Foundations eBook Chapter 10: Medical and Surgical Asepsis PDF

CHAPTER 10 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT All health care personnel must perform hand hygiene, SECTION: SAFETY AND INFECTION CONTROL either with an alcohol‑based product or with soap and...

CHAPTER 10 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT All health care personnel must perform hand hygiene, SECTION: SAFETY AND INFECTION CONTROL either with an alcohol‑based product or with soap and water, before and after every client contact, and after CHAPTER 10 Medical and removing gloves. When hands are visibly soiled, after Surgical Asepsis contact with body fluids, before eating, and after using the restroom, wash them with a nonantimicrobial or antimicrobial soap and water. It is also important for clients and visitors to practice hand hygiene. Perform hand hygiene using recommended Asepsis is the absence of illness‑producing antiseptic solutions when caring for clients who micro‑organisms. Hand hygiene is the are immunocompromised or have infections with multidrug‑resistant or extremely virulent primary behavior. micro‑organisms. Perform hand hygiene after contact with anything in Medical asepsis refers to the use of precise clients’ rooms and after touching any contaminated practices to reduce the number, growth, and items, whether or not gloves were worn, and before putting gloves on and after taking them off. spread of micro‑organisms (“clean technique”). It Performing hand hygiene might be necessary between applies to administering oral medication, managing tasks and procedures on the same client to prevent cross‑contamination of different body sites. nasogastric tubes, providing personal hygiene, and Wash hands with soap and warm water. Rub hands performing many other common nursing tasks. together vigorously, and rinse under running water. Wash for at least 15 seconds to remove transient flora Surgical asepsis refers to the use of precise and up to 2 min when hands are more soiled. After washing, dry hands with a clean paper towel before practices to eliminate all micro‑organisms from an turning off the faucet. If the sink does not have foot or object or area and prevent contamination (“sterile knee pedals for turning off the water, use a clean, dry paper towel to turn off the faucet(s). technique”). It applies to parenteral medication For hand hygiene with an alcohol‑based product, administration, insertion of urinary catheters, dispense the manufacturer’s recommended amount (usually 3 to 5 mL) in the palm of the hand. Rub hands surgical procedures, sterile dressing changes, together vigorously, remembering to cover all surfaces and many other common nursing procedures. of both hands and fingers. Continue to rub until both hands are completely dry. Before beginning any task or procedure that requires aseptic technique, health care team ADDITIONAL PERSONAL HYGIENE MEASURES members must check for latex allergies. If the Emphasize the importance of covering the mouth and client or any member of the team has a latex nose when coughing or sneezing, using and disposing of facial tissues, and performing hand hygiene to prevent allergy, the team must use latex‑free gloves, spraying and spreading droplet infections. Encourage equipment, and supplies. Most facilities use clients and visitors to practice respiratory hygiene/ cough etiquette. Ensure spatial separation of 3 ft from non-latex (nitrile) gloves. However, it is the those with a cough, or have them wear a mask. health care team’s responsibility to identify latex Wash hair frequently and keep it short or pulled back to prevent contamination of the care area or the clients. allergies and use items that are latex-free. Keep natural nails short and clean and free of nail gels and acrylic nails. The area around and under the nails can harbor micro‑organisms. PRACTICES THAT PROMOTE Remove jewelry from hands and wrists to facilitate MEDICAL ASEPSIS hand disinfection. HAND HYGIENE PROTECTIVE CLOTHING Always use hand hygiene. Wash hands with an antimicrobial Use masks, gloves, gowns, and protective eyewear to help or plain soap and water, using alcohol‑based products (gels, control the contact and spread of micro‑organisms to staff foams, and rinses; or performing a surgical scrub). and clients. The three essential components of handwashing are the following. ◯ Soap ◯ Running water ◯ Friction FUNDAMENTALS FOR NURSING CHAPTER 10 Medical and Surgical Asepsis 49  PHYSICAL ENVIRONMENT Any sterile, non-waterproof wrapper that comes in contact with moisture becomes non-sterileby a wicking Additional examples of practices that reduce the growth action that allows microbes to travel rapidly from a non- and spread of micro‑organisms are changing linens daily, sterile surface to the sterile surface. cleaning floors and bedside stands, and separating clean Keep all surfaces dry. from contaminated materials. Discard any sterile packages that are torn, Do not place items on the floor (even soiled laundry). punctured, or wet. The floor is grossly contaminated. Do not shake linens because doing so can spread micro‑organisms in the air. Keep soiled items from touching clothing. NURSING INTERVENTIONS Clean the least soiled areas first to prevent moving more contaminants into the cleaner areas. EQUIPMENT Use plastic bags for moist, soiled items, following Select a clean area above waist level in the client’s facility protocol for bag selection, to prevent further environment (a bedside stand) to set up the sterile field. contamination of items or of individuals handling Check that all sterile packages (additional dressings, the soiled items. Put all soiled items directly into the sterile bowl, sterile gloves, and solution) are dry and appropriate receptacle to avoid handling soiled items intact and have a future expiration date. Any chemical more than once. tape must show the appropriate color change. Place all laboratory specimens in biohazard containers Make sure an appropriate waste receptacle is nearby. or bags for transport or disposal. Pour any liquids used for client care directly into the drain and avoid splattering to prevent spreading droplets. Empty PROCEDURE body fluids at water level of toilet to avoid splashing. Perform hand hygiene. STERILE FIELD SETUP PRACTICES THAT MAINTAIN Open the covering of the package per the A STERILE FIELD manufacturer’s directions, slipping the package onto the center of the workspace with the top flap of the Prolonged exposure to airborne micro‑organisms can wrapper opening away from the body. make sterile items non-sterile. Grasp the tip of the top flap of the package, and with Avoid coughing, sneezing, and talking directly over a the arm positioned away from the sterile field, unfold sterile field. the top flap away from the body. Advise clients to avoid sudden movements; refrain from Next, open the side flaps, using the right hand for the touching supplies, drapes, or the nurse’s gloves and gown; right flap and the left hand for the left flap. and avoid coughing, sneezing, or talking over a sterile field. Grasp the last flap and turn it down toward the body. Only sterile items can be in a sterile field. ADDITIONAL STERILE PACKAGES The outer wrappings and 1‑inch edges of packaging that Open next to the sterile field by holding the bottom contains sterile items are not sterile. The inner surface edge with one hand and pulling back on the top flap of the sterile drape or kit, except for that 1‑inch border with the other hand. Place the packages that will be around the edges, is the sterile field to which other used last furthest from the sterile field; open these first. sterile items can be added. To position the field on the Add them directly to the sterile field. Lift the package table surface, grasp the 1‑inch border before donning from the dry surface, holding it 15 cm (6 in) above sterile gloves. Discard any object that comes into the sterile field, pulling the two surfaces apart, and contact with the 1‑inch border. dropping it onto the sterile field. Touch sterile materials only with sterile gloves. Consider any object held below the waist or above the POUR STERILE SOLUTIONS chest contaminated. Remove the bottle cap. Sterile materials can touch other sterile surfaces or Place the bottle cap face up on a clean (non- materials; however, contact with non-sterile materials sterile) surface. at any time contaminates a sterile area, no matter how Hold the bottle with the label in the palm of the hand so short the contact. that the solution does not run down the label. First pour a small amount (1 to 2 mL) of the solution Microbes can move by gravity from a non-sterile item to into an available receptacle. a sterile item. Pour the solution (without splashing) onto the dressing Do not reach across or above a sterile field. or site without touching the bottle to the site. Do not turn your back on a sterile field. Sterile solutions expire 24 hr after opening and Hold items to add to a sterile field at a minimum of recapping in some facilities. Other facilities’ policies 6 inches above the field. state that once a sterile solution container is opened, it can be used only once and then thrown away. 50 CHAPTER 10 Medical and Surgical Asepsis CONTENT MASTERY SERIES  STERILE GLOVES Once the sterile field is set up, don sterile gloves. Sterile gloving includes opening the wrapper and handling only the outside of the wrapper. Don gloves by using the following steps. With the cuff side pointing toward the body, use the nondominant hand and pick up the dominant‑hand glove by grasping the folded bottom edge of the cuff and lifting it up and away from the wrapper. While picking up the edge of the cuff, pull the dominant glove onto the hand. With the sterile dominant‑gloved hand, place the fingers of the dominant hand inside the cuff of the nondominant glove, lifting it off the wrapper and putting the nondominant hand into it. When both hands are gloved, adjust the fingers. During that time, only a sterile gloved hand can touch the other sterile gloved hand. At the close of the sterile procedure or if the gloves tear, remove the gloves. Take them off by grasping the outer Active Learning Scenario part of one glove at the cuff area, avoiding touching the wrist and pulling the glove down over the fingers A nurse is reviewing with a newly licensed nurse the and into the hand that is still gloved. Then, place the procedure for putting on sterile gloves. Use the ATI Active ungloved hand inside the soiled glove and pull the glove Learning Template: Nursing Skill to complete this item. off so that it is inside out and only the clean inside part DESCRIPTION OF SKILL: List the steps involved is exposed. Discard into an appropriate receptacle. in putting on a pair of sterile gloves. Application Exercises 1. When entering a client’s room to change a surgical 4. A nurse is reviewing hand hygiene techniques with dressing, a nurse notes that the client is coughing a group of assistive personnel (AP). Which of the and sneezing. Which of the following actions should following instructions should the nurse include when the nurse take when preparing the sterile field? discussing handwashing? (Select all that apply.) A. Keep the sterile field at least 6 ft A. Apply 3 to 5 mL of liquid soap to dry hands. away from the client’s bedside. B. Wash the hands with soap and B. Instruct the client to refrain from coughing water for at least 15 seconds. and sneezing during the dressing change. C. Rinse the hands with hot water. C. Place a mask on the client to limit the spread D. Use a clean paper towel to turn off hand faucets. of micro‑organisms into the surgical wound. E. Allow the hands to air dry after washing. D. Keep a box of facial tissues nearby for the client to use during the dressing change. 5. A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the 2. A nurse has removed a sterile pack from its outside following events should the nurse recognize as cover and placed it on a clean work surface in contaminating the sterile field? (Select all that apply.) preparation for an invasive procedure. Which of A. The provider drops a sterile instrument the following flaps should the nurse unfold first? onto the near side of the sterile field. A. The flap closest to the body B. The nurse moistens a cotton ball with sterile B. The right side flap normal saline and places it on the sterile field. C. The left side flap C. The procedure is delayed 1 hr because the D. The flap farthest from the body provider receives an emergency call. D. The nurse turns to speak to someone who enters through the door behind the nurse. 3. A nurse is wearing sterile gloves in preparation E. The client’s hand brushes against the for performing a sterile procedure. Which of the outer edge of the sterile field. following objects can the nurse touch without breaching sterile technique? (Select all that apply.) A. A bottle containing a sterile solution B. The edge of the sterile drape at the base of the field C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with the other gloved hand FUNDAMENTALS FOR NURSING CHAPTER 10 Medical and Surgical Asepsis 51