Sterile (Scrubbing) Environment Lecture 3

Front 1

What is sterile technique also called?

Back 1

surgical asepsis

Front 2

What is the goal of sterile technique?

Back 2

to render and keep objects and areas free of microorganisms

Front 3

When is surgical asepsis used?

Back 3

operating room

labor and dilevery areas

certain diagnostic testing areas

pt. bedside(urinary catheter, sterile dressing changes, or preparing and injecting meds)

Front 4

What are the sterile field basic principles?

Back 4

•Only a sterile object touches another sterile object.

•Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the sterile package touching unsterile clothing.

•Outside of a sterile package is considered unsterile.

•Avoid spilling any solution on the sterile field. A wet field is considered contaminated.

•Hold sterile objects above the level of the waist.

•Avoid talking, coughing, sneezing or reaching over a sterile field or object.

•Never walk away or turn your back on a sterile field.

•Keep all items sterile that are brought in contact with broken skin, or used to penetrate the skin to inject substances into the body. •Use dry, sterile forceps when necessary. •Consider the edge (outer 1 inch) of a sterile field to be contaminated. •Consider an object contaminated if you have any doubts as to its sterility.

Front 5

How do we create and maintain a sterile environment?

Back 5

Donning surgical attire

Performing surgical hand scrub

Donning sterile gown and gloves

Preparing a sterile field

Performing perioperative skin prep

Draping the pt. and equipment

Front 6

What are the three areas of the surgical suite?

Back 6

Unrestricted area

The semi restricted area

The restricted area

Front 7

What is the Unrestricted area?

Back 7

control point where both OR personnel and other members of the health care facility communicate. Street clothes are permitted in this area.

Front 8

What is the semi restricted area?

Back 8

peripheral support area (hallways, storage areas, processing area, OR offices). Scrub attire and caps are required in these areas

Front 9

What is the restricted area?

Back 9

the area where surgical procedures are performed and where unwrapped supplies are sterilized. Scrub attire, caps, masks are required in this area.

Front 10

What are the supplies and equipment for surgical attire?

Back 10

Scrub top and pants

Long sleeved warm up jacket for unscrubbed persons

Disposable bouffant hat or hood

Shoe covers

Protective eyewear

Disposable mask

Front 11

What is the donning procedure?

Back 11

-Obtain a clean scrub top, pants, and a disposable hat or hood. Select a top and pants for proper fit and comfort.

-Remove jewelry, cracked or chipped nail polish, and street clothes.

-Cover hair with the bouffant had or hood before donning the scrub top to prevent the possible dispersal of microorganisms and scalp hair on the scrub attire.

-Adjust the hat or hood to cover all scalp hair. Persons with beards or long sideburns should obtain a beard cover to contain all facial hair. --After donning the pants, tuck the top and pants' ties into the pants to prevent the possible dispersal of body scuff from beneath the shirt. Pants should not come in contact wit the floor during dressing.

-Change to comfortable, supportive, protective footwear to protect the feet against falling items such as sharps and heavy instruments and to allow one to move quickly and safely in an emergency.

-On entering the restricted area of the surgical suite and other designated areas, such as the substerile area, the sterile center core, and the scrub sink area when team members are scrubbing apply a surgical mask.

-Form the pliable nosepiece of the mask over the bridge of the nose, tie the mask at the back of the head and behind the neck, allowing the mask to fit securely and preventing venting at the sides. Change masks between procedures and remove them by handling the strings only.

-Avoid touching the filter portion of the mask and discard in an appro. Receptacle. Masks are either on or off; do not wear a mask around the neck, on top of the head, or in a pocket.

-Before scrubbing, apply protective eyewear or a mask with a protective splash guard visor to protect against uncontrolled body fluid splashes.

-During laser procedures, wear laser masks and protective eyewear specified for the type of laser in operation. Clean eyewear with an antimicrobial agent between surgical procedures.

-Do no wear surgical scrub attire outside the surgical suite. If laboratory coats or cover gowns are worn, they should have long sleeves, be completely closed, and fall below the knees.

Front 12

What are the supplies for performing the surgical hand scrub?

Back 12

-Scrub sink with foot, knee, or automatic controls

-water that is set at a confortable temperature adn moderate flow to prevent spraying of surgical attire

-high filtration masks

-scrub brushes

-metal or plastic nail stick

-broad spectrum antimicrobial agents

Front 13

What is the procedure for the surgical hand scrub?

Back 13

-Inspect the OR attire by adjusting the hat or hood to cover and contain all hair. The mask should completely cover both the most and mouth and fit securely to prevent venting at the sides. Tuck all loose scrub attire and strings into the scrub pants. Replace or adjust shoe covers to completely protect shoes.

-Examine the hands and forearms for good skin integrity, remove all jewelry. Nails should be free from polish and short, and cuticles should be in good condition.

-Open the sterile scrub brush package and position it for easy access.

-Turn on the water, adjusting the temp. and spray so that scrub attire does not become wet.

-Wash and rinse the hands for the initial wash with water and a small amt of antimicrobial agent to remove transient flora and gross contaminants.

-Remove the plastic nail stick and the scrub brush from the package and add an antimicrobial agent from a dispenser or squeeze an impregnate sponge to generate lather. Clean nails and cuticles under running water while holding the scrub brush in the opposite hand; repeat for the other hand.

-Select either the anatomic timed scrub or the counted brush stroke method. Each takes about 5 min. to complete. er gowns are worn, they should have long sleeves, be completely closed, and fall below the knees.

Front 14

What is the anatomic timed scrub?

Back 14

1.Scrub the nails for 30 seconds with brush. 2.Scrub the fingers, including ea side and web space, for 1 min. with sponge.

3.Scrub palmar surfaces for 15 seconds with brush.

4.Scrub dorsal surface 15 seconds with sponge.

5.Scrub forearm, divided in half, to 2 inches above the elbow 1 min. with sponge (30 seconds ea half).

6.Repeat process for the other hand. above the elbow 40 strokes with sponge 6.Repeat the process for the other hand.

Front 15

What is the counted brush stroke method?

Back 15

•Counted brush stroke method.

1. Scrub nails with 20 strokes with brush. 2.Scrub fingers, including ea side and web space, 10 strokes with brush.

3.Scrub palmar surfaces 10 strokes with brush. 4.Scrub dorsal surface 10 strokes with sponge. 5.Scrub forearm, divided in half, to 2 inches

Front 16

slide 15-28 not done

Back 16

k

Front 17

When will alcohol be used?

Back 17

-70-90%

-intermediate leve

To disinfect thermometers, medication vials, etc.

Front 18

When will Glutaraldehydee be used?

Back 18

-High level

To disinfect endoscopes, thermometers, and rubber items

Front 19

When will chlorine Compounds be used?

Back 19

-dilution of 1:50 is high-level

To disinfect countertops, floors, other surfaces

Front 20

When will Orthophthaladehyde be used?

Back 20

-high level

To clean and process endoscopes

Front 21

When will hydrogen peroxide be used?

Back 21

-low level

May be used to clean work surfaces, not widely used in health care settings

Front 22

When will iodine and iodophors be used?

Back 22

-intermediate level

May be used as disinfectant or antiseptic

Front 23

When will phenolics be used?

Back 23

-inermediate or low level

Have toxid effects, used as environment not sporicidal disinfectants

Front 24

When will Quaternary Ammonium Compounds be used?

Back 24

Cleaning agents for noncritical suface

Front 25

slide 32-34

Back 25

k

Front 26

Explain sterile draping:

Back 26

•Drapeshould ideally be waterproof

•Touch only the outer 1 inch of the drape

•Holdingdrape on the corners and allowing to unfold away from the body and surfaces

•Positioning the drape on the work table with the moisture-proof side down

• Donot reach over.

Front 27

37-57

Back 27

pics

Front 28

What is the purpose of skin prep?

Back 28

remove as many microorganisms as possibly by mechanical and chemical means to reduce the potential of infection.

Front 29

What are the two aspects to skin preparation for a sterile procedure?

Back 29

mechanical

chemical

Front 30

What is the chemical method of skin preparation?

Back 30

•Thearea to be penetrated should be cleaned with an antiseptic solution.

•Onceyou start to clean the area of interest, do this in a circular motion beginningin the center and working outward.

•Donot cross anything over the area that has been prepped.

•Steriletechnique is maintained during the skin prep for sterile procedures!