Topic 4: SURGICAL ASEPSIS
SURGICAL ASEPSIS
➢ a system of practices to remove all microorganisms from an object / area and to prevent new
microorganisms from contaminating it.
Sterilization
➢ complete elimination of all microorganisms including spores from an item or area.
METHODS OF STERILIZATION:
1. Moist Heat: use of steam under
pressure where temperature exceeds
boiling point
E.g. Autoclave – most efficient method
but not for sharp instruments
2. Dry Heat Sterilizer: Operates like an
oven used to sterilize sharp instruments
3. Radiation:
➢ Used to sterilize drugs, food, and
other heat sensitive items
➢ Makes use of ionizing radiation to
penetrate deeply into objects
➢ Disadvantage: Highly expensive and
can cause sterility among personnel
INDICATIONS FOR STERILE
TECHNIQUE:
 When skin is intentionally perforated/
incised like in DR, OR
 When skin is diseased / injured (burn)
4. Boiling Water: Least expensive & least
efficient because some spores resist
boiling point.
5. Chemical:
a. Gas Autoclave
b. Disinfectant – used to eliminate
microbes on inanimate objects and it
is harmful to tissues
▪ E.g. Lysol, cidex
c. Antiseptic – used on skin/tissues
▪ E.g. Betadine, ROH 70%, hydrogen
peroxide 10%
Both have bactericidal and
bacteriostatic properties
 When a catheter / surgical instrument is
inserted into a body cavity that is
considered sterile
STERILE FIELD
➢ A microorganism free area established
by:
o Using the innermost side of a sterile
wrapper
o Using a sterile drape
➢ Maintain a sterile field by:
o Wrapping equipment in a
o variety of materials like plastic,
paper, glass
PRINCIPLES OF SURGICAL ASEPSIS
1. All objects in the sterile field must be
sterile
2. Sterile objects become unsterile when
touched by unsterile objects
3. Sterile items that are out of vision or
below the waist level of the nurse must
be considered unsterile
4. Sterile objects become unsterile by
prolonged exposure to airborne
microorganisms
5. Fluids flow in the direction of gravity
6. Moisture that passes thru a sterile object
draws microorganisms from unsterile
surfaces above or below it to the sterile
surface by capillary action
7. The edges of a sterile field are
considered unsterile
8. The skin cannot be sterilized and is
therefore unsterile
9. Conscientiousness, alertness & honesty
are essential qualities in maintaining
surgical asepsis
Basic principles of Aseptic Technique
All materials in contact with the surgical wound and used
within the sterile field must be sterile.
Sterile surfaces or articles may touch other sterile surfaces
or articles and remain sterile; contact with unsterile objects
at any point renders a sterile area contaminated.
Gowns of the surgical team are considered sterile in front
the chest to the level of the sterile field.
Sterile drapes are used to create a sterile field. Only the
top surface of a draped table is considered sterile.
Items should be dispensed to a sterile field by methods
that preserve the sterility of the items and the integrity of
the sterile field.
The movements of the surgical team are from sterile to
sterile areas and from unsterile to unsterile areas.
Scrubbed persons and sterile items contact only sterile
areas; circulating nurses and unsterile field items contact
only unsterile areas.
Movement around a sterile field must not cause
contamination of the field. Sterile areas must be kept in
view during movement around the area. At least a 1-foot
distance from the sterile field must be maintained to
prevent inadvertent contamination.
Whenever a sterile barrier is breached, the area must be
considered contaminated. A tear or puncture of the drape
permitting access to an unsterile surface underneath
renders the area unsterile. Such a drape must be
replaced.
Every sterile field should be constantly monitored and
maintained. Items of doubtful sterility are considered
unsterile. Sterile fields should be prepared as close as
possible to the time of use.
Additional principles
o Tables are sterile only at table level.
o Unsterile persons avoid reaching over a sterile field;
sterile persons avoid leaning over an unsterile area.

DO’S AND DONT’S

1. Do keep your hands above your waist.
2. Don’t reach over the sterile field.

3. Don’t touch anything in the sterile field with your

bare hands.

4. Don’t talk over the sterile field

5. Don’t turn your back on the sterile field.