Asepis and Antisepsis Dr. Farooq Ahmed Rana MBBS, FCPS, FRCS Eng Assistant Professor Surgical unit III SIMS/SHL
Transcript
1. Dr. Farooq Ahmed Rana MBBS, FCPS, FRCS Eng Assistant
Professor Surgical unit III SIMS/SHL
2. Learning objectives Explain the concepts of medical and
surgical asepsis. Identify types of microorganisms causing
infections. Identify types & signs of localized and systematic
infections. Identify risks for nosocomial infections. Explain chain
of infection.
3. Identify factors influencing a microorganism's capability to
produce an infectious process. Identify measures that break each
link in the chain of infection. Principles of Surgical Asepsis. The
OR scrub.
4. Asepsis and Antiseptics Asepsis is the freedom from
disease-causing microorganisms. To decrease the possibility of
transferring microorganisms from one place to another, asepsis is
used. Aseptic techniques are those aimed at minimising infection
Asepsis usually involves The use of sterile instruments The use of
a gloved no touch technique Antisepsis is the removal of transient
microorganisms from the skin and a reduction in the resident
flora
5. History 1847 - Semmelweis identifies surgeons hands as route
of spread of puerperal infection 1865 - Lister introduces hand and
wound asepsis with the use of carbolic acid 1880 - von Bergmann
invents the autoclave
6. There are two basic types of Asepsis Medical & Surgical
asepsis.
7. 1. Medical Asepsis Includes all practices intended to
confine a specific microorganism to a specific area, limiting the
number, growth, and transmission of microorganisms.
8. In medical asepsis, objects are referred to as clean, which
means the absence of almost all microorganisms, or dirty (soiled,
contaminated), which means likely to have microorganisms, some of
which may be capable of causing infection.
9. Methods in Medical Asepsis Hand hygiene Carry linens away
from your body No linens on floor Cover mouth when sneezing Do not
raise dust Do not shake linens Clean to dirty Transmission
precautions
10. 2. Surgical Asepsis or Sterile Technique, refers to keep an
area or object free of all microorganism, it includes practices
that destroy all microorganisms and spores. Surgical asepsis is
used for all procedures involving the sterile areas of the
body.
11. Sepsis is the state of infection and can take many forms,
including septic shock.
12. Types of microorganisms causing infections
13. 1. Bacteria can live and be transported through air, water,
food, soil, body tissues and fluids, and inanimate objects. 2.
Viruses (causes the common cold) hepatitis, herpes, and human
immunodeficiency virus. 3. Fungi include yeasts and molds. Candida
albicans 4. Parasites They include protozoa such as the that causes
malaria.
14. Types of infection
15. A local infection is limited to the specific part of the
body where the microorganisms remain. If the microorganisms spread
and damage different parts of the body, it is a systemic
infection.
16. When a culture of the person's blood reveals
microorganisms, the condition is called bacteremia. When bacteremia
results in systemic infection, it is referred to as
septicemia.
17. Acute infections generally appear suddenly or last a short
time. A chronic infection may occur slowly, over a very long
period, and may last months or years.
18. Nosocomial infections Classified as infections that are
associated with the delivery of health care services in a health
care facility. Nosocomial infections can either develop during a
client's stay in a facility or manifest after discharge.
19. The incidence of nosocomial infections is significant.
Major sites for these infections are the respiratory and urinary
tracts, the bloodstream, and wounds.
20. Factors that contribute to nosocomial infection risks are
invasive procedures, medical therapies, the existence of a large
number of susceptible persons, inappropriate use of antibiotics,
and insufficient hand washing after client contact and after
contact with body substances.
21. 4. Method of transmission There are three mechanisms
22. A. Direct transmission Involves immediate and direct
transfer of microorganisms from person to person through touching,
biting, kissing, or sexual intercourse. Droplet spread is also a
form of direct transmission.
23. B. Indirect transmission Material objects, such as toys,
soiled clothes, cooking or eating and surgical instruments, or
dressing, water, food, blood, serum, and plasma. Animal or
flying.
24. C. Air born transmission may involve droplets or dust.
25. 5. Portal of entry Before a person can become infected,
microorganisms must enter the body. The skin is a barrier to
infectious agents; however, any break in the skin can readily serve
as a portal of entry.
26. 6. Susceptible Host A susceptible host is any person who is
at risk for infection. A compromised host is a person at "increased
risk.
27. Factors Increasing Susceptibility to Infection 1. Age
influence the risk of infection. 2. Heredity influences the
development of infection. 3. The nature, number, and duration of
physical and emotional stressors can influence susceptibility to
infection.
28. 4. Resistance to infection depends on adequate nutritional
status. 5. Some medical therapies predispose a person to infection.
For example, radiation treatments for cancer, some diagnostic
procedures may also predispose the client to an infection.
29. Cleaning, Disinfecting, and Sterilizing The first links in
the chain of infection, the etiologic agent and the reservoir, are
interrupted by the use of antiseptics (agents that inhibit the
growth of some microorganisms) and disinfectants (agents that
destroy pathogens other than spores) and by sterilization.
30. Cleaning Cleanliness inhibits the growth of microorganisms.
When cleaning visibly soiled objects, nurses must always wear
gloves to avoid direct contact with infections microorganisms.
31. Disinfecting A disinfectant is a chemical preparation, such
as phenol or iodine compounds, used on inanimate objects .
Disinfectants are frequently caustic and toxic to tissues. An
antiseptic is a chemical preparation used on skin or tissue .
32. Disinfectants and antiseptics often have similar chemical
components, but the disinfectant is a more concentrated solution
.
34. Alcohol > Denaturing of Protein Chlorhexidine >
Disruption of Cell wall Triclosan > Disruption of cell wall
Iodine/ Iodophores > Oxidation / Substitution of free
Iodine
35. When disinfecting articles, nurses need to follow agency
protocol and consider the following:
36. 1. The type and number of infectious organisms. 2. The
recommended concentration of the disinfectant and the duration of
contact. 3. The temperature of the environment. 4. The presence of
soap. Some disinfectants are ineffective in the presence of soap or
detergent.
37. 5. The presence of organic materials, the presence of
saliva, blood, pus can readily inactive many disinfectants. 6. The
surface areas to be treated. The disinfecting agent must come into
contact with all surfaces and areas.
38. The basic principles of surgical asepsis
39. 1. All objects used in a sterile field must be sterile. 2.
Sterile objects become un-sterile when touched by un-sterile
objects. 3. Sterile items that are out of vision or below the waist
level of the nurse are considered unsterile.
40. 4. Sterile objects can become unsterile by prolonged
exposure to airborne microorganisms. 5. Fluids flow in the
direction of gravity.
41. 6. Moisture that passes through a sterile object draws
microorganisms from un- sterile surfaces above or below to the
sterile surface by capillary action.
42. 7. The edges of a sterile field are considered un-sterile.
8. The skin cannot be sterilized and is un- sterile.
43. Personal Protective Equipment Gloves Gown Mask Protective
Eyewear
44. Surgical Asepsis Precautions Sterile can touch only sterile
Do not spill on a sterile field Hold objects above waist Do not
reach over field Do not turn back on field Outer 1 inch is
considered sterile If in doubt, treat as contaminated
45. There Is No Compromise with Sterility Its Considered
Sterile or Unsterile.
46. The OR Scrub
47. The Surgical Scrub Definition. The surgical scrub is the
process of removing as many microorganisms as possible from the
hands and arms by mechanical washing and chemical antisepsis before
participating in a surgical procedure. Despite the mechanical
action and the chemical antimicrobial component of the scrub
process, skin is never sterile.
48. The Methodology of the Scrub
49. The Timed Method All surgical scrubs are 5 minutes in
length. All are performed using a surgical scrub brush and an
antimicrobial soap solution.
50. Surgical Scrub Procedure 1. Wet the hands and forearms 2.
Apply antiseptic agent from the dispenser to the hands. 3. Wash the
hands and arms thoroughly to 2 inches above the elbows, several
times. Rinse thoroughly under running water with the hands upward,
allowing water to drip from the flexed elbows.
51. 4. Take a sterile brush or sponge (from a package or
dispenser) and apply an antiseptic agent ( if it is not impregnated
in the brush). Scrub each individual finger, including the nails,
and the hands, a half minute for each hand.
52. 5. Hold the brush in one hand and both hands under running
water, and clean under the fingernails with a disposable plastic
nail cleaner. Discard the cleaner after use. 6. Again scrub each
individual finger, including the nails and the hands with the
brush, half a minute for each hand.
53. The Final Rinse 1. Be sure to keep both arms in the upright
position (careful not to touch the faucet!) so that all water flows
off the elbows and not back down to the freshly scrubbed hands.
Bring arm through the water once, starting with the fingers, then
pull the arm straight out. Do not let water run down to hands, must
drip off elbows
54. 7. Rinse the hands and brush, and discard the brush. 8.
Reapply the antimicrobial agent and wash the hands and arms,
applying friction to the elbows, for 3 minutes. Interlace the
fingers to clean between them. 9. Rinse the hands and arms as
described in the previous slide.
55. Drying the Hands and Arms 1. Reach down to the opened
sterile package containing the gown, and pick up the towel. Be
careful not to drip water onto the pack. Be sure no one is within
arms reach. 2. Open the towel full- length, holding one end away
from the nonsterile scrub attire. Bend slightly forward.
56. 3. Dry both hands thoroughly but independently. To dry one
arm, hold the towel in the opposite hand and, using the oscillating
motion of the arm, draw the towel up to the elbow. 4. Carefully
reverse the towel, still holding it away from the body. Dry the
opposite arm on the unused end of the towel.
57. Gowning and Gloving Techniques 1. Reach down to the sterile
package and lift the folded gown directly upward. 2. Step back away
from the table into an unobstructed area to provide a wide margin
of safety while gowning. 3. Holding the folded gown, carefully
locate the neckline.
58. 4. Holding the inside front of the gown just below the
neckline with both hands, let the gown unfold, keeping the inside
of the gown toward the body. Do not touch the outside of the gown
with bare hands. 5. Holding the hands at shoulder level, slip both
arms into the armholes simultaneously.
59. 6. The circulator brings the gown over the shoulders by
reaching inside to the shoulder and arm seams. The gown is pulled
on, leaving the cuffs of the sleeves extended over the hands. The
back of the gown is securely tied or fastened at the neck and
waist, touch the outside of the gown at the line of ties or
fasteners in the back only.
60. Gloving by the Closed Glove Technique 1. Using the right
hand and keeping it within the cuff of the sleeve, pick up the left
glove from the inner wrap of the glove package by grasping the
folded cuff.
61. 2. Extend the left forearm with the palm upward. Place the
palm of the glove against the palm of the left hand, grasping in
the left hand the top edge of the cuff, above the palm. In correct
position, glove fingers are pointing toward you and the thumb of
the glove is down
62. 3. Grasp the back of the cuff in the left hand and turn it
over the end of the left sleeve and hand. The cuff of the glove is
now over the stockinette cuff of the gown, with the hand still
inside the sleeve.
63. 4. Grasp the top of the left glove and underlying gown
sleeve with the covered right hand. Pull the glove on over the
extended right fingers until it completely covers the stockinette
cuff.
64. 5. Glove the right hand in the same manner, reversing
hands. Use the gloved left hand to pull on the right glove.
65. Gloving the Right Hand
66. Scrubbing, Gowning, and Gloving Complete
67. Questions for Discussion 1. What would you do if, during
your OR experience, you accidentally touched an unsterile object
with your sterilely gloved hand? 2. What would you do if, while
scrubbing, you accidentally touched the faucet? 3. Is it OK to
prepare a sterile field an hour before the scheduled surgical case
and leave the room to set up another OR room? Why or why not? 4.
What should you do if you notice a break in sterile technique by
another member of the OR team that they may/or may not be aware
of?