Medical and Surgical Asepsis PDF

**MEDICAL AND SURGICAL ASEPSIS** Asepsis or aseptic means the absence of germs, such as bacteria, viruses, and other microorganisms that can cause disease. Healthcare professionals use aseptic technique to protect patients from infection. Aseptic technique is a standard healthcare practice that he...

**MEDICAL AND SURGICAL ASEPSIS** Asepsis or aseptic means the absence of germs, such as bacteria, viruses, and other microorganisms that can cause disease. Healthcare professionals use aseptic technique to protect patients from infection. Aseptic technique is a standard healthcare practice that helps prevent the transfer of germs to or from an open wound and other susceptible areas on a patient's body. The skin is the body's first line of defense against germs. A person is vulnerable to infection as soon as there is a break in their skin, regardless of whether it occurs as a result of an accidental injury or a surgical incision. Aseptic technique helps prevent healthcare-associated infections (HCAIs). An HCAI is an infection that a person acquires as a result of treatment from a healthcare professional. According to the Centers for Disease Control and Prevention (CDC)Trusted Source, one in every 31 hospital patients will have at least one HCAI. Common HCAIs include: - catheter-associated urinary tract infection - central line-associated bloodstream infection - Clostridium difficile infection - surgical site infection - ventilator-associated pneumonia These types of infection are a significant concern in the healthcare community. HCAIs can lead to severe health complications for affected individuals and disciplinary consequences for medical facilities. **Definition of terms** **Sepsis** is a clinical condition where a person has a systemic reaction to a bacterial infection from a localized infection in one part of the body, such as a wound or infected tooth. Sepsis, relatively common, can be treated with antibiotics, but when the body doesn't respond to treatment options, the patient may enter septic shock, a progression of sepsis. Septic shock leads to death in up to 40% of cases. **Asepsis,** on the other hand, is the normal state of not being in sepsis. Commonly used in pathology, asepsis indicates an individual is free of sepsis. For example, a patient suffering from sepsis who responds well to treatment will improve and eventually will return to the state of asepsis. **Types of asepsis** There are two types of asepsis -- medical and surgical. Medical or clean asepsis reduces the number of organisms and prevents their spread; surgical or sterile asepsis includes procedures to eliminate [micro-organisms](https://en.wikipedia.org/wiki/Micro-organism) from an area and is practiced by surgical team, nurses and other members of healthcare profession. **Antiseptic** is a substance that stops or slows down the growth of microorganisms. They are frequently used in hospitals and other medical settings to reduce the risk of infection during surgery and other procedures. They are chemicals that people apply to the skin. They can reduce the number of microorganisms living on the skin, in wounds, and in mucous membranes. Different types of antiseptic vary in cost, effectiveness, uses, and potential side effects. Healthcare workers often use antiseptics before carrying out medical procedures, such as drawing blood and performing surgery. Antiseptics are also available over the counter for cleaning and treating minor cuts. Some may also be suitable as a substitute for soap. Some common types of antiseptics include: - alcohols, such as isopropyl alcohol and ethyl alcohol - quaternary ammonium compound - chlorhexidine and other diguanides, for use before operations - antibacterial dye, to treat burns and wounds - peroxide and permanganate, to disinfect the skin or to use as a mouthwash - halogenated phenol derivative, in soaps and solutions - quinolone derivative, which treats wounds and can be an ingredient in throat lozenges **Uses of antiseptics** Antiseptics have several potential uses. Some of the most common include: - preventing infections on the skin, particularly for cuts, scrapes, or minor burns - dry hand-washing, which healthcare workers may do between different procedures or patients - cleaning the skin before a medical procedure, such as a blood draw or surgery - treating throat infections with mouthwashes or lozenges - cleaning mucous membranes, to treat infections or before using a catheter **Disinfectants and antiseptics** are both made from chemicals. In fact, they often share similar active ingredients. However, disinfectants tend to have higher concentrations, which are not suitable for use on the skin or mucous membranes. **Aseptic techniques** range from simple practices, such as using alcohol to sterilize the skin, to full surgical asepsis, which involves the use of sterile gowns, gloves, and masks. Healthcare professionals use aseptic technique practices in hospitals, surgery rooms, outpatient care clinics, and other healthcare settings. Using aseptic technique prevents the spread of infection by harmful germs. Healthcare professionals use aseptic technique when they are: - performing surgical procedures - performing biopsies - dressing surgical wounds or burns - suturing wounds - inserting a urinary catheter, wound drain, intravenous line, or chest tube - administering injections - using instruments to conduct a vaginal examination - delivering babies **Clean technique** is often sufficient for long-term care, in-home care, and some outpatient clinical settings. Healthcare professionals use clean technique for people who are not at high risk of infection. For example, they may use clean technique when changing the dressing on a wound that is healing. Clean technique focuses on reducing the number of microorganisms in general. Some examples of clean technique practices include thorough handwashing, wearing gloves, and maintaining a clean environment or work area. Clean technique uses non-touch practices. Non-touch practices prohibit healthcare professionals from touching key parts of objects, such as syringe tips and the inside of sterile dressings, even when they are wearing gloves. The medical community define clean technique as a modified form of aseptic technique, as maintaining proper hygiene and a clean environment will help achieve asepsis. **Aseptic technique** (also known as sterile technique) is a process or procedure used to achieve asepsis to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site that may result in the development of infection (Wilson, 2019). An aseptic technique is required for many clinical interventions including wound dressing and insertion of invasive devices, as well as the maintenance of these devices (Loveday et al, 2014). Healthcare workers who perform an aseptic technique should receive training on how to correctly perform the procedure; this should include a competency assessment (Loveday et al, 2014). The aseptic technique is a method of preventing the transmission of infection to the patient during the performance of various clinical procedures. The correct practice of this technique requires the understanding of some principles and facts. The aim of using aseptic technique is to eliminate germs, which are disease-causing microorganisms. According to the U.S. Joint Commission, there are several different aspects of aseptic technique practices: - barriers - patient and equipment preparation - environmental controls - contact guidelines **Barriers** Barriers prevent the transfer of germs between healthcare professionals, patients, and the environment. Aseptic barriers include: - sterile gloves - sterile gowns - sterile masks - sterile drapes - protective wrappers on sterilized instruments **Patient and equipment preparation** - disinfecting a patient's skin using antiseptic wipes - sterilizing equipment and instruments before a procedure - keeping sterilized instruments inside plastic wrappers to prevent contamination before use ### Environmental controls ### Healthcare professionals also have to consider the patient's immediate surroundings. It is essential to maintain an aseptic environment before and during procedures. The designated procedural area is also called an aseptic field. ### Maintaining an aseptic field involves: - ### keeping doors closed - ### minimizing movement in and out of the aseptic field - ### limiting entry to necessary personnel only - ### permitting only one patient per aseptic field ### Contact guidelines ### Once a healthcare professional has washed their hands and donned their sterile barriers, they must follow sterile-to-sterile contact guidelines. These guidelines prohibit any contact between sterile and nonsterile items. At this point, healthcare professionals can only touch sterile objects and surfaces, and they must avoid touching nonsterile items and surfaces at all costs. ### The same guidelines apply to sterile devices. If a sterile instrument falls on the ground and the wrapper sustains damage, a healthcare professional must remove the instrument and re-sterilize it before use. **PRINCIPLES OF THE ASEPTIC TECHNIQUE** --------------------------------------- 1. 2. 3. - - - - - 4. ### ### **Creating a sterile field** ### A. B. ### **Use of sterilized instruments and dressings** ### - #### **Disinfection and use of endoscopes in sterile body passages** - #### **Use Of Speculum & Endoscopes In Non-Sterile Body Passages** **Maintaining sterility of sterile field & instruments** -------------------------------------------------------- **Minimizing bacteria at entry points by antisepsis** ----------------------------------------------------- **Practice of aseptic technique** --------------------------------- a. Maintaining the sterility of instruments, devices & solutions during transport and storage --------------------------------------------------------------------------------------------- - - - - - - ### **Non-touch technique** ### a. b. c. d. ### **Maintaining sterility of the gloved hand** ### - - - **Aseptic technique in various situations** ------------------------------------------- ### ### **Procedure when working alone** #### **Performing urinary catheterization** #### **Performing laryngeal suction on a patient with tracheostomy** #### **Disconnecting & reconnecting iv/arterial cannulas** ### **Procedures where at least two persons must be involved** - Inserting a central line (performer and assistant). - #### **Inserting chest drains, peritoneal dialysis & urinary catheter** - #### **Performing tracheo-bronchial suction on a ventilated patient** - #### **When delivering babies** - #### **Performing wound toilet & dressing.** **Sterilization and decontamination methods** Sterilization is necessary for the complete destruction or removal of all microorganisms (including spore-forming and non-sporeforming bacteria, viruses, fungi, and protozoa) that could contaminate pharmaceuticals or other materials and thereby constitute a health hazard. Since the achievement of the absolute state of sterility cannot be demonstrated, the sterility of a pharmaceutical preparation can be defined only in terms of probability. The efficacy of any sterilization process will depend on the nature of the product, the extent and type of any contamination, and the conditions under which the final product has been prepared. The requirements for Good Manufacturing Practice should be observed throughout all stages of manufacture and sterilization. *Sterilization* can be defined as a process that destroys or eliminates all forms of microbial life and is carried out in health-care facilities by physical or chemical methods. Steam under pressure, dry heat, EtO gas (ethylene oxide, formaldehyde), hydrogen peroxide gas plasma, and liquid chemicals are the principal sterilizing agents used in health-care facilities. Sterilization destroys all microorganisms on the surface of an article or in a fluid to prevent disease transmission associated with the use of that item. Sterilization is intended to convey an absolute meaning; unfortunately, however, some health professionals and the technical and commercial literature refer to "disinfection" as "sterilization" and items as "partially sterile." When chemicals are used to destroy all forms of microbiologic life, they can be called chemical sterilants. These same germicides used for shorter exposure periods also can be part of the disinfection process (i.e., high-level disinfection). Classical sterilization techniques using saturated steam under pressure or hot air are the most reliable and should be used whenever possible. Other sterilization methods include filtration, ionizing radiation (gamma and electron-beam radiation), and gas (ethylene oxide, formaldehyde). When it comes to products that cannot be sterilized in the final containers, aseptic processing is necessary. Materials and products that have been sterilized by one of the above processes are transferred to presterilized containers and sealed, both operations being carried out under controlled aseptic conditions. Whatever method of sterilization is chosen, the procedure must be validated for each type of product or material, both with respect to the assurance of sterility and to ensure that no adverse change has taken place within the product. Failure to follow precisely a defined, validated process could result in a non-sterile or deteriorated product. Most medical and surgical devices used in healthcare facilities are made of materials that are heat stable and therefore undergo heat, primarily steam, sterilization. However, since 1950, there has been an increase in medical devices and instruments made of materials (e.g., plastics) that require low-temperature sterilization. Ethylene oxide gas has been used since the 1950s for heat- and moisture-sensitive medical devices. Within the past 15 years, a number of new, low-temperature sterilization systems (e.g., hydrogen peroxide gas plasma, peracetic acid immersion, ozone) have been developed and are being used to sterilize medical devices. This section reviews sterilization technologies used in healthcare and makes recommendations for their optimum performance in the processing of medical devices. Medical devices that have contact with sterile body tissues or fluids are considered critical items. These items should be sterile when used because any microbial contamination could result in disease transmission. Such items include surgical instruments, biopsy forceps, and implanted medical devices. If these items are heat resistant, the recommended sterilization process is steam sterilization, because it has the largest margin of safety due to its reliability, consistency, and lethality. However, reprocessing heat- and moisture-sensitive items requires use of a low-temperature sterilization technology (e.g., ethylene oxide, hydrogen peroxide gas plasma, peracetic acid). **Some sterilization methods include:** - Steam Sterilization - Flash Sterilization - Low-Temperature Sterilization Technologies - Ethylene Oxide "Gas" Sterilization - Hydrogen Peroxide Gas Plasma - Peracetic Acid Sterilization **Other Sterilization Methods are:** Ionizing Radiation, Dry-Heat Sterilizers, Liquid Chemicals, Performic Acid, Filtration, Microwave, Glass Bead "Sterilizer", Vaporized Hydrogen Peroxide (VHP®), Ozone, Formaldehyde Steam, Gaseous Chlorine Dioxide, Infrared Radiation. **Sterilizing Practices** The delivery of sterile products for use in patient care depends not only on the effectiveness of the sterilization process but also on the unit design, decontamination, disassembling and packaging of the device, loading the sterilizer, monitoring, sterilant quality and quantity, and the appropriateness of the cycle for the load contents, and other aspects of device reprocessing. Healthcare personnel should perform most cleaning, disinfecting, and sterilizing of patient-care supplies in a central processing department in order to more easily control quality. The aim of central processing is the orderly processing of medical and surgical instruments to protect patients from infections while minimizing risks to staff and preserving the value of the items being reprocessed957. Healthcare facilities should promote the same level of efficiency and safety in the preparation of supplies in other areas (e.g., operating room, respiratory therapy) as is practiced in central processing. Ensuring consistency of sterilization practices requires a comprehensive program that ensures operator competence and proper methods of cleaning and wrapping instruments, loading the sterilizer, operating the sterilizer, and monitoring of the entire process. Furthermore, care must be consistent from an infection prevention standpoint in all patient-care settings, such as hospital and outpatient facilities. **Decontamination** Decontamination is an important factor in preventing hospital-acquired infection in primary and secondary care settings. The decontamination of instruments and medical devices plays a very important role in the prevention of health care-associated infections (HAIs). Indeed, improper decontamination of surgical instruments, endoscopic devices, respiratory care devices and reusable haemodialysis devices still occurs in many settings, leading to HAIs. In addition, in many low-resource settings, reuse of single-use medical devices is common practice. This is a general term used to describe the removal of microbial contamination to make an item safe, meaning that it no longer poses a risk. It is often used to refer to equipment or the environment and does not necessarily mean that they are sterile. Decontamination can be a combination of processes, including cleaning, disinfection and sterilisation. Washing with detergent and hot water can, in certain situations, be a satisfactory method of decontamination. Decontamination is a series of processes that effectively remove or destroy infectious agents or other contaminants (e.g. organic matter) in order to prevent the spread of infection. There are three levels of decontamination: cleaning, disinfection and sterilization. **Cleaning:** This is a process which physically removes infectious agents and the organic matter on which they thrive but does not necessarily destroy infective agents. Cleaning is an essential pre-requisite to ensure safe effective disinfection or sterilization. **Disinfection:** A process used to reduce the number of viable infectious agents but which may not necessarily inactivate some microbial agents, such as certain viruses and bacterial spores. Disinfection does not achieve the same reduction in microbial contamination levels as sterilization. **Sterilization:** A process used to render an object free from viable infectious agents including viruses and bacterial spores