1. Medical/Surgical Asepsis
Presented by:
Cynthia Bartlau, RN, PHN, MSN

2. Objectives
At the completion of this lesson the student will be able to
Discuss concepts related to the chain of infection
Differentiate medical and surgical asepsis
Discuss equipment used for maintaining medical and/or surgical asepsis
Identify common sources for contamination
Describe proper hand placement during aseptic procedures

3. Beginning of Modern Asepsis
Previous to the discovery of asepsis many people died due to post-operative (and other) infection
Dr. Ignaz Semmelweis
Told doctors to wash their hands
Scottish surgeon named Joseph Lister
Inspired by Louis Pasteur’s formulation of the germ theory of disease
Used carbolic acid in operating rooms
Drastic reduction in infections

4. Theory of Infection Control
Microorganisms
Bacteria
Fungi
Viruses
Protozoa

5. Pathogenic Non-pathogenic Disease causing Infectious agent
Causes disease in healthy person
Opportunistic pathogen
Causes disease in susceptible person
Virulence
Communicable diseases
Non-pathogenic
Resident flora
Colonization
Can cause disease if transmitted to other areas

6. Infection Local Systemic Acute vs. chronic infection
Specific area of body is infected
Systemic
Microorganisms spread & damage other body areas
Bacteremia when microbes enter blood stream
Septicemia – when bacteremia spreads through all of the body systems
Acute vs. chronic infection

7. Nosocomial – infections that occur as a result of health care delivery
Endogenous source
Exogenous sources
Iatrogenic – infection directly caused by any diagnostic or therapeutic source

8. Drug-Resistant Pathogens
MRSA-Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections.
VRE-Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin.
MDR TBMultidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease.-

9. Chain of Infection Bacteria Viruses Fungi Protozoa Helminthes People
Equipment
Water
Chain of
Infection
Neonates
Diabetics
Immunosuppressed
Cardiopulmonary Disease
Secretions
Excretions
Droplets
Skin
Broken Skin/Mucous Membrane
Gastrointestinal/Respiratory/ Urinary Tract
Direct-Indirect Contact/Fomite
Injection/Ingestion
Airborne/Aerosols

10. Medical Asepsis AKA: Clean technique
Practices that inhibit the growth & spread of pathogenic microorganisms
Handwashing
Standard precautions
Transmission based precautions
PPE
Now we will discuss the principles of infection control.
The first is medical asepsis also known as clean technique.
Transmission based precautions= airborne, droplet, contact
PPE = gown, gloves and mask
Remove gloves first, untie gown 1st if tied in front, then mask then gown

11. The JCAHO Sentinel Event Alert quotes Julie Gerberding, MD, director of the CDC, as stating
Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance.
Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.

12. Antiseptics Prevent or inhibit growth of pathogenic organisms
Not effective against spores or viruses
Can be use on the skin
Alcohol
Betadine
Sterile NS (normal saline)
Sterile Water (boiled)

13. Disinfection Destruction of pathogens other than spores
Boiling water and chemicals
Bleach solutions
Zephirin
Irritate or damage skin
Used on objects not people

14. Surgical Asepsis AKA: Sterile technique
Practices that destroy all microorganisms & their spores
Used in specialized areas & skills
Care of surgical wounds
Catheter insertion
Invasive procedures
Surgery

15. Sterilization
Destruction of pathogens & non-pathogens, including spores and viruses
Steam under pressure
Gas
Radiation
Chemicals
Autoclave is most common piece of equipment used

16. CDC recommendations
Preoperative/prophylactic antibiotic administration
No preoperative hair removal (unless hair will interfere with operation)

17. Sterile Technique
Procedures that keep an object or area free from living organisms
Sterile vs. contaminated areas
Articles must remain away from and in front of the body and above the waist

18. Sterile Technique Never reach across the sterile field
Never turn your back to the sterile field
Two inches around border is considered contaminated
Sterile field must be kept dry

19. Sterile Gloving Only touch the outside of the package with bare hands.
The inside of the package, in which the gloves are placed, is considered sterile.
The wrapper, when opened provides a sterile field.
Grasp only the outside edge of the wrapper.

20. The inside of the glove may be touched with the bare hand
Grasp the first glove at the top edge of the folded-down cuff and slip in hand
Slip gloved fingers into cuff of second glove and slip in second hand without contaminating
The outer aspect of the glove must remain sterile
Includes wrist area
Keep hands above level of waist
Sterile to sterile only
If contamination occurs, start again with new pair of gloves

21. Techniques to Remove Articles from Sterile Wraps
Drop technique
For gauze pads, dressings, small items
Wrapper is partially opened , held upside down over sterile field, dropped onto sterile field
Mitten technique
For bowls, drapes, linen…
Using the wrap as a mitten, sterile supplies can be placed on a sterile field
Transfer forceps
For cotton balls, small items, or articles
Sterile gloves or transfer forceps are used to transfer objects to sterile field

22. Skills to Demo & Practice
Donning & Removing Sterile Gloves

23. Questions?