OPERATING ROOM TECHNIQUE

ASEPSIS & STERILE TECHNIQUE Third line of defense:

MCROBIOLOGIC CONSIDERATIONS Can be acquired naturally or induced therapeutically it

• Knowledge of causative microorganisms
including their modes of transmission, life cycles,
and methods of control is the basis of
prevention of infection
requires actual exposure to the pathogen in some form
during which temporary or quasi-permanent resistance is
attained. Methods include the following:
 Passive immunity

 Active immunity

THREE LINES OF DEFENSE

First line of defense:

Knowledge of how the cycle of infection works is the
Involves generalized good health & incorporates most important element of prevention. Considerations
include but are not limited to the following:
Natural biochemical, mechanical & anatomic protection
through the ff: • Identifying the reservoir of the pathogen
 Skin • Identifying the portal of exit of the pathogen
from the reservoir
 Mucous membranes
• Identifying how pathogens are transmitted
 Reflexes
• Identifying the portal of entry into a susceptible
 Sneeze
host
 Genitourinary / reproductive tracts
• Identifying the invasion of the susceptible host
 Eyes
INFECTIOUS PROCESSES IN THE BODY
 Cellular Level
• changes in Vital signs
 Stomach Acid
• lab tests
 Muscular closure of orifices
• clinical manifestations

RISK FOR EXPOSURE

Second line of defense:
 Surgeon, assistants & scrub person have higher
involves the collaborative effort of several body systems risk by role & proximity because of incidence of
to prevent the proliferation of pathogenic microorganism needle sticks & puncture wound
it includes the following:
 Circulator, environmental services personnel &
 Inflammatory response instrument processors are also at increased risk
for body substance exposure because of
 Antibody production
specimen handling, cleaning processes & other
 Temperature elevation contaminants in the environment.
  Patients is also at risk to include
immunosuppression, an immature immune
system, radiation therapy, burns, diabetes,
nutritional depletion, smoking, chemotherapy for
cancer, older patients, steroid use, sickle cell
disease, alcoholism, liver & kidney disease &
preexisting infection being treated with antibiotic
therapy
TYPES OF PATHOGENIC MICROORGANISMS
 infections may be caused by one or several
combinations of microorganisms; each of the
five main types is described according to
structure, life cycle & mode of transmission
COMMON MICROORGANISMS IN AN OPERATING
ROOM ENVIRONMENT
 Ignaz Semmelweis advocated the value of
handwashing
 Louis Pasteur taught his germ theory that physicians
begin to study the cause of infections and means of
controlling them
 Robert Koch isolated the tubercle bacillus, advocated
the use of bichloride of mercury as an antiseptic
 Joseph Lister pursued the work of Pasteur first to
use carbolic solution on dressings that reduce the
mortality of his patients; He believed infections were
borne
 In Amsterdam, Lister's antiseptic principles of
surgery were truly accepted by the medical
profession
 German surgeons played a role in the transition from
antisepsis to asepsis
 Gustav Adolf Neuber introduced mercuric chloride to
clean his apron; he advocated the scrubbing the
furniture with disinfectant, wearing gowns, boots &
caps and sterilized everything that came in contact
with wounds
 Surgical team is the most common source of
transmission followed followed by contaminated
instrumentation
 Transmission-Based Precautions should be
implemented in the perioperative environment and
in any area with the potential to transmit potentially
pathogenic microorganisms
 Areas critical for the introduction & spread of
microorganisms: semirestricted And restricted areas
 Considering how microorganism proliferate fast
certain advances in aseptic technique & infection
control were introduced that include the following:
 Operating Room ventilation
o Sterilization & disinfection methods
o Improved barriers between sterile, clean &
contaminated surfaces
o Surgical technique
o Antimicrobial prophylaxis
 Despite advances, surgical-site infections (SSI)
continue to cause significant Morbidity & mortality in
surgical patients
Factors to consider when evaluating the reasons for the
emergence of resistant
Microorganisms include the following:
• Inadequate doses of antibiotic
• Improper selection of antibiotic
• Previous use of ineffective antibiotic
• Sequestered infectious site or retained foreign
body
• Inadequate infection control practices
HUMAN-BORNE SOURCES OF CONTAMINATION
• Skin
• Hair
• Nasopharynx
• Human Error
• Cross infection
NONHUMAN FACTORS IN CONTAMINATION
1. Fomites
 contaminated particles are present in the dust
that rests on inanimate objects such as
furniture, OR surfaces, equipment, supplies and
fabrics
 in maintaining an aseptic environment, the
following key points should be considered:
  prompt decontamination of used equipment
& reusable supplies
 prompt disinfection of OR surfaces
 separation of clean and soiled items
 proper packaging & storing of supplies
 placement of dust covers over sterile items
during transport and while in prolonged
storage
2. Air
 microorganisms have an affinity for horizontal
surfaces-floor, from the floor microorganisms
are projected into the air
 an effective ventilation system is essential to
prevent patients and personnel From breathing
potentially contaminated air which can
predispose them to infection
o Community –Acquired Infection
o Communicable Infection
o Spontaneous Infection
o Nosocomial Infection
STANDARD PRECAUTIONS
 established by the CDC (Center for Disease
Control & Prevention) and enforced by OSHA
 formerly referred to as Universal Precautions
 protect health care workers from contact with
blood and body fluids of all patients
 it include considerations for the following:
 All body fluids
 Handwashing
 Barrier clothing
 Handling of used patient care equipment
 Occupational exposure to bloodborne
pathogens
 Patient placement
1. Protective barriers & personal protective
equipment (PPE)
 appropriate barriers prevent contact of the skin
& mucous membranes with blood and body
substances
 other barriers materials must prevent blood &
other fluids from passing through or reaching
the wearer's clothing or body
 include gloves, eyewear, gowns, hair covers &
masks
a. GLOVES:
reduce contamination of hands; Latex, vinyl & other
material: are used in manufacturing of these gloves
(1) Sterile gloves are worn for procedures that
involve the invasion of body tissues when sterile
field is created; double gloving does not prevent
puncture wounds but may be appropriate for
procedures in which the risk of glove tears is
high
(2) Unsterile latex or vinyl examination gloves are
worn for procedures That do not require a
sterile field such as handling specimens
(3) General-purpose utility gloves are worn for
cleaning instruments & for decontaminating &
housekeeping procedures involving potential
blood contact
(4) Gloves are changed after every contact with
patients or contaminated Items; washing gloves
between patient contacts is not an acceptable
practice
(5) The hands are washed immediately after glove
removal
b. MASKS
Protect personnel from aerosols and patients from
droplets, they are worn for all invasive procedures;
specialty masks to filter laser plume; should be changed
immediately if grossly contaminated by a splash of blood
or body fluid
c. EYEWEAR
With shields protects the mucous membranes of the
eyes, & full face shields protect the mucous membranes
of the eyes, nose and mouth, they are worn for
procedures in which blood, bone chips, amniotic fluid,
and the aerosol of other body fluids may splash or be
projected into the eyes; Googles with enclosed sides &
chin-length face offer better protection than do simple
eyeglasses
d. GOWNS/APRON
Made of fluid-resistant material protect the wearer from
a splash with blood & body fluids; a plastic apron may
be worn under a woven fabric gown
e. SHOE COVERS / BOOTS:
Protect the wearer when gross contamination on the
floor can be anticipated; grossly soiled shoe covers or
knee high disposable boots are removed before the
wearer leaves the room
2. Prevention of puncture injuries
Needles, knife blades, and sharp instruments present a
potential hazard for the handler and user
Skin may be punctured or cut if caution is not taken
a. Do not manipulate sharps by hand;
b. use an instrument, such as a heavy hemostat, to
attach and remove the scalpel blade;
c. arm the needle directly from the suture packet
when possible
d. do not bend or break an injection needle
e. Pass needles in a needle holder or use a "neutral
zone" to transfer sharps on field
f. Remove instruments from the surgical field after
use and return them to mayo stand or
instrument promptly
4. Oral procedures
 Blood contaminated saliva and gingival fluid
is expected during dental & surgical
procedures in the oropharyngeal cavity
 Mouth protection, Ambu bags and/or other
ventilation devices should be available for
emergency airway resuscitation
 Respiratory secretions coughed up during
endotracheal procedures are often infectious
5. Care of specimens
 All specimens of blood, body fluids and
tissues should be contained to prevent
leaking during transport to the laboratory
 the outside of the container should be clean
 The circulator while wearing gloves needs to
disinfects the outside of the culture tube
handed from the sterile field or a container if
it has been contaminated
6. Decontamination
 Trash is disposed of by incineration or
sent to a sanitary landfill in sealed
Containers as required by local
ordinances or state regulations
 Trash bags must be leak proof and of
sufficient thickness and strength to
Ensure integrity during transport waste
segregation should be observed
9. Handwashing
 Thorough handwashing with an improved
antimicrobial agent after every contact with a
patient, contaminated items or suspected
contamination protects both patient and
personnel
10. No touching of mucous membranes
 eating and drinking is prohibited in any area
where there is a risk for exposure
 applying lip balm or cosmetics or adjusting
contact lenses in the perioperative environment
significantly increases the risk of exposure
 hand to mouth and hand to eye contact can
contribute to microbial transmission
11. Prophylaxis
 perioperative personnel are encouraged to know
their HIV, HBV, HCV Antibody status
 personnel who participate in invasive procedures
are at risk for bloodborne Exposure and should
have the HBV immunization series

 all instruments are thoroughly cleaned

before sterilization or high level
disinfection,gloves, masks and eyewear are
worn for cleaning procedures

7. Laundry

 soiled woven fabrics should be handled

as little as possible and are transported
to the laundry in leak proof bags
 all laundry is considered contaminated
and should be handled only by glove
hands

8. Waste

 Blood suctioned fluids may be safely

poured down a drain that is Connected
to a sanitary sewer
 A solidifying agent can be added to
disposable suction containers to
Disinfect the produce and convert it
into solid waste

PRINCIPLES OF STERILE TECHNIQUE
 is the foundation of modern surgery
 the patient is the center of the sterile field,
which includes the personnel wearing sterile
attire and the areas of the patient, operating
bed & furniture that are covered with sterile
drapes
 strict adherence to the recommended practices
of sterile technique reflects the surgical
conscience of the perioperative team and is
mandatory for the safety of the patient and
personnel in the environment
Principles of sterile technique are applied in the
following conditions:
1. Prior to operation, materials and supplies to be
used must be sterilized
2. Prior to operation, the number of bacteria in the
skin should be minimized through surgical hand
scrub and skin prep
3. Before surgery, the sterile field shuld be
established by draping the client with sterile
drapes
4. During surgery, sterility should be observed
while handling the sterile supplies and when in
contact with the incision
5. At the end of the operation, the room should be
disinfected.
PRINCIPLES OF STERILE TECHNIQUE
1. The sterile team wears sterile attire
2. When in doubt, discard!
3. Tables are sterile only at the top level
4. Sterile to sterile; unsterile to unsterile
5. Once opened, used at once and do not reuse
6. Below the top of a sterile table is unsterile
7. Sterile table is created as close as possible to
the scheduled time of use
8. Sterile areas must be constantly kept in sight
9. Sterile person should maintain sterility
10. Sterile persons limit contact with sterile areas
11. Unsterile persons avoid sterile areas or reaching
over a sterile field
12. Once the sterile pack or drape is damaged, it
becomes contaminated and unsterile
13. Microorganism must be at a minimum level
14. Sterile persons touch only sterile items or areas,
while unsterile persons touch only unsterile
items or areas
15. Only sterile items are used within the sterile field
16. The edges of anything that encloses sterile
contents are considered unsterile
17. Sterile areas are continuously kept in view
18. The sterile field is created as close as possible to
the time of use
19. Destruction of the integrity of microbial barriers
results in contamination
20. Microorganisms must be kept to an irreducible
minimum
21. Sterile persons keep contact with sterile areas to
a minimum
22. Sterile persons keep well within the sterile area
REMEMBER:
 Always face the sterile field
 Eliminate moisture that causes contamination
 Prevent unnecessary traffic and air current
 Sterile articles unused and opened are no longer
sterile after procedure
 Gowns are considered sterile only from waist to
shoulder level and in front
 Sterile person should pass each other back to
back
 Sterile person faces the sterile area when
passing it
 Sterile person turn his back to a non-sterile
person or area when passing
 Surgeons makes an effort in sponge only once
for mopping, then discard it into a pail
 Sterile packages are laid on dry areas
 The skin cannot be sterilized
 Infected areas are grossly contaminated, avoid
scattering the contamination

 The GIT more especially the colon is

contaminated