Aseptic Techniques PDF

Aseptic Techniques ​ Asepsis ○​ No living organisms are present ​ Properly sterilizing surgical equipment ​ Cleaning the operating room ​ Scrubbing and draping ​ Circulating or scrub nurse, surgical assistant ​ Sources of microorganisms from two routes: ○​...

Aseptic Techniques ​ Asepsis ○​ No living organisms are present ​ Properly sterilizing surgical equipment ​ Cleaning the operating room ​ Scrubbing and draping ​ Circulating or scrub nurse, surgical assistant ​ Sources of microorganisms from two routes: ○​ Exogenous route: microorganisms that are introduced from outside a closed system ​ Air ​ Surgical supplies ​ Patient’s skin ​ Surgical team ○​ Endogenous route: produced within the organism ​ Bacteremia: Through the bloodstream from the body’s own flora (the microbes that live in the human body ​ The longer the equipment/cavity is out, the more it is exposed to bacteria ​ Surgery designation – classification of surgical wounds ○​ Clean an incision in which no inflammation is encountered in a surgical procedure, without a break in sterile technique, and during which the respiratory, gastrointestinal and genitourinary tracts are not entered ○​ Clean-contaminated an incision through which the respiratory, gastrointestinal or genitourinary tract is entered under controlled conditions but with no contamination encountered ○​ Dirty an incision undertaken during an operation in which the viscera are perforated or when acute inflammation with pus is encountered during the operation and for traumatic wounds where treatment is delayed, and there is fecal contamination or devitalized tissue present Decontamination Processes ​ Sterilization: the destruction of ALL microorganisms and spores from a material ​ Disinfection: the elimination or reduction of harmful microorganisms but not spores. Kills vegetative microorganisms and inactivates viruses, but does not kill high numbers of bacterial spores There are two methods physical and chemical Sterilization: Physical Methods ​ Filtration: used to physically remove contaminants from chemically or thermally sensitive biomaterials in liquid form. Ex: a protein-based drug ​ Radiation: uses ionizing radiation to kill microorganisms and neutralize harmful organisms. It’s a common method for sterilizing medical devices and tissue for transplant, ex: utilization of gamma rays, electron beams, x-rays ​ Heat-Autoclave ○​ moist/wet uses high heat and pressure to expose items to steam ○​ Dry uses high temperatures to kill microorganisms by denaturing proteins  ​ Most autoclaves use suturated steam under pressure ○​ What is the method most commonly used for sterilization? ○​ What is the method most commonly used for moist sterilization? steam ○​ How does heat destroy bacteria? Breaks down and deactivates the protein ​ According to the CDC, autoclaves are the sterilizer of choice; they’re fast, reliable, and economical ​ There are two types of autoclaves: ○​ Gravity displacement: Water is heated in a chamber, continued heating creates pressure, and steam displaces air within the chamber forcing it out through a vent. Cycle timing begins when the temperature reaches 270℉. After sterilization, the door is cracked for 10 mins. Do not open door too wide as this allows outside air to condense inside the packs leaving moisture and open to corrosion ○​ Pre-vacuum: Equipped with a boiler to generate steam and a vacuum system to remove air. Exposure time begins immediately. At the completion of the cycle, steam is vacuumed and replaced by hot, dry sterile air. Air pockets are eliminated and processing times are reduced due to the vacuum. ​ Proper pack preparation ○​ All materials were thoroughly cleaned ○​ Complex instruments disassembled ○​ Labeled with handler, date of sterilization, contents ○​ Indicator strip ​ Proper loading containers are placed right side up and instrument packs are loaded vertically and longitudinally with space between them to allow steam to travel all around. Pouches placed on top shelves and wrapped packs on lower shelves. ​ Temp. and time: 250℉ (121C) for 20-30 minutes 15-20psi ​ Flash sterilization: sterilization of single instruments can be done at 270℉ for 3-4 minutes (at 30psi) in a fenestrated metal tray if a pre-vacuum autoclave is used ○​ Emergency sterilization process only ​ After sterilization, allow packs to cool slowly ​ Quality control ○​ Additional indicators ​ Autoclave tape – useful for identifying packs and articles have been exposed to steam ​ Fusible melting pellet glass- indicates that a temperature of at least 118C was reached, does not indicate whether proper time or steam saturated was achieved ​ Culture tests- biological challenge test ​ Chemical indicators- available in many types. Color change when subjected to saturated steam for adequate periods of time. Placed in center of pack ​ Air removal test (pre-vacuum sterilizers) Sterilization: Chemical Methods ​ Ethylene Oxide ○​ Flammable, explosive, toxic  ○​ Penetrates paper and plastic packaging ​ Wrapped in plastic packaging, sealed ○​ Temp. Vs. time ​ 12 hours at room temp. ○​ Quarantine in a well-ventilated area for 7 days. 12 to 18 hours in aerator ○​ Kills microorganisms by alkylation which is the destruction of metabolic pathway ○​ Special training required ​ Hydrogen peroxide gas plasma ○​ Safer for environment and personnel than ethylene oxide ○​ A significant disadvantage is that materials such as linens, gauze sponges, wood, some plastics, and liquids cannot be sterilized using this method ○​ Technique and mechanism: special pouches use to wrap packs, vacuum empties air in instrument chamber. Hydrogen peroxide is injected, pressure is lowered and radio waves applied. This creates free radicals that kill off microorganisms ​ Sterilization takes approx. 1 hour and no aeration period is necessary after the sterilization cycle is complete Chemical Disinfection ​ Chlorhexidine ○​ Available as aqueous, tincture and detergent ○​ Effective against bacteria, mold, yeast, and viruses ○​ Rapid onset, long residual activity ​ Iodine ○​ Surgical prep, topical wound therapy, joint/body cavity lavage ○​ Available as aqueous solution, tincture and iodophors ○​ Povidone-iodine: One of the most common surgical scrubs in veterinary hospitals ​ Alcohols ○​ Evaporate rapidly with no residual activity ○​ Solely bactericidal ○​ Contact time ​ Phenols (carbolic acid) ○​ Replaced by newer, safer, more effective agents ​ Quaternary ammonium ○​ Bactericidal ○​ Nontoxic ​ Chloride ○​ Broad bactericidal and virucidal activity ○​ Bleach commonly used as environmental disinfectant in hospitals Chemical Sterilization ​ Liquid sterilization ○​ Glutaraldehyde is a colorless, oily liquid that is used as a disinfectant and sterilizing agent. It has a strong odor and is toxic. Used to sterilize heat-sensitive medical equipment, such as surgical instruments, endoscopes, and dialysis machines. Used in cold sterile trays ​ Cold sterilization ○​ Soaking instruments in disinfecting solutions (chlorhexidine or glutaraldehyde)  ○​ Used only for minor procedures (superficial/contaminated sites) or equipment that cannot tolerate other sterilization methods ○​ Must be rinsed thoroughly ○​ Sterility not guaranteed Operating Room Preparation ​ Room should be “opened” no more then an hour prior to procedure ​ Operating room design and layout should be simple, uncluttered ​ Daily and weekly cleaning schedules ○​ After every surgery ○​ Daily cleaning at the end of the day ○​ Weekly cleaning of all surfaces ​ Floor ​ Beneath movable objects Small Animal Patient Preparation: Skin Prep ​ Surgical clip ​ Transitional surgical scrub ○​ Presurgical scrub: antiseptic scrub alternates with alcohol or sterile saline ○​ 3-5 cycles outward spirals ○​ Final sterile surgical scrub: after animal is positioned on operating table ○​ Sterile gloves, sterile gauze sponges ​ One-step preps ○​ Enhance skin adherence of incise drapes ○​ Region is flammable until dry Small Animal Patient Preparation: Positioning ​ Based on procedure and surgeon preference ​ Position description ○​ Named for body part in contact with table ○​ How would you describe the position of a patient lying on its abdomen? Sternal recumbency ​ Aids to position maintenance ○​ What are some? ​ Ties ​ Tape ​ Sandbags ​ Foam wedges ​ Leg suspension for orthopedic procedures Surgical Team Preparation: Attire ​ Shoes ​ Scrub suits/gowns ​ Surgical caps ​ Masks ​ Booties ​ All personnel in the operating suite must be wearing masks, booties, surgical cap  ​ True or false: masked personnel should turn away from the patient when talking, coughing, or sneezing Surgical Team Preparation: Surgical Hand Scrub ​ Important protection in case of sterile technique break ​ Procedure ○​ Surgical cap and mask on, jewelry off ○​ Nail picks ○​ Gown pack and gloves opened before scrub ○​ Sterile to not sterile hand/forearm position ○​ Scrub brushes ○​ Counted brush strokes or timed ​ Waterless hand antiseptics Surgical Team Preparation: Gowning and Gloving ​ Thoroughly dried hands and arms ​ Closed gloving versus open gloving ​ Assisted gloving Maintaining Sterility ​ Nonsterile personnel touch only nonsterile items ○​ Never reach over sterile fields ​ Sterile personnel ○​ Only touch sterile items or areas ○​ Always face the sterile field ​ Scrubbed-in personnel ○​ Neckline, back, armpit area not sterile ○​ Hands stay above waist level The patient ​ Draping ○​ Performed by scrubbed-in personnel ○​ Quarter drapes ○​ Townel clamps ○​ Drape covers animal, surgical table, and instrument stand ○​ Translucent, self-adhesive, antiseptic incise drapes ○​ Draping a suspended limb ○​ Sterile packs may be opened after draping Opening Sterile Items ​ Nonsterile assistant only ○​ Touch outside of pack only ○​ Smaller packs held in one hand ○​ Opening faces away ​ Sterile saline-pour into sterile bowl