Surgical Asepsis Principles & Practices

Surgical Asepsis

• The aim is to eliminate all microorganisms through specific techniques
• Practices ensure equipment and supplies are free from pathogens (harmful microbes) and non-pathogens (harmless microbes)
• The goal of surgical asepsis is sterility
• Required whenever the skin or sterile tissue is penetrated
• Examples include catheterization, IV insertion, suctioning, sterile dressing change, and blood collection
• PSWs may assist with these procedures, necessitating an understanding of surgical asepsis principles

Principles of Surgical Asepsis

• A sterile field is a work area free from pathogens, non-pathogens, and spores
• Clean is different from Sterile
• Sterile gloves and equipment are necessary for surgical procedures

Practices of Surgical Asepsis

• A sterile item can only contact another sterile item
• A sterile item becomes contaminated if it touches a clean item
• A sterile package is contaminated if open, torn, punctured, wet, or moist
• A sterile package is contaminated after its expiration date
• Only sterile items should be placed on a sterile field
• Sterile gloves or forceps should be used to handle sterile items
• An item is considered contaminated if its sterility is uncertain
• Contaminated items must be discarded or re-sterilized
• A sterile field/items should be within sight and above waist level to avoid contamination
• Keep sterile gloved hands above waist level and within sight
• Do not leave a sterile field unattended or turn your back to it or a sterile item because if you can't see it, it's contaminated.
• Airborne microbes can contaminate sterile items/fields; avoid prolonged exposure to air
• Prevent drafts by closing doors and avoiding extra movements
• Avoid coughing, sneezing, talking, or laughing over a sterile field by turning the head away
• Wear a mask when talking during a sterile procedure
• Do not assist with sterile procedures if you have a respiratory infection
• Avoid reaching over the sterile field
• Fluids flow downwards due to gravity.
• Hold wet items down because if they are held up, fluid flows down into a contaminated area
• Avoid spilling/splashing when pouring sterile fluids
• The edges of a sterile field are considered contaminated
• A 2.5 cm (1 inch) margin around the sterile field is contaminated
• Sterile items should be placed inside the 2.5 cm margin
• Honesty is crucial; acknowledge contamination to yourself and staff
• Remove the contaminated item and correct the situation by opening another sterile field or requesting new items
• Report the contamination to your supervisor

Sterile Gloves

• Sterile gloves are required for sterile procedures
• Applied after setting up the sterile field
• Only sterile equipment/ items can be handled with sterile gloves
• You cannot touch anything outside of the sterile field with sterile gloves
• Sterile gloves are disposable and come in peel-back packaging and various sizes
• Right and left gloves are marked
• Keep sterile gloved hands above waist level and within vision
• Replace contaminated, torn, cut, or punctured gloves immediately
• Review steps for sterile gloves application

Surgery

• It is performed for various reasons, including:
• Removing a diseased organ/body part
• Removing a tumor
• Repairing injured organs/tissues
• Many surgeries necessitate hospitalization before and after
• Ambulatory surgery (one-day surgery) doesn't require an overnight stay and can be performed in outpatient clinics, e.g., cataract surgery
• Some outpatient procedures require home preparation, e.g., colonoscopy

Types of Surgeries

• Elective surgery is scheduled but not urgent; the delay doesn't cause permanent damage, disability, or death and includes hip-replacement surgery
• Urgent surgery must be done soon to prevent damage, disability, or disease, such as cancer or coronary artery surgery
• Emergency surgery is done immediately to save life or prevent disability, e.g., after a car accident

Preparation Before Surgery

• Clients need psychological support to overcome fears and concerns
• Understand and respect client’s fears.
• Common fears include disfigurement, scarring, disability, pain, discomfort, exposure, nausea, and vomiting
• Common concerns include caring for family, loss of control/job, and payment of bills/loans/mortgages

Your Role

• Listen when clients express fears/concerns about surgery
• Refer surgery-related questions to the nurse
• Explain procedures and their reasons
• Communicate effectively
• Report verbal/non-verbal signs of fear/anxiety to the supervisor
• Report a client’s request for a spiritual advisor to the supervisor

Preoperative Period

• The preoperative period is a few minutes or many days and preparation prevents complications
• Patient teaching is done by the nurse
• Activities include tests, skin preparation, and personal care
• Abdominal surgeries often need a preoperative enema and some surgeries need insertion of a catheter
• Deep-breathing, coughing, and leg exercises are to be done after surgery
• The post-anesthesia unit is where the client wakes up post surgery
• Clients are NPO (nothing by mouth) for 6-8 hours to prevent vomiting/aspiration during/after anesthesia, and may receive an IV infusion
• The physician orders food/fluids when the client is stable
• Repositioning and turning should be done every 2 hours
• Early ambulation should take place as soon as possible post surgery
• Address pain
• Needed treatments/equipment include a catheter, nasogastric tube, oxygen, wound care, cast, traction, suction, and drains
• Position restrictions involve informing the client about positions to maintain after surgery, such as abduction after hip replacement
• Special tests include x-rays, blood work, electrocardiograms (ECG), blood type, and cross-matching Personal care involves:
• Giving a complete bed bath, shower, or tub bath
• Removing makeup and nail polish
• Caring for hair by removing hairpins, clips, wigs, and hairpieces
• Giving oral hygiene
• Removing dentures and all jewellery
• Valuables, e.g., dentures, glasses, hearing aids, contact lenses and jewellery should be stored safely
• Ensure skin preparation and complete the preoperative checklist
• Nurse provides preoperative medications 45 mins to 1 hour before surgery
• The patient should be kept in a low position and bed rails should be raised to prevent falls after medications are given
• Review safety precautions for clients having surgery

Anesthesia

• Anesthesia is a medication-induced loss of feeling/sensation
• Three types of anesthesia include:
  1. General anesthesia, where the medication produces unconsciousness and loss of feeling/sensation, and is given intravenously or inhaled
  2. Regional anesthesia, which results in loss of sensation/feeling in a large body area, but the client does not lose consciousness
  3. Local anesthesia, which blocks sensation in a specific small area via injection

Postoperative Period

• In this period, the client is taken to a post-anesthesia or recovery room
• Recovery takes 1-2 hours with close monitoring by nurses, frequent vital signs
• The client leaves recovery once their VS are stable, respiratory function is good, and they are awake/responsive
• The client's room should be prepared with all equipment before arrival
• They are transferred to their bed and provided extra blankets due to the cold OR
• Vital signs are checked every 15 minutes for the first hour, then every 30 minutes, then hourly for 4 hours, and finally every 4 hours

Postoperative Period: Observations

• Perform observations on:
  • Vital signs with blood pressure, pulse, respiratory rate, temperature, cyanosis, and saturation level
  • Surgical dressing and bleeding
  • Catheters, IV tubing, drains, and tube placement
  • Respiratory status
  • Complaints of pain and nausea/vomiting
  • Intake and output
  • Voiding after surgery
  • Confusion and disorientation
  • Pale, clammy skin
  • Check for increased drainage from drains/dressing

Postoperative Period: Care

• Positioning should ensure good breathing, with the head of the bed raised slightly and repositioning every 1-2 hours to prevent respiratory/circulatory complications
• Coughing and deep breathing prevent pneumonia (lung inflammation/infection) and atelectasis (lung collapse); perform these exercises every 1-2 hours when the client is awake
• Stimulate circulation to prevent blood clots (thrombus) and emboli
  1. Leg exercises increase venous blood flow and prevent thrombus formation; to be done every 1-2 hours while awake
  2. Elastic stockings/bandages are applied to prevent thrombus formation
• Early ambulation helps prevent pneumonia, atelectasis, thrombus, constipation, and urinary tract infections
• Nutrition/fluids progress from NPO to clear fluids, light diet, and then a regular diet
• Monitor eliminations, voiding and prevent constipation
• Comfort/rest are key with pain management
• Daily personal hygiene maintains the client's emotional well being