◈ ISOLATION

PRECAUTION

◈ 3 Elements in the Transmission of Infection within Hospitals

1. Source

a. Human sources -patients, personnel, or, on occasion, visitors.

b. Patients’ own endogenous flora- bacteria that naturally reside in a closed system

c. Inanimate environmental objects that have become contaminated, including equipment and medications.

2. Host

Person’s immune resistance among persons to pathogenic microorganisms.

3. Transmission

Microorganisms are transmitted in hospitals by several routes, and the same microorganism may be transmitted by
more than one route. There are five main routes of transmission -- contact, droplet, airborne, common vehicle, and
vector-borne.

◈ Main Routes of Transmission

1. Contact transmission- refers to infection that is spread through direct or indirect contact with an infected
person

a. Direct-contact transmission- involves a direct body surface-to-body surface contact and physical transfer
of microorganisms between a susceptible host and an infected or colonized person

b. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object,
usually inanimate

2. Droplet transmission- occurs when droplets containing microorganisms generated from the infected person are
propelled a short distance through the air and deposited on the host's conjunctivae, nasal mucosa, or mouth.

3. Airborne Transmission- airborne droplet nuclei of evaporated droplets containing microorganisms that remain
suspended in the air for long periods of time or dust particles containing the infectious agent.

4. Common Vehicle Transmission applies to microorganisms transmitted by contaminated items such as food, water,
medications, devices, and equipment.

5. Vector-borne Transmission occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit
microorganisms

◈ Fundamentals of Isolation Precautions

1. Hand washing and Gloving

◈ Washing hands between patient contacts and after contact with blood, body fluids, secretions, excretions,
and equipment or articles reduces the contamination risks of transmitting microorganisms from one person
to another or from one site to another on the same patient

Gloving

Purposes:

a. gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when
touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin;
b. Gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be
transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous
membranes and non-intact skin

c. Gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a
patient or a fomite can transmit these microorganisms to another patient.

2. Patient Placement

a. Private room is important to prevent direct- or indirect-contact transmission when the source patient has poor
hygienic habits, contaminates the environment, or cannot be expected to assist in maintaining infection control
precautions to limit transmission of microorganisms (ie, infants, children, and patients with altered mental status)

b. Cohorting- Patients infected by the same microorganism usually can share a room, provided they are not infected
with other potentially transmissible microorganisms and the likelihood of re-infection with the same organism is
minimal.

3. Transport of Infected Patients

Important considerations:

(1) Appropriate barriers (eg, masks, impervious dressings) are worn or used by the patient to reduce the opportunity
for transmission of pertinent microorganisms to other patients, personnel, and visitors and to reduce contamination
of the environment;

(2) Personnel in the area to which the patient is to be taken are notified of the impending arrival of the patient and
of the precautions to be used to reduce the risk of transmission of infectious microorganisms;

(3) Patients are informed of ways by which they can assist in preventing the transmission of their infectious
microorganisms to others.

4. Masks, Respiratory Protection, Eye Protection, Face Shields

A surgical mask generally is worn by hospital personnel to provide protection against spread of infectious large-
particle droplets that are transmitted by close contact and generally travel only short distances (up to 3 ft) from
infected patients who are coughing or sneezing.

Masks, eye protection, and face shields in specified circumstances to reduce the risk of exposures to bloodborne
pathogens

5. Gowns and Protective Apparel

- Gowns and protective apparel are worn to provide barrier protection and to reduce opportunities for
transmission of microorganisms in hospitals.

- Gowns are worn to prevent contamination of clothing and to protect the skin of personnel from blood and
body fluid exposures.

6. Patient-Care Equipment and Articles

- Special handling and disposal of used patient-care equipment and articles are prudent or required,
including the likelihood of contamination with infective material; the ability to cut, stick, or otherwise cause injury
(needles, scalpels, and other sharp instruments {sharps}); the severity of the associated disease; and the
environmental stability of the pathogens involved.

7. Linen and Laundry

soiled linen contaminated with pathogenic microorganisms are laundered in a manner that avoids transfer of
microorganisms to patients, personnel, and environments.

8. Routine and Terminal Cleaning

The room, or cubicle, and bedside equipment of patients on Transmission-Based Precautions are cleaned using the
same procedures used for patients on Standard Precautions, unless the infecting microorganism(s) and the amount
of environmental contamination indicate special cleaning.

◈ Entering and Leaving the Isolation Room

◈ Preparation of the Isolation Room or Area

◈ Ensure that appropriate hand washing facilities and hand-hygiene supplies are available.

◈ Stock the sink area with suitable supplies for hand washing, and with alcohol-based hand rub, near the point
of care and the room door.

◈ Ensure adequate room ventilation.

◈ Post signs on the door indicating that the space is an isolation area.

◈ Keep a roster of all staff working in the isolation areas, for possible outbreak investigation and contact
tracing.

◈ Remove all non-essential furniture and ensure that the remaining furniture is easy to clean, and does not
conceal or retain dirt or moisture within or around it.

◈ Stock the PPE supply and linen outside the isolation room or area (e.g. in the change room). Setup a trolley
outside the door to hold PPE. A checklist may be useful to ensure that all equipment is available.

◈ Place appropriate waste bags in a bin. If possible, use a touch-free bin. Ensure that used (i.e. dirty) bins
remain inside the isolation rooms.

◈ Place a puncture-proof container for sharps disposal inside the isolation room or area.

◈ Keep the patient's personal belongings to a minimum. Keep water pitchers and cups, tissue wipes, and all
items necessary for attending to personal hygiene, within the patient's reach.

◈ Dedicate non-critical patient-care equipment (e.g. stethoscope, thermometer, blood pressure cuff and
sphygmomanometer) to the patient, if possible. Thoroughly clean and disinfect patient-care equipment that
is required for use by other patients before use.

◈ Place an appropriate container with a lid outside the door for equipment that requires disinfection or
sterilization.

◈ Keep adequate equipment required for cleaning or disinfection inside the isolation room or area, and ensure
scrupulous daily cleaning of the isolation room or area.

◈ Set up a telephone or other method of communication in the isolation room or area to enable patients,
family members or visitors to communicate with health-care workers. This may reduce the number of times
the workers need to don PPE to enter the room or area.

◈ Wearing and Removing Personal Protective Equipment

Before entering the isolation room or area:

◈ Collect all equipment needed;

◈ Perform hand hygiene with an alcohol-based hand rub (preferably when hands are not visibly soiled) or soap
and water;

◈ Put on PPE in the order that ensures adequate placement of PPE items and prevents self-contamination and
self-inoculation while using and taking off PPE; an example of the order in which to don PPE when all PPE
items are needed is hand hygiene, gown, mask or respirator, eye protection and gloves,

Leaving the isolation room or area

 ◈ Either remove PPE in the anteroom or, if there is no anteroom, make sure that the PPE will not contaminate
either the environment outside the isolation room or area, or other people.

◈ Remove PPE in a manner that prevents self-contamination or self-inoculation with contaminated PPE or
hands.

◈ Perform hand hygiene with an alcohol-based hand rub (preferably) or soap and water whenever ungloved
hands touch contaminated PPE items.

General Principles in Removing PPE:

a. Remove the most contaminated PPE items first;

b. Perform hand hygiene immediately after removing gloves;

c. Remove the mask or particulate respirator last (by grasping the ties and discarding in a rubbish bin);

d. Discard disposable items in a closed rubbish bin;

d. Put reusable items in a dry (e.g. without any disinfectant solution) closed container; an example of the order in
which to take off PPE when all PPE items are needed is gloves (if the gown is disposable, gloves can be peeled off
together with gown upon removal), hand hygiene, gown, eye protection, mask or respirator, and hand hygiene

◈ Isolation Precautions
You Tube Video Link
https://www.youtube.com/watch?v=VlUWsNC3ibs

///DrCSLumboRN

BLOOD TESTS

Complete blood count (CBC) measures the size, number, and maturity of the different blood cells in a specific
volume of blood.

It measures the types and numbers of cells in the blood, including red and white blood cells and platelets. This test is
used to determine general health status, screen for disorders and evaluate nutritional status.

Component Normal range

Men: 4.32–5.72 million

Red blood cells cells/mcl; women: 3.90–5.03 million
cells/mcl

White blood cells 3,500 to 10,500 cells/mcl

Platelets 150,000 to 450,000/mcl

Men: 13.5–17.5 grams/deciliter

Hemoglobin
(g/dl); women: 12.0–15.5 g/dl
 Men: 38.8–50.0
Hematocrit
percent; women: 34.9–44.5 percent

Abnormal levels of these components may indicate:

1. Nutritional deficiencies, such as vitamin B-6 or B-12

2. Iron deficiency

3. Bone marrow issues

4. Tissue inflammation

5. Infection

6. Heart conditions

7. Cancer

Abnormal red blood cell, hemoglobin, or hematocrit levels may indicate anemia, iron deficiency, or heart disease

Low white cell count may indicate an autoimmune disorder, bone marrow disorder, or cancer

High white cell count may indicate an infection or reaction to medication

Basic Metabolic Panel

This test measures glucose, sodium, potassium, calcium, chloride, carbon dioxide, blood urea nitrogen and creatinine
which can help determine blood sugar level, electrolyte and fluid balance as well as kidney function.

2. Complete metabolic panel

A complete metabolic panel (CMP) includes all the measurements of a BMP as well as additional proteins and
substances related to liver function:

a. Albumin

b. Total protein

c. Alkaline phosphatase (ALP)

d. Alanine aminotransferase (ALT)

e. Aspartate aminotransferase (AST)

f. Bilirubin

Hemoglobin A1C (HbA1c) Test

A hemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to hemoglobin. The test
shows what the average amount of glucose attached to hemoglobin has been over the past three months.

HbA1c results are given in percentages. Typical results are below.

Normal: HbA1c below 5.7%

Prediabetes: HbA1c between 5.7% and 6.4%

Diabetes: HbA1c of 6.5% or higher

Fasting Blood Sugar/ Fasting Plasma Glucose

◈ A blood sugar test measures the amount of a sugar called glucose in a sample of blood.

◈ Glucose is a major source of energy for most cells of the body, including brain cells. Glucose is a building
block for carbohydrates.

◈ Normal value after at least an 8-hour fast: 70-110mg/dl (3.9-6.2 mmol/L)

◈ Confirmation of Diabetes Mellitus: 126 mg/dl (7 mmol/L) or more obtained on 2 or more occasions

◈ Levels ranging from 110-125 mg/dl are considered impaired glucose tolerance

Cholesterol Test

This measures the cholesterol levels in the blood. The test checks the level of the following:

◈ LDL levels. “Bad" cholesterol; the main source of blockages in the arteries.

◈ HDL levels. “Good" cholesterol, HDL helps get rid of LDL cholesterol.

◈ Total cholesterol. The combined amount of low-density lipoprotein (LDL) cholesterol and high-density
lipoprotein (HDL) cholesterol in the blood.

◈ Triglycerides A type of fat found in your blood. According to some studies, high levels of triglycerides may
increase the risk of heart disease, especially in women.

Total Cholesterol Level Category

Less than 200mg/dL Desirable

200-239 mg/dL Borderline high

240mg/dL and above High

High Low

men: < 40 mg/dL; women: < 50

HDL > 60 mg/dL
mg/dL

LDL > 160 mg/dL < 100 mg/dL

 Triglyceride >150 mg/dl < 150 mg/dL

High levels may mean the person is at risk for heart disease

Creatine Kinase Test

This test measures the amount of creatine kinase (CK) in the blood. CK is a type of protein, known as an enzyme. It is
mostly found in the skeletal muscles and the heart, with lesser amounts in the brain.

3 types of CK enzymes:

◈ CK-MM, found mostly in skeletal muscles

◈ CK-MB, found mostly in the heart muscle

◈ CK-BB, found mostly in brain tissue

◈ Troponin.

◈ Higher than normal CK-MM enzymes may mean a muscle injury or disease, such as muscular dystrophy or
rhabdomyolis.

◈ Higher than normal CK-MB enzymes may mean an inflammation of the heart muscle or are having or had a
heart attack.

◈ Higher than normal CK-BB enzymes may mean the person had a stroke or brain injury.

◈ Higher than normal Troponin may mean that the person recently had recently had a heart attack or heart
injury.

Alkaline Phosphatase Test

An alkaline phosphatase test is used to detect diseases of the liver or bones.

High alkaline phosphatase levels in the liver can indicate:

◈ Cirrhosis

◈ Hepatitis

◈ A blockage in the bile duct

◈ Mononucleosis, which can sometimes cause swelling in the liver

◈ Moderately high levels of alkaline phosphatase may indicate conditions such as Hodgkin lymphoma, heart
failure, or a bacterial infection.

◈ Low levels of alkaline phosphatase may indicate hypophosphatasia, a rare genetic disease that affects bones
and teeth. Low levels may also be due to a deficiency of zinc or malnutrition.

◈ Normal Range: 20–140 units per liter (U/L) in healthy adults

Alanine Aminotransferase (ALT, or SGPT) Test

 Alanine aminotranferase (ALT) is an enzyme found in the highest amounts in the liver and kidney however much
smaller amounts of it are also found in the heart and muscles. Injury to the liver results in the release of the
substance into the blood.

ALT is measured to see if the liver is damaged or diseased.

ALT normal range in blood is 7 - 55 units/L depending on the hospital/laboratory

Higher-than-normal levels of ALT can indicate liver damage. Increased levels of ALT may be a result of:

◈ Hepatitis, which is an inflammatory condition of the liver

◈ Cirrhosis, which is severe scarring of the liver

◈ Death of liver tissue

◈ Tumor or cancer in the liver

◈ a lack of blood flow to the liver

Most lower-level ALT results indicate a healthy liver.

Aspartate Aminotransferase (AST, or SGOT) Test

An aspartate aminotransferase (AST) test is often part of an initial screening for liver disease (with ALT/SGPT). This
also helps in heart diseases to diagnose acute myocardial infarction.

AST is found in many tissues throughout the body, including the liver, heart, muscles, kidney, and brain. If any of
these organs or tissues is affected by disease or injury, AST is released into the bloodstream.

Age U/L

Newborn 25 to 75

Infants 15 to 60

Adult 8 to 20

>60 years Male = 11 to 60

Female = 10 to 20
 Clinical Condition The Rise In SGOT Level

With Reference To The Normal Value

Viral hepatitis and liver diseases may reach 100 times

Infectious hepatitis ALT > AST

Toxic hepatitis Extremely high level

Thyroid Panel
Infectious mononucleosis 20 times
It is a thyroid
Intrahepatic cholestasis lower values

Extrahepatic cholestasis Increased value

Cirrhosis Normal to 4 to 5 times

Metastatic carcinoma 5 to 10 times

Acute myocardial infarction 4 to 5 times

Fatal myocardial infarction 10 to 15 times

Progressive muscular dystrophy May reach 8 times

Dermatomyositis May reach 8 times

Pulmonary emboli 2 to 3 times

Acute pancreatitis 2 to 5 times

Crushed muscular injury, Gangrene 2 to 5 times

Hemolytic diseases 2 to 5 times

function test that checks how well the thyroid is producing and reacting to certain hormones, such as:

◈ Triiodothyronine (T3). Along with T4, this regulates the heart rate and body temperature.

◈ T3 resin uptake (RU). This measures how well a hormone called thyroxin-binding globulin is binding.

◈ Thyroxine (T4). Along with T3, this regulates metabolism and growth.

◈ Thyroid-stimulating hormone (TSH). This helps regulate the levels of hormones the thyroid releases.

Normal values:

◈ T3:100–200 nanograms per deciliter of blood (ng/dL)

◈ T3RU:depends on T3 levels (will be low if T3 levels are high, and vice versa)

◈ T4: 5.0–12.0 micrograms per deciliter (μg/dL)

◈ TSH:0.4–4.0 milli-international units per liter of blood (mIU/L)

A high level of T4 indicates an overactive thyroid (hyperthyroidism).

Abnormally high levels most commonly indicate presence of Grave’s disease which is often associated with
hyperthyroidism.

Abnormally low levels of TBG often indicate a problem with the kidneys or with the body not getting enough protein.
Abnormally high levels of TBG suggest high levels of estrogen in the body.

Abnormally high levels of TSH suggest primary hypothyroidism or possibly Goiter

Coronavirus (Covid-19) Test

Rapid Antibody Testing

- Blood test that identifies antibodies produced by the immune system. This is the body's response as it
develops immunity to the virus.

-This test can read two kinds of antibodies: the immunoglobulin M (IgM), which is the early immune
response, and the immunoglobulin G (IgG), which is the delayed immune response.

Results and implications:

IgM can be found in patients who are positive for COVID-19 by RT-PCR and are still infected and infectious.

IgG is found in those previously tested as positive, but have recovered.

Coronavirus (Covid-19) Test

Real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) test- popularly known as the Swab test

-The test can detect the virus up to 2 days before symptoms start to appear.

-This can also pick up on the remnants of the virus that are no longer viable — as in the case of a confirmed
patient who has recovered

◈ A negative result means the test did not find coronavirus.

◈ A positive result means the person had coronavirus when the test was done.

Sputum Test/ Sputum Culture

Bacteriologic test of the sputum to determine presence of respiratory tract infection or other lung-related disorders

Flora commonly found in the respiratory tract include alpha-hemolytic streptococci, Neisseria species and
diphtheroids. The presence of normal flora doesn’t rule out infection

Abnormal and significant finding commonly include presence of Mycobacterium tuberculosis..

Other abnormal findings

◈ Off-white, yellow or green sputum can indicate pneumonia or bronchitis

◈ Red or rusty can indicate presence of bleeding or a more serious condition that needs more testing

◈ Grey or back can indicate that the person is a smoker or someone who works in a sooty place (like a coal
mine)
Stool Tests

Common Types:

◈ A gFOBT (Guaiac-based Fecal Occult Blood test) uses a chemical reaction on a paper card to find traces of
minute blood in the stool

◈ A FIT (Fecal Immunochemical Test) uses specific antibodies for human blood to find traces of minute blood in
the stool.

◈ A stool culture looks for bacteria that are not normally found in the GI tract.

◈ Stool fat testing looks for extra fat in the stool to see if the body is having trouble absorbing fat from food.

◈ Fecal Analysis will assess for presence of disease in the gastrointestinal (GI) tract evidenced in stool samples;
Stool evaluation and examination for ova and parasites, rotavirus antigen, Clostridium difficile toxin

◈ Normal stool usually appears brown, soft and well-formed in consistency. It does not contain blood, mucus,
pus or harmful micro-organisms.

◈ Abnormal results from different types of tests may be caused by:

➢ Inflammation of the intestine, such as Ulcerative Colitis or Crohn’s disease

➢ Hemorrhoids (enlarged, swollen veins inside or outside of the anus)

➢ Polyps (growths attached to the colon or rectum)

➢ Anal fissures (thin tears in the lining of the anus)

➢ Peptic ulcers

➢ Infection

➢ Parasites

➢ Digestive conditions, such as not absorbing certain fats or other nutrients

➢ Use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS)

➢ Cancer

Characteristic Normal Result

Appearance Solid and formed

Color Brown

Epithelial cells Few to moderate

Fecal fat See "Fecal Fat" study

Leukocytes (WBCs) Negative

Meat fibers Negative

Occult blood Negative

Reducing substances Negative

Trypsin 2+ to 4+

Ova and parasites (O&P) No presence of parasites, ova, or larvae

Rotavirus Negative

Clostridium GDH, toxin A Negative

or toxin B
Stool findings (Physical features) Possible Causes

1. Diarrhea mixed with blood and mucous Typhoid, Amoebiasis, and large colon carcinoma

2. Diarrhea mixed with Pus and mucous Ulcerative colitis, Salmonellosis, Intestinal tuberculosis, Shigellosis,
Regional enteritis, and acute diverticulitis

3. Patty stool with high-fat contents Cystic fibrosis and CBD – obstruction

4. Formed stool with attached mucous Constipation, Mucous colitis, and excessive straining

5. Small, hard dark balls like Constipation

6. Clay-colored, pasty, and little odor Bile duct obstruction, and barium ingestion.

7. Black, tarry, sticky, watery, voluminous Upper GI tract bleeding, Noninvasive infections like Cholera,
Staphylo.coccal food poisoning, and Toxigenic E. Coli and
Disaccharidase deficiency

Cerebrospinal Fluid Analysis

Test to assist in the differential diagnosis of infection or hemorrhage of the brain:

◈ Infectious diseases of the brain and spinal cord including meningitis and encephalitis;

◈ Autoimmune disorders, such as Guillain-Barré Syndrome and multiple sclerosis

◈ Bleeding in the brain

◈ Brain tumors

.
 Conventional
Lumbar Puncture Units SI Units

Color and appearance Crystal clear

Protein (Conventional Units ×

10)

Older adult 15–60 mg/dL 150–600 mg/L

Glucose (Conventional Units ×

0.0555)

Adult/older adult 40–70 mg/dL 2.2–3.9 mmol/L

Lactic acid (Conventional Units ×

0.111)

Adult Less than 25.2 Less than 2.8 mmol/L

mg/dL

IgG (Conventional Units ×

10)

Less than 3.4 Less than 34 mg/L

mg/dL

Lumbar Puncture Conventional Units SI Units

Myelin basic protein (Conventional

Units × 1)

Less than 4 ng/mL Less than 4 mcg/L

Oligoclonal bands Absent

Gram stain Negative

India ink Negative

Culture No growth

RBC count 0 0

WBC count (Conventional

Units × 1)
 5 yr–adult 0–5/microL 0–5/mm3

VDRL Nonreactive

Cytology No abnormal cells

seen

WBC Differential Adult

Lymphocytes 40%–80%

Monocytes 15%–45%

Neutrophils 0%–6%

Critical Findings

◈ Positive Gram stain, India ink preparation, or culture

◈ Presence of malignant cells or blasts

◈ Elevated WBC count

◈ Adults: Glucose less than 37 mg/dL (SI: Less than 2.1 mmol/L); greater than 440 mg/dL (SI: Greater than 24.4
mmol/L)

◈ Children: Glucose less than 31 mg/dL (SI: Less than 1.7 mmol/L); greater than 440 mg/dL (SI: Greater than
24.4 mmol/L)

Arterial Blood Gas (ABG) Analysis

Purposes:

◈ To evaluate the efficiency of pulmonary gas exchange;

◈ To assess the integrity of the ventilatory control system;

◈ To determine the acid-base level of the blood

◈ To monitor respiratory therapy

Normal ABG Values fall within the following ranges:

 PaO2 80-100 mmHg

PaCo2 35-45 mmHg

pH 7.35-7.45

o2CT 15%-23%

SaO2 95-100%

HCo2 22-26 mEq/L

RESULTS FINDINGS

Low Pao2, O2CT, and Sao2 levels and a Respiratory muscle weakness or paralysis, respiratory center inhibition
high Paco2 (from head injury, brain tumor, or drug abuse), and airway obstruction
possibly from mucus plug or a tumor.

Low Pao2, O2CT, and Sao2 but Paco2 Pneumothorax, impaired diffusion between alveoli and blood
normal

Low O2CT – with normal Pao2, Sao2 Severe anemia, decreased blood volume, and reduced hemoglobin
and Paco2 values oxygen carrying capacity.

SURGICAL ASEPSIS
◈ Asepsis

◈ Aseptic technique is a process or procedure used to achieve asepsis to prevent the transfer of
potentially pathogenic micro-organisms to a susceptible site that may result in the development of
infection (Wilson, 2019).

◈ An aseptic technique is required for many clinical interventions including wound dressing and
insertion of invasive devices, as well as the maintenance of these devices (Loveday et al, 2014).

◈ Surgical Asepsis
 ◈ Surgical asepsis includes procedures to eliminate, rather than reduce, micro-organisms from an area
and is practised by surgical teams and nurses in operating theatres and procedure areas, including
interventional radiology (NICE, 2012).

◈ Surgical asepsis, also called “aseptic/sterile technique,” eliminates microorganisms before they can
enter an open surgical wound or contaminate a sterile field.

◈ Surgical asepsis is always practiced in operating rooms, special procedure or diagnostic areas, burn
units, and in labor and delivery areas. It is also used during invasive procedures at the bedside, such
as inserting chest tubes, central lines, and catheters.

Principles of Surgical Asepsis

Safety considerations:

◈ Hand hygiene is a priority before any aseptic procedure.

◈ When performing a procedure, ensure the patient understands how to prevent contamination of equipment
and knows to refrain from sudden movements or touching, laughing, sneezing, or talking over the sterile
field.
◈ Choose appropriate PPE to decrease the transmission of microorganisms from patients to health care
worker.
◈ Review hospital procedures and requirements for sterile technique prior to initiating any invasive procedure.
◈ Health care providers who are ill should avoid invasive procedures or, if they can’t avoid them, should
double mask.
◈ All personnel involved in an aseptic procedure are required to follow the principles and practice set forth by
their specific institutions.
◈ These principles must be strictly applied when performing any aseptic procedures, when assisting with
aseptic procedures, and when intervening when the principles of surgical asepsis are breached.
◈ It is the responsibility of all health care workers to speak up and protect all patients from infection.

Principle Additional Information

1. All objects used in a sterile field must be Commercially packaged sterile supplies are marked
sterile. as sterile; other packaging will be identified as
sterile according to agency policy.

Check packages for sterility by assessing intactness,

dryness, and expiry date prior to use.

Any torn, previously opened, or wet packaging, or

packaging that has been dropped on the floor, is
considered non-sterile and may not be used in the
sterile field.

2. A sterile object becomes non-sterile when Sterile objects must only be touched by sterile
touched by a non-sterile object. equipment or sterile gloves.

Whenever the sterility of an object is questionable,

consider it non-sterile.

Fluid flows in the direction of gravity. Keep the tips

of forceps down during a sterile procedure to
prevent fluid travelling over entire forceps and
potentially contaminating the sterile field.
3. Sterile items that are below the waist level, or Keep all sterile equipment and sterile gloves above
items held below waist level, are considered to waist level.
be non-sterile.
Table drapes are only sterile at waist level.

4. Sterile fields must always be kept in sight to Sterile fields must always be kept in sight
be considered sterile. throughout entire sterile procedure.

Never turn your back on the sterile field as sterility

cannot be guaranteed.

5. When opening sterile equipment and adding Set up sterile trays as close to the time of use as
supplies to a sterile field, take care to avoid possible.
contamination. Do not reach over the opened
Stay organized and complete procedures as soon as
sterile pack.
possible.

Place large items on the sterile field using sterile

gloves or sterile transfer forceps.

Sterile objects can become non-sterile by prolonged

exposure to airborne microorganisms.

6. Any puncture, moisture, or tear that passes

through a sterile barrier must be considered Keep sterile surface dry and replace if wet or torn.
contaminated.

7. Once a sterile field is set up, the border of one

Place all objects inside the sterile field and away
inch at the edge of the sterile drape is
from the one-inch border.
considered non-sterile.

8. If there is any doubt about the sterility of an Known sterility must be maintained throughout any
object, it is considered non-sterile. procedure.

9. Sterile persons or sterile objects may only The front of the sterile gown is sterile between the
contact sterile areas; non-sterile persons or shoulders and the waist, and from the sleeves to
items contact only non-sterile areas. two inches below the elbow.

Non-sterile items should not cross over the sterile

field. For example, a non-sterile person should not
reach over a sterile field.

When opening sterile equipment, follow best

practice for adding supplies to a sterile field to avoid
contamination.

Do not place non-sterile items in the sterile field.

10. Movement around and in the sterile field Do not sneeze, cough, laugh, or talk over the sterile
must not compromise or contaminate the sterile field.
field.
Maintain a safe space or margin of safety between
sterile and non-sterile objects and areas.

Refrain from reaching over the sterile field.

Keep operating room (OR) traffic to a minimum, and

keep doors closed.
 Keep hair tied back.

When pouring sterile solutions, only the lip and

inner cap of the pouring container is considered
sterile. The pouring container must not touch any
part of the sterile field. Avoid splashes.

SURGICAL GOWNING AND GLOVING

INTRODUCTION

◈ Scrubbing, gowning, and gloving of surgical personnel are important elements in the preparation of an
aseptic environment for the patient and surgical team.

◈ Scrubbed personnel don sterile gowns and sterile surgical gloves over surgical attire to prevent
microorganisms on their hands and clothing from being transferred to patients undergoing invasive
procedures.

◈ The sterile gown and gloves also serve to protect the hands and clothing of surgical personnel from
microorganisms that are present in the patient or the environment.

Surgical Attire

A preliminary step in the processes of scrubbing, gowning, and gloving is ensuring that proper surgical attire is worn.
All members of the surgical team are responsible for knowing and following facility policies on surgical attire:

a. Surgical attire should be clean, freshly laundered, and facility approved for use only within the surgical suite.

◈ Surgical attire should be changed daily or more frequently, if it becomes soiled. Soiled surgical attire should
be placed in designated containers after use.

◈ The surgical attire selected should completely cover other garments worn beneath them.

◈ If a two-piece pantsuit is worn, the top of the scrub suit should be secured at the waist, tucked into the
pants, or fit close to the body

◈ Personnel should cover all head and facial hair, including sideburns and necklines, when in the semi-
restricted and restricted areas of the surgical suite.

◈ Masks must be worn in the restricted areas of the OR suite when open sterile items and equipment are
present. The mask should fully cover both nose and mouth and be secured to conform to facial contours and
prevent venting.

◈ In addition to providing proper surgical attire, personal protective equipment (PPE) should be available and
used to protect personnel from hazardous conditions in the semirestricted and restricted areas of operating
suite.

Scrubbing Procedure

The scrub person performs the surgical hand scrub before donning sterile gown and gloves.

Before the surgical hand scrub, the scrub person should open the gown package containing a sterile gown, towel,
and gloves and place them on a table in the OR.
To prevent possible contamination of the sterile field, the main instrument table should not be used for this
purpose.

Self-Gowning Procedure

Picking up the Gown

1. With one hand, pick up the entire folded gown from the wrapper by grasping the gown through all
layers, being careful to touch only the inside top layer which is exposed.
2. Once your hands are securely pinching the gown in these slots, step back from the shelf and allow
the gown to drop.
3. Make sure the gown does not touch any surrounding unsterile objects

Opening the Gown

Inserting arms into the sleeves of the gown

4. Grasp the inside shoulder seams and open the gown with the armholes facing you
5. Carefully insert your arms part way into the gown one at a time, keeping hands at shoulder level
away from the body.
6. Slide the arms further into the gown sleeves and when the fingertips are level with the proximal
edge of the cuff, grasp the inside seam at the cuff hem using thumb and index finger. Be careful
that no part of the hand protrudes from the sleeve cuff
7. Put your hands into the sleeves
8. Slide your arms further down the gown sleeves

Fastening the gown

8. A theater assistant will fasten the gown behind you, positioning it over the shoulders by grasping the
inside surface of the gown at the shoulder seam. The theatre assistant’s hands should only ever be in
contact with the inside surface of the gown.
9. The theatre assistant then prepares to secure the gown at the neck and upper back. Gowns differ in
how they are secured, but most with have either ties, buttons or velcro tabs.
a. An assistant will fasten the gown behind you. A final tie will also be done by the assistant

Tying a disposable sterile gown

1. There is a cardboard slip holding two ties together across the front of the gown.

2. Detach the cardboard slip from the short tie, ensuring you keep hold of the short tie in your left hand.

3. Now pass the cardboard slip to the theatre assistant, ensuring not to make direct contact with their hand.

4. They will pass the tie around your back – now take the tie, and let them pull the cardboard off the tie so that you
can tie a bow at your waist

5.Detach the tie from the cardboard and tie a knot

◈ GLOVING TECHNIQUE

1. Open the inner glove packet that you previously dropped onto your sterile field.

Pick up one glove by the folded cuff edge with your sleeve-covered hand

3. Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing towards you. The
palm of the hand inside the gown sleeve must be facing upward toward the palm of the glove.
 ◈ Place the glove’s rolled cuff edge at the seam that connects the sleeve to the gown cuff. Grasp the bottom
rolled cuff edge of the glove with the thumb and index finger of the hand the glove is on top of.

◈ Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing towards you.

4. While holding the glove’s cuff edge with one hand, grasp the uppermost edge of the glove’s cuff with the opposite
hand.

5. Continuing to grasp the glove, stretch the cuff of the glove over the hand.

◈ Using the opposite sleeve covered hand, grasp both the glove cuff and sleeve cuff seam and pull the glove
onto the hand. Pull any excessive amount of glove sleeve from underneath the cuff of the glove.

Pull the glove over the hand.

6. Using the hand that is now gloved put on the second glove in the same manner. Check to make sure that each
gown cuff is secured and covered completely by the cuff of the glove.

Pick up the glove

Place it on the sleeve, fingers pointing towards you

Pull the gloves over the hand

7. Adjust the fingers of each glove as necessary so that they fit appropriately.

Key Points

Keep your hands in your sleeves so that you do not touch the glove on the outside of the gown with your bare
hands.

Keep your hands above your waist and in front of you

Ensure you do not touch anything around you that is not sterile – this includes your face, mask, and hair cap.