Medical And Surgical Asepsis Flashcards
(52 cards)
1
Q
Medical asepsis
A
Deals with reducing the probability of infectious organisms being transmitted to a susceptible individual
2
Q
The process of reducing the total number of organisms is called?
A
Microbial dilution
-there are 3 levels of microbial dilution
3
Q
3 levels of microbial dilution
A
- simple cleanliness
- disinfection
- sterilization
4
Q
Simple cleanliness
A
Proper cleaning, dusting, linen handling and hand hygiene
5
Q
Disinfection
A
The destruction of pathogens by using chemical materials
6
Q
Sterilization
A
- Surgical asepsis
- involves treating items with heat, gas or chemicals to make them germ free
7
Q
Antiseptic vs disinfectant
A
Antiseptic: a substance that tends to inhibit the growth and reproduction of microorganisms
Disinfectant: liquid chemical applied to objects to eliminate many or all pathogenic microorganisms
8
Q
Disinfection
A
- there are articles or surfaces that cannot be sterilized, therefore these articles must be disinfected
- used on objects ex tables, floors, walls, and any equipment
9
Q
Surgical asepsis
A
- the complete destruction of all organisms and spores from equipment used to perform patient care procedures
- procedures that require sterile equipment: lumbar punctures, catheterization and injections or equipment if required for immunocompromised patients
- used in both the OR and the areas in the diagnostic imaging department
10
Q
Sterile conscience
A
-an awareness of sterile technique and responsibility for telling the person in charge whenever you contaminate a field or observe the contamination by someone else
11
Q
Technologists and the OR
A
- inexperienced techs are not sent to the OR alone, an experienced tech will guide them through
- special surgical scrub attire must be worn
- before bringing equipment into the operating room, you must wipe it down with a germicidal solution
12
Q
Sterile corridor
A
- area between the patient drape and the instrument table is maintained as a “sterile corridor”
- access to this area is limited, permitted only to those wearing sterile attire and the radiographer is excluded from this part of the room
- head of the table is usually not in the sterile field, and is a safe area from which the radiographer can assess the situation and work from
13
Q
Technologist in the operating room
A
- doors to the theatres are to be kept closed during a surgical procedure, and traffic in and out of the room is strictly controlled
- only persons directly involved in the procedure may be present
- whether the radiographer stays or leaves throughout depends on type of surgery
- if the need for imaging is not planned, radiographers may be called to the OR at a moments notice, be dressed and ready for such situations
14
Q
Radiographer and Surgical team
A
Include:
- surgeon
- surgical assistant
- anesthesiologist
- RN’s (scrub nurse and float/circulating nurse)
- rad tech
15
Q
Surgeon
A
- the physician who plans and performs the surgical procedure and makes all surgical decisions
- surgical assistant: usually another surgeon, may be a resident or may be several assistants depending on the patients surgical needs
16
Q
Anesthesiologist
A
- a physician with special education in anaesthesiology
- makes decisions concerning the type of anaesthesia required, monitors patients vital signs
17
Q
Some surgical procedures requiring imaging include:
A
- operative cholangiograms
- urethral retrograde and stent placements
- orthopaedics: fractures, joint replacements
- pacemaker insertion
- intravascular trauma
- determination of the presence of foreign objects
18
Q
The OR environment
A
Divided into 3 zones:
- Unrestricted zone: persons may enter in street clothing, change room
- Semi-restricted zone: only persons dressed in scrub clothing with hair and shoe covers on may enter, outer corridor
- Restricted zone: only persons wearing scrub suits, hair coverings, shoe coverings and masks are allowed, operating rooms, inner corridor (supplies and sterilization devices)
19
Q
Rules in the OR
A
- to proceed from the “unrestricted zone” to the “semi-restricted zone” it is required to don scrubs with the top tucked into the pants or to wear a top that is close to the body
- hair, beards, or moustaches must be covered with a surgical cap
- shoe covers must be worn in restricted area
- before entering the room where a surgical procedure is in progress or the room is being prepared for a procedure, all personnel must put on a surgical mask
- various types of masks are worn to protect the patient from airborne or droplet contamination by a healthcare worker
- most facilities have dedicated x-ray equipment in the OR such as mobiles and C-arms
20
Q
Sterile field
A
- if the sterile field is already established, and procedure postponed, cover it immediately with a sterile drape
- airborne contamination is just as serious as a break in sterile technique
21
Q
Cleaning a sterile field after the procedure
A
- upon completion of the procedure, don gloves and thoroughly clean all reusable items before returning them to central sterile supply
- thorough cleaning is important because items must be free of all residue so the sterilizing agent can penetrate to all surfaces
- discard disposable items, placing needles in sharps containers and the remainder in biohazard bags or pails
22
Q
Packing and storing sterile supplies
A
- indicators are placed inside and outside of each pack to be sterilized. This indicates that sterilization has penetrated all surfaces
- when the indicator changes colour, it is proof that the contents of the pack have been exposed to the sterilization method sufficiently to change the colour of the indicator
- materials used for packing items to be sterilized: cloth, no woven fabrics, paper and plastic
- in addition to chemical inhibitors, hospitals use biological indicators (BIs) to ensure that all forms of microbial life are destroyed during the sterilization process
23
Q
Packing and storing sterile supplies
A
- items packaged must be covered completely by the wrapper and securely fastened with tape or a heat seal that cannot be reused
- contents must be identifiable and evidence of exposure to sterilization agents must be present
- items must be wrapped to allow opening and removing them without contamination
- area has to be draft free
- items sterilized in the hospital and stored in a closed cupboard are considered sterile for 30 days
- on an open shelf considered sterile for 21 days
- items sealed in plastic bags immediately after sterilization are considered sterile for 6-12 months
- commercially packaged sterilization items are considered sterile until the seal is broken, the package has been damaged or until expiration date has passed
24
Q
Sterile packages criteria
A
Packages are considered sterile if they meet the following criteria:
- they are clean, dry, and unopened
- their expiration date has not been exceeded
- their sterility indicators have changed to a predetermined colour, confirming sterilization
25
Opening sterile packs
1. Place tray on clean surface
2. Just before procedure begins, break the seal and open
3. Unfold the first corner away from you; then unfold the two sides
4. Pull the front fold down toward you and drop it
5. Do not touch the inner surface
6. The inner wrap, if there is one, is opened in the same manner
7. It's non-disposable equipment that is processed by sterile central supply, double wrapped in cloth and sealed with a sterile indicator
26
Opening sterile packs (commercial packs)
- usually wrapped in paper or plastic
- frequently sealed in plastic to ensure prolonged sterility
- sealed at the edges most commonly
- seal can be separated at the top and back until the sterile article is exposed
- never cut pack open or pierce with a sharp object or knife
- never tear packs open or allow contents to slide over the edge
- contents should be lifted out using a sterile glove or flipped out
27
Draping for sterile procedure
- after skin has been prepared and allowed to dry, sterile drapes placed to area of interest
- drapes applied in such a way that the opening leaves only the operative site exposed
- handle drapes as little as possible
- usually physician places sterile drapes
- first put on sterile gloves and then place drapes
- first drape on the body part closest to you so that the sterility of your gloves is maintained
- once drape is placed it may not be moved
28
Sterile gowning
1. Grasp gown and remove it from table
2. Step away from the table
3. Gown is folded inside out
4. Hold away from your body, and allow gown to unfold without letting it touch the floor
5. Open gown and hold by the shoulder seams
6. Place both arms into the armholes of the gown and wait for assistance
7. Assistant will put the gown over your shoulders and arms until your hands are exposed
8. Assistant will tie gown for you
29
Putting on sterile gloves
- open glove wrapper and expose the gloves
- sterile gloves are always packaged folded down at the cuff so that they may be put on more easily
- glove your dominant hand first
- pick up the right glove with the left hand at the folded cuff and slide the right hand into the glove, leaving the cuff folded down
- when the glove is over your hand, leave it and pick up the left glove with your gloved right hand under the fold
- pull the glove over your hand and over the cuff of the gown in one motion
- place the fingers of your gloved left hand under the cuff of the right and pull it over the cuff of the gown
- after the cuffs of the gloves cover the cuffs of the gown, you can adjust the gloves
30
Methods of sterilization
Five methods are used
- chemical
- dry heat
- conventional gas
- gas plasma technology
- autoclaving (steam)
31
Chemical sterilization
- involves the immersion and soaking of objects in a bath of germicidal solution followed by a sterile water rinse
- effectiveness of this process depends on solution strength and temperature, and the immersion time of up to 6-10 hours
- disadvantage: difficult to control accurately, not used often
- advantages: used if objects can't go into autoclave or gas, effective at destroying microorganisms but will not kill spores
32
Dry heat
- such as that in an oven
- advantage: required to sterilize some sharp instruments, certain powders and greasy substances
- disadvantage: time varies from 1-6 hours at a temperature range of 165-170 degrees Celsius or 329-338 degrees Fahrenheit
- not commonly used
33
Conventional gas
- used for items that would be damaged by high temperatures are usually sterilized with a mixture of gases (freon and ethylene oxide)
- advantage: used primarily for electrical, plastic, rubber items, optical ware and used for items from isolation rooms ex telephones, stethoscopes, blood pressure cuffs etc
- disadvantages: gases are poisonous and must be dissipated by means of aeration in a controlled environment. Aeration is a slow process so items need to be sent for sterilization well in advance of the time they will be needed
34
Gas plasma technology
Advantages:
-safer method of sterilizing heat and moisture safe items. No toxic fumes, byproducts or residues; and no handling of chemicals
-uses very low heat and moisture
-effectively kills both microorganisms and spores
Disadvantage:
-cannot sterilize instruments that have long, narrow lumina. It can not be used for powders, liquids or any cellulose materials, such as paper, cotton, linen or muslin
▪️items are cleaned, wrapped and placed in a compact mobile unit where low-temperature hydrogen peroxide gas plasma diffuses through the wrapped instruments
▪️gas plasma is formed within the sterilization unit when vaporized hydrogen peroxide is subjected to radio-frequency energy, changing the vapor into a low temp plasma
▪️plasma then breaks down into free radicals (atoms with unpaired electrons in their outer shells)
▪️free radicals destroy the microorganisms by stripping their atoms of electrons
▪️remaining free radicals are converted into nontoxic by products (water and oxygen)
▪️used to sterilize endoscopes, fiber optic devices, microsurgical instruments, and powered instrumemnts
35
Autoclaving (steam)
-a device that provides steam sterilization under pressure
advantages:
-most commonly used sterilization method
-cheap, quick and most convenient for items that can withstand heat and moisture
-high temps can be achieved under pressure making this an extremely effective method
-temp range from 121-135 degrees Celsius or 250-275 degrees Fahrenheit
-indication of sterilization by tape indicator
36
Skin preparation
Purpose: to remove as many microorganisms as possible by mechanical and chemical means to reduce the potential for infection
-two methods: mechanical and chemical methods
37
Skin preparation: mechanical methods
- may include removal of hair and always a friction scrub with antiseptic soap and water
- skin prep is a sterile procedure, and all items used must be kept sterile
- person performing the skin prep wears sterile gloves
38
skin preparations: chemical methods
- performed after the mechanical skin prep
- skin around the area to be penetrated is often painted with an antiseptic solution
- destroys some of the remaining microbes, and acts as a deterrent to further microbial growth for a brief period
- when painting the patients skin with antiseptic cleanser, do this in a circular motion beginning at the center of the area and working outward
39
Standard precautions apply to
- blood
- all body secretions
- secretions and excretions (except sweat), regardless of whether they contain visible blood
- non-intact skin
- mucous membranes
40
What is our current system for precautions?
Standard precautions
41
Microbial dilution
The process of reducing the total number of organisms
42
What is the difference between surgical and medical asepsis?
Surgical asepsis: COMPLETE DESTRUCTION of all organisms and spores from equipment used. Surgical environment
Medical asepsis: REDUCE PROBABILITY of infectious organisms being transmitted to a susceptible individual, hand hygiene etc
43
List some ways to fight the spread of infection:
- hand hygiene
- clean linens
- isolation precautions when needed
- do not come to work sick
- avoid touching face
- work shoes that you leave there, don't wear them home
- change into scrubs at work and leave them there
44
The rules of surgical asepsis
- basic rules apply whenever and wherever the sterile procedure is done
- used in both the OR and areas in the diagnostic imaging department
- refer to "rules for surgical asepsis" handout
45
Zone 1 in the surgical suite
An unrestricted zone, persons may enter in street clothing
46
Zone 2 in the surgical suite
A semi-restricted zone- only persons dressed in scrub dress with hair covered and shoes covered may enter
47
Zone 3 in the surgical suite
A restricted zone- only persons wearing scrub dress, shoe covers and masks are allowed to be present. If a surgical procedure is in progress, the doors to this area are kept closed, and only person directly involved in the procedure may be present. Those "directly" involved in the operation are dressed in sterile gowns and sterile gloves. They are often referred to as "being scrubbed"
48
True/ false: in the surgical departments techs must remove any body piercing jewelry as it may become loose and fall onto the sterile field
True
49
All persons who expect to proceed from the _____ zone into a ____ zone must go the dressing area, don scrub attire and tuck the top of the attire into the pants or wear a scrub jacket that fits close to the body
Unrestricted zone into a semi restricted zone
50
All hair, beards or mustaches must be ____ with a surgical cap and mask
Covered
51
Before proceeding into zone ___, all persons must scrub hands and arms for medical asepsis. It is believed that bare skin may shed microorganisms. In many institutions, all who are not scrubbed for the surgical procedure must wear a scrub jacket to cover bare arms
3
52
Before entering a room where a surgical procedure is in progress, a ____ must be donned
A mask
