TOPIC B

Topic Title: Surgical and Medical Asepsis

Topic Objectives:
At the end of the topic, the student should be able to:
1. Differentiate between surgical and medical asepsis.
2. State the three major contributing factors in healthcare-associated infections
3. Differentiate between Standard Precautions and Transmission-Based Precautions, and state the three
types of Transmission-Based Precautions
4. Describe the types of patients placed in Protective Environments
5. Cite three important considerations in the handling of each of the following in healthcare settings: food,
eating utensils, fomites, and sharps

Topic Contents:

Aseptic Technique
Asepsis is the condition of being free from disease-producing microorganisms. (Beckett-Davis, 2003.
Aseptic Technique implies all those procedures that reduce or eliminate pathogens and their actions or
minimize their areas of existence. James (2003) defined aseptic as a discipline that consists of a series of
events to guard the patient against infection.

Aseptic technique is used to reduce the direct or indirect transfer of germs to any surface, article or
person, as in the following circumstances:

1) With traumatic wounds, which are assumed to be contaminated beforehand, aseptic technique refers
to applying a dressing in a manner so that additional contamination is not induced.
2) In administration of preparations by injection or infusion, it refers to measures designed to prevent or
minimize introduction of pathogens beneath the skin.
3) In surgery, it normally implies sterile conditions in and around the patient area.

Health care personnel can carry out aseptic technique through the following simple activities:
1) Keeping their hands clean and as free from contamination as possible.
2) Ensuring that all sterile items are kept free from all microorganisms. Dressings that are to be applied to
wounds, needles, and instruments to be inserted through the skin, and syringes to be filled for
injection into the body must not touch anything unsterile before being used.
3) Keeping from breathing, coughing, or sneezing on wounds or sterile items.

Medical Asepsis

Medical asepsis includes all the procedures used to protect the patient and his environment from the
spread of infectious organisms. Medical asepsis or the aseptic technique is based on maintaining cleanliness to
prevent the spread of pathogenic microorganisms and to ensure that the environment is free from microbes
as much as possible. Moreover, it involves limiting microbes to specific areas and rendering objects either
clean or dirty.

Principles of Medical Asepsis

The following are the principles that govern the practice of medical asepsis (Audly, 1991).
1) Wash hands frequently but especially before handling food, before eating, after using a handkerchief,
after going to the toilet, before and after each client contact, and after removing gloves.
 2) Keep soiled items and equipment from touching the clothing.
3) Do not place soiled bed linen or any other items onto the floor.
4) Avoid having clients cough, sneeze, or breath directly on others.
5) Move equipment away from you when brushing, dusting, or scrubbing articles.
6) Avoid raising dust.
7) Clean the least soiled areas first then move to more soiled ones.
8) Dispose of soiled or used items directly into the drain in order, to avoid splatter in the sink and onto
you.
9) Avoid leaning against sinks, supplies, or equipment.
10) Avoid touching your eyes, face, nose, and mouth.
11) Use practices of personnel grooming that help prevent spreading microorganisms.
12) Follow guidelines conscientiously for isolation or barrier techniques as prescribed by agency.

Basic Procedures of Medical Asepsis

Hospital-acquired (nosocomial) infections and cross infections and cross’ infections (infections that are
transmitted between individuals with different pathogens) show the need of applying basic principles of
medical asepsis. The following steps outline the basic procedures used in applying medical asepsis (Sell &
Wright, 1990):
1) Perform handwashing or hand hygiene before attending patient’s care. Handwashing is the most
important step in preventing and controlling infection. There may be times when you do not have the
materials or the time do a thorough handwash; however, always wash your hands and clean your
fingernails if time permits.
2) Disinfect materials as required.
3) Maintain clean patient care environment.
a) Concurrent cleaning. Disinfect and dispose of infectious matter immediately during, the course of a
disease. This is a constant task.
b) Terminal cleaning. Disinfect contaminated material after a patient dies, transfers, or is discharged.
4) Use clean and dirty utility rooms. Clean rooms are used to store clean, unused equipment. Dirty rooms
are rooms used to store contaminated items such as used linen, trash, contaminated equipment,
dietary trays, and basic laboratory tests.
5) Store and handle linen properly.
a) Clean linen. Store clean linen in a clean room marked for clean linen only.
b) Dirty or soiled linen. Dirty linen is linen that has been used and maybe contaminated with blood,
urine, feces, and so forth. Store dirty linen in the “dirty” utility room.
6) Store and handle equipment and supplies, properly. Store clean and dirty equipment and supplies in
separate areas. Clean dirty equipment thoroughly before placing with clean equipment for reuse of
another patient.
7) Dispose of water materials.
a) Uncontaminated trash. Uncontaminated trash results from normal living routine of patients. This
requires no special handling. Remove all unconsumed food items from patient care areas as soon
as possible after patients have finished eating.
b) Contaminated trash. Contaminated trash results from contamination with bodily secretions and/or
of the patient. This requires special handling:
 Seal each bag according to local SOP before removing from patient’s bedside.
 Place each bag in specific area or container designated and labeled “contaminated trash”.
 Remove each bag from the ward or clinic frequently according to the agency policy.
 c) Excretions. Clean bedpans and urinals after use. Flush away all contents promptly unless specimens
are required. Cover the bedpan or urinal with paper cover when it is necessary to carry it from
patient’s room to another area.
8) Follow specific isolation techniques for patients with communicable diseases.

Isolation Systems/ Techniques

Isolation refers to techniques used to prevent or to limit the spread of infection. Isolation precautions
are classified as:
agent
1) Standard precautions (1st Tier Precaution) similar to Universal Precaution
2) Transmission-based precautions (2nd Tier Precaution)
a) Contact precaution
b) Droplet precaution
c) Airborne precaution

3) Protective isolation (formerly known Reverse Isolation)

1) Standard Precautions are to be applied to the care of ALL patients in ALL healthcare settings, regardless
of the suspected or confirmed presence of an infectious.

Before entering the patient’s room, the nurse should assess and perform the appropriate skills, wear
the proper PPE and prepare equipment and devices for specific isolation techniques:

Handwashing

The most important and most basic technique in preventing and controlling infections and preventing the
transmission of pathogens is handwashing
There are many components of Personal protective equipment (PPE). The most common are listed below:

1) Gloves. Gloves can protect both patients and healthcare personnel from exposure to infectious
materials that may be carried on hands. Healthcare personnel should wear gloves when
a) anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin, and other
potentially infectious materials,
b) having direct contact with patients who are colonized or infected with pathogens transmitted by
the contact route,
c) handling or touching visibly or potentially contaminated patient-care equipment and
environmental surfaces.

Gloves must be changed between tasks and procedures on the same patient whenever there is risk
of transferring microorganisms from one body site to another. Always remove gloves promptly after use
and before going to another patient. Thoroughly wash your hands immediately after removing gloves;
there is always the possibility that the gloves contained small tears in them or that your hands became
contaminated while removing the gloves.

2) Isolation Gowns.
Isolation gowns are worn in conjunction with gloves and with other PPE when indicated. Gowns
are usually the first piece of PPE to be donned. They protect the healthcare worker’s arms and exposed
body areas and prevent contamination of clothing with blood, body fluids, and other potentially
infectious material. When applying Standard Precautions, an isolation gown is worn only if contact with
blood or body fluid is anticipated. However, when Contact Precautions are used, donning of both gown
and gloves upon room entry is indicated. Isolation gowns should be removed before leaving the
patient-care area to prevent possible contamination of the environment outside the patient’s room.
Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. The
outer, “contaminated,” side of the gown is turned inward and rolled into a bundle, and then discarded
into a designated container for waste or linen to contain contamination.
3) Masks.
Masks are used for three primary purposes in healthcare settings:
a) They are worn by healthcare personnel to protect them from contact with infectious material from
patients.
b) They are worn by healthcare personnel when engaged in procedures requiring sterile technique to
protect patients from exposure to pathogens that may be present in a healthcare worker’s mouth
or nose.
c) They are placed on coughing patients to limit potential dissemination of infectious respiratory
secretions from the patient to others.

Surgical Mask

4) Respiratory Protection.
Respiratory protection requires the use of a respirator with N95 or higher filtration to prevent
inhalation of infectious particles. Do not confuse masks with particulate respirators. Respirators are
recommended when working with patients with tuberculosis, severe acute respiratory syndrome
(SARS), Middle East Respiratory Syndrome Coronavirus (MERSCoV)coronavirus disease 19 (Covid 19),
smallpox, and during the performance of aerosol-generating procedures on patients with avian or
pandemic influenza.
An N95 mask or N95 respirator is a particulate-filtering facepiece respirator that meets the U.S.
National Institute for Occupational Safety and Health (NIOSH) N95 classification of air filtration,
meaning that it filters at least 95% of airborne particles.
 N 95 mask

The National Institute for Occupational Safety and Health (NIOSH) is responsible for conducting
research and making recommendations for the prevention of work-related injury and illness.

5) Eye Protection.
Types of eye protection include goggles and disposable or non-disposable face shields. Masks
may be used in combination with goggles, or a face shield may be used instead of a mask and goggles.
Even when Droplet Precautions are not indicated, eye, nose, and mouth protection are necessary when
it is likely that there will be a splash or spray of any respiratory secretions or other body fluids. Eye
protection and masks are removed after gloves are removed.

Goggles

Faceshields
 Personal protective equipment (PPE) includes gloves, gowns, masks, eye protection, and respiratory
protection.

Patient-Care Equipment
Organic material (e.g., blood, body fluids, secretions, excretions) must be removed from medical
equipment, instruments, and devices prior to high-level disinfection and sterilization because residual
proteinaceous material reduces the effectiveness of disinfection and sterilization processes. All such
equipment and devices must be handled in a manner that will protect healthcare workers and the
environment from potentially infectious material. Cleaning and disinfection must include computer keyboards
and personal digital assistants (PDAs). Whenever possible, the use of dedicated medical equipment, such as
stethoscopes, blood pressure cuffs, and electronic thermometers, reduces the potential for transmission.
Items such as commodes, intravenous pumps, and ventilators must be thoroughly cleaned and disinfected
before use by or on another patient.

Environmental Control
The hospital must have, and employees must comply with, adequate procedures for the routine care,
cleaning, and disinfection of environmental surfaces such as bedrails, bedside tables, commodes, doorknobs,
sinks, and any other surfaces and equipment in close proximity to patients.

Linens
Textiles such as bedding, towels, and patient gowns that have become soiled with blood, body fluids,
secretions, or excretions must be handled, transported, and laundered in a safe manner. Soiled textiles must
not be shaken, must not come in contact with the healthcare worker’s body or clothing, and must be
contained in a laundry bag or designated bin.

Disposal of Sharps
Needlestick injuries and injuries resulting from broken glass and other sharps are the primary manner
in which healthcare workers become infected with pathogens such as HIV, HBV, and HCV. Thus, Standard
Precautions include guidelines regarding the safe handling of such items. Needles and other sharp devices
must be handled in a manner that prevents injury to the user and to others who may encounter the device
during or after a procedure. Accidents can be prevented by employing safer techniques (such as by not
recapping needles), by disposing of used needles in appropriate sharps disposal containers, and by using
safety-engineered sharp devices. Safety devices may be an integral part of the needle (including butterfly
needles), the evacuated tube holder, or the syringe.
Listed here are desirable characteristics of needle safety features:
• It is as simple to use as possible, requiring little training to use it effectively.
• It is an integral part of the device, not an accessory.
• It provides a barrier between the hands of the healthcare worker and the needle after its use.
• It allows the worker’s hands, to remain behind the needle at all times.
• It is in effect before disassembly and remains in effect after disposal to protect users and trash
handlers and for environmental safety.
 Sharps Container

Contaminated needles and other contaminated sharps must not be bent, recapped, or
removed, and shearing or breaking of needles is prohibited. All contaminated needles, lancets, scalpel
blades, and other sharps must be disposed of immediately after use, by placing them in special
containers known as sharps containers. This is true whether or not the sharp contains a safety feature.
Sharps containers are rigid, puncture resistant, leak proof, disposable, and clearly marked with a
biohazard label. Sharps containers must be easily accessible to all personnel needing them and must be
located in all areas where needles are commonly used, as in areas where blood is drawn, including
patient rooms, emergency rooms, ICUs, and surgical suites. When full, sharps containers are properly
disposed of as biohazardous waste.

Biohazard Symbol

2) Transmission-based precautions (2nd Tier Precaution)

a) Contact Precautions
Contact transmission is the most important and frequent mode of transmission of HAIs. Contact
Precautions are used for patients known or suspected to be infected or colonized with
epidemiologically important pathogens that can be transmitted by direct or indirect contact.
Examples include multidrug-resistant bacteria, C. difficile-associated diseases, respiratory syncytial
virus (RSV) infection in children, scabies, impetigo, and viral hemorrhagic fevers.

Health care-associated infections (HAIs) are infections people get while they are receiving
health care for another condition. HAIs can happen in any health care facility, including hospitals,
ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities.

Major types of HAIs:

 Catheter – associated urinary tract infection (CAUTI)

 Central line – associated bloodstream infection (CLABSI)
 Surgical site infection (SSI)
 Ventilator – associated events (VAE)

b) Droplet Precautions
Technically, droplet transmission is a form of contact transmission. However, in droplet
transmission, the mechanism of transfer is quite different than in either direct or indirect contact
transmission.
Droplets are produced primarily as a result of coughing, sneezing, and talking, as well as during
hospital procedures such as suctioning and bronchoscopy. Transmission occurs when droplets
(larger than 5 μm in diameter) containing microbes are propelled a short distance through the air
and become deposited on another person’s conjunctiva, nasal mucosa, or mouth. Because of their
size, droplets do not remain suspended in the air. Droplet Precautions must be used for patients
known or suspected to be infected with microbes transmitted by droplets that can be generated in
the ways previously mentioned
 c) Airborne Precautions
Airborne transmission involves either airborne droplet nuclei or dust particles containing a
pathogen. Airborne droplet nuclei are small-particle residues (5 μm or less in diameter) of
evaporated droplets containing microbes; because of their small size, they remain suspended in air
for long periods. Airborne Precautions apply to patients known or suspected to be infected with
epidemiologically important pathogens that can be transmitted by the airborne route.

Airborne Infection Isolation Rooms The preferred placement for patients who are infected with
pathogens that are spread via airborne droplet nuclei, and therefore require Airborne Precautions, is in
an airborne infection isolation room (AIIR). An AIIR is a single-patient room that is equipped with
special air handling and ventilation systems. AIIRs are under negative pressure to prevent room air
from entering the corridor when the door is opened, and air that is evacuated from such rooms passes
through high efficiency particulate air (HEPA) filters to remove pathogens. Standard and Airborne
Precautions are strictly enforced.

Airborne infection isolation room. Protective environment

3) Protective Environments
Certain patients are especially vulnerable to infection, particularly to invasive environmental
fungal infections. Examples of such patients are patients with severe burns, those who have leukemia,
 patients who have received a transplant (such as a hematopoietic stem cell transplant),
immunosuppressed persons, those receiving radiation treatments, leukopenic patients (those having
abnormally low white blood cell counts), and premature infants. These patients can be protected by
placing them in a Protective Environment (sometimes referred to as protective isolation or positive
pressure isolation).
The Protective Environment is a well-sealed single patient room in which vented air entering
the room is passed through HEPA filters. The room is under positive pressure to prevent corridor air
from entering when the door is opened. Strategies to minimize dust include scrubbable surfaces rather
than upholstery and carpet. Crevices and sprinkler heads are routinely cleaned. Appropriate Standard
and Transmission-Based Precautions are strictly enforced.

Handling Food and Eating Utensils

Contaminated food provides an excellent environment for the growth of pathogens. Most often,
human carelessness, especially neglecting the practice of handwashing, is responsible for this contamination.
Regulations for safe handling of food and eating utensils are not difficult to follow. They include the following:

 Using high-quality, fresh food

 Properly refrigerating and storing food
 Properly washing, preparing, and cooking food
 Properly disposing of uneaten food
 Thoroughly washing hands and fingernails before handling food and after visiting a restroom
 Properly disposing of nasal and oral secretions in tissues and then thoroughly washing hands and
fingernails
 Covering hair and wearing clean clothes and aprons
 Providing periodic health examinations for kitchen workers
 Prohibiting anyone with a respiratory or gastrointestinal disease from handling food or eating utensils
 Keeping all cutting boards and other surfaces scrupulously clean
 Rinsing and then washing cooking and eating utensils in a dishwasher in which the water temperature
is greater than 80°C
According to the CDC, the combination of hot water and detergents used in dishwashers is sufficient to
decontaminate dishware and eating utensils; no special precautions are needed.

Handling Fomites
As previously described, fomites are any nonliving or inanimate objects other than food that may
harbor and transmit microbes. Examples of fomites in healthcare settings are patients’ gowns, bedding,
towels, and eating and drinking utensils; and hospital equipment such as bedpans, stethoscopes, latex gloves,
electronic thermometers, and electrocardiographic electrodes that become contaminated by pathogens from
the respiratory tract, intestinal tract, or the skin of patients. Telephones and computer keyboards in patient-
care areas can also serve
as fomites. Transmission of pathogens by fomites can be prevented by observing the following rules:
 Use disposable equipment and supplies wherever possible
 Disinfect or sterilize equipment as soon as possible after use
 Use individual equipment for each patient
 Use electronic or glass thermometers fitted with onetime use, disposable covers or use disposable,
single-use thermometers; electronic and glass thermometers must be cleaned or sterilized on a regular
basis, following manufacturer’s instructions
 Empty bedpans and urinals, wash them in hot water, and store them in a clean cabinet between uses
 Place bed linen and soiled clothing in bags to be sent to the laundry
Medical Waste Disposal
Materials or substances that are harmful to health are referred to as biohazards (short for biologic
hazards). According to OSHA standards, medical wastes must be disposed of properly. These standards include
the following:
 Any receptacle used for decomposable solid or liquid waste or refuse must be constructed so that it
does not leak and must be maintained in a sanitary condition. This receptacle must be equipped with a
solid, tightfitting cover, unless it can be maintained in a sanitary condition without a cover.
 All sweepings, solid or liquid wastes, refuse, and garbage shall be removed to avoid creating a menace
to health and shall be removed as often as necessary to maintain the place of employment in a sanitary
condition.
 The medical facility’s infection control program must address the handling and disposal of potentially
contaminated items.
Aseptic Technique Lecture Activity

1) Research for the following:

a) Role of the Microbiology Laboratory in Healthcare Epidemiology

b) Role and Responsibility of the nurse in isolating patient with and without communicable
diseases and when assigned to patient in isolation room.
c) Role and responsibility of an Infection Control Nurse.

Note: Kindly read Chapter 12 in your Ebook.

Sterile Technique

Sterile technique refers to the way sterile materials are handled in order, to keep them free of living
microorganisms (germs). Sterile technique prevents contamination. Sterile technique prevents contamination. Sterile
technique is needed in any procedure involving contact with an open wound, breaking skin or mucous membrane, or
entrance into a normally sterile body cavity. In the controlled setting of the operating room, sterile can be practices
exactly. The following three rules are the basis of the sterile technique.
1. Any article is either sterile or contaminated.
2. A sterile article that has been touched by a contaminated article is no longer sterile.
3. Any sterile article that has become unintentionally wet or damp is no longer sterile.

Principles of Surgical Asepsis

Surgical asepsis is known as the sterile technique. It requires strict compliance to ordered and specific
procedures which render an area free from all microorganisms including bacterial spores. An object or area is described
as either sterile or unsterile. Surgical asepsis is used in the operating room, delivery room, during surgical procedures,
catherization, and during dressing changes.

The following are the principles of surgical asepsis:

1. Only a sterile object can touch another sterile object.
2. Open sterile packages so that the first edge of the wrapper is directed away from the worker in order, to avoid
the possibility of a sterile wrapper touching unsterile clothing.
3. Avoid spilling any solution on a cloth or paper used as a field for a sterile set up.
4. Hold sterile objects above the level of the waist.
5. Avoid talking, coughing, sneezing, or reaching over a sterile field or object.
6. Never walk away from or turn your back on the sterile field.
7. All items brought into contact with broken skin or used to penetrate the skin in order, to inject substances into
the body, or to enter normally sterile body cavities, should be sterile.
8. Use dry sterile forceps when necessary.
 9. Consider the edge (outer 1 inch) of a sterile field to be contaminated.
10. Consider an object contaminated if you have any doubt as to its sterility.

Basic Procedures of Surgical Asepsis

1. Set up for, assist with, and perform sterile procedure in a clean environment.
2. Wash hands thoroughly before beginning any sterile procedure
3. Use only sterile supplies.
4. Keep unused sterile equipment sterile during preparation for and while performing the procedure. An object or
surface is sterile when it has been made free from all living microorganisms by one of the processes of
sterilization.
5. Create a sterile field which is a work surface area prepared to hold sterile equipment during sterile technique
procedure. The sterile field provides an area in which sterility is continually maintained.
6. Add sterile objects to a sterile field.
The following steps are recommended in adding sterile items to a sterile field without contaminating the
object or the field. Always remember that the area within one inch of the edge of the wrapper is considered, to
be contaminated. A sterile article that touches this area is contaminated and should be discarded.
a. Hold the sterile package in one hand with the flaps up. This is done away from the sterile field.
b. Grasp the outside edges of the sterile wrapper with your free hand in order, to protect the sterility of
the package contents.
c. Unwrap the sterile package. Be careful not to contaminate the inside of the wrapper or the sterile
object.
d. Hold the edges of the sterile wrapper back around your waist so that they will not accidentally drag
across the sterile field. Thus, the hand supporting the sterile object is enclosed by the wrapper.
e. Drop small sterile items directly into the sterile field.
f. Place large items on the field using sterile gloves or sterile transfer forceps.
7. Give sterile items to another healthcare professional. Open sterile packages without contaminating the
contents. Hold the items so that a sterile worker can grasp item without contaminating himself or item. Use the
same procedure as in adding sterile objects to a sterile field.
8. Open and pour sterile liquids. Sterile liquids are necessary for many procedures requiring sterile technique.
a. Lift or unscrew the cap.
i. Do not touch bottle rim and inside cap, as these items are considered sterile.
ii. As you remove the cap, listen for a vacuum release sound. If there is no vacuum release sound,
assume that the liquid is not sterile and get another bottle of liquid to use instead.
b. Hold the cap in your hand or rest the cap upside down on the table (not on the sterile field) since the
outside of the cap is contaminated) so that the inside of the cap does not become contaminated. If the
cap becomes contaminated, it cannot be used to reseal the bottle of sterile liquid and the leftover
portion of the sterile liquid must be discarded.
c. Glove your nondominant hand.
i. Make sure the glove package has not been contaminated (torn, and so forth) and that the
gloves are of the proper size.
ii. Perform a patient care handwash, if you have not already done so.
iii. Place the package on a clean, dry surface.
iv. Peel back the outer wrapper.
v. Remove the inner package and place it so that the end marked “cuff” is toward you.
vi. Grasp the lower corner and open the package to a flat position.
vii. Grasp the lower corner of the package and pull to the side in order, to expose the cuffs.
viii. Using your dominant hand, grasp the cuff of the glove on the same side as your nondominant
hand.
 ix. Remove the glove from the wrapper, step back, and insert your nondominant hand into the
glove.
d. Hold the sterile bottle in your ungloved hand with the label against your palm. This protects the label
from dripping the solution. Also, a clean label can be read easily.
e. If the bottle was opened previously, pour small amount of liquid into a was container, usually an emesis
basin. Pre-pouring will cleanse the lid of the bottle. The container should not be inside the sterile field.
f. Pick up the container into which the liquid is to be poured with your gloved hand and step back from
the sterile field. This is done to keep any liquid from dropping onto the sterile field. If a sterile field
becomes wet, consider it to be contaminated.
g. Hold the bottle about 6 inches above the container into which the liquid is being poured and pour the
liquid slowly in a steady stream into the sterile container. Pouring slowly in a steady stream avoids
splashing.
i. Do not touch the bottle lip against the container. If the lip of the bottle touches the container,
the container will not be sterile.
ii. Do not allow the bottle to pass over the sterile field. If the bottle passes over any part of the
sterile field, then that part of the field is considered contaminated, because a microscopic
organism could have fallen from the bottle or your hand onto the field.
h. Replace the container onto the sterile field.
i. Replace the cap securely on the bottle. If the cap or rim of the bottle becomes contaminated, discard
the bottle.
j. Remove the sterile glove by grasping the portion over the heel of the hand and pulling the glove off.
Discard the glove in an appropriate container.
k. Write the date and time and your initials on the bottle label.
l. Return the bottle to the storage area.
i. Agency policy may require that you discard the bottle rather than reusing it.
ii. Vacuum-packed sterile liquids can normally be used for 24 hours if the bottle is released.
iii. If your ungloved hand or other contaminated object touches the neck of the bottle, inside the
bottlecap, the bottle rim, or the lip of the cap, the rim or cap is considered contaminated, and
you must discard the bottle.
9. Assist with the withdrawal of a sterile solution from a vial. Some sterile liquids that are used as medications for
injection come in small bottles with rubber tops. These tops can be pierced with a sterile in order, to withdraw
the sterile contents. When performing this procedure, you will be assisting a physician, or other medical
personnel who is wearing sterile gloves and cannot touch the outside of the vial because the vial is
contaminated. You, however, will not be gloved. The following are the procedures needed to perform this task:
a. Obtain a correct vial of solution. Check the bottle against the physician’s orders to verify that the
solution is correct (correct name, dosage, and route.
b. Clean the vial stopper with an alcohol swab.
c. Hold the vial firmly with the label up so that the person with the sterile gloved hands can verify that the
solution is the proper one. The gloved person then:
i. Pulls the plunger of the syringe to the amount of solution required.
ii. Inserts the needle through center of rubber stopper.
iii. Pushes the plunger into the syringe to increase air pressure inside vial.
iv. Pulls plunger out to somewhat more than the prescribed level.
v. Withdraws the needle with a quick straight pull. (If the needle touches the outside of the vial,
then the needle is contaminated, and the entire procedure must be done again.)
d. Discard or store vial in accordance with agency policy.
10. Notify healthcare personnel that the sterile field is contaminated. Any individual who observes the
contamination of the sterile field, regardless of rank of position, must immediately notify all individuals
performing the procedure that the sterile field is contaminated and how the contamination occurred.
 DIFFERENCES BETWEEN MEDICAL AND SURGICAL ASEPSIS
PARAMETER MEDICAL ASEPSIS
Focus Cleanliness
Purpose Reduce the transmission of pathogenic
microorganisms from the patient to
another person
Isolation Patients with communicable disease are
isolated from other patients.
zone A zone in the isolation unit is established
as contaminated. Everything within zone
of isolation is considered contaminated.
Nothing goes out of the zone without
being disinfected or wrapped in a clean to
allow handling in a clean zone.
Handwashing or Hands and forearms are washed for 1 to
Hand hygiene 2 minutes to remove surface
contaminants and soil. Hands and
forearms are dried with paper towels.
Gowns Clean gowns are worn to protect the
healthcare worker. The inside of the
gown is clean. The outside of the gown in
contact with the patient and his
environment is contaminated.
Status of patient The patient is the reservoir of infection.
Goals of care Confine disease-causing microorganisms
and prevent its spread to others.
References:
1. https://nurseslabs.com/principles-of-sterile-technique/
2. https://www.youtube.com/watch?v=R8eQ9T0CZNw
3. https://www.youtube.com/watch?v=AmHpnDYzWDs
4. https://www.youtube.com/watch?v=OIPjtclwP6k
5. https://www.youtube.com/watch?v=iwvnA_b9Q8Y
SURGICAL ASEPSIS
Sterility
Prevent the introduction of any
microorganisms into an open wound on
the patient or into a body cavity.
Patients requiring surgery are taken to
the OR.
A zone in the site of operation or
wound is established as a sterile field
item touches an unsterile object, it is
considered contaminated. Only sterile
items are brought into the sterile field.
Hands and forearms are scrubbed for
10 minutes to reduce the bacterial
count on the skin surface. Hands and
arms are dried with sterile towel.
Sterile gowns are worn to protect the
patient from the health care worker.
The outside of the gown in contact with
the sterile field is kept sterile.
Other persons aside from the patient
and his environment are the reservoirs
of infection.
Reduce the number of microorganisms
and prevent the spread of infection to
others.