Presented by: Kenneth M. Sabido, RN, MN 1 at the end of the session, the students will be able to: a. Identify the medical and surgical aseptic techniques. b. Familiarize the OR technique terminologies. c. Identify the sterilization techniques. d. Enumerate the various aseptic technique Principles. e. Perform the surgical hand washing, surgical hand brushing correctly. f. Perform sterile gowning, closed and open gloving. g. Identify the duties and responsibilities of a Scrub nurse and a Circulating nurse. 2 Scrubbing Drying of Hands Gowning Gloving Preparing Patient’s Skin For Surgery Common Surgical Instruments 3 MEDICAL ASEPSIS (CLEAN TECHNIQUE) - Prevent the spread of disease from one person to the another. - Hand washing is the most important medical asepsis technique. SURGICAL ASEPSIS (STERILE TECHNIQUE) - Use of effective sterile technique. No organisms are carried to the client. - Microorganisms are destroyed before medical asepsis technique. Note: sterile to sterile remains sterile. Sterile to clean or dirty becomes contaminated. 4 5 DISINFECTION Process resulting in the destruction of pathogens but not necessarily their spores. STERILIZATION Process of exposing articles to steam under pressure or to chemical disinfectants long enough to kill all microorganisms and spores. Methods of Sterilization Autoclaving Purpose: prevent spread of microorganisms and infection Radiation Gas sterilization with ethylene oxide 6 General Principles Microorganisms move through space on air current. Microorganisms are transferred from one surface to another whenever a non-sterile object touches another surface. Microorganisms move from one object to another as a result to gravity when a non-sterile item is held above another item. 7 General Principles Microorganisms travel rapidly along any moisture through a wicking action. Microorganisms move slowly along a dry surface. Microorganisms are released into the air on droplet nuclei whenever a person breathes or speaks. 8 Principles Of Aseptic Technique Persons who are sterile touch only sterile articles, person who are not sterile touch only non-sterile articles. If in doubt about the sterility of anything, consider it not sterile. Non-sterile persons avoid reaching over a sterile field. Sterile persons avoid leaning over a non-sterile area. Tables are sterile only at the table level. 9 Gowns are considere d sterile only from waist to shoulder level in front and the sleeves. Principles Of Aseptic Technique The edges of anything that encloses sterile content is not consider ed sterile. Sterile persons keep well within the sterile area. Nonsterile persons keep away from sterile areas. Sterile persons keep contact with sterile area to a minimum . Moisture may cause contamin ation. 10 Persons who are sterile touch only sterile articles, person who are not sterile touch only non-sterile articles. If in doubt about the sterility of anything, consider it not sterile. Non-sterile persons avoid reaching over a sterile field. Sterile persons avoid leaning over a non-sterile area. Tables are sterile only at the table level. Gowns are considered sterile only from waist to shoulder level in front and the sleeves. 11 The edges of anything that encloses sterile contents is not considered sterile. Sterile persons keep well within the sterile area. Non-sterile persons keep away from sterile areas. Sterile persons keep contact with sterile area to a minimum. Moisture may cause contamination. 12 1. The first principle of surgical asepsis states that all materials in a sterile field must be sterile. All objects added to your sterile field must also be sterile. If you put your hands into the sterile field, they must be covered using sterile gloving technique and the gloves should also begin in sterile packaging. 2. The second principle states that a sterile barrier that has been compromised by punctures, tears or moisture has to be considered contaminated. If a sterile field has been set up and it is accidentally torn, the openings can allow microorganisms to invade and contaminate. 13 3. The third principle states that once a package is opened, a 2.5 cm (1 inch) border around the edge is considered unsterile. For example, many procedures contain setup of sterile packaging that is opened before sterile gloves are applied. During this time the 1 inch unsterile border is the only section that can be touched. 4. The fourth principle states that tables draped as part of a sterile field are considered sterile only at the table level. Therefore the table legs, underside of the table, or any shelves below the table level are to be considered unsterile. 14 5. The fifth principle examines questions or doubts. It states that if there are any questions or doubts about an object's sterility, the object should be considered unsterile. 6. The sixth principle states that sterile people and objects should only come into contact with sterile fields, and unsterile people and objects should only come into contact with unsterile areas, such as the 2.5 cm border. 15 7. The seventh principle states that movement around or in the sterile field must not compromise or contaminate the sterile field. While performing procedures requiring a sterile field, it is important to remember that correct sterile technique must always be followed. 8. The eighth principle says that anything out of your range of vision or below waist level is considered contaminated and unsterile. For instance, if an object is dropped below the waist, it is no longer sterile. The backside of the body, which is out of your range of vision, is also considered unsterile. Therefore, you should never turn your back on your sterile field and bring all tables needed in procedures up to your waist level. 16 9. The ninth and last principle of surgical asepsis states that a sterile object or field can become contaminated by lingering exposure to air. While performing a sterile procedure, one should stay organized and finish the procedure as quickly as possible. 17 All of the equipment that will be needed should be assembled before a procedure. Thus, the nurse avoids the sterile area unattended because the equipment is missing. 18 Sterile items are packaged in paper or plastic containers and are impervious to microorganism as long as they are dry and intact. 19 Sterile supplies have chemical tapes indicating that a sterilization process has taken place. The tapes changes color during the sterilization process. 20 21 22 23 24 Put on surgical attire including cap & mask Examine hands & forearms for cuts & abrasions Remove watches, bracelets & all finger jewelry Nails should be clipped and unpolished 25 26 27 28 Rinse hands and arms separately without touching anything, keeping hands above elbows Keep hands in front, above the waist and not higher than the axilla and move to location of sterile towels. 29 From the opened sterile pack, pick up folded top end corner of towel 30 Away from table, open towel in full length by holding towel on one end in a slightly bent position to avoid touching attire 31 Pat dry fingers, in between fingers, back and palm of hands and dry arm in oscillating motion ( Avoid contaminating hands in the areas proximal to elbow ) 32 Reverse the towel to start drying the other hand using the same procedure before. 33 Discard or drop towel. 34 GOWNING Reach down to the sterile pack and lift the folded gown directly upward & bring away from table in an unobstructed area 35 GOWNING Hold the pre-folded gown, carefully locating neck band & sleeves holding it at shoulder level. Allow it to unfold gently. Do not shake gown. 36 Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. GOWNING 37 GOWNING Position hands at shoulder level and allow circulating nurse to securely tie or fasten the gown at the neck and waist at the back only. 38 Open the sterile inner wrapper containing sterile gloves while hands are covered by gown sleeves - Using the left hand inside gown, pick up folded edge of right glove with thumb & index finger Lay glove on the sleeves of the cuff of the right arm, thumb-side down, with glove opening positioned toward the fingers 39 Position the palm on the right hand upward inside the sleeve. Grasp the fold of the glove through the gown cuff and firmly anchor it using the left hand. 40 With the left hand still inside the sleeve, grasp the upper side of the gloves cuff and stretch it over the cuff of the gown. 41 Pull the sleeves up to draw the cuff over the wrist and extend the fingers of the right hand into the gloves’ fingers. 42 43 44 45 46 47 48 49 50 51 52 1. 2. 3. 4. 5. SKIN. Skin is the largest organ in the body and the most prominent layer of the abdomen. This serves as the first line of defense against microorganisms. SUBCUTANEOUS. This is also known as the fatty layer since most of the body’s stored fats is found here. FASCIA. This covers the layer of abdominal muscles. It tends to constrict the muscles to help in the proper contraction. This is the toughest among the five layers. MUSCLE. As the name says, this is the layer that contains the muscles. There are groups of muscles in this layer that are responsible for the shape of the abdomen and can be stretched due to age or pregnancy. PERITONEUM. This is a thin one-cell thick membrane that lines the abdominal cavity and indirectly covers some of the most vital organs in the abdomen. 53 54 55 56 57 58 59 60 TYPES OF SPONGES 1. OPERATING SPONGES 2. ABDOMINAL PACK 3. MEDIUM PACK 4. SQUARE PACK 5. PROSTATIC PACK 6. NASAL PACK 61 7. CHERRY BALLS 8. EYE PATCH 9. PEANUT 10.COTTONOIDS 11. COTTON BUDS 12. SURGICEL 62 63 DISSECTING or CUTTING GRASPING or HOLDING CLAMPING or OCCLUDING RETRACTING or EXPOSING 64 SUTURING or STAPLING SUCTIONING ASPIRATING VIEWING 65 66 67 SHARPS Metzenbaum Mayo Suture scissors Scalpel 68 SHARPS blades 69 CLAMPS • • • • • Kelly Mosquito Medium Curves Straight Clamps Ochsners 70 RETRACTORS • • • • • Richardson Army Navy Malleable Deaver Self Retaining 71 72 73 74 75 Allis Babcock 76 77 NEEDLES & SUTURES • Needles • Cutting • Round 78 Absorbable: Non-Absorbable: - Plain Catgut - Silk - Vicryl - Ethibond, Ethilon - Monocryl - Prolene - Dexon - Ti-Cron - Plain Chromic - Nurolon 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93
