Asepsis and Sterile TechniqueANES 1502

ANESTHESIA TECHNOLOGY FUNDAMENTALS

COLLEGE OF DUPAGE

Human microbe relationships

Indigenous microflora: microbes that live on the skin and inside human body

- “opportunistic pathogens”

- bacteria, fungi, viruses, and protozoa

- microflora=harmless, however, microflora + surgical wound = pathogen

Symbiosis

-Mutualism

-Commensalism

-Parasitism

Pathogen and Infection

Pathogens- microorganisms that cause infection

- commensal microbes: opportunistic by entering through a surgical skin incision

- nosocomial: UTI

- airborne viruses: common cold

Human-Microbe Relationships

Mutualism- both organisms benefit and depend on one another to a certain extent

Escherchia coli: in the colon, produces vit K

1) Synergism- 2 organisms work together to achieve a result neither could obtain alone

-Fusobacteria and spirochetes work together to cause trench mouth

Commensalism- one organism benefits but the other neither benefits nor is harm

-indigenous microflora on the skin can obtain nutrients but do not affect the skin

-competitive exclusion

Parasitism- one benefits and the host is harmed

-endoparasites-: intestinal worms

Pathogens associated with SSI

Bacteria

-prokaryotes, binary fission

Tuberculosis (TB)

-Mycobacterium tuberculosis: airborne droplet nuclei

-Precautions : wearing gloves, gowns, eyewear, and NIOSH approved respirators

Viruses

- nonliving particles that are completely reliant on the host cell for survival

-largest: 300nm -smallest: poliovirus-30nm

-Capsis: protein covering of DNA/RNA

-Capsomeres: the capsis is composed of protein molecules

-Nucleocapsid: nucliec acid-capsid combo

Pathogens- SSI

Emerging Infectious Diseases

-MDR: multidrug resistant strains

-Strain “W”

-viruses constantly mutate and evolve

-ebola virus, dengue virus, Lassa virus

Prions

- Prusiner 1982

-Creutzfeldt-Jakob disease (CDJ), scrapie (sheep disease)

Pathogens- SSI

Parasites

-unicellular and multicellular protozoan

-Helminths: round and flat

-tapeworm, flukes, and roundworms

-transmission: ingestions of contaminated food/water that contains the worm or eggs

-skin, fecal-oral contamination, arthropod bite

-protozoa-unicellular eukaryotes that are responsible for causing human diseases such as malaria and chronic sleeping sickness.

- amebas, flagellates, ciliates, coccidia, and microsporidia

-Entamoeba histolytica- cause of amebic dysentary

Pathogens-SSI

Fungi

-Mycology- study of fungi

- examples: yeast, mushrooms, and molds

-Mycoses- fungal diseases

-Zygomycosis- bread mold

-rhinocerebral zygomycosis

- increased organ transplants and immunosuppressive drugs and antibiotics

-plastic surgery and bone transplant

Methods of Transmission

Primary agent: bacterium, virus, fungi, or parasite

SSI: acquired at time of surgery, than after

-environmental and endogenous

Personnel-WEAR PROPER OR ATTIRE!

Environment

Fomites- inanimate object that harbors microorganisms.

The Patient

Factors that increase SSI

Age

Obesity

General Health

Nasal Carriers of S. aureus

Remote Infections

Pre-op Hospitalization

Factors of SSI

Preexisting illness and related treatment

Pre-op hair removal

Type of procedure

Duration of procedure

Surgical conscience

Is the practice of strict adherence to aseptic technique by ALL surgical team members, which includes, YOU, the SURGICAL TECHNOLOGIST!

Honesty, moral integrity, responsibility

Need the ability to recognize and correct breaks in aseptic technique

If there is hesitation and/or unable to admit = there is no place for you in the OR

THERE CAN BE NO COMPROMISE OF ASEPTIC TECHNIQUE

STANDARD PRECAUTIONS

Basic terminology

Antiseptic

Asepsis

Bacteriocidal

Bacteriostatic

Bioburduen

Contamination

Cross-contamination

Terminology cont’d

Decontamination

Disinfectant

Event-related sterility

Fomite

Fungicide

Infection

Nosocomial

Terminology

Pathogen

Resident flora

Sepsis

Spore

Sporicide

Sterile

Sterile field

Terminology

Sterile technique

Sterilization

Strike-through contamination

Surgically clean

Terminal disinfection

Terminal sterilization

Transient flora

Vector

Virucide

Principle of Asepsis

Principle 1: sterile field is created for each procedure

Principle 2: sterile team member must be appropriately attired prior to entering sterile field

Principle 3: movement in and around the sterile field must not compromise the sterile field

Principle 1

Time

Instrument sets, peel packs and wrappers

Chemical indicators

Sterile edges

Opening packages

Items that fall below table edges

Questionable sterility

Causes of contamination

Principle 2

Sterile portion of gown

Sterile portion of table

Proper technique with arms and hands

Surface for gowning and gloving

Sitting during surgery

Platform standing

Principle 3

Sterile to sterile

Sterile individuals keep within sterile area

Nonsterile to nonsterile

Characteristics of Bacteria

Morphology: size, shape and arrangements of bacteria

Morphology

Coccobacilli

Morphology

Bacillus- rod shape

Spirilla- spiral shape

L-Form- bacteria that lose normal shape (environmental)

Growth and Motility

Varies with agar medium

Rate

Flagella

Cilia

Nutritional/02 Requirements

Classifications: ex) oxygen, carbon, nitrogen

- obligate aerobes

-microaerophiles

-obligate anaerobes

-facultative anaerobes

-aerotolerant anaerobes

-capnophiles

Pathogenicity

Ability to cause disease

- release of exotoxins and endotoxins

- release of enzymes

- presence of a protective capsule

- attachment to host cell

Metabolism, proteins, & genetics

Metabolism is the secretion of waste products

Proteins specific to bacterial species

DNA is unique to each bacteria species

Staining

Simple

Gram

Acid-fast

Spore forming

Bacterial species capable of forming spores

Unfavorable conditions = cell is enclosed in a protein capsuleto

High survival

NOT REPRODUCTION

Difficult to destroy

Disinfection, decontamination, & sterilization

Disinfection: process in which most but NOT ALL the microorganisms on INANIMATE are destroyed

-Decontamination

Antisepsis: process in which most but NOT ALL microorganisms on ANIMATE surfaces are destroyed

-Antiseptic: solutions

-Sterilization: destruction of ALL microorganisms, including SPORES, on inanimate surfaces

Disinfection principles and disinfecting agents

Cleaning physical removal of blood and body fluids, as well as BIOBURDEN, from inanimate objects.

Disinfection

-high, intermediate, and low levels

Sterilization

-steam, chemical agents, high velocity electron bombardment, and ultraviolet radiation

-critical, semi-critical, and noncritical

Disinfectant efficiency

Concentration level of disinfectant solution

Number and type of microbes present

Physical factors of the solution

- temperature

- water hardness

- pH level

- exposure time

ALWAYS FOLLOW MANUFACTURER’S INSTRUCTIONS!

High Level Disinfectant Compounds

Glutaraldehyde/Cidex

pH: 7.5-6.5

Best overall disinfectant/liquid sterilant

Complete immersion in liquid

Endoscopes

Shelf life of 14 days/28 days

High Level Disinfectant Compounds

Sodium hypochlorite

Household bleach

Disinfectant for surfaces, floors, and equipment

CDC recommended on blood and body fluid spills

Intermediate Level Disinfectant Compound

Phenol Carbolic acid

Large areas and general basis

Quaternary Ammonium Compounds “quats”

Bactericidal, fungicidal, pseudomonacidal

Not sporicidal or tuberculocidal

Common: benzalkonium chloride, dimethyl benzyl ammonium chloride and the newer, diakyl quat

Alcohol Isopropyl and ethyl alcohol: diluted 60-70%

Bactericidal, virucidal, fungicidal, tuberculocidal, NOT sporicidal

Environmental decontamination

Role: minimize microbial counts in the OR environment

Surfaces and characteristics

Pre-op, intra-op and post-op

Standard precautions and PPE

Environmental services

Decontamination practices in the OR

-pre, intra, post, or between

Terminal cleaning

Weekly cleaning

Dirty cases

Surgical Instrument Decontamination Process

ALL ITEMS USED ON STERILE FIELD AND/OR ON OPEN TISSUE MUST BE STERILIZED!

Decontamination is the first step Cleaning

Disinfected

Lubricated (if necessary)

Sorted

Reassembled

Wrapped

Sterilized

Stored properly

Cleaning

Presoaking in basin Sterile water

Enzymatic solution

Proteolytic enzymatic cleaner

Lipolytic enzymatic cleaner

Detergent solutions

Table 7-8

Rinsed and dried

Chelation, enzymatic, emulsification, and solubilization

Table 7-9

Manual cleaning

1. Instruments immersed in a solution. Friction will loosen organic material. With stainless steel: back and forth motion; circular can scatch.

2. Rinse in distilled water. NO TAP WATER!

3. AVOID spotting the instruments, so DRY!

Decontamination

Washer-sterilizer

Washer decontaminator

Ultrasonic washer

Considerations:

Use of tray- perforated/wire mesh

Heavier instruments place on the bottom

Hinges left open

Disassemble any instrument

Concave surfaces should be placed upside down

Washer decontaminator

“WD”

DOES NOT INCLUDE STERILIZING PHASE

Purpose: allow hands off processing

Considered “clean”

Washer sterilizer

“WS”

Stainless steel and heat tolerated items

MUST BE CLEAN BEFORE USE!

Stainless steel must not be placed near other metals = fusion

Use free rinsing, low sudsing, neutral pH detergent

NOT USED DIRECTLY ON PATIENTS NOT A BIOLOGICALLY MONITORED PROCESS

Types of WS machines

Tunnel like chmaber

Horizontal/cabinet type

Gravity cycle of 270 degrees

Ultrasonic cleaner

After instruments are placed in WD or WS, they’re place in the ultrasonic cleaner

Removes small organic particles, or places that cannot be reached

Box locks, serrations, and ratchets

Cavitation

High frequency sound waves

Molecules are forced in a rapid motion which form bubbles

Implosion occurs to create a vacuum, dislodging particles

Metal mesh trays

Each cycle last 4-5 minutes

Special Care

Items with lumens

Rigid and flexible endoscopes

Lubrication

“milking”