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Western COLLEGE Mindanao OF State NURSING University Zamboanga City
LIST OF WRITTEN REQUIREMENTS:
1. Guidelines of Aseptic Technique Principles
The aseptic technique is a method of preventing the transmission of infection to the patient during the performance of various clinical procedures. The correct practice of this technique requires the understanding of some principles and facts.
Principles of Asepsis
Safety considerations:
● Hand hygiene is a priority before any aseptic procedure. ● When performing a procedure, ensure the patient understands how to prevent contamination of equipment and knows to refrain from sudden movements or touching, laughing, sneezing, or talking over the sterile field. ● Choose appropriate PPE to decrease the transmission of microorganisms from patients to healthcare workers. ● Review hospital procedures and requirements for sterile technique prior to initiating any invasive procedure. ● Healthcare providers who are ill should avoid invasive procedures or, if they can’t avoid them, should double mask.
Principle Additional Information
- All objects used in a sterile field must be sterile.
Commercially packaged sterile supplies are marked as sterile; other packaging will be identified as sterile according to agency policy.
Check packages for sterility by assessing intactness, dryness, and expiry date prior to use.
Any torn, previously opened, or wet packaging, or packaging that has been dropped on the floor, is considered non- sterile and may not be used in the sterile field.
- A sterile object becomes non-sterile when touched by a non-sterile object.
Sterile objects must only be touched by sterile equipment or sterile gloves.
Whenever the sterility of an object is questionable, consider it non-sterile.
Fluid flows in the direction of gravity. Keep the tips of forceps down during a sterile procedure to prevent fluid travelling over entire forceps and potentially contaminating the sterile field.
considered contaminated.
- Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile.
Place all objects inside the sterile field and away from the one-inch border.
- If there is any doubt about the sterility of an object, it is considered non-sterile.
Known sterility must be maintained throughout any procedure.
- Fluid flows in the direction of gravity. When cleaning a wound, clean the highest point first.
- Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas.
** Skin cannot be sterilized. **
The front of the sterile gown is sterile between the shoulders and the waist, and from the sleeves to two inches below the elbow.
Non-sterile items should not cross over the sterile field. For example, a non-sterile person should not reach over a sterile field.
When opening sterile equipment, follow best practice for adding supplies to a sterile field to avoid contamination.
Do not place non-sterile items in the sterile field.
- Movement around and in the sterile field must not compromise or contaminate the sterile field.
Do not sneeze, cough, laugh, or talk over the sterile field.
Maintain a safe space or margin of safety between sterile and non-sterile objects and areas.
Refrain from reaching over the sterile field.
Keep operating room (OR) traffic to a minimum, and keep doors closed.
Keep hair tied back.
When pouring sterile solutions, only the lip and inner cap of the pouring container is considered sterile. The pouring container must not touch any part of the sterile field. Avoid splashes.
STRATEGIES IN PREVENTION OF INFECTION
When the skin or mucous membranes are breached (surgery, insertion of IV or Arterial lines, lumbar puncture, insertion of epidural catheters)
MANAGING TRAUMATIC AND SURGICAL WOUNDS Where a site already has resident bacteria (i.e. nose, external ear, throat, vagina), or is an infected wound; it is also important to follow (albeit a less strict) aseptic technique in order to prevent the introduction of other more virulent organisms especially the usual hospital resident species such as Multiresistant Staphlococcus aureus, Pseudomonas aerogenosa, Klebsiella pneumonia, Acinetobacter and Extended spectrum beta-lactamase producing organisms (ESBL).
PRINCIPLES OF THE ASEPTIC TECHNIQUE
The technique consists of the following set of processes:
- Creating a microorganism-free environment (sterile field)
- Use of sterilized instruments and dressings
- Maintaining sterility of sterile field and instruments by preventing microbial contaminationby contact with non-sterile objects; such as: the patient’s body, the care providers body, non-sterile instruments, equipment, body fluids etc.
- Antisepsis of point of entry and hands of task performer.
CREATING A STERILE FIELD
The sterile field is a microorganism-free area without danger of them being contaminated. It is made up of two areas i.e.:
A. The first area is a place that accommodates the instruments, dressing and lotions to place instruments used for the intended procedure. Usually, this is created by opening a sterile set fully on a trolley. The inside of the wrapper forms the sterile work surface. No other items should be on the trolley. It is important for this area is wide enough to accommodate all instruments.
B. The second is a designated work area for the care provider to perform his/her tasks on the patient. It is created by covering the patient’s body and bed or table that he/she lies on with drapes made of sterilized fabric or synthetic sheets.
USE OF STERILIZED INSTRUMENTS AND DRESSINGS
Instruments used in invasive procedures are usually pre-sterilized. Sterilization removes all forms of microorganisms including spores.
Disposable instruments are sterilized using Ethylene oxide gas sterilization or Gamma radiation and kept sterile in packages. Reusable items are sterilized by steam at high temperature (autoclaving) or chemicals (Ethylene oxide etc.). Some instruments e.g. endoscopes cannot be sterilized by high temperature sterilization. Low temperature plasma sterilization technique (SterradTM) or high level disinfectant is then used. Proprietary dressings are usually sterilized by Gamma radiation whereas gauze is autoclaved at the hospital’s Central Sterile Supplies Department (CSSD).
Disinfection And Use Of Endoscopes In Sterile Body Passages Endoscopes passed into body cavities that do not have indigenous bacteria or are not colonized by bacteria, must be disinfected before use. These include bronchoscopes, cystoscopes, ureteroscopes, brposcopes and hysteroscopes. Disinfection removes all bacteria and viruses except spores. The instruments can be disinfected using chemicals such as glutaraldehyde (CidexTM), Gigasept and Peracetic acid. Disinfection should be done just before use and the instrument kept in a sterile field. It is not proper for these instruments to be disinfected a day onchoscopes or more earlier. Instruments that become heavily contaminated must be sterilized. Chemical sterilization differs from disinfection in the duration of soaking i.e. at least 30 minutes or more for sterilization as opposed to 10 minutes for disinfection. Otherwise low temperature hydrogen peroxide plasma sterilization sterilizer (e.g. SterradTM) is used. Biopsy forceps, catheters and stents must be sterile (preferably disposable). Use Of Speculum & Endoscopes In Non-Sterile Body Passages Instruments and endoscopes passed into body cavities that has resident bacteria or are likely to be colonized by bacteria such as the mouth, vagina, nose, pharynx, external ear, esophagus, stomach, duodenum and colon, must be disinfected but not necessarily asterilized. They can be disinfected using disinfectants (glutaraldehyde [CidexTM], 70%
liquid has seeped through the package the packages are accidentally opened Such items should not be used. They should be re-sterilized if possible. During transport, proper trolleys and containers should be used. Storage areas should be kept clean, free of vermin and away from water sprays. Antiseptic solutions, including saline, should be of adequate strength and not diluted (e.g. Chlorohexidine 1: 2000 is ineffective). They need to have a ‘use by’ date. ‘In use’ test (C&S) need to be done now and then.
NON-TOUCH TECHNIQUE Microorganisms especially bacteria is everywhere in the environment. Their content in the air is dependent on:
a. the cleanliness of the room and equipment within it b. filtration of the air c. air exchange (removal of stale air in exchange for fresh air) d. direction of flow (from clean to non-clean areas)
These facts and that the bacteria can be killed by heat was known to Louis Pasteur 1887 Ref: http://en.wikipedia.org/wiki/Louis_Pasteur In most clinical settings the amount and type of organisms in the air is minimal. As such, exposure of objects to air for the duration of clinical procedures is not considered as contamination and does not cause them to loose their sterility.
However, contact with any other non-sterilized object renders the instrument or item non- sterile. Hence the most effective way of maintaining sterility of sterilized instruments and other items is the non-touch technique. In this technique work processes are devised so that the sterile or disinfected item or instrument does not come into contact with non-sterile items. This can be achieved by studying the possible instances where contamination can occur in the context of various procedures and devising methods of avoiding it.
Reference: says:, F., says:, D. A. S., says:, E. sule, says:, E. J., says:, P., says:, P. R. I. S. C. A. O. U., & Says:, A. (2017, June 19). HEALTHCARE SERVICE DELIVERY. Retrieved September 12, 2022, from Principles and practice of aseptic technique. https://drdollah.com/aseptic-technique/
2. 5 Phases of the Intraoperative Period
There are five phases in the Intraoperative Period, this includes: Admission – The intraoperative period starts with the client being admitted to the operating room for surgery. Induction of Anesthesia – The second phase then involves the anesthesiologist wherein the patient is prepared for the induction of anesthesia. Operative Procedure – The period commences with the operation proper led by the main surgeon. This also involves the participation of the scrub nurses and circulating nurse. Post-operative care – This phase involves the aftercare of the patient after the operation proper. This is in preparation for their transfer to the post-anesthesia care unit. Post - anesthesia care unit (PACU) - After receiving anesthesia for a surgery or procedure, a patient is sent to the PACU to recover and wake up. The PACU is a critical care unit where the patient's vital signs are closely observed, pain management begins, and fluids are given.
3. Roles of the circulating and scrub nurses
Nursing Functions Circulating Nurse The circulating nurse manages the operating room and protects the safety and health needs of the patient by monitoring activities of members of the surgical team and checking the conditions in the operating room. Responsibilities of a circulation nurse are the following:
Before an operation Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table Make sure theater is clean Arrange furniture according to use Place a clean sheet, arm board (arm strap) and a pillow on the OR table Provide a clean kick bucket and pail Collect necessary stock and equipment
Signs the theater register Ensures specimen are properly labeled and signed After an Operation Hands dressing to the scrub nurse Helps remove and dispose of drapes Helps to prepare the patient for the recovery room Assist the scrub nurse, taking the instrumentations to the service (washroom) Ensures that the theater is ready for the next case Scrub Nurse
The scrub nurse assists the surgeon during the whole procedure by anticipating the required instruments and setting up the sterile table. The responsibilities of the scrub nurse are:
Before an operation Ensures that the circulating nurse has checked the equipment Ensures that the theater has been cleaned before the trolley is set Prepares the instruments and equipment needed in the operation Uses sterile technique for scrubbing, gowning and gloving Receives sterile equipment via circulating nurse using sterile technique Performs initial sponges, instruments and needle count, checks with circulating nurse
When surgeon arrives after scrubbing Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet. Then, assist in draping the patient aseptically according to routine procedure Place blade on the knife handle using needle holder, assemble suction tip and suction tube Bring mayo stand and back table near the draped patient after draping is completed Secure suction tube and cautery cord with towel clips or allis Prepares sutures and needles according to use
During an operation Maintain sterility throughout the procedure Awareness of the patient’s safety
Adhere to the policy regarding sponge/ instruments count/ surgical needles Arrange the instrument on the mayo table and on the back table
Before the Incision Begins Provide 2 sponges on the operative site prior to incision Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon Hand the retractor to the assistant surgeon Watch the field/ procedure and anticipate the surgeon’s needs Pass the instrument in a decisive and positive manner Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge Always remove charred tissue from the cautery tip Notify circulating nurse if you need additional instruments as clear as possible Keep 2 sponges on the field Save and care for tissue specimen according to the hospital policy Remove excess instrument from the sterile field Adhere and maintain sterile technique and watch for any breaks
End of Operation Undertake count of sponges and instruments with circulating nurse Informs the surgeon of count result Clears away instrument and equipment After operation: helps to apply dressing Removes and siposes of drapes De-gown Prepares the patient for recovery room Completes documentation Hand patient over to recover room
4.) Surgical Needles and Sutures with illustrations
5. Forceps and Surgical Scissors with illustrations
FORCEPS
Also known as non – locking forceps, thumb forceps, or pick – up forceps. It is used for grasping tissue or objects. And can be toothed (serrated) or non-toothed at the tip.
- Tissue Forceps – non toothed forceps used for fine handling of tissue and traction during dissection.
- Adson Forceps – it is toothed at the tip used for handling dense tissue, such as skin closures.
- Bonney Forceps – heavy forceps used for holding thick tissue, e.g., fascial closure.
- DeBakey & Russian Forceps – used for traumatic tissue grasping during dissection.
DeBakey Forceps
Russian Forceps
SCISSORS
Used for cutting tissue, suture, or for dissection. Scissors can be straight or curved and may be used for heavy cutting or finer structures.
- Mayo Scissors – heavy scissors available in multiple varieties. Straight scissors are used for cutting suture, “suture scissors”, while curved scissors are used for cutting heavy tissue, e.g., fascia.
6. Layers of the abdomen with corresponding sutures & needles with
illustrations
ABDOMEN – is the part of the body that is located between the thorax and pelvis. It is a muscle that protects vital organs underneath and it also provides structure for the spine.
Layers of the Abdomen consists of:
● Skin ● Camper’s fascia (superficial fatty layer of subcutaneous tissue) ● Scarpa’s fascia, (deep membranous layer of subcutaneous tissue) ● Internal Oblique ● External oblique ● Transversus abdominus ● Transversalis fascia ● Abdominal peritoneum (parietal)
Abdominal Layer Type of Suture Needle Illustration for sutures Illustration for needle
- Skin Silk Reverse Cutting Needle
- Subcutan eous Fatty Layer
Vicryl Tapered Needle
- Membran e fascia Vicryl Reverse Cutting Needle
- External Oblique vicryl Tapered needle
- Internal Oblique Chronmc gut Tapered needle
