Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Sterile Technique
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hospital Acquired Infections (HAI) Also known as nosocomial infections Acquired by patients whose natural defenses against infection are often missing or overridden in the health care setting HAIs are very expensive in terms of money and human life
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hospital Acquired Infections (HAI) (cont.) The CDC estimates that 250,000 patients a year get an HAI just from urinary catheters alone Patients with an HAI need additional treatment and longer hospital stays, and incur higher health care costs The CDC also reports that between 10% and 25% of patients who acquire an HAI die
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Sterile Technique Involves: –Creating a sterile field (a microbe-free area to work in) –Using equipment and supplies that have been made sterile (completely free of microbes) to minimize the risk of infection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Sterilization for Equipment and Supplies Category I: Critical—for items that carry a very high risk because they penetrate the skin or are placed in body cavities that are normally free of microbes Category II: Semi-critical—for items that come into contact with mucous membranes and carry a moderate risk for causing infection Category III: Non-critical—for items that come into contact with intact skin and carry a lower risk for causing infection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins High-level Disinfection Involves using a very strong chemical to kill microbes on items that will come in contact with a person’s skin or mucous membranes Kills almost all microbes except for some bacterial endospores
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Sterilization The most complete method of killing all microbes Kills microbes as well as endospores
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What is the most complete method of killing all microbes as well as endospores? A. High-level disinfection B. Sanitation C. Sterilization D. Disinfection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Sterilization Sterilization is the most complete method of killing all microbes; it kills microbes as well as endospores.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Sterile Packages Fabric-wrapped: items inside are sterilized onsite Envelope-wrapped package: one corner is opened at a time to create a sterile field; may be made of fabric or paper Peel/sterilization pouches: small sterile items wrapped in a combination of paper and plastic. Both sides are peeled at the same time, enabling the user to carefully drop the item onto the sterile field
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications That an Item Is Sterile Commercially prepared items have writing on the outside of the packaging Items that are sterilized onsite will have two chemical indicator strips –Outside strip changes color after being processed –Indicator strip inside the package will also change color to show the sterilizing agent penetrated the packaging
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications That an Item Is Sterile (cont.) The sterility of items is maintained as long as a sterile package is stored properly and the packaging material is not damaged or placed on a wet surface
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Sterilized items usually reach expiration in about one (1) year A. True B. False
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False Sterilized items have no expiration date.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins When Creating a Sterile Field, You Need: A sterile area where other sterile supplies can be opened, arranged, and moved around A place where sterile supplies can be opened in a manner that does not contaminate them or the sterile field Sterile gloves to arrange and use sterile supplies within the sterile field, and, if you wish, sterile transfer forceps to move items around within the sterile field.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Procedures That Require a Sterile Field Inserting urinary catheters Giving injections Starting intravenous (IV) lines Changing sterile dressings
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question All instruments, supplies, and gloved hands remain sterile so that _______ are not introduced into the body A.Asepsis B.Calories C.Microbes D.Disinfection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C.Microbes Sterilization prevents endospores and microbes from entering the body.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Guidelines for sterile items a sterile object may not touch a nonsterile object sterile objects must not be wet. Moisture draws microorganisms into the sterile object a one in border is between an sterile area and a nonsterile area (place sterile items in the center of the sterile field away from the edges) do not turn your back on a sterile field ( you can’t see the field and don’t know what touched it) Anything below the waist is considered out of the sterile range (all surgery trays should be positioned above the waist, hold all above waist) All sterile objects must be held in front and away from the body
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Do not cough, sneeze, or talk over a sterile field Do not reach over the sterile area Do not pass contaminated dressings or instruments over the sterile field. Contaminated instruments should be placed in a separate container or area Be aware of actions in order to determine if the sterile field has been compromised Guidelines for sterile item
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Outer wrapper of sterile packages are contaminated and should be opened without touching the inner contents Sterile solutions in bottles should be poured into sterile basins or sups on the sterile field without touching the rim of the bottle and without splashing solution onto the sterile Guidelines for sterile items
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Using an Envelope-Wrapped Package
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Using a Sterile Drape
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pouring Liquid Into a Sterile Container
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Transfer Forceps
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Sterile Gloves
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins THINK ABOUT IT You are working at the bedside of Mrs. Thomas, preparing to assist the nurse with a sterile dressing change. You have created a sterile field on the over-bed table and you are arranging the supplies for the nurse to use. Mrs. Thomas is occasionally a bit disoriented as the result of her pain medication. Suddenly, she reaches up to the field and removes a stack of gauze sponges you have just arranged. What should you do? What steps could you take to prevent this from happening in the future?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins You must discard the sterile field and set up a new one. Explaining to Mrs. Thomas that sterile technique is being used to lower her risk of infection and helping her to understand how sterility is maintained may help to prevent this from happening in the future.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins THINK ABOUT IT You are preparing to set up a sterile field and open sterile supplies for a procedure in a patient’s room. You plan to arrange your sterile field on the over-bed table. What must you do to prepare this area before setting up the sterile field?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The over-bed table must be cleaned with a disinfectant, and dried thoroughly.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins THINK ABOUT IT It is time for the sutures to be removed from Mr. Wilson’s wound. Kari, the nurse you are working with, is preparing to carry out this procedure using sterile technique. You have assisted her by setting up the sterile field and opening the sterile supplies. You are now wearing sterile gloves and have everything neatly arranged for the procedure. Right before Kari starts to clean Mr. Wilson’s wound, you notice a hole in one of your gloves, and you are not sure how it got there. What should you do?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins First, you must alert Kari that the sterile field may have become contaminated, so that she can stop the procedure. Then you must discard the sterile field and set up a new one.