1. Aseptic technique Jianhui Li & Jianfeng Wei
Department of Hepatobiliary Surgery
The First Affiliated Hospital

2. Definition Aseptic is defined as “without microorganisms”
remove or kill microorganisms from hands and objects
employ sterile instruments and other items.
reduce patients’ risk of exposure to microorganisms that cannot be removed

3. Pretest
Five questions compose a pretest to gauge your knowledge and ability firstly.

4. 1. The Definition of Asepsis is:
A. Soiled or infected with organisms
B. Capable of producing disease
C. Absence of microorganisms

5. Wrong Answer Try Again

6. The Absence of Microorganisms
Correct!
The Absence of Microorganisms

7. 2. Cross-contamination is defined as:
A. Producing or capable of producing disease.
B. Transmission of microorganisms from patient to patient and from inanimate objects to patients.
C. Severe toxic state resulting from infection with pyogenic organisms.

8. This is the Wrong answer
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9. Cross-contamination is the Transmission of microorganisms
Correct!!
Cross-contamination is the Transmission of microorganisms

10. A. Closing the surgical wound B. Setting up the sterile field
3. Which task or function during a surgical procedure is designed as being within the scope of the practice of the scrub nurse?
A. Closing the surgical wound
B. Setting up the sterile field
C. Administering blood products

11. Wrong Answer!
Go back and try again

12. The Scrub nurse prepares the sterile field
Right Again!!
The Scrub nurse prepares the sterile field

13. 4. For which member of the surgical team is a “surgical scrub” unnecessary?
A. Anesthetist
B. Surgical technologist
C. Scrub nurse

14. Wrong Answer!!
Return and try again

15. Proceed onto the next question, please
WOW!
Another Right answer!
Proceed onto the next question, please

16. 5. Which is the best technique for you to use when rinsing your hands and forearms after a surgical scrub?
A. Rinsing is not performed after a surgical scrub because it will reduce the antimicrobial activity of the cleansing solution.
B. Rinsing should start at the elbow with the water running down back down to the hand.
C. Rinsing should start with the hand positioned such that water runs off the elbow rather than down to the hands.

17. Wrong Again!!!!
Try Again

18. You have completed your pretest so it’s time to continue ...
Correct Answer!!
You have completed your pretest so it’s time to continue ...

19. “12” Principles of Aseptic Technique

20. 1. Only Sterile Items Are Used Within A Sterile Field
Discard any contaminated items:
If a sterile package is found in a contaminated area.
If uncertain about the actual timing or operation of the sterilizer.
If an unsterile person comes into close contact with a sterile table.
If a sterile table or unwrapped sterile items are not under constant supervision.

21. 2. Sterile Persons are Gowned and Gloved
Hands are kept away from the face, and the elbows are kept close to the sides.
The back of the gown is considered contaminated.
The gown is considered sterile only to the highest level of the sterile tables.

22. 3. Tables Are Sterile Only At The Table Level
Sterile table.
Only the top of a sterile, draped table is considered sterile. The edges and sides of the drape extending below table level are considered unsterile.
Anything falling or extending over the table edge, such as a piece of suture, is unsterile.
When unfolding a sterile drape, the part that drops below the table surface is not brought back up to table level.

23. 4. Sterile Persons Touch Only Sterile Items or Areas
Sterile team members maintain contact with the sterile field by means of sterile gowns and gloves.
The unsterile circulator does not directly contact the sterile field.
Supplies are brought to sterile team members by the circulator, who opens the wrappers on sterile packages.

24. 5. Unsterile Persons Avoid Reaching Over the Sterile Field
The unsterile circulator never reaches over a sterile field to transfer sterile items.
The circulator holds only the lip of the bottle over the basin when pouring solution into a sterile basin in order to avoid reaching over the sterile area.
The scrub person sets basins or glasses to be filled at the edge of the sterile table.

25. 6. Edges of Anything That Encloses Sterile Contents Are Considered Unsterile
Sterile persons lift contents from packages by reaching down and lifting them straight up, holding their elbows high.
The flaps on peel-open packages should be pulled back, not torn, to expose the sterile contents. The contents should not be permitted to slide over the edges.
After a sterile bottle is opened, the contents are either used or discarded. The cap cannot be replaced without contaminating the pouring edges.

26. Sterile tables are set up just prior to the surgical procedure.
7. The Sterile Field Is Created As Close As Possible to the Time of Use
Sterile tables are set up just prior to the surgical procedure.
It is virtually impossible to uncover a table of sterile contents without contamination. Covering sterile tables for later use is not recommended.
A covered table is not under observation at all times.

27. 8. Sterile Areas Are Continuously Kept in View
Sterile persons face sterile areas.
Someone must remain in the room to maintain vigilance when sterile packs are opened in a room or a sterile field is set up.

28. 9. Sterile Persons Keep Well Within the Sterile Area
Sterile persons stand back at a safe distance from operating bed when draping the patient.
Sterile persons pass each other back to back at a 360-degree turn.
Sterile persons turn their backs to an unsterile person or area when passing.
Sterile persons face a sterile area to pass it.
Sterile persons stay within the sterile field. They do not walk around or go outside the room.

29. 10. Sterile Persons Keep Contact With Sterile Areas to a Minimum
Sterile persons do not lean on sterile tables or on the draped patient.
Sitting or leaning against an unsterile surface is a break in technique.

30. 11. Unsterile Persons Avoid Sterile Areas
Unsterile persons maintain a distance of at least 1 foot from any area of the sterile field.
Unsterile persons face and observe a sterile area when passing to be sure they do not touch it.
Unsterile persons never walk between two sterile areas.
The circulator restricts to a minimum all activity near the sterile field.

31. 12. Destruction of the Integrity of Microbial Barriers Results in Contamination
Sterile packages are laid on dry surfaces only.
If a sterile package wrapped in absorbent material becomes damp or wet, it is discarded. The package is considered unsterile if any part of it comes in contact with moisture.
Drapes are placed on a dry field.
If solutions soak through a sterile drape to an unsterile area, the wet area is covered with impervious sterile drapes or towels.
Sterile items are stored in clean, dry areas.
Sterile packages are handled with clean, dry hands.

33. The Surgical Scrub Definition.
The surgical scrub is the process of removing as many microorganisms as possible from the hands and arms by mechanical washing and chemical antisepsis before participating in a surgical procedure.

34. Surgical Scrub Procedure
Wet the hands and forearms
Apply antiseptic agent from the dispenser to the hands.
Wash the hands and arms thoroughly to 2 inches above the elbows, several times. Rinse thoroughly under running water with the hands upward, allowing water to drip from the flexed elbows.
Take a sterile brush or sponge and apply an antiseptic agent.

35. Hold the brush in one hand and both hands under running water, and clean under the fingernails with a disposable plastic nail cleaner. Discard the cleaner after use.
Again scrub each individual finger, including the nails and the hands with the brush, half a minute for each hand.

36. The Final Rinse
Be sure to keep both arms in the upright position (careful not to touch the faucet!) so that all water flows off the elbows and not back down to the freshly scrubbed hands.

37. Drying the Hands and Arms
Reach down to the opened sterile package containing the gown, and pick up the towel. Be careful not to drip water onto the pack. Be sure no one is within arm’s reach.
Open the towel full-length, holding one end away from the nonsterile scrub attire. Bend slightly forward.

38. Dry both hands thoroughly but independently
Dry both hands thoroughly but independently. To dry one arm, hold the towel in the opposite hand and, using the oscillating motion of the arm, draw the towel up to the elbow.
Carefully reverse the towel, still holding it away from the body. Dry the opposite arm on the unused end of the towel.

39. Gowning and Gloving Techniques
Reach down to the sterile package and lift the folded gown directly upward.
Step back away from the table into an unobstructed area to provide a wide margin of safety while gowning.
Holding the folded gown, carefully locate the neckline.

40. Holding the inside front of the gown just below the neckline with both hands, let the gown unfold, keeping the inside of the gown toward the body. Do not touch the outside of the gown with bare hands.
Holding the hands at shoulder level, slip both arms into the armholes simultaneously.

41. The circulator brings the gown over the shoulders by reaching inside to the shoulder and arm seams. The gown is pulled on, leaving the cuffs of the sleeves extended over the hands. The back of the gown is securely tied or fastened at the neck and waist, touch the outside of the gown at the line of ties or fasteners in the back only.

42. Gloving by the Closed Glove Technique
Using the right hand and keeping it within the cuff of the sleeve, pick up the left glove from the inner wrap of the glove package by grasping the folded cuff.

43. Extend the left forearm with the palm upward
Extend the left forearm with the palm upward. Place the palm of the glove against the palm of the left hand, grasping in the left hand the top edge of the cuff, above the palm. In correct position, glove fingers are pointing toward you and the thumb of the glove is down

44. Grasp the back of the cuff in the left hand and turn it over the end of the left sleeve and hand. The cuff of the glove is now over the stockinette cuff of the gown, with the hand still inside the sleeve.

45. Grasp the top of the left glove and underlying gown sleeve with the covered right hand. Pull the glove on over the extended right fingers until it completely covers the stockinette cuff.

46. Glove the right hand in the same manner, reversing hands
Glove the right hand in the same manner, reversing hands. Use the gloved left hand to pull on the right glove.

47. Gloving the Right Hand

48. Scrubbing, Gowning, and Gloving Complete

49. Alternative gloving

50. Movie materials

51. Theatre Etiquette

52. Pre scrubbing

53. Scrubbing

54. Hand Drying

55. Gowning and gloving

56. Glove changing

57. Alternative gloving

58. Practice
To get these concepts, re-read the information in your textbook and practice in the lab using gloves and cover gowns
Be sure to review this information prior to doing an intra-operative rotation
Be very conscious of your body and space when in the OR!!!!!!
Patient’s depend on us to maintain sterility at all times, so be aware and vigilant

59. Questions for Discussion
What would you do if, during your OR experience, you accidentally touched an unsterile object with your sterilely gloved hand?
What would you do if, while scrubbing, you accidentally touched the faucet?
Is it OK to prepare a sterile field an hour before the scheduled surgical case and leave the room to set up another OR room? Why or why not?
What should you do if you notice a break in sterile technique by another member of the OR team that they may/or may not be aware of?

60. Thank You !