Interactive Training CD for Medical Students
Reproductive System
Module :
Infection Prevention: A- and Antiseptic Techniques
in Surgical Setting
Reproductive System,
Medical School of Universitas Padjadjaran,
Bandung
2005
MIR-C Corporate
Production Team:







Director
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.)
Main contributors
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Yayat Ruchiyat, MD, FINACS (Dig.)
Warko Karnadihardja, MD, FINACS (Dig.)
Nurhayat Usman, dr., SpB-KBD
Lisa Hasibuan, MD
Nina K. Poetri T., SKp,
Dadang Sunarya AMK
Dedy Rusnadi AMK,
Alia Rahmi AMK,
Editorial Team
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Casting
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Artistic
: MIR-C Corporate
Productions
: Medical School of Universitas Padjadjaran
Bandung
Credits
Special thanks to:
 Central Operating Theatre Unit of
Hasan Sadikin General Hospital

Infection Prevention Module
Introduction
Infection control
Antiseptic techniques
Operating Theater
Aseptic techniques
Introduction
Description
Objectives
Description

Infection Prevention in Surgical
Setting is one of important
preventive methods in order to
achieve infection control in clinical
and surgical practices.
Objectives

The aims of this method are :
– To minimize surgical site infection
– To protect health personnel
– To improve wound healing
– To minimize disability, morbidity, &
mortality
– To reduce the cost of hospital care
Specific Learning Objectives :
To describe the definition and history of
sterilization, disinfection, decontamination,
anti and a - septic techniques.
 To describe six methods of sterilization.
 To describe three categories of surgical
instruments
 To describe 6 rules of aseptic techniques

Specific Learning Objectives :

To perform aseptic techniques correctly,
including (P5):
–
–
–
–
–
Applying surgical attire
Hand washing
Surgical scrubbing
Gloving
Surgical Gowning
Definition:
– Sterilization : Processes by which all pathogenic
& non pathogenic microorganisms, including
spores, are killed.
– Disinfection: Chemical or physical process of
destroying all pathogenic microorganisms,
except spore bearing ones; used for inanimate
objects, but not on tissues.
Definition:
– Decontamination : Process or method by which all
contaminated materials that can cause diseases are
removed.
– Aseptic techniques : Methods by which contamination
with microorganisms is prevented.
– Antiseptic techniques: Prevention of sepsis by the
exclusion, destruction, or inhibition of growth and
multiplication of microorganisms from body tissues and
fluids.
Infection Control

Why should we apply a and antiseptic
techniques ?
Historical backgrounds :

Ignas Sammelweis (1818 - 1865)
– Puerperal fever  increased maternal mortality
– Hand scrub with chlorinated-lime solution prior to
examination.
– Father of nosocomial infection.

Louis Pasteur (1860)
– Discover the process of fermentation by microorganisms
– Germ theory: against spontaneous generation theory.
Historical backgrounds :

Joseph Lister (1865)
– Use carbolic acid solution on surgical dressing in
the operating room  mortality  (Listerization)
– Father of modern surgery (Antiseptic technique)

Ernst Von Bergmann (1886)
– Introduced “steam sterilizer”
– Basic of sterilization
 aseptic technique
– Later: “pressure & vacuum steam sterilizer” was developed
Methods of Infection control

Anti septic techniques

Design and traffic patterns of the
operating theatre

Aseptic techniques
Anti septic techniques
Sterilization
The objective of modern surgery
 For inanimate objects
 Problem :

– Some items are not heat resistance
Techniques of Sterilization

Physical:
– Heat
– Radiation/ ultraviolet ray
– Boiling water
– Ultrasound
 Chemical:
– Liquid
– Gas
Heat Sterilization

Dry :
– Commonly cause damage
– For powder, oils, and jelly

Moist :
–
–
–
–
Steam
High pressure   spores 
Vacuum  constant temperature
Autoclave
Chemical Sterilization
Generally as disinfection
 Mechanism of action :

– Protein coagulation
– Enzyme denaturation in cells
– Lysis

Depend on : number of microorganisms, soiling,
concentration, and temperature.
Solutions



Jodium and Jodophor
– Good bactericide, but irritant
– Mixture : povidone-jodine 10%
Alcohol Solution of 70% or 90%
Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)
– Spores are killed within 3 hours
Solutions

Hexachloropene (Halogenated phenol)
– Bacterio-static, particularly Gram (+) bacteria
– For scrubbing

Chlorhexidine gluconate
– Bactericide : Gram (+) & (-).
– Good for antiseptic
Gas Sterilization
Formaldehyde
 Ethilene-oxide
 - propionolactone

Boiling Water
Mild boiling
 Vigorous boiling


More active, if 2% sodium-carbonate or 0,1 % sodiumhydroxide being added
The Operating Theater
Transitional
Zone
Clean
Zone
Semi –
Restricted
Area
S
C
R
U
B
S
U
I
T
Restricted area
Sterile
core
Traffic patterns of Operating Theatre

The use of aseptic principles requires
regulation of traffic and flow patterns of the
personnel, patient, equipment, and supplies in
operating theatre

Aims : to protect the safety and privacy of
patients and the cleanliness and integrity of the
environment.
unrestricted area

Elevators

Corridors
outside
surgical
suite
unrestricted area

Entrance

Reception
desk

Patient
suite
Transitional Zone (Video)

Locker
room

Dressing
room
Clean Zone (Video)

Surgical
suite and
corridors

Sterile core
Scrub Area (Video)
Sterile Core (Video)
Putting on surgical attire

In the semi & restricted area:
–
–
–
–
–
Scrub suit : shirt & trousers
Hair covering: surgical cap/hood
Masks : disposable/ re-useable
Goggle (optional): protective eyewear
Shoe covers
are compulsory
Surgical attire

Male
personnel

Female
personnel

Personnel
with veil
Surgical Instruments in the Operating Theatre

Critical items :
– Sterile, because of being used for penetrating
skin or mucosa

Semi critical items :
– In contact with skin or mucous membrane

Non critical items :
Aseptic techniques
Aseptic techniques
1.
2.
3.
4.
5.
6.
Rules at clean zone
Procedures in sterile area
Talk as necessary
Restrict unnecessary movements
Sterile instruments, remove non sterile one
Avoid & Replace wet surgical drapes/towels
Hand washing

Indications:
– Between patient contacts
– Before performing or assisting with invasive
procedures
– Before taking care of particularly susceptible
patients
– Before and after touching wounds
– Immediately after gloves are removed
Hand washing
– Before and after performing sterile procedures
– After contact with blood or body substances, mucous
membranes, soiled linen, waste, or contaminated
equipment.
– Between tasks at different body sites on the same
patient to prevent cross contamination
– After taking care of infected patient
– After touching contaminated inanimate sources
Hand washing

Preparation

The procedure
Surgical Scrubbing Procedure
Purposes:
– To remove debris and transient organisms
from the nails, hands, and forearms.
– To reduce the resident microbial count to a
minimum.
– To inhibit rapid rebound growth of
microorganisms.
Purposes:
– To minimize the re-growth of microorganisms
for the length of the procedure.
– To reduce the numbers of microorganisms on
hands
– To reduce contamination of the operative site
by recognized or unrecognized breaks in
surgical gloves.
Preparation:
Recognizing glove sizes
Actual procedure:
Strokes technique







Rinsing hands &
arms
Scrubbing with
antiseptic solution
Rinsing arms
Scrubbing with
brush or sponge
Rinsing arms
Scrubbing with
antiseptic solution
Drying arms
Actual procedure:
Five minute technique
Gowning

The goal:
– to ensure a safe, protective, and
aseptic environment to the patient and
the surgical team.
Gowning & closed gloving techniques

Drying hands with
sterile towel

Applying gown

Closed gloving
technique
– The final step of the aseptic
techniques before performing surgery.
– Sterile gloves are worn to permit the
wearer to handle sterile supplies or
tissues of the operative wound.
– Sterile gloves establish a shield that
protects the patient from contamination
by flora from the hands of health care
workers.

Open technique
Closed technique
Skin preparation

The goals:
–

to cleanse the skin and bring both the
resident and transient bacterial counts to an
irreducible minimum, therefore reducing the
risk of wound contamination and subsequent
surgical site infection.
performed just before the surgical
incision has been performed.
Skin preparation

Skin painting

Skin draping
Ready for surgery
Gown and gloves removal
After surgery:

Gown, Gloves
removal

Simultaneous
removal