1. Infection Control Lesson 3: Surgical Asepsis34
Infection Control
Lesson 3:
Surgical Asepsis

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Define surgical asepsis.
Explain the difference between sanitization, disinfection, and sterilization.

3. Critical Thinking Questions
When might you use medical asepsis versus surgical asepsis?
What is the difference?

4. Medical versus Surgical Asepsis
A reminder:
Medical asepsis – the elimination of organisms that have left the body
Surgical asepsis – the practice of creating and maintaining a sterile environment in which organisms are destroyed before they enter the body

5. Surgical Asepsis: Sanitizing Instruments
Sanitization:
Prevents pathogens from spreading by inhibiting or inactivating pathogens
Should be used for instruments that touch only the skin surface
Ultrasound is another means of sanitizing equipment

6. Critical Thinking Question
What process is used for instruments that break the surface of the skin?

7. Sanitizing Equipment and Supplies
Disposable gloves
Rubber gloves
Plastic brush
Towel
Sink with running water
Container to hold instruments
Low-sudsing (low-pH) detergent or germicidal agent
Note: Instruments should be rinsed under warm water immediately after surgery or submerged in water containing a low-pH detergent.

8. Sanitizing Instruments
Apply both disposable and rubber gloves
Place a low-sudsing detergent or germicidal agent in a large container with water

9. Sanitizing Instruments
Rinse instruments in clear water in either sink or container
Delicate or sharp instruments should be separated from the rest
Scrub each instrument individually with brush and detergent under running water
Open instruments to thoroughly scrub all serrated edges and hinge areas
Rinse instruments thoroughly under hot water

10. Sanitizing Instruments
If instruments cannot be cleaned immediately, soak them in a water and bleach solvent solution – Then, begin again with step 1 when ready to wash
After thoroughly rinsing cleaned instruments, roll them in a towel to dry
Check the condition of all instruments for defects or remaining soil

11. Sanitizing Instruments
Wrap instruments for sterilization or place them in an ultrasonic cleaner

12. Disinfecting Instruments
Disinfection destroys or inhibits disease-causing organisms
Methods include:
Alcohol (70% Isopropyl); used for:
Skin surfaces, stethoscopes, table surfaces
Chlorine (sodium hypochlorite or bleach) diluted; used for:
Broad spectrum of microorganisms
Formaldehyde; used for:
Disinfecting and sterilizing

13. Disinfecting Instruments
Hydrogen peroxide:
Nonhuman surfaces and products
Glutaraldehyde:
Viruses
Bacteria
Fungi
Some spores
Spirilla bacteria

14. Sterilizing Instruments
Kills pathogenic and nonpathogenic microorganisms
Uses:
Heat (steam or dry)
Chemicals
High-velocity electron bombardment
Ultraviolet-light radiation

15. Sterilizing Instruments
Any supplies that touch open wounds or internal body tissue must be sterilized
Sterile gloves must be worn when touching sterile equipment; if they are not, the equipment is considered contaminated
The process of putting on sterile or nonsterile gloves is sometimes referred to as donning

16. What is an Autoclave? Autoclaves are used for sterilization
Autoclaves cause organisms to explode, thus killing them
Types:
Steam under pressure
Dry heat (320º F for 1 hour)
Dry gas
Radiation
Autoclaves must be cleaned before use

17. Types of Autoclaves Steam under pressure Dry heat (320º F for 1 hour)
Dry gas
Radiation

18. How an Autoclave Works
Microorganisms are killed by the condensation of steam on items, which causes organisms to explode, thus killing them
Requires 15 pounds of pressure and a temperature of 250º F to 270º F
Uses distilled water
Consists of:
Jacket (outer chamber) – creates steam buildup
Inner chamber – receives steam; materials placed here

19. Gauges of an Autoclave Depending on type, three gauges may be present:
Jacket pressure gauge–indicates outer chamber pressure
Chamber pressure gauge–indicates inner chamber pressure
Temperature gauge–indicates inner chamber temperature

20. Cleaning an Autoclave Should be sanitized before each use
If detergent is used, should be rinsed thoroughly before use
Air exhaust valve must be cleaned and free of lint before use

21. Critical Thinking Question
Why must you clean the autoclave?

22. Wrapping Instruments and Materials
Wrappings must be permeable
Wrappings must be strong
Wrappings include:
Heavy paper
Muslin
Plastic
Stainless steel containers

23. Wrapping Instruments and Materials
Wrapping is generally two layers
All items must:
Be wrapped completely
Be sealed with tape that notes the date of sterilization and the name of the item
Instruments with hinges should be in an open position, the tubing should be free of kinks, and syringes should be unassembled

24. Autoclave Indicator Tapes
Indicator tapes are placed in the autoclave
The lines on the tape change color during the process to indicate the appropriate temperature has been reached

25. Autoclave Sterilization Pouches and Bags
Sterilization pouches or bags are used to hold individual instruments:
The instrument must be small and lightweight
The pouch must not rupture during autoclaving
The pouch will have sterilization indicators both inside and outside

26. Critical Thinking Question
When and why should you use a sterilization bag?

27. Autoclave Trays
Used only for those instruments that will be used immediately
Trays are perforated
Instruments can be autoclaved without being wrapped
A towel is usually placed under the instruments to absorb moisture
The lid should be placed on the tray immediately after sterilization

28. Handling Individual Packs
Items should be wrapped in individual packs that can be handled by their outer wrapping for storage and use without contaminating the inner items
When individual packs are opened, the contents must be removed without contamination
Containers and jars should be placed on their sides

29. Handling Individual Packs
Solutions should be autoclaved separately
Plastic containers and bags will seal during sterilization

30. Time and Pressure Requirements
Always follow manufacturer’s requirements
Items will not be sterilized if time or pressure is inaccurate
Autoclaves should be periodically checked for efficiency:
Send one item to an outside lab to check for sterility

31. Critical Thinking Question
What could be the result of a malfunctioning autoclave?

32. Drying Autoclaved Goods
Drying is as important as achieving the correct temperature and pressure during autoclaving
Improperly dried items can lead to bacteria growth
To dry goods:
Open the autoclave door ¾ inch before the drying cycle
Run the dry cycle per the manufacturer’s instructions

33. Sterilization Indicators
Used to indicate sterilization
Strips and tape are two types
The strip is placed inside the wrapper or in the chamber
The appearance of dots or a change in color indicate proper sterility

34. Shelf Life of Autoclaved Packages
The oldest items should always be used first
Items are considered sterile for:
21 to 30 days
Plastic bags: 21 days
Muslin: 30 days
Shelf life is 1 month, but depends on how the item was wrapped
Follow manufacturer’s
instructions

35. Questions? 35