INFECTION CONTROL
DR. EYAD ABOU ASALI
WHAT IS INFECTION?
An invasion of
body tissue by
microorganism
s and their
growth there.
What is Infection Control:
• All of the practices used to prevent the
spread of microorganisms that could
cause disease in a person.
• Infection control practices help to
protect clients and healthcare
providers from disease by reducing
and/or eliminating sources of infection.
Types of microorganisms causing
infections
1. Bacteria can live and be transported through
air, water, food, soil, body tissues and fluids,
and inanimate objects.
2. Viruses (causes the common cold) hepatitis,
herpes, and human immunodeficiency virus.
3. Fungi include yeasts and molds. Candida
albicans
4. Parasites They include protozoa such as the
that causes malaria.
Microorganisms.
vary in their
• Ability to produce disease.
• Severity of the diseases they produce.
• Degree of communicability.
Type of infections
• Local: limited to specific part of the body.
• Systemic: microorganisms spread and
damage different of the body.
• Bacteremia: when a culture of the
person’s blood reveals to
microorganisms.
• Septicemia: when Bacteremia results in
systematic infections.
• Acute infections: generally appear
suddenly or last a short time.
• A chronic infections : occur slowly,
over a very long period and may last
months or years.
What do u know about Nosocomial
Infections?
• Infections that are associated with the
delivery of health care services in a
healthcare setting, clients are at increased
risk of having infection.
• Most nosocomial infections are
transmitted by health care workers and
clients as a result of direct contact.
Nosocomial infections
• classified as infections that are associated with
the delivery of health care services in a health
care facility. Nosocomial infections can either
develop during a client's stay in a facility or
manifest after discharge.
• The incidence of nosocomial infections is
significant. Major sites for these infections are
the respiratory and urinary tracts, the
bloodstream, and wounds.
Factors that contribute to nosocomial
infection risks are invasive procedures,
medical therapies, the existence of a large
number of susceptible persons, inappropriate
use of antibiotics, and insufficient hand washing
after client contact and after contact with body
substances.
Factors Increasing Susceptibility to Infection
1. Age influence the risk of infection.
2. Heredity influences the development of
infection.
3. The nature, number, and duration of physical
and emotional stressors can influence
susceptibility to infection.
• Stressors elevate blood cortisone. Prolonged
elevation of blood cortisone decrease antiinflammatory responses depletes energy stores,
lead to a state of exhaustion, and decrease
resistance to infection.
4. Resistance to infection depends on adequate
nutritional status.
5. Some medical therapies predispose a person to
infection. For example, radiation treatments for
cancer, some diagnostic procedures may also
predispose the client to an infection.
6. Certain medication also increase susceptibility
to infection. Anticancer medications may
depress bone marrow function, resulting
inadequate production of white blood cells, antiinflammatory and antibiotics medications.
What are the Types of
nosocomial infection?(N I)
Endogenous NI: Autoinfection (infections
occur from the patients’ own.
Exogenous
NI: occurs from an infected
or patient to other patients, health care
workers and visitors ( hospital
environment and personel).
Nosocomial infections lead to
•
•
•
•
•
Increased healthcare costs,
Extended hospital stays.
Prolonged recovery time.
Cause disability and discomfort.
Loss of life.
Principles of Basic Infection
Control:
1. Microorganisms move through space on air
currents – avoid shaking or tossing linen.
2. Microorganisms are transferred from one
surface to another whenever objects touch. A
clean item touching a less clean item
becomes “dirty” – keep hands away from
face, keep linens away from uniforms, an
item dropped on the floor is considered
dirty.
(cont.)
3. Microorganisms are transferred by gravity
when one item is held above another, avoid
passing dirty items over clean items
4. Microorganisms are released into the air on
droplet nuclei whenever a person breathes or
speaks – avoid breathing directly in
someone’s face; when someone
coughs/sneezes, cover mouth with kleenex,
discard, wash hands.
5. Microorganisms move slowly on dry surfaces,
but very quickly through moisture.
6. Proper Hand washing removes many of the
microorganisms that would be transferred by
the hands from one item to another – always
wash hands between patients.
The Chain of Infection
• Infectious agent – microorganisms (bacteria,
viruses) able to cause diseases if invade tissue,
grow &multiply.
• Resident – normally reside on the skin in
stable numbers.
• Transient – attach loosely to the skin by
contact with another – easily removed by
hand washing.
Host must be susceptible to the strength
and numbers of the microorganisms.
To reduce susceptibility –
• prevent nosocomial infection,
• provide adequate nutrition & rest,
• promote body defenses against infection &
provide immunization.
How can we break the Chain of Infection
• There are many ways to break the chain of
infection in each of the links: look at the
next slide)
Body Defense Against Disease
• Nonspecific Defense System:
1. Anatomic and physiological barriers
• Intact skin and mucous membrane.
• Normal secretion (acidic) on the skin inhibits bacterial
growth.
• Nasal passages (moist mucous membranes, and
cilia).
• The lung have alveolar macrophages.
• The eye is protected by tear (inhibiting).
• Stomach acidity inhibit growth
2- Specific defenses system
It involve the immune system.
Antigens : is a substance that induce a state of
sensitivity or immune responsiveness
(immunity).
Antibodies destroy or control antigen providing
protection against most common infections.
IMMUNITY
Active immunity:
antibodies are produced by the body in
response to an antigen (vaccines).
Passive immunity:
the host receives natural or artificial (from
an injection of immune serum) antibodies are
produced by another source (animal,
human).
Types of Immunity
How to prevent of nosocomial infection?
•
•
•
•
Hand hygiene
Break the chain of infection
provide adequate nutrition & rest.
promote body defenses against
infection & provide immunization.
• Follow the principles of aseptic
technique.
• HANDWASHING!
is the most important
measure you can use to
prevent the spread of
infection.
Cleaning?
inhibits the growth of microorganism
Disinfecting:
Is a chemical preparation, such as phenol or
iodine compounds, used on inanimate
Sterilization : It is the process of killing or
destroys all microorganisms including
spores and viruses .
A sterile field : It is a microorganism-free
area.
ASEPSIS
• Sepsis: Is the state of infection.
• Asepsis : Is the freedom from disease
microorganisms.
• Clean : absence of almost all
microorganisms.
• The term asepsis means the
absence of disease-producing
microorganisms
• Aseptic technique is an effort to keep the
client as free from exposure to infectioncausing pathogens as possible
There are two basic
types of asepsis
Medical & Surgical
asepsis.
ASEPSIS
• MEDICAL
• USED DURING DAILY ROUTINE CARE
TO BREAK THE INFECTION CHAIN
• SURGICAL
• REQUIRES ABSENCE OF ALL MICROORGANISMS
1. Medical asepsis
Includes all practices intended to confine a
specific microorganism to a specific area,
limiting the number, growth, and transmission of
microorganisms.
In medical asepsis, objects are referred to as
clean, which means the absence of almost all
microorganisms, or dirty (soiled, contaminated,
which means likely to have microorganisms,
some of which may be capable of causing
infection.
2. Surgical asepsis or sterile
Technique, refers to keep an area or object
free of all microorganism, it includes
practices that destroy all microorganisms
and spores. Surgical asepsis is used for all
procedures involving the sterile areas of
the body.
• Sepsis is the state of
infection and can take
many forms, including
septic shock.
ASEPSIS IS THE CONTROL OR
ELIMINATION OF:
• INFECTIOUS AGENTS
• CLEANSING
• DISINFECTION AND STERILISATION
CLEANSING
THE REMOVAL OF ALL FOREIGN MATERIALS:
• FROM OBJECTS
• GENERALLY INVOLVES WATER
• MECHANICAL ACTION
• WITH OR WITHOUT DETERGENTS
DISINFECTION/STERILISATION
• DISINFECTION
ELIMINATES PATHOGENIC ORGANISMS WITH
THE EXCEPTION OF BACTERIAL SPORES
• STERILISATION
ELIMINATES AND DESTROYS ALL MICROORGANISMS, SPORES AND VIRUSES
ASEPTIC TECHNIQUE
• A METHOD USED TO PREVENT
CONTAMINATION OF WOUNDS AND OTHER
SUSCEPTIBLE SITES
• USING ONLY STERILE OBJECTS AND
FLUIDS
Asepsis:
Sterilization and Disinfection
Asepsis
It is keeping medical instruments free from
microorganisms
This is accomplished by:
I. Sterilization
II. Disinfection
I. Sterilization
It is one of the basic steps in surface asepsis.
Definition: Sterilization refers to the use of
different procedures to destroy all forms of
microorganisms including bacterial spores.
What to sterilize?
• It is mandatory to sterilize :
– all instruments that penetrate soft tissues and
bone.
– Instruments that are not intended to
penetrate the tissues, but that may come into
contact with oral tissues.
• If the sterilization procedure may damage the
instruments, then, sterilization can be replaced
by Disinfection procedure
II. Disinfection
It a is less lethal process than sterilization.
Definition: It is a procedure intended to reduce
microorganisms as far as possible (but not
bacterial spores).
Thus, disinfection can never replace sterilization
Which procedure to use?
Category
Items in each category
Procedure
Critical
Items that: (1) enter the tissue; (2)
Enter vascular system; (3) through
which blood flows
Sterilization
Semi-critical
Items that: (1) touch mucous
membranes; (2) touch non-intact
skin (e.g. endoscopes, respiratory
therapy equipment, and diaphragms)
High level
disinfection
Non-critical
Items such as bedpans, blood
pressure cuffs, and bedside tables
Low level
disinfection
I. Sterilization - Process
Sterilization: is a process that destroys all
microorganisms, including spores and viruses.
• Four commonly used methods of
sterilization are
1. Moist heat
2. Gas
3. Boiling water
4. Radiation
Sterile Technique
The basic principles of surgical asepsis
1. All objects used in a sterile field must be strile.
2. Sterile objects become un-sterile when touched
by un-sterile objects.
3. Sterile items that are out of vision or below the
waist level of the nurse are considered unsterile.
4.Sterile objects can become unsterile by
prolonged exposure to airborne microorganisms.
5. Fluids flow in the direction of gravity.
6. Moisture that passes through a sterile object
draws microorganisms from un-sterile surfaces
above or below to the sterile surface by capillary
action.
7. The edges of a sterile field are considered unsterile.
8. The skin cannot be sterilized and is un-sterile.
Sterilization – instrument Packing
• Often instruments are packed for sterilization to
be stored and handled without being
contaminated.
• Packing depend on the intended shelf life after
sterilization.
• The available packing options are:
– Textile has shelf life of 1 month
– Paper has shelf life of 1 – 6 months
– Nylon, glass, and metal have shelf life of 1 year
if tightly closed
Sterilization Principles
There are 3 different sterilization principles:
1. Heat sterilization
2. Chemical sterilization
3. Radiation sterilization
Instrument Processing Area
•
•
Use a designated processing area to
control quality and ensure safety
Divide processing area into work areas
– Receiving, cleaning, and decontamination
– Preparation and packaging
– Sterilization
– Storage
Automated Cleaning
•
•
•
Ultrasonic cleaner
Instrument washer
Washer-disinfector
Manual Cleaning
•
•
Soak until ready to clean
Wear heavy-duty utility gloves,
mask, eyewear, and protective
clothing
Preparation and Packaging
•
•
•
•
Critical and semi-critical items that will be
stored should be wrapped or placed in
containers before heat sterilization
Hinged instruments opened and unlocked
Place a chemical indicator inside the pack
Wear heavy-duty, puncture-resistant utility
gloves
Instrument processing flowchart
Remove
Items from
operatory
Use holding
Solutions if
necessary
Clean by
Automated
Or manual
method
Store
Package
Sterilize
1. HEAT STERILIZATION
1. Heat Sterilization
Advantages: It is the simplest, most effective and
inexpensive method.
There are 2 procedures depending on the
tolerance of the material used:
a) Steam sterilization (Autoclaving)
b) Dry heat sterilization
1.a. Heat – Steam Sterilization
• Use saturated steam above 100º C on packed items.
• Objects occupy 4/5 of autoclave volume to facilitate
circulation.
• Process is divided into 3 periods as follows:
– Pre-vacuum period: air is
withdrawn from device
– Sterilizing period: steam is
introduced under pressure to
specific temperatures &
times.
– Post-vacuum: steam is
withdrawn to dry autoclave
Table shows samples of time-temperature relationships for
steam sterilization
Steam Sterilization
Advantages & Disadvantages
• Advantages:
– good penetration
– maintains integrity of liquids (e.g. Lubricants)
due to the 100% humidity within the chamber.
• Disadvantages:
– Non stainless steel metal items corrode
– may damage plastic and rubber items
– sharp instruments get dulled.
Operation cycle of Steam
Sterilization
• 4 cycles
– 1. heat – up ~~~~~~~ generates steam
– 2. sterilization cycle~~~ reaches the temp.
needed to sterilize
– 3. depression cycle~~releasing the pressure
– 4. Drying cycle ~~~~~dries instruments
Sterilization Monitoring
Types of Indicators
•
•
Mechanical
– Measure time, temperature, pressure
Chemical
– Change in color when physical parameter is
reached
•
Biological (spore tests)
– Use biological spores to assess the
sterilization process directly
1.b. Dry-Heat Sterilization
• Involves heating at atmospheric pressure and
often use a fan to obtain uniform temperature by
circulation.
• Heat at 180º for half hour , 170º for 1 hr., or
160º C for 2 hrs.
• Times are the periods during which object is
maintained at the respective temp.
• Adequate sterilization with heat depends on:
– Temperature
– Length of time
• Higher temperatures require shorter treatment
times.
• Thermal death time (TDT) is the shortest length of
time needed to kill all organisms at a specific
temperature.
• Thermal death point (TDP) is the lowest temperature
needed to kill all organisms in 10 minutes.
Dry-Heat Sterilization
Disadvantages
• Disadvantages:
– Less reliable than autoclaving
– Large temp difference may arise within
device.
– sharp instruments get dulled
– Many materials do nottolerate dry heat
2. CHEMICAL STERILIZATION
2. Chemical Sterilization - Types
• The chemical compounds used can be:
a) Gas Sterilization
b) Liquid Sterilization
• Generally, chemical sterilization procedures
have the disadvantages of presenting health
hazards to users (e.g. poisonous, flammable, )
2.a) Gas Sterilization
• The gas used in this procedure is ethylene
oxide.
• Procedure:
– Keep objects in constant atmospheric
humidity.
– Heat to temperatures between 30º and 60º C.
– maintain for a period of 10 hrs.
– Residual ethylene oxide must be ventilated
• Formalin gas autoclaves have been developed
for sterilizing endoscopes and ansthetic
apparatus.
Gas Sterilization – Disadvantages
• Ethylene oxide (& formalin) autoclaves have
the following disadvantages:
– Difficult to operate
– Unsuitable for hospitals but used in industry
(e.g. for sterilizing disposable materials that
can not tolerate high temperatures).
2.b) Liquid Sterilization
• Can be performed with buffered glutaric
aldehyde.
• Procedure:
– Immerse object in liquid for several hours.
– Rinse with sterile water after end of
procedure.
3. RADIATION STERILIZATION
3. Radiation Sterilization
• Provides effective way of sterilization when used
in high doses.
• Gamma radiation (from 60Co).
• Procedure:
– Objects on belt conveyer
– Expose objects to 25 to 30 kGy for about 24
hrs.
Radiation Sterilization
Advantages and Disadvantages
• Advantages:
– Clean process
– Dry process
– Ensures full exposure of object from all
directions
• Disadvantages:
– Posses threat to humans (radiation)
– Lengthy process
– Requires very qualified personnel
II. DISINFECTION
• A disinfectant is a chemical preparation, such
as phenol or iodine compounds, used on
inanimate objects .
• Disinfectants are frequently caustic and toxic to
tissues. An antiseptic is a chemical preparation
used on skin or tissue .
Disinfection - Types
• As mentioned before, disinfection can not kill all
microorganisms but only reduce its number.
• Disinfection can be accomplished with:
1. Heat disinfection
2. Chemical disinfection
• Object that can be disinfected are bedpans,
patient skin before operation and surgeon hands
before putting gloves.
1. Heat Disinfection
• It is accomplished by boiling water
atmospheric pressure for at least 5 min’s
at
2. Chemical disinfection
• Number of different agents are used according
to tolerance of objects and infectious agents.
– Using phenol with cleaning component
destroy the membrane of microorganisms.
– Using 70% alcohol for skin which denatures
proteins of microorganisms.
– Use soap containing hexachlorophene for
hands.
– In case of hepatitis use 5% solution of
chloramines or heat disinfection
A SATISFACTORY AGENT SHOULD:
• Be active against a wide range of organisms and
spores. Only few are truly sterilizer
• Have a rapid action
• Should not be toxic or irritant to the skin
• Should be Persistent
There is no one disinfectant which can be
used to kill all micro-organisms in all
situations.
Types of Chemical disinfectants
• Inorganic:
– Iodine
– Chlorine
• Organic:
– Alcohols
– Aldehydes
– Phenols
– Cationic surface-active agents
Inorganic disinfectants
The halogens: Chlorine and Iodine
• Have a rapid action against vegetative
organisms and spores= true sterilizers
• Their action is annulled by foreign organic
material
Iodine disinfectants
The broadest spectrum of all topical antiinfectives, with action against bacteria, fungi,
viruses, spores, protozoa, and yeasts.
• Tincture iodine:
– 2.5% iodine & 2.5% potassium iodide in 90%
ethanol.
– Best skin disinfectant
– Irritating to raw surfaces: due to its alcoholic
component
– Allergic dermatitis
• Iodophors: Solutions of iodine in non-ionic
detergents= Povidone iodine= Betadine
– Less irritating and less staining
– Less disinfectant than tincture
•
•
•
•
•
Chlorine disinfectants
Powerful, Disinfect water
Particularly active against viruses
Concentrated solutions too corrosive
Usually diluted with a compatible
detergent
Organic Disinfectants
• Alcohols: bactericidal: 50-70% ethanol
• Aldehydes:
– Formalin: irritant, powerful=sterilizer
– Glutaraldehyde: less irritant, not volatile, more
rapid action.
• Phenols: continued activity in organic matter as
human excreta.
– Phenol: Toxic, expensive
– Cresols: Lysol
– Chloroxylenol: Dettol
– Chlorhexidine: Hibitane- Alkanol
– Hexachlorophane
• Cationic surface-active agents:
– Cetrimide: Cetavlon
Alcohol
• Isopropyl Alcohol 70% (or Ethyl Alcohol 90%)
ADVANTAGES:
• Causes protein denaturation, cell lysis, and metabolic
interruption.
• Degreases the skin.
DISADVANTAGES:
• Ineffective against bacterial spores and poorly effective
against viruses and fungi.
Glutaraldehyde (Cidex)
Cold Sterilization:
• Instruments must be dry before immersion.
• Glutaraldehyde is bactericidal, fungicidal,
viricidal, and sporicidal
• Sterilization: a 10 hour immersion. This
prolonged chemical action can be more
detrimental to surgical instruments.
• 3 hours exposure time is needed to destroy
spores.
• If the instruments need to be "disinfected" only,
cold sterilization is okay as disinfection will take
place in only 10 minutes.
Lysoformin
• Formaldehyde & glutaral
• Lysoformin: liquid concentrate with which any dilution
required can be made by simply adding water (20ml + 48L)
• The timing depends on the concentration used:
– flexible endoscopes
– deactivation of HBV & HIV
• Used for heat labile instruments and cleaning
• Does not harm metal instruments
Chlorhexidine Gluconate
Hibitane vs Alkanol
Broadest spectrum
Better residual activity than iodophors
Occasional skin sensitivity
ADVANTAGES:
Rapid action
Residual activity is enhanced by repeated use
Less susceptible to organic inactivation than
povidone iodine
DISADVANTAGES:
Occasional skin sensitivity.
Inactive against bacterial spores
Activity against viruses and fungi is variable and
inconsistent
May harm metal instruments
Disinfectant
Status
Use
Alcohols (70% or 90%)
(intermediate-level)
bactericidal,
tuberculocidal, fungicidal,
and virucidal
to disinfect thermometers,
medication vials, etc.
Glutaraldehyde (high-level)
broad antimicrobial range,
fungicidal and virucidal
to disinfect endoscopes,
thermometers, and rubber
items
Chlorine Compounds
(dilution of 1:50 is highlevel)
concentrations of 1000
ppm inactivate bacterial
spores
to disinfect countertops,
floors, other surfaces
Orthophthalaldehyde
(high-level)
bactericidal, virucidal,
fungicidal, tuberculocidal
in 12 minutes at room
temperature
to clean and process
endoscopes
Hydrogen Peroxide (lowlevel)
6% solutions effective
against some bacteria,
fungi, and viruses
may be used to clean work
surfaces, not widely used
in health care settings
Iodine and Iodophors
(intermediate-level)
vegetative bactericidal, M.
tuberculosis, most viruses
and fungi, no sporicidal
capability
may be used as
disinfectant or antiseptic
Phenolics (intermediate- or
low-level)
most formulations are
tuberculocidal,
bactericidal, virucidal, and
fungicidal
have toxic effects, used as
environmental not
sporicidal disinfectants
Quaternary Ammonium
Compounds
not recommended for
high-, intermediate- or lowlevel disinfection
cleaning agents for
noncritical surfaces
Asepsis – Summary
Asepsis
Sterilization
Heat
Disinfection
Chemical
Steam
Dry heat
Radiation
Gas
Heat
Gamma
Chemical
Boiling water
Phenol
Ethylene oxide
70% Alcohol
Formalin
Hexachlorophene
Heat or
chloramines solution
Liquid
Glutaric
Aldehyde
PROPER INSTRUMENT
PROCESSING
DECONTAMINATION
CLEANING
HIGH-LEVEL
DISINFECTION
STERILIZATION
STEAM
Under
pressure
DRY
HEAT
CHEMICAL
BOILING
USED OR STORED
CHEMICAL
STEAM
• When disinfecting articles, nurses
need to follow agency protocol and
consider the following:
Ultraviolet Light Sterilization
Ultraviolet (UV) light has been used to help
disinfect the air for more than 50 years.
For example, UV irradiation can interrupt
transmission of airborne infections in enclosed
indoor environments where living conditions are
poor and people are crowded together. Because
UV irradiation has very limited energy, UV light
does not penetrate dust, mucous or water.
Therefore, despite manufacturers= claims, it
cannot be used to sterilize water.
Although in theory intense UV light can be both
bactericidal and viricidal, in practice only limited
disinfection of instruments can be achieved.
This is because the UV rays can kill only those
microorganisms that are struck directly by UV
light beams.
For surfaces that cannot be reached by the UV
rays (e.g., inside the barrel of a needle or
laparoscope), any microorganisms present will
not be killed.
Other disadvantages of UV:
• It requires a reliable source of electricity.
It is not effective in areas of high relative
humidity.
• UV bulbs require frequent cleaning to remain
effective.
• Exposure to UV rays can burn the skin and
eyes.
• As a consequence, UV irradiation is neither a
practical nor effective method in most situations
Conclusion
• In summary:
– Sterilization and disinfection are costly and
time consuming process
– However, it is an essential in all health care
facilities to avoid spread of diseases.
– It depends on the ehtics of the instrument
users.
– Users should keep in mind that contaminated
instrument present risk to patient as well as
the user himself.
The Early OR:
No Masks Required
Masks and gowns3 for some
Masks, Gowns3and a Nun
Minimally Invasive Brain Surgery
Presbyterian Hospital
How to Enter the OR
•
•
•
•
•
•
Change into clean scrubs
Remove all jewelry, watches and rings
Remove your pager and cell phone
Put on a surgical cap, mask, shoe covers
Hair must be completely covered
Mask must be tied before entering the OR
Caps
The Bouffant
The Cap
Masks and Eye Protection
No!
• Wrong mask, no
eye protection
No!
• Ditto
Masks and Eye Protection
+
Better!
Best!
Outside the OR:
Key People/Areas
• “The Front Desk”
• “Charge Nurse”
– In charge of all the OR staffing, equipment,
troubleshooting
• OR Secretary
– Calls patients to the OR, coordinates the OR
schedule
– Just slightly less busy than an air traffic
controller
• Preoperative Holding Area (“Preop Hold”)
• “Recovery”
• Recovery Room Nurses
Front Desk:
Montefiore OR
The OR Team
• “Circulator” (AKA The Boss)
– A nurse responsible for patient care and safety,
medical record documentation, OR equipment
– Helps obtain and keep track of instruments and
supplies (circulating between sterile and non-sterile
fields)
• “Scrub”
– An OR Tech or RN who gowns and gloves the
surgeons; also sets up, maintains and passes
instruments within the sterile field
• “Anesthesia”
– Attending Anesthesiologist, Resident or CRNA,
Medical Students, Anesthesia Tech
– Administers preoperative sedation, intraoperative
anesthesia, and postoperative analgesia in the
Circulator:
Montefiore OR 36
Opening sterile pack
• Passing sterile object to a sterile person
• Putting an object in the sterile field
Scrub:
Montefiore OR 36
Anesthesia:
Montefiore OR 36
The Instrument Table
The Mayo Stand
Once you are scrubbed in, gowned
and gloved4..
Where is the sterile field??
Or, What am I allowed to touch??
and@
Where do I put my hands??
Where is the sterile field?
• You:
– Front of the gown from chest to the waist
– Gloved hands and arms to the elbows
• Patient:
– Draped part down to the OR table
– Anything that falls below the level of the patient table
is considered contaminated
• Sterile Field:
– Covered part of the “Mayo stand” (small table where
the most commonly used instruments are kept)
– Top of the “Back Table” where additional instruments
are kept. The sides of the Back Table are not
considered sterile
– Disposable light handles
The Sterile Field
ANY QUESTIONS??????