ATI/NCLEX Review Questions On Surgical Asepsis.

Surgical Asepsis

• Surgical asepsis prevents infections in healthcare settings
• It is utlized during surgeries, labor and delivery, burn units, and invasive procedures
• A sterile environment is crucial for reducing infection risk

Achieving Surgical Asepsis

• Wear protective gear: hair cover, mask, eyewear, and shoe covers
• Hand scrub, sterile gown and gloves are required
• Healthcare teams are responsible for sterile environments
• Replace items if sterility is questionable
• Sterile areas must be in sight and within sterile field boundaries
• Non-aseptic team members must stay 1 foot away and face the sterile field
• Check for latex allergies before procedures and use latex-free equipment

Preparing a Sterile Field

• Prepare the sterile field on a clean, dry, flat surface with minimal moisture risk
• Check sterile item integrity and expiration date
• Place the item on the work surface
• Sterile drapes cover work surfaces and come in various shapes and sizes
• The inner drape surface, except a 1-inch border, is the sterile field

Opening Sterile Drape

• Reach around the sterile drape and open side flaps after removing the plastic outer wrapping
• Position the drape to accommodate the work surface
• Discard objects contacting the 1-inch border

Preparing Sterile Field

• Lay the drape flat and open the side flaps
• Gently pull the drape away from the wrapper, avoiding touching other surfaces
• Position the drape with fluid-resistant side down
• Sterile items can now be placed

Pouring Sterile Solution

• Loosen the cap
• Check the container's contents and expiration date
• Carefully pour the solution from a distance

Adding Sterile Items to a Sterile Field

• Drop small items from 6 inches above the sterile field
• Set down larger objects gently by gathering the wrap's ends around the wrist
• Dispose of the outer wrapper
• Add additional sterile supplies the same way

Sterile Technique

• Keep a distance from non-sterile areas and only touch the sterile field with sterile gowns/gloves
• Avoid reaching over the sterile field, consider items out of view or below the waist contaminated
• Consult the person in charge, and correct sterility issues

Putting on Sterile Gloves

• Place gloves on a clean, dry surface at or above waist level
• Expose gloves by folding flaps up and away
• Use closed-gloving to prevent gown contamination

Sterile Gloves and Gowns

• Sterile gloves prevent spread of infection
• Open-gloving is for changing gloves during procedures needing only sterile gloves
• Assisted-gloving is for helping teammates apply gloves
• Sterile gowns protect patients and healthcare providers from infection
• The whole gown is considered sterile when placed on the sterile table
• Consider the gown's front (chest to the table/waist) and sleeves (fingertips to 2 inches above the elbows) sterile

Open-gloving Technique

• Expose both gloves by folding back the wrapper's inner edges
• Pull the glove over the dominant hand using the thumb and first two fingers of the non-dominant hand
• Avoid skin contact with the fingers of the non-dominant hand
• Grab the folded edge of the glove cuff for the outside surface
• Slide the gloved hand's fingers under the second glove's cuff
• Pull the second glove over the non-dominant hand, keeping the cuff folded
• Adjust the gloves as needed

Assisted-gloving Technique

• The assistant picks up the glove for the team member's to insert their hand
• Gloves are held under the cuff and stretched open
• The sterile team member points thumb away when placing it in the glove
• The assistant pulls the cuff of the glove over the gown's cuff

Sterile Field

• Place the right size and type of gown on the sterile field before starting a surgical hand scrub
• If the gown doesn't fit, movement could be difficult
• Put on a sterile gown right after a surgical hand scrub, and drying hands/forearms with a sterile towel
• Ensure nothing nonsterile touches and contaminates the outside of the gown when putting it on

Sterile Gown Guidelines

• Sterile gowns are pre-opened and lifted from the sterile field while only touching the inside surface below the neck band
• Step back from the sterile field while a team member picks up with scrubbed hands, letting the gown unfold and using only the inside surface
• Put arms carefully into the sleeves, only inserting hands to the seam while holding hands and arms up
• The assistant/circulating nurse gets inside the gown at shoulder level and pulls the gown over shoulders, securing neck and waist ties and the tie in front (for a wraparound gown)
• Replace soiled gowns

Assisting with Sterile Gowning

• Open the gown and only touch the inside surface near the neck/shoulder areas
• Have surgical team members put their arms into the gown sleeves
• Pull the gown onto the shoulders/adjust, and only touch the inside
• Help secure the gown in the front (for a wraparound gown)

Hand Hygiene for Gowning

• Use an antimicrobial agent to remove debris and transient micro-organisms
• Traditionally, surgical hand scrubs used antimicrobial agents and sterile brushes/sponges
• Brushless techniques using 50-90% alcohol with chlorhexidine gluconate are alternatives

Additional Guidelines

• Remove jewelry and apply surgical attire before pre-scrub wash/rinse
• Well-groomed nails must be shorter than 1/4 inch and avoid artificial nails
• Replace nail polish older than 4 days to avoid bacterial growth

Pre-scrub Wash and Rinse

• Perform the process to remove superficial micro-organisms and debris
• Clean the subungual area/cuticles with a nail-cleaning tool at the start of the day or when soiled

Surgical Hand Scrub

• Wash hands/arms 2 inches (5 cm) above the elbows with surgical scrub for 1 minute
• Use an antimicrobial agent with a sponge/brush or alcohol-based rub
• Use timed scrub or counting stroke method for traditional scrubs
• Length of time or number of strokes varies by agency
• Dry hands/forearms before using alcohol-based rub
• Cover all surfaces of thumbs, fingers, hands, and forearms to 2 inches above the elbow with the alcohol-based product
• Rub the product until the skin feels dry
• Apply thoroughly before sterile gown/gloves

Moving from Scrub Sink

• Prevent hand/forearm contamination by keeping hands in front of the body and above the waist
• Back through the door if contact with the door is possible

Preparing Surgical Area

• Remove all jewelry
• Cover hair, face, and shoes before entering the surgical area
• Hands should stay above elbows during the surgical scrub
• The scrub sink should be deep and wide enough to hold both arms without water splashing
• Follow manufacturer recommendations for alcohol-based rubs to ensure surgical asepsis

Surgical Attire and Hand Scrubbing

• Wear surgical attire before starting the surgical hand scrub
• Prewash/rinse from fingers to 2 inches above elbows with an antimicrobial agent
• Wash from clean to less clean areas (hands to arms)
• Allow hands to air-dry before applying sterile gown/gloves

Alcohol-based Handrub

• Apply cap/hood, shoe covers, face mask, and eyewear before starting surgical hand asepsis
• Dispense the recommended amount of alcohol-based rub into one hand
• Dip the opposite hand's fingers and work the product under the nails
• Allow hands to air-dry before applying sterile gown/gloves

Documentation

• It is essential for communicating/recording client care
• Gather required medical record information to provide safe and efficient care
• Note the procedure, timing, client's response, and any specimens/cultures obtained
• Exclude the client's name, room number, birth date, medical record number, and demographic information

Aseptic Technique

• Documenting the surgical hand scrub or sterile gown/gloves is not required
• The outlined facility's policy/procedure manual should be followed by all employees

ATI/NCLEX Review Questions on Surgical Asepsis

• A circulating nurse observes a surgical technician’s glove being punctured on a sterile field, the immediate action is to remove the surgical technician from the sterile field and have another scrubbed team member takeover (C).
• During a sterile dressing change, when a nurse touches the outer packaging of a sterile gauze accidentally with a non-sterile glove, the nurse should discard the entire package and obtain a new one. (A)
• In preparing to open a sterile pack containing instruments for a surgical procedure, the healthcare provider maintains the sterility during the opening process by, opening the farthest flap first, then the side flaps, and the closest flap last, to protect the sterile field (C).
• A nurse is assisting a surgeon with a sterile procedure when an instrument falls on the floor, the nurse should remove the contaminated instrument from the sterile field (B).
• When donning sterile gloves with an open gloving technique and the nurse touches the inner, exposed side of the glove cuff with an ungloved hand, the nurse should discard the glove and don a new sterile glove on the contaminated hand (B)
• When a nurse is preparing to pour a sterile solution onto a sterile field, the nurse must prevent from recapping the bottle after pouring the solution (D)
• In a surgical procedure, a surgeon that is scrubbing in should not be wearing artificial nails (D).
• After completing a surgical hand scrub, a surgical team member who accidentally brushed against a non-sterile surface should have the surgical hand scrub procedure redone from the beginning (D)
• For a nurse setting up a sterile field on a Mayo stand, it is essential to point the drape with the fluid-resistant side facing to prevent strike-through contamination (B)
• When pouring medicine that is being added to a sterile for a patient the maximum acceptance distance that a bottle can be to to a sterile container is 6 inches (B)