Principles_of_Sterile_Technique_OT_Posting_2018_(new).pptx

Principles of sterile technique & asepsis presented for operating theatre posting based on Berry&Kohns

1. PRINCIPLES OF STERILE TECHNIQUE By: Stn. Jocelyn, Stn. Lovely and Stn. Julee Group 83/ July’16

2. Principles of Sterile Technique The principles of sterile technique are applied under the following conditions: In preparation for an invasive procedure by sterilization of necessary materials and supplies In preparation of the sterile team to handle sterile supplies and intimately contact the surgical site by scrubbing, gowning and gloving. In the creation and maintenance of sterile field, including skin preparation and draping of the patient. In the maintenance of sterility throughout the entire surgical procedure. Breaches in sterility are remedied immediately. In terminal sterilization and disinfection at the conclusion of the surgical procedure.

3. 1. Only sterile items are used within the sterile field Items such as sterile instruments sets, drapes, sponges and basins are obtained from the sterile core. Every person who dispenses a sterile item to the field must be sure of its sterility and of its remaining sterile until its use. If there is any doubt about the sterility of any item, it should be considered not sterile and therefore should not be used. The phrase “when in doubt, throw it out” applies to this situation.

4. 2. Sterile personnel are gowned and gloved Gowns are only considered sterile only from the chest to the level of the sterile field in front, and from 2 inches above the elbows to the cuffs on the sleeves.

5. 2. Sterile personnel are gowned and gloved

6. 2. Sterile personnel are gowned and gloved The following practices are observed: - Sterile people must keep their hands in sight at all times and at or above waist level or the level of the sterile field.

7. 2. Sterile personnel are gowned and gloved

8. 3. Tables are sterile only at table level Because tables are sterile only at table level, OT personnel must adhere to the following: Only the top of a sterile, draped table is considered sterile. The edges and the sides of the drape extending below table levels are considered contaminated. The Mayo stand, when covered by a sterile drape may be placed over the sterile field. Minimal contact is had with the underside of the Mayo drape. Anything falling or extending over the table or operating bed edge, such as a piece of suture or suction tip, is contaminated. The scrub person does not touch the part hanging below the level of the established sterile field.

9. 3. Tables are sterile only at table level When unfolding or applying a sterile drape, it is unfolded away from the sterile person and the part that drops below the table level. Once placed, the drape is not moved or shifted. Cords, tubing, and other materials are secured on the sterile field with a nonperforating clip to prevent them from sliding over the edge of the operating bed.

10. 4. Sterile personnel touch only sterile items or areas; unsterile personnel touch only unsterile items or areas Sterile members maintain contact with the sterile field by means of sterile gowns and gloves. The unsterile circulating nurse does not directly contact the sterile field. Supplies are brought to sterile team members and opened by the circulating nurse using aseptic technique. The circulating nurse ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.

11. 5. Unsterile personnel avoid reaching over the sterile field; sterile personnel avoid leaning over an unsterile area The unsterile circulating nurse never reaches over a sterile field to transfer sterile items.

12. 5. Unsterile personnel avoid reaching over the sterile field; sterile personnel avoid leaning over an unsterile area

13. 6. The edges of anything that encloses sterile contents are considered unsterile When opening sterile packages, a margin of safety is always maintained. The inside of a wrapper is considered sterile within 1 inch of the edges. The sterile item should be presented to the scrub person.

14. 7. The sterile field is created as close as possible to the time of use Setting up as close to the time of use is in the best interest of the patient. Covering sterile tables for later use is not recommended. The sterile field is not in direct vision and is not considered sterile. It is not appropriate to set up a room and leave it unattended. Taping the door shut is not a guarantee of continued sterility.

15. 8. Sterile areas are continuously kept in view Sterile personnel face sterile areas Someone must remain in the room to maintain vigilance when sterile packs are opened in a room or a sterile field is set up. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated. Covered tables are not in view and may pose questionable sterility issues.

16. 9. Sterile personnel keep well within the sterile area Sterile personnel allow a wide margin of safety when passing unsterile areas and observe the following rules: Sterile personnel stand back at a safe distance from the operating bed when draping the patient. Sterile personnel face a sterile area to pass it. Sterile personnel ask an unsterile individual to step aside rather than risk contamination Movement within and around a sterile area is kept to a minimum to avoid contamination of sterile items or personnel. Sterile personnel stay within the sterile field. They do not walk around or go outside the room.

17. Sterile personnel pass each other back to back at a 360° turn.

18. 10. Sterile personnel must keep contact with sterile areas to a minimum To keep contact with the sterile areas to a minimum, sterile personnel observe the following rules: Sterile personnel do not lean on sterile tables or on the draped patient. Leaning on the patient can cause injury to tissues and structures, Sitting or leaning against an unsterile surface is a break in technique. If the sterile team sits to operate, they do so without proximity to unsterile areas.

19. 11. Unsterile personnel avoid sterile areas A wide margin of safety must be maintained when passing sterile areas by observing the following rules: Unsterile personnel maintain a distance of at least 1 foot (30cm) from any area of the sterile field. Unsterile personnel face and observe a sterile area when passing it to be sure they do not touch it. Unsterile personnel never walk between two sterile areas (e.g. between sterile instrument tables) The circulating nurse restricts to a minimum all activity near the sterile field.

20. 12. Destruction of the integrity of microbial barriers results in contamination The integrity of a sterile package and the appearance of the process must be checked for sterility just before opening. Sterile packages are laid only on dry surfaces. Sterile items are stored in clean, dry areas. Drapes are placed on a dry field. Sterile packages are handled with clean, dry hands. If a sterile drape were to get wet during an operation, the drape is not removed, but a new sterile drape is placed on the sterile field over the wet drape. This is because any wet drape that is left can harbor microorganisms, such causing a risk of microbial growth.

21. 13. Microorganisms must be kept to an irreducible minimum Skin cannot be sterilized. Skin is a potential source of contamination in every evasive procedure. All possible means are used to prevent the entrance of microorganisms into the wound. Mechanical washing and chemical antisepsis is used to remove or inactive transient and resident flora from the skin around the surgical site of the patient and from the hands and arms of sterile team members. If a glove is torn or punctured by a needle or instrument, it is changed immediately. The puncturing needle or instrument is removed from the sterile field. A sterile dressing should be applied to the surgical site before the drapes are removed to reduce the risk of the incision being touched by contaminated hands or objects.

22. DRESS CODE FOR OPERATING THEATRE COMPLEX

23. Head cover Visor eye shield or chin-length face shield Mask Sterile gown (disposable or reusable) Sterile gloves (powdered or non-powdered) Shoe covers Scrubs

24. SCRUBBING, GOWNING AND GLOVING

25. Surgical Hand Cleansing (Scrubbing) Purpose: To remove or deactivate soil, debris, natural skin oils, hand lotion, and transient microorganisms from the hands and forearms of sterile team members. Sterilized reusable scrub brushes

26. Surgical Hand Cleansing (Scrubbing) Antimicrobial Skin-Cleansing Agents Chlorhexidine Gluconate Iodophors ( A povidone - iodine complex) comes in concentrations of 10%, 7.5%, 2% and 0.5% Triclosan 1% Alcohol. Ethyl or isopropyl alcohol (60% to 90%) Hexachlorophene (3%) Parachlorometaxylenol (1% - 3.75%)

27. Surgical Hand Cleansing (Scrubbing) General Preparations The skin and nails should be kept clean and in good condition, and the cuticles should be uncut. Fingernails should not reach beyond the fingertips to avoid glove puncture. Fingernail polish should not applied. All jewelry is removed from the fingers, wrists, and neck. Jewelry harbors microorganisms.

28. Gowning and Gloving Purpose: A sterile gown and gloves are worn to exclude skin as a possible contaminant and to create a barrier between the sterile and nonsterile areas. The scrub person will don the gown before the gloves. The scrub person may don the gloves in one or two ways: by the closed gloving technique or by the open gloving technique . Closed gloving method: is preferred for establishing the initial sterile field by the scrub person. Open gloving method: is used when changing a glove during a surgical procedure or when donning gloves for procedures not requiring gowns.

29. Gowning and Gloving

30. Closed Gloving Technique

31. Open Gloving Technique

32. INSPECT STERILE ITEMS BEFORE OPENING

33. MAINTAINING STERILITY WHILE OPENING AND PASSING A STERILE ITEM

34. Opening Sterile Supplies Before any sterile supplies are opened, the integrity of each package must be checked for tears or watermarks. If either is present, the package is unsafe to open. Check the external chemical indicator tape to be certain the item has been exposed to a sterilization process. Touch only the outside of the outer wrappers. Avoid reaching over sterile contents and the sterile table. The inner basket of instruments is considered sterile, but the container itself is not. Mechanical items such as staplers should not be flipped onto the field. The mechanism can be damaged and may malfunction when used in patient care. Do not open until a sterile team member is free to take it directly.

35. Opening Sterile Supplies MOST IMPORTANTLY: Check the expiry date of every package to see if the item has expired or not.

36. Passing a sterile item When passing a sharp instrument, take care to direct the blade away from yourself and all other personnel. Eye contact is recommended when passing a scalpel. Some surgeons prefer the no-passing technique: the knife is placed on an instrument towel, magnetic pad or tray for the surgeon to pick up. The surgeon will replace the knife onto this surface or tray after the incision is made. The scrub person should not allow the scalpel to remain on the sterile field after use. Pass instruments in a decisive and positive manner. When the surgeon extends his/her hand, the instrument should be placed firmly in his/her palm in the proper position for use.

37. TO CREATE AND MAINTAIN A STERILE FIELD

38. Creating a sterile field A sterile field should be created as close as possible to the time of use. The edges of anything that encloses sterile contents are considered unsterile. When pouring a solution, the bottle of solution should be at eye level

39. Maintaining a sterile field If there is any doubt about the sterility of an item, it should be considered unsterile. If an unsterile person or object comes into close contact with a sterile table or vice versa then it is considered unsterile. Sterile field is considered contaminated if the sterile table or unwrapped sterile items are not under constant observation. Unsterile personnel should avoid reaching over the sterile field. Sterile areas are continuously kept in view. Sterile personnel keep well within the sterile area.

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