CVT 103 Sterile Procedure

Question 0

THE STERILE CONSCIENCE: If you have any reason at all to believe that the integrity of a sterile field has been compromised, YOU MUST remedy it, even if it involves breaking down the field and establishing a new one, and bearing the wrath of impatient physicians and co-workers. The alternative may be significant or severe injury to the patient.

Answer 0

a

Question 1

Technologists in all three specialties may find themselves in a situation involving sterile fields:

Answer 1

the O.R., the cath lab, or procedures in the ICU.

Question 2

The point of establishing a sterile field and using sterile techniques is to minimize the possibility of

Answer 2

infection during invasive procedures.
This protects both the patient and the medical team.
Each lab has specific procedures and protocols; we will discuss basic principles

Question 3

Asepsis:

Answer 3

Methods of preventing, and maintaining freedom from, infection

Question 4

Aseptic:

Answer 4

Free from all septic organisms

Question 5

Antiseptic:

Answer 5

Capable of destroying pathogenic organisms

Question 6

Sterile:

Answer 6

Free of all organisms Pathogenic: Causing or giving rise to di

Question 7

Pathogenic:

Answer 7

Causing or giving rise to disease

Question 8

Sterile field:

Answer 8

An area prepared for a medical procedure that is sterile

Question 9

Three main topics for sterile procedure:

Answer 9

Scrubbing, gowning, gloving.

Question 10

Personnel involved in sterile procedures:

Answer 10

Circulator: NOT STERILE.

Scrub person: STERILE

Question 11

Circulator:

Answer 11

Helps others to gown up, delivers items to sterile field, etc.
NOT STERILE.

Question 12

Scrub person:

Answer 12

Performing or assisting with procedure. STERILE.

Question 13

6 Basic principles for prevention of circulation of pathogens:

(Air currents and dust can provide mobility for bugs.)

Answer 13

1. Mouth and nose always covered
2. Avoid unnecessary talking; avoid sneezing or coughing
3. Do not shake or flip linen
4. Bag soiled linen, dressings, sponges, etc. ASAP
5. Keep opening of doors to a minimum
6. No visitors (or keep to a minimum)

Question 14

Maintaining sterile field:

Answer 14

1. All items in operative area must be sterile.
2. If any doubt about sterility, it’s dirty.
   a. Date on package not legible or out-of-date
   b. Sterile package in unsterile area
   c. Sterile items or field left unattended

Question 15

2. If any doubt about sterility…

Answer 15

it’s dirty.

a. Date on package not legible or out-of-date
b. Sterile package in unsterile area
c. Sterile items or field left unattended

Question 16

Sterile personnel:

Answer 16

touch ONLY sterile items

a. Sterile persons only should work over sterile areas
b. Do not reach over sterile field
c. Do not lean on sterile field or play with items (minimal handling)

Question 17

Opening objects onto sterile field:

Answer 17

Quick peel and dump carefully from the side; don’t hover over field. Or peel and let scrubbed person take it.

Question 18

Only certain parts of the gown are considered sterile:

Answer 18

1. Front of gown from waist to shoulders
2. Front portion of entire sleeve
3. Back portion of sleeve beyond elbow (or total sleeve to ~2 inches above elbow)

Question 19

When passing sterile person or sterile area— margin of safety:

Answer 19

1. Pass back to back
2. Ask person to step aside— don’t try to squeeze past
3. Don’t walk between two sterile fields
4. If you are a sterile person, face sterile areas, keep back to unsterile areas

Question 20

Hands and arms:

Answer 20

1. Keep away from face
2. Keep above waist level and in sight
3. Avoid grasping or hanging onto front of gown
4. Don’t tuck hands into armpits

Question 21

Sterile and unsterile areas:

Answer 21

1. Top of table only is sterile; anything dangling over edge is not sterile.
2. Items falling below table-top or waist level are no longer sterile—discard
   Edges of sterile wrappers are not sterile; remove items without touching edges.
   Sterile wrappers that tear or pull open are unsterile at their edges. Lids and caps of sterile fluid containers are unsterile at their edges.

Question 22

Scrub pack has:

Answer 22

Scrubbing Scrub pack has fingernail pick, brush/sponge, and germicidal soap. (Medical people should keep nails short. Long nails aren’t clean, also could perforate gloves. Fake nails are bad. Nail polish isn’t good either.)

Question 23

Long scrub at beginning of day:

Answer 23

8 to 12 minutes complete.

Question 24

Short scrub between cases:

Answer 24

6 to 8 minutes.

Question 25

The scrub procedure:

Answer 25

- Change from street clothes into scrubs. - Remove jewelry, get hair bundled out of the way. - Surgical hat/hood to cover hair completely. - Shoe covers (non-conductive) - Goggles if appropriate - Face mask: covers nose and mouth (pinch slightly over bridge of nose). Don’t open sides in order to breathe more easily. - Lead apron for cath cases

Question 26

Quick wash:

Answer 26

fingertips to 2 inches above elbows. | First waste a few drops of soap from dispenser (not clean at spout). Pick nails with nail pick under running water.

Question 27

Gown pack:

Answer 27

Obviously must be opened and ready for you at the end of your scrub. If necessary, you can open it before scrubbing, but it must not be out of your sight. (Any sterile item out of sight must be considered unclean.)

Question 28

Opening gown pack (or any sterile pack):

Answer 28

First pull back flap away from you, then the two side flaps, finally the flap toward you— this is always last, so you’re not reaching across the sterile package.

Question 29

Now scrub, always moving from

Answer 29

distal to proximal.

Question 30

Now scrub

Answer 30

20 strokes per surface (30 for nails/fingertips) Finger/thumb tips Four surfaces each digit Palm, back, and edges of hand Distal, then proximal forearm to 2 inches above elbow (don’t get sleeves wet) Repeat for other hand/arm Rinse from fingers to hand to forearm to elbow, always letting water run toward elbow— not from elbow to hand.

Question 31

Drying: Towel

Answer 31

Towel is on top of gown in gown pack. Pick the towel up carefully, not touching or dripping onto the gown. Don’t let the towel brush against a table or anything else.

Question 32

Dry:

Answer 32

Divide towel into four surfaces Top right for grabbing, top left dries left hand Bottom left for grabbing, bottom right dries right hand Discard towel

Question 33

Gown:

Answer 33

Touch only inside; outside stays sterile Keep hands inside sleeves (up to but not inside white cuffs) Helper ties inside-back tie (this can wait till after gloving) After gloving, hand colored portion of tag (on long end of tie) to helper Hold onto shorter tie—don’t let go Spin to left, then pull tie from tag held by helper Tie up

Question 34

Closed gloving:

Answer 34

Lay glove on wrist with thumb down, fingers toward elbow Grab cuff through sleeve with thumb With other hand (through sleeve), pull cuff around end of sleeve and wriggle hand into glove; be sure glove covers white cuff of sleeve Don’t touch inside of glove cuff once it’s on, and don’t pull any sleeve out from under glove cuff Repeat for other hand Watch those thumbs! They get into trouble.

Question 35

The trick with closed gloving is

Answer 35

to release the thumb of the hand being gloved at the right moment to allow the hand to slip through the white cuff into the glove just as you’re pulling the glove over. It’s a timing thing that must be practiced a lot to get comfortable with it.

Question 36

Open gloving:

Answer 36

Touch only inside of glove for the first one Touch only the outside of glove for the second one Watch those thumbs!

Question 37

Ungowning:

Answer 37

Now the outside is dirty, the inside clean (or at least not contaminated). Pull to break ties, work through insides of sleeves to peel off gown and gloves together, rolling inside out into a wad. Don’t touch the outside of gown or gloves. Dispose of gown and gloves into appropriate container