Reproductive System,Medical School of Universitas Padjadjaran, Bandung2005

MIR-C Corporate

Interactive Training CD for Medical StudentsReproductive SystemModule :

Infection Prevention: A- and Antiseptic Techniquesin Surgical Setting

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 CorporateProductions : Medical School of Universitas Padjadjaran Bandung

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

Infection Prevention Module IntroductionInfection controlAntiseptic techniquesOperating TheaterAseptic techniques

IntroductionDescription Objectives

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

ObjectivesThe aims of this method are :

To minimize surgical site infectionTo protect health personnelTo improve wound healingTo minimize disability, morbidity, & mortalityTo 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 instrumentsTo describe 6 rules of aseptic techniques

Specific Learning Objectives :To perform aseptic techniques correctly, including (P5):

Applying surgical attireHand washingSurgical scrubbingGlovingSurgical 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 mortalityHand scrub with chlorinated-lime solution prior to examination.Father of nosocomial infection.

Louis Pasteur (1860)Discover the process of fermentation by microorganismsGerm 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 sterilizerBasic of sterilization aseptic techniqueLater: pressure & vacuum steam sterilizer was developed

Methods of Infection controlAnti septic techniques

Design and traffic patterns of the operating theatre

Aseptic techniques

Anti septic techniques

SterilizationThe objective of modern surgeryFor inanimate objectsProblem :Some items are not heat resistance

Techniques of SterilizationPhysical:HeatRadiation/ ultraviolet rayBoiling waterUltrasoundChemical:LiquidGas

Heat SterilizationDry : Commonly cause damageFor powder, oils, and jellyMoist :SteamHigh pressure spores Vacuum constant temperatureAutoclave

Chemical SterilizationGenerally as disinfectionMechanism of action :Protein coagulationEnzyme denaturation in cellsLysis

Depend on : number of microorganisms, soiling, concentration, and temperature.

Solutions Jodium and JodophorGood bactericide, but irritantMixture : povidone-jodine 10%Alcohol Solution of 70% or 90%

Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)Spores are killed within 3 hours

SolutionsHexachloropene (Halogenated phenol)Bacterio-static, particularly Gram (+) bacteriaFor scrubbing

Chlorhexidine gluconateBactericide : Gram (+) & (-).Good for antiseptic

Gas SterilizationFormaldehydeEthilene-oxide- propionolactone

Boiling WaterMild boilingVigorous boiling

More active, if 2% sodium-carbonate or 0,1 % sodium-hydroxide being added

The Operating Theater SterilecoreClean ZoneTransitional Zone

Restricted areaSemi Restricted AreaSCRUB SUIT

Traffic patterns of Operating TheatreThe 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 areaEntrance

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 attireIn the semi & restricted area:

Scrub suit : shirt & trousersHair covering: surgical cap/hoodMasks : disposable/ re-useableGoggle (optional): protective eyewearShoe covers

are compulsory

Surgical attire

Male personnel

Female personnel

Personnel with veil

Surgical Instruments in the Operating TheatreCritical 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 techniquesRules at clean zoneProcedures in sterile areaTalk as necessaryRestrict unnecessary movements Sterile instruments, remove non sterile one Avoid & Replace wet surgical drapes/towels

Hand washingIndications:

Between patient contactsBefore performing or assisting with invasive proceduresBefore taking care of particularly susceptible patientsBefore and after touching woundsImmediately after gloves are removed

Hand washingBefore 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 washingPreparationThe 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 techniqueRinsing hands & armsScrubbing with antiseptic solutionRinsing armsScrubbing with brush or spongeRinsing armsScrubbing with antiseptic solutionDrying 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 preparationThe 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