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Interactive Training CD for Medical Students

Reproductive System
Module :

Infection Prevention: A- and Antiseptic Techniques


in Surgical Setting
Reproductive System,
Medical School of Universitas Padjadjaran,
Bandung
2005
MIR-C Corporate

Production Team:

Director
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.)
Main contributors
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Yayat Ruchiyat, MD, FINACS (Dig.)
Warko Karnadihardja, MD, FINACS (Dig.)
Nurhayat Usman, dr., SpB-KBD
Lisa Hasibuan, MD
Nina K. Poetri T., SKp,
Dadang Sunarya AMK
Dedy Rusnadi AMK,
Alia Rahmi AMK,
Editorial Team
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Casting
: Kiki Lukman, MD, MSc, FINACS (Dig.)
Artistic
: MIR-C Corporate
Productions : Medical School of Universitas Padjadjaran
Bandung

Credits
Special

thanks to:
Central Operating Theatre Unit of
Hasan Sadikin General Hospital

Infection Prevention Module


Introduction
Infection control
Antiseptic techniques
Operating Theater
Aseptic techniques

Introduction
Description
Objectives

Description
Infection

Prevention in Surgical
Setting is one of important
preventive methods in order to
achieve infection control in clinical
and surgical practices.

Objectives
The

aims of this method are :

To minimize surgical site infection


To protect health personnel
To improve wound healing
To minimize disability, morbidity, &
mortality
To reduce the cost of hospital care

Specific Learning Objectives :


To describe the definition and

history of
sterilization, disinfection, decontamination,
anti and a - septic techniques.
To describe six methods of sterilization.
To describe three categories of surgical
instruments
To describe 6 rules of aseptic techniques

Specific Learning
Objectives :
To perform aseptic techniques correctly,

including (P5):

Applying surgical attire


Hand washing
Surgical scrubbing
Gloving
Surgical Gowning

Definition:
Sterilization : Processes by which all pathogenic
& non pathogenic microorganisms, including
spores, are killed.
Disinfection: Chemical or physical process of
destroying all pathogenic microorganisms,
except spore bearing ones; used for inanimate
objects, but not on tissues.

Definition:
Decontamination : Process or method by which all
contaminated materials that can cause diseases are
removed.
Aseptic techniques : Methods by which contamination
with microorganisms is prevented.
Antiseptic techniques: Prevention of sepsis by the
exclusion, destruction, or inhibition of growth and
multiplication of microorganisms from body tissues and
fluids.

Infection Control

Why

should we apply a and antiseptic


techniques ?

Historical backgrounds :
Ignas Sammelweis (1818 - 1865)

Puerperal fever increased maternal mortality


Hand scrub with chlorinated-lime solution prior to
examination.
Father of nosocomial infection.
Louis Pasteur (1860)

Discover the process of fermentation by microorganisms


Germ theory: against spontaneous generation theory.

Historical backgrounds :
Joseph Lister (1865)

Use carbolic acid solution on surgical dressing in


the operating room mortality (Listerization)
Father of modern surgery (Antiseptic technique)
Ernst

Von Bergmann (1886)

Introduced steam sterilizer


Basic of sterilization
aseptic technique
Later: pressure & vacuum steam sterilizer was developed

Methods of Infection
control
Anti

septic techniques

Design

and traffic patterns of the


operating theatre

Aseptic

techniques

Anti septic techniques

Sterilization
The objective of modern surgery
For inanimate objects
Problem :

Some items are not heat resistance

Techniques of
Sterilization
Physical:

Heat
Radiation/ ultraviolet ray
Boiling water
Ultrasound
Chemical:
Liquid
Gas

Heat Sterilization
Dry :

Commonly cause damage


For powder, oils, and jelly
Moist :

Steam
High pressure spores
Vacuum
constant temperature
Autoclave

Chemical Sterilization
Generally as disinfection
Mechanism of action :

Protein coagulation
Enzyme denaturation in cells
Lysis
Depend on : number of microorganisms, soiling,

concentration, and temperature.

Solutions

Jodium and Jodophor


Good bactericide, but irritant
Mixture : povidone-jodine 10%
Alcohol Solution of 70% or 90%
Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)
Spores are killed within 3 hours

Solutions
Hexachloropene (Halogenated phenol)

Bacterio-static, particularly Gram (+) bacteria


For scrubbing
Chlorhexidine gluconate

Bactericide : Gram (+) & (-).


Good for antiseptic

Gas Sterilization

Formaldehyde
Ethilene-oxide
- propionolactone

Boiling Water
Mild boiling
Vigorous boiling
More active, if

2% sodium-carbonate or 0,1 % sodiumhydroxide being added

The Operating Theater

Transitional
Zone

Clean
Zone
Semi
Restricted
Area

S
C
R
U
B
S
U
I
T

Restricted area

Sterile
core

Traffic patterns of Operating


Theatre

The use of aseptic principles requires


regulation of traffic and flow patterns of the
personnel, patient, equipment, and supplies in
operating theatre

Aims : to protect the safety and privacy of


patients and the cleanliness and integrity of the
environment.

unrestricted area

Elevators

Corridors
outside
surgical
suite

unrestricted area

Entrance

Reception
desk

Patient
suite

Transitional Zone
(Video)

Locker
room

Dressing
room

Clean Zone (Video)

Surgical
suite and
corridors

Sterile core

Scrub Area (Video)

Sterile Core (Video)

Putting on surgical
attire
In

the semi & restricted area:


Scrub suit : shirt & trousers
Hair covering: surgical cap/hood
Masks : disposable/ re-useable
Goggle (optional): protective eyewear
Shoe covers

are compulsory

Surgical attire

Male
personnel

Female
personnel

Personnel
with veil

Surgical Instruments in the Operating


Theatre
Critical items :

Sterile, because of being used for penetrating


skin or mucosa
Semi critical items :

In contact with skin or mucous membrane


Non critical items :

Aseptic techniques

Aseptic techniques
1.
2.
3.
4.
5.
6.

Rules at clean zone


Procedures in sterile area
Talk as necessary
Restrict unnecessary movements
Sterile instruments, remove non sterile one
Avoid & Replace wet surgical drapes/towels

Hand washing
Indications:

Between patient contacts


Before performing or assisting with invasive
procedures
Before taking care of particularly susceptible
patients
Before and after touching wounds
Immediately after gloves are removed

Hand washing
Before and after performing sterile procedures
After contact with blood or body substances, mucous
membranes, soiled linen, waste, or contaminated
equipment.
Between tasks at different body sites on the same
patient to prevent cross contamination
After taking care of infected patient
After touching contaminated inanimate sources

Hand washing
Preparation

The

procedure

Surgical Scrubbing
Procedure

Purposes:
To remove debris and transient organisms
from the nails, hands, and forearms.
To reduce the resident microbial count to a
minimum.
To inhibit rapid rebound growth of
microorganisms.

Purposes:
To minimize the re-growth of microorganisms
for the length of the procedure.
To reduce the numbers of microorganisms on
hands
To reduce contamination of the operative site
by recognized or unrecognized breaks in
surgical gloves.

Preparation:

Recognizing glove sizes

Actual procedure:
Strokes technique

Rinsing hands &


arms
Scrubbing with
antiseptic solution
Rinsing arms
Scrubbing with
brush or sponge
Rinsing arms
Scrubbing with
antiseptic solution
Drying arms

Actual procedure:
Five minute technique

Gowning

The goal:
to ensure a safe, protective, and
aseptic environment to the patient and
the surgical team.

Gowning & closed gloving


techniques
Drying hands with

sterile towel
Applying gown
Closed gloving

technique

The final step of the aseptic


techniques before performing surgery.
Sterile gloves are worn to permit the
wearer to handle sterile supplies or
tissues of the operative wound.

Sterile gloves establish a shield that


protects the patient from contamination
by flora from the hands of health care
workers.

Open

technique

Closed technique

Skin preparation

The goals:

to cleanse the skin and bring both the


resident and transient bacterial counts to an
irreducible minimum, therefore reducing the
risk of wound contamination and subsequent
surgical site infection.

performed just before the surgical


incision has been performed.

Skin preparation

Skin

painting

Skin

draping

Ready for surgery

Gown and gloves


removal
After surgery:

Gown, Gloves
removal

Simultaneous
removal