Medical/Surgical Asepsis
Presented by:
Cynthia Bartlau, RN, PHN, MSN
Objectives

At the completion of this lesson the student
will be able to
Discuss concepts related to the chain of infection
 Differentiate medical and surgical asepsis
 Discuss equipment used for maintaining medical
and/or surgical asepsis
 Identify common sources for contamination
 Describe proper hand placement during aseptic
procedures

Beginning of Modern Asepsis
Previous to the discovery of asepsis many
people died due to post-operative (and other)
infection
 Dr. Ignaz Semmelweis

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Told doctors to wash their hands
Scottish surgeon named Joseph Lister
Inspired by Louis Pasteur’s formulation of the
germ theory of disease
 Used carbolic acid in operating rooms


Drastic reduction in infections
Theory of Infection Control

Microorganisms
Bacteria
 Fungi
 Viruses
 Protozoa


Pathogenic
 Disease
causing
 Infectious agent
 Causes disease in healthy person
 Opportunistic pathogen

Causes disease in susceptible person
 Virulence
 Communicable

diseases
Non-pathogenic
 Resident
flora
 Colonization
 Can cause disease if transmitted to other areas
Infection

Local


Specific area of body is infected
Systemic

Microorganisms spread & damage other body
areas
 Bacteremia
when microbes enter blood stream
 Septicemia – when bacteremia spreads through all of
the body systems

Acute vs. chronic infection

Nosocomial – infections that occur as a
result of health care delivery
Endogenous source
 Exogenous sources


Iatrogenic – infection directly caused by any
diagnostic or therapeutic source

Drug-Resistant Pathogens
MRSA
 VRE
 MDR TB

Causative Agent
Reservoir
Bacteria
People
Viruses
Equipment
Fungi
Water
Protozoa
Helminthes
Susceptible Host
Neonates
Diabetics
Chain of
Infection
Portal of Exit
Secretions
Excretions
Immunosuppressed
Droplets
Cardiopulmonary Disease
Skin
Portal of Entry
Broken Skin/Mucous Membrane
Gastrointestinal/Respiratory/
Urinary Tract
Mode of
Transmission
Direct-Indirect Contact/Fomite
Injection/Ingestion
Airborne/Aerosols
Medical Asepsis
AKA: Clean technique
 Practices that inhibit the growth & spread of
pathogenic microorganisms

Handwashing
 Standard precautions
 Transmission based precautions
 PPE


The JCAHO Sentinel Event Alert quotes Julie
Gerberding, MD, director of the CDC, as
stating

Clean hands are the single most important factor
in preventing the spread of dangerous germs
and antibiotic resistance.
Beyea, S. C. (2003, July). Keeping patients safe from infection - Patient safety first. AORN Journal.
Antiseptics
Prevent or inhibit growth of pathogenic
organisms
 Not effective against spores or viruses
 Can be use on the skin

Alcohol
 Betadine

Disinfection
Destruction of pathogens other than spores
 Boiling water and chemicals

Bleach solutions
 Zephirin

Irritate or damage skin
 Used on objects not people

Surgical Asepsis
AKA: Sterile technique
 Practices that destroy all microorganisms &
their spores
 Used in specialized areas & skills

Care of surgical wounds
 Catheter insertion
 Invasive procedures
 Surgery

Sterilization

Destruction of pathogens & non-pathogens,
including spores and viruses
Steam under pressure
 Gas
 Radiation
 Chemicals


Autoclave is most common piece of
equipment used

CDC recommendations
Preoperative/prophylactic antibiotic
administration
 No preoperative hair removal (unless hair will
interfere with operation)

Sterile Technique
Procedures that keep an object or area free
from living organisms
 Sterile vs. contaminated areas
 Articles must remain away from and in front
of the body and above the waist

Sterile Technique
Never reach across the sterile field
 Never turn your back to the sterile field
 Two inches around border is considered
contaminated
 Sterile field must be kept dry

Sterile Gloving
Only touch the outside of the package with
bare hands.
 The inside of the package, in which the
gloves are placed, is considered sterile.
 The wrapper, when opened provides a sterile
field.
 Grasp only the outside edge of the wrapper.



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The inside of the glove may be touched with the bare
hand
Grasp the first glove at the top edge of the foldeddown cuff and slip in hand
Slip gloved fingers into cuff of second glove and slip
in second hand without contaminating
The outer aspect of the glove must remain sterile




Includes wrist area
Keep hands above level of waist
Sterile to sterile only
If contamination occurs, start again with new pair of gloves
Techniques to Remove Articles
from Sterile Wraps

Drop technique



Mitten technique



For gauze pads, dressings, small items
Wrapper is partially opened , held upside down over
sterile field, dropped onto sterile field
For bowls, drapes, linen…
Using the wrap as a mitten, sterile supplies can be
placed on a sterile field
Transfer forceps


For cotton balls, small items, or articles
Sterile gloves or transfer forceps are used to transfer
objects to sterile field
Skills to Demo & Practice

Donning & Removing Sterile Gloves
Questions?