must be upheld by all surgical team members at all times  There can be NO compromise of sterile technique

Environment  Fomite  Inanimate objects on which microbes may reside  OR furniture, your scrubs, your hair, your shoes, contaminated solutions, contaminated dressing supplies such as tape that is reused  Reason all operating rooms are cleaned after every surgical procedure  Airborne  Laminar flow system (air moves from vents in ceiling out vents in near the floor)  Result of laminar flow is positive pressure (air is moving down so if a door is opened the air rushes out the door not in the room)  20 air exchanges per hour in an operating room via HEPA filters, 20% of those being fresh air.

Patient  Most SSIs are contracted through the patient’s own endogenous or normal flora  Preoperative prophylaxis with antibiotics reduces risk of SSIs

Risk Factors for SSIs  Age  Obesity  General physical health  Nasal carriers of S.aureus  Remote infections (infections going on in another part of the body at time of surgery)  Ex. Yeast infection present and patient is having surgery in the groin area  Preoperative hospitalization (reason most surgeries are performed the day of admission)  Smoking  Malnutrition  Diabetes  Malignancy (cancer)  Immunosuppression  Preoperative hair removal  Procedure type or wound classification (see page 293)  Procedure duration

Principles of Asepsis 1.A sterile field is created for each surgical procedure procedure  See pages

Principles of Asepsis 2.Sterile team members must be appropriately attired prior to entering the sterile field  See pages

Principles of Asepsis 3.Movement in and around the sterile field must not compromise the sterile field  See page 155