Unit 101.3
Standard Precautions
Sterile Field & Gloving
Sterilization Packaging

• Identify practices of aseptic technique.
• Demonstrate ability to implement infection control through hand washing, standard precautions, packaging, for sterilization, preparing a sterile field and sterile gloving.

• designed to reduce the risks of transmission from both recognized and unrecognized sources of infection
• Precautions apply to:
– * all blood & body fluids
– * all body secretions and excretions (except sweat)
– * non-intact skin
– * mucous membranes

• when touching body fluids, or there is a potential of body fluid splatters, barriers must be worn
• this is a standard written by Occupational
Safety and Health Administration (OSHA)

• mandates that healthcare workers comply with all the safety standards
• mandates that employers provide and comply with the safety standards

• facilities are inspected for compliance & major fines are imposed for violations
• healthcare workers are mandated to attend yearly bloodborne pathogens training
• 29CFR Part 1910.1030 is the portion of the code pertaining to safety practices in the healthcare industry

Fundamentals of Standard
Precautions
• Handwashing
– single most important measure to reduce the risk of transmitting microorganisms from person to person or site to site
– OSHA mandates handwashing be done before and after each patient contact, and before applying gloves and after removal of gloves

• to reduce the risk of bloodborne pathogen exposure, barriers are to be worn when appropriate:
– gloves
– gowns
– boots
– masks
– protective eyewear
– hats/caps

• worn for three reasons:
• to provide a protective barrier
• to reduce transmission of disease from hands to patients
• to reduce likelihood of transmission of disease from patient to patient
– wearing gloves does not replace need for handwashing

• 3 Types
– sterile
• worn during sterile procedures to maintain sterility and during invasive procedures to prevent contamination
– exam
• worn as a barrier
– utility gloves
• worn for custodial purposes

Exam Gloves
Non-latex Latex

Sterile Gloves worn during sterile procedures

Utility gloves are worn for custodial activities.
Disinfect gloves after each use. Replace when torn.

– cover mouth and nose
– worn when there is potential splatter of blood or body fluids to mucous membranes of eyes, nose and mouth
– reduces risk of transmission of bloodborne pathogens
– specific types of masks for airborne diseases
(wear the correct one)

– if tuberculosis is suspected or diagnosed, NIOSH approved, Hepafilter or N95 mask is required
Masks that meet standards

– worn during procedures that are likely to generate splashes or sprays of blood or body fluids to the eyes

• worn to reduce the risk of contamination of clothing and skin from blood and body fluid exposures
– the gown must be made with impermeable or fluid resistant material

• Required in specialty areas:
– surgery
– special procedure rooms
– trauma center during specific procedures that will produce splash & splatter of blood and other body fluids

• Required in specialty areas of:
– surgery
– special procedure rooms
– trauma center during specific procedures that produces splash
& splatter of blood and other body fluids

• risk of transmitting nosocomial infections is often highest before a definitive diagnosis is made, therefore:
– use standard precaution barriers for all patients
– carefully monitor signs & symptoms
– familiarize yourself with the isolation standards in your facility and use them appropriately. Work smart

• Purpose
– to decrease the risk of transmission of microorganisms within the hospital by:
• protecting infected patient from further infection
• protecting uninfected patients, visitors & staff
• minimizing the spread of infection
• compliance with isolation standards is a must to minimize disease transmission

• patient may feel dirty or contaminated
• limits number of visitors
• may elicit fear from relatives and friends
• limits ability to move about freely
• adds to cost of hospital bill
• adds stress
• may feel sense of hesitation from caregiver
• elderly and children feel lonely

• specimens of blood, tissue or other potentially infectious (OPI) materials shall be placed in a biohazard, leakproof bag for collecting, storage, handling, transporting and processing

– Includes items that:
• are dripping with blood
• drip blood when squeezed,
• unfixed body tissue
(know facility policies)
– * biohazard wastes placed in red biohazard bags and labeled
– * managed by a biological waste firm

– * DO NOT pick up broken glass with hands. Wear utility gloves & use dustpan w/broom or forceps
Contaminated broken glass

Contaminated Sharps
Biohazard Waste
• must be placed in puncture resistance container immediately after use
• must be clearly labeled in accordance with
OSHA standards
Sharps Containers

• all regulated waste shall either be incinerated, treated with chemicals or decontaminated by an autoclave to destroy bloodborne pathogens

– contaminated laundry to be handled as little as possible
– minimum agitation
– bagged in appropriately labeled bags prior to transport to laundry facilities
If soaked, must be placed in leakproof laundry container

• contaminated work surfaces shall be decontaminated immediately or as soon as feasible after any spill of blood or infectious material with appropriate disinfecting solution

• Must be cleaned with:
– * professional disinfecting solution or
– * 10% bleach solution
(made fresh daily)

• workplace must have appropriate written schedule for housekeeping:
– based on activity and soil present
– cleaned immediately after blood spill
– broken glass must be picked up with mechanical device and placed in sharps container
– this is an OSHA regulation

• when this label is present, there is a potential risk of bloodborne pathogen contamination within the container or area designated

• OSHA mandates the following when signs are present:
– no eating/drinking in designated area
– no smoking in designated area
– no application of make up and lip balm in designated area
– no handling of contact lenses in designated area
– no storage of food/drink in coolers/refrigerators that are preserving biohazard products

Sterile drape serves as sterile field
• Definition
– a designated area prepared with sterile drape & equipment from which a sterile procedure will be conducted. This area is free of all microorganisms
Sterile gauze
Sterile instrument

• How to determine if an item is sterile:
– disposable items have manufacturer’s endorsement, & must be free of holes, wetness or stains

• How to determine if an item is sterile:
• indicator (arrows, dots, bars), change color when sterilized
• wrappers must be free of holes, wetness, stains
• check expiration dates when appropriate
• INDICATORS that have changed color DO NOT
INSURE STERILITY
Indicator arrows

Shelf Life
Sterile Equipment
• “Timed Shelf Life” standards are frequently used when packages are sterilized in-house (reusable items)
• when pharmaceuticals are inside of a sterile package, the Timed Shelf Life standards must be used and consider the expiration date of the pharmaceutical when labeling

Shelf Life
Sterile Equipment
• Timed Shelf Life considers:
– type & configuration of package
– number times package is handled
• Manufactures recommend only 3 touches :
– remove from sterilizer to storage shelf
– remove from storage shelf to procedure site
– open to use
– storage area (open or closed shelves)
– environmental conditions (cleanliness, temperature, humidity)
– use of dust covers (or not)
– date indicated

Shelf Life
Sterile Equipment
• “Event-Related Shelf Life”:
– recognizes that product remains sterile until some event causes item to be contaminated
– commercial manufactures of sterilized items use Event-Related standards
– sterile items should be placed on shelf in order to ensure the oldest item is used first when using Event-Related standards

Shelf Life
Sterile Equipment
• products such as latex gloves and specialized catheters may degrade over a period of time. It may become hard, dry and crack. This must be taken into account, as quality of the item may no longer be effective
• don’t stock-pile these types of products

Shelf Life
Sterile Equipment
• regardless of standard used to determine sterility, the assessment process is the same:
– * check for wetness, tears, stains, soil, cracks!
– * check date when appropriate!
– * check indicator when appropriate!
• there must be consistent policies & procedures throughout facility to satisfy the accreditation boards

– purpose of wrapping is to prevent recontamination during storage and handling
– material used for wrapping should not tear or puncture easily, or allow for penetration of organisms
– materials should open easily to prevent contamination

• double thickness disposable paper/or reusable cloth with sealed plastic dust cover
• rigid containers
• manufacturer’s wrap
• paper peel pouches

• wear exam gloves
• check items for cleanliness
• wrap on clean and dry surface
• wrap according to procedure
• label package and date according to procedure

• inside 1” border of sterile package
• contents of package if not contaminated by improper technique
Red line indicates 1” border of each package

• outside of package
• outside 1” border of inside of package
• any part of drape used as field that hangs over edge of surface hosting the sterile field
Drape hanging over edge of table is NOT sterile

• Do not walk away or turn your back on a sterile field
• Do not cough, sneeze, talk or chew gum over the sterile field
• Do not reach/lean over sterile field
• Do not spill on a sterile field
• Do not use fans in areas of sterile fields
• Do not set up a sterile field on a contaminated surface

• Do not touch anything inside the 1” border of the sterile field or package unless it is sterile
• Do no put sterile items below your waist.
They will be contaminated
• Do not use anything that you have a doubt about the sterility
• Do not take it personally if someone identifies a break in sterile field technique

• Nursing
– urinary catheters, wound care, surgery, trach suctioning, etc.
• Respiratory Therapy
– suctioning
• Medical Asst.
– minor surgery
• Physical Therapist Asst.
– wound care
• Occupational Therapy
Asst .
– wound care
• Dental Asst.
– tooth extractions
• Dental Hygiene
– certain cleaning procedures
• Surgical Technology
– all surgical procedures

• For Cleaning Instruments:
– wear utility gloves
– rinse instruments after procedure
– scrub with soap and brush or use ultrasonic cleaner
– check grooves and hinges for residual material
– rinse thoroughly to remove soap
– dry thoroughly before wrapping and sterilization takes place

• a wet instrument placed into an Ethylene
Oxide Sterilizer will cause an explosion when the sterilizer is processing

• Key Factors:
• sterile gloves should be worn during sterile procedures to:
– maintain the sterility of the equipment being used
– prevent cross contamination of patient during invasive procedures

• Key Factors :
– select the correct size
– hands should be washed & dried before & after gloves
– open gloves on clean/dry surface
– touch only the outer 1” border of inside wrapper
– use “dominant” hand to pick-up the opposite glove first

• Key Factors:
– gloves must be applied above the waist to maintain sterility
– do not apply gloves over any sterile field
(including own wrapper)
– do not allow a gloved thumb to touch gloves during application
– gloves are placed in wrapper with the thumbs up
– keep gloved hands above waist

• Key Factors:
– keep gloves away from face
– think “dirty to dirty”! Don’t reach inside 1st glove to remove, pinch outside of glove only
– don’t use ungloved thumb on dirty 2nd glove

• Key Factors:
– “A dirty glove should not touch an uncovered part of your body”
– “An uncovered part of your body, should not
touch a dirty glove”
– Be SAFE

• List all protective barriers.
• Compare and contrast the different types of gloves.
• Discuss items to be placed in biohazard waste, waste receptacles, and restrictions where biohazard signs are placed.
• Define sterile field.
• Discuss time and event related self-life considerations.
• Discuss what areas are and are not sterile.