Principles of Asepsis and Sterile Techniques Primary goal of the surgical team, • Preventing surgical site infection in the

operating room • includes o patient risk assessment o environmental cleaning o disinfection and sterilization of instrumentation o patient antibiotic prophylaxis o use of standard precautions. The goal of asepsis • is to prevent the contamination of the open surgical wound by isolating the operative site from the surrounding nonsterile environment. o accomplished by creating and maintaining the sterile field o by following aseptic principles aimed at preventing microorganisms from contaminating the surgical wound. Personalities  Ignaz Semmelweis – handwashing  Louis Pasteur – germ theory  Robert Koch – use of bichloride of mercury as an antiseptic  Joseph Lister – Father of modern Surgery  Gustav Neuber – used mercuric cholride in cleaning his apron Transmission Based Precautions  Airborne  transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], Mycobacterium. tuberculosis, and possibly SARS-CoV  Droplet  is, technically, a form of contact transmission, respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the respiratory tract of the infectious individual to susceptible mucosal surfaces of the recipient, generally over short distances.  Contact  Direct  occurs when microorganisms are transferred from one infected person to another person without a contaminated intermediate object or person  blood or other blood-containing body fluids from a patient directly enters a caregiver’s body through contact with a

mucous membrane or breaks (i.e., cuts, abrasions) in the skin  mites from a scabies-infested patient are transferred to the skin of a caregiver while he/she is having direct ungloved contact with the patient’s skin  Indirect  involves the transfer of an infectious agent through a contaminated intermediate object or person

 Hands of healthcare personnel  Patient-care devices  Shared toys  Instruments that are inadequately cleaned between patients before disinfection or sterilization
Human Bourne Sources of Contamination      SKIN HAIR NASOPHARYNX HUMAN ERROR CROSS-INFECTION

NON-Human Factors in Contamination  FOMITES  any inanimate object or substance capable of carrying infectious organism  Air Sources of Infection     Community Acquired Infection Communicable Infection Spontaneous Infection Nosocomial Infection – Exogenous and Endogenous

Control of Airborne Contamination  Air-Conditioning System  Doors  Traffic and Movement

 Lint Standard Precautions  Protective barriers and personal protective equipment  Prevention of puncture injuries  Management of puncture injuries  Oral Procedures  Care of specimens  Decontamination  Laundry  Waste  Handwashing  No touching of mucous membranes  Prophylaxis Principles of Sterile Technique Principle #1 • Scrubbed persons function within a sterile field. Principle #2 • Sterile drapes are used to create a sterile field. Principle #3 • All items used within a sterile field must be sterile. Principle #4 • All items introduced onto a sterile field should be opened, dispensed, and transferred by methods that maintain sterility and integrity. Principle #5 • A sterile field should be maintained and monitored constantly. Principle #6 • All personnel moving within or around a sterile field should do so in a manner to maintain the sterile field. Principle #7 • Policies and procedures for maintaining a sterile field should be written, reviewed annually, and readily available within the practice setting. In Summary:  Know what is sterile  Know what is unsterile  Keep the two apart  Remedy the contamination immediately PLEASE REMEMBER!!!!  When there is doubt, throw it OUT!!!  THERE should be NO COMPROMISE on Sterility

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