Sterile Technique Principles

Basic Principles of Sterile Technique

• Only sterile items are used in sterile fields
• If an object's sterility is doubtful, it must be considered unsterile
• Unsterile objects should be removed, covered, or replaced
• Sterile fields must be continually monitored
• Set up sterile fields close to the time of use
• Sterile personnel should avoid unsterile areas
• Anything below table level or waist level and undersurfaces of drapes are unsterile
• Items falling below these levels are contaminated
• Gowns are sterile on the sleeves and front from the waist up
• The back of a gown and area below the waist are unsterile
• People in sterile gowns and gloves should pass each other back to back
• A sterile person can only touch what is sterile
• Unsterile persons cannot reach above or over a sterile field
• Sterile materials must be kept dry, as moisture permits contamination
• Wet packages must be resterilized or discarded
• If solution soaks through a sterile field to a nonsterile field, the wet area must be redraped
• Sterile gloves should be kept in sight and above waist level

Portable and Surgical Radiography

• Radiography in a surgical environment requires strict attention to sterile technique
• Guidelines vary between surgeons and facilities
• Radiographic cassettes are sometimes positioned under the table through a tunnel device
• Other equipment is enclosed in sterile covers and positioned by the physician
• Students will observe procedures during surgery
• Machinery is often left outside the room until right before a procedure
• The surgeon or the procedure itself dictates when set-up should occur before an operation

Gonadal Shielding for Neonatal Portable Radiography

• There are two methods for gonadal shielding which are:
  • Contact: direct placement on infant's gonads
  • Shadow: casting a shadow using the collimator light
• Disadvantages for each include:
  • Contact: higher potential for cross-infection
  • Shadow: requires precise technique

C-Arm Drapping Technique

• The most common approach involves draping the image intensifier and C-arm with a snap cover
• A sterile, clear plastic sheet is suspended from a horizontal metal bar with two vertical suspending rods on the patient's affected side
• An opening in the sheet, attached to the patient with special adhesive, provides access to the surgical site
• Drape the site with an additional sterile cloth
• The C-arm is moved over the anatomical area of interest

Tracheostomy

• An operation under sterile technique which involves cutting into the skin over the trachea and making a surgical wound
• It is used for emergency situations to replace an airway provided by an ET tube
• It addresses the need for airways that have been in place for several weeks
• Must be covered with a dressing to prevent skin breakdown
• It is imperative to avoid touching a tracheostomy, unless under sterile technique

Urinary Catheters

• Urinary catheterization involves the insertion of a tube into the bladder using aseptic technique
• Two main types:
  • Straight Catheter
  • Foley Catheter - a retention balloon type
• An indwelling catheter is any catheter intended to remain in place

Suprapubic Catheter

• Involves inserting a closed drainage system about 1 inch above the symphysis pubis into the bladder
• Indications for use:
  • Required for long-term catheterization
  • Urethral injury or obstruction is present
  • Gynecological surgeries have been performed

Condom Catheter

• Condom Catheters are susceptible to infection at the tip of the penis
• Regular cleaning, care, and sleeve changes are required

Pacemakers

• Doctors recommend pacemakers for cases of bradycardia and heart block
• Bradycardia is a slower than normal heartbeat
• Heart block is a problem with the heart's electrical system and it disrupts electrical signals moving through the heart
• Heart block can result from aging, heart damage from a heart attack, or conditions disrupting electrical activity and also nerve and muscle disorders
• A pacemaker system consists of a battery, a computerized generator, and wires with sensors that are called electrodes on one end
• The wires connect the generator to the heart
• A battery powers the generator, and both are surrounded by a thin metal box
• Pacemakers monitor and control heartbeats
• Electrodes detect the heart's electrical activity and send data to the computer in the generator
• If there is an abnormal heart rhythm, the computer directs the generator to send electrical pulses to the heart that travel through wires

Surgical Zones

• Surgical suites are divided into 3 zones:
  • Zone 1: An unrestricted zone where street clothing is permitted
  • Zone 2: A semi-restricted zone which requires scrub dress and covered hair and shoes
  • Zone 3: A restricted zone which demands scrub dress, shoe covers, and masks

Surgical Department Dress and Behaviour Protocol

• Shoes must be comfortable with closed heel and toe and not cloth covered becuase cloth covered shoes may allow blood, body fluids and other fluids to permeate and will not protect the feet from heavy objects
• Personal hygiene must be meticulous and take a shower before the work day
• Jewelry, long or artificial fingernails, and nail polish are prohibited
• Any body piercing jewelry must be removed
• If going from Zone 1 to Zone 2, one must wear a scrub suit, tucking the blouse into pants or wearing a fitted scrub blouse
• All hairs, beards, or mustaches must be covered with a surgical cap and mask
• Shoe covers must be placed over shoes to reduce contamination
• Scrub hands and arms for medical asepsis before going in Zone 3
• A mask must be donned before entering a surgical procedure room

Surgical Team Members

• Surgeon: Physician who plans and performs the procedure
• Surgical Assistant: Another surgeon or surgical resident
• Anesthesiologist: Makes decisions on anesthesia type
• Nurse Anesthetist: A registered nurse with anesthesia education who administers anesthesia and monitors the patient
• Circulating Nurse: Oversees patient safety and maintains the surgical environment
• Scrub Nurse/Technician: Dons sterile attire, sets up sterile fields, and assists the surgeon with instruments and equipment needed
• Radiologic Technologist: Present at the surgeon's request to perform imaging procedures