1.SURGICAL ASEPSIS Prepared by, K.THILAGAVATHI,M.Sc(N)., Lecturer

2. SURGICAL ASEPSIS Refers to the procedures used to keep theobject or areas sterile or completely free from micro organisms. In surgical asepsis all practices aredirected to the elimination of both pathogenic and nonpathogenic microorganisms. 3. Principles in surgical asepsis Principles Always face the sterile field. Do not turn back or side on a sterile fieldRationale Sterile objects which are out of vision are considered questionable and their sterility cannot be guaranted.Keep sterile equipment above Waist level and table level are your waist level or above table considered margins of safety level. and will promote maximum visibility of the sterile field. Do not speak, sneeze and cough over a sterile field.To prevent or droplet infection.Never reach across sterile fieldWhen a nonsterile object is held above a sterile object, Gravity causes micro organisms to fall into the sterile field. 4. PrinciplesRationaleKeep the unsterile objects Micro organisms may be away from the sterile field. transferred whenever a non sterile object touches a sterile field. Keep the sterile field dryMicro organisms do not pass easily through a dry surface.The edge of the sterile field is considered unsterile.Proximity to a contaminated area makes sterilty doubtful.Handle liquids cautiously near the sterile field or prevent drapes or wrappers from becoming wet.When a liquid wets it connects a nonsterile field with a sterile field. 5. Principles Rationale Each sterile supply should To ensure sterility. be clearly labeled as to its contents, time and date of sterilization.Never assume that a object is sterile. Always check the sterility expiration date. Avoid sweeping and dusting when the sterile objects are opened.Sterility of an object wrapped in paper or cloth becomes doubtful after 4 weeks. Micro organisms travel in the dust particlesPut on mask, Wash hands, put on gowns and gloves before handling sterile supplies.To prevent contamination. 6. PROCEDURES INCLUDED IN SURGICAL ASEPSIS Surgical hand scrub Donning a sterile gown Applying and removing a sterilegloves 7. 1.Surgical hand scrub Purpose : Remove as many micro organismsfrom the hands as possible before the sterile procedure. 8. 1.SURGICAL HAND SCRUB 9. Equipment Warm running water Antiseptic Soap Solution Hand brush stored in a sterilecontainer Transferring forceps Sterile towel 10. Steps of the procedure 1.Makesure fingernails are short,clean,healthy.Nail polish should be removed. 2.Remove jewelries(Rings, Bracelets). 3.Apply personal protective equipment(PPE) includes surgical shoe covers,Cap,Facemaskand protective eyewear. 11. 4.Open disposable brush impregnated with antimicrobial soap5.If no disposable brush is not available/some hospital use brush sterilized and stored in the small bin. 12. 6.Use a transferring forceps to pick up the brush from the sterile bin. 7. Turn on the water andadjust the flow so that the water is warm. Warm water removes less of the protective oil of the skin than hot water. 8.Wet hands and arms. Keep hands above elbowsRationale: Movement of water and dirt will flow from handsto less clean areas thus preventing contamination of the hands during scrub. 13. 9.Wet scrub brush or apply antibacterial soap if not already impregnated in the brush. 10.Anatomic timed scrub: Starting with fingertips, scrubeach anatomic area (Nail, fingers each side and web space,palmar,dorsal surface and Forearm) for around 5 minutes. 14. 11.Scrub vigorously using vertical strokes in a circular manner. Repeat with other hand. Rationale: Ensures that all surfaces will be systematically scrubbed to remove transient and resident micro organisms.12.Counted brush stroke method: Starting finger tips, scrub each anatomic area for the designated number of strokes. Scrub vigorously using vertical strokes. 15. 13.Rinse hands thoroughly under warm running water, holding hands upward. This is to allow water to drain towards the flexed elbows.Rationale : Prevents contamination of the hands from dirtier areas. Remember do not touchanything before and after rinsing hands. Touching non sterile objects would mean the surgical scrub need to be repeated. 16. 14.Keep hands held upward to allow water to drip from the hands to elbow.15.Dry hands with a sterile towel. 17. 2.Donning a sterile gown 18. 2.Donning a sterile gown Purpose : To apply entire necessary to safely carryout sterile procedures usually in the operating room and delivery room. 19. Donning a sterile gown 1.Grasp folded sterile gown at the necklineand step away from the sterile field. Allow gown to gently unfold, being carefulthat does not touch the floor. The inside of the gown is towards the user. Rationale: Maintains sterility of the gown and positions it for donning. 20. 2.Holding the arms at the shoulder level, grasp the sterile gown just below the neckband near the shoulders and slide arms in the sleeves until the fingers are at the end of the cuffs but not through the cuffs.Rationale : The finger remain in the cuffs to protect the sterility of the gown andprepared for closed gloving. 21. 3.Have someone tie the back of the gown ,taking care that only the ties are touched and not the sides of the gown. Rationale: Maintains sterility of the gown. Gowns are considered sterile in front of the shoulders sterile from 2 inches above the elbow to the wrist. 22. 3.APPLYING AND REMOVING STERILE GLOVES 23. Donning a glove Purpose : Prevent transfer of micro organismsfrom hands to sterile objects or open wounds. 24. A.Applying gloves 1.With fingers still within the cuff of the gown, open the inner sterile glove package and pick up the firstglove by the cuff, using the nondominant hand. Rationale :Maintains the sterility of the gloves. 2.Position the glove over the cuff of the gown so the fingers are in alignment and stretch the entire glove over the cuff of the gown, being careful not to touchits edge. Finger remain within the cuff of the gown. 25. 3.Use the sterile gloved hand to pick up the second glove, placing it over the cuff of the gown of the other hand and repeat the glove applicationprocess. 4.Adjust gloves for comfort and fit, taking care tokeep gloved hands above waist level at all times. Rationale : If gloved hands fall below the waist level,there are no longer Sterile. 26. B.Removing gloves:1.Wash gloved hands first. 2.With dominant hand,grasp outer surface of nondominat glove just below thumb. Peel off glove insideout,without touching exposed wrist. Rationale :After use, outer surface of gloves is contaminated and could transfer micro organisms to the nurses wrist. 27. 3.Placed ungloved hand under thumb side of second cuff and peel off the fingers holding first glove inside second glove. Discard into appropriate binRationale: Folding contaminated glove surfaces toward the inside minimize the chance totransfer of micro organisms. Use glove to glove skin to skin technique when removing gloves. 4.Wash hands before and after removing gloves to prevent contamination of hands.