Student Objectives

Define surgical asepsis and differentiate between medical asepsis and surgical asepsis. Explain the radiographer’s responsibility for maintaining surgical aseptic technique when it is a required part of patient care. Differentiate between disinfection and sterilization. Explain the methods you must use as a radiographer to determine the

sterility of an invasive procedure. List the rules for surgical asepsis. Demonstrate the correct methods of opening a sterile pack and of placing a sterile field. Demonstrate the correct method of putting on a sterile gown and sterile

gloves. Demonstrate the skin preparation for a sterile procedure. Explain your responsibilities for the safety of the surgical team, the patient, and yourself in the operating room. Demonstrate the correct method of removing and reapplying a sterile

dressing.

Student Learned Objectives

Surgical asepsis differs from medical asepsis: * Medical asepsis is defined as any practice that helps reduce the number and spread of microorganisms. * Surgical asepsis is defined as the complete removal of microorganisms and their spores from the surface of an object.

The practice of surgical asepsis begins with cleaning the object in question using the principles of medical asepsis. A sterilizing process using a specific technique recommended for that item is completed by applications of heat or a chemical action accomplish total removal of microorganism and spores.

Procedures and Aseptic Technique

Any medical procedure that involves penetration of body tissue (an invasive procedure) requires the use of surgical aseptic technique.

* MAJOR AND MINOR SURGICAL PROCEDURES* ADMINISTRATION OF PARENTERAL MEDICATIONS* INVASIVE RADIOGRAPHIC IMAGING PROCEDURES* CATHETERIZATION OF THE URINARY BLADDER* TRACHEOSTOMY CARE

* DRESSING CHANGES

Because surgical asepsis is also routinely practiced in the special areas of the radiology department, you as a radiographer, must be familiar with required procedures in OR or the surgical suite.

Prevention

Before ANY procedure can be performed:* The patients skin must be prepared/skin prep removes oils,

dirt and as many microorganisms as possible before the procedure.

* Hair is considered to be a contaminant and is frequently removed from the skin surrounding the operative site.

* Removing a patients’ dressing or reapply a simple sterile dressing needs to be performed correctly to prevent any potential for infection.FYI: as a radiographer you need to recognize breaches in aseptic

technique and also be able to remedy the problem quickly. If not, contamination will go unrecognized, and infection may result.

The Environment and Surgical Asepsis

Methods of transmission are direct and indirect contact:DropletsVehicleAirborne

Every possible effort is made to protect the patient from infection. Creating an environment that establishes barriers that limits the source

of contamination All persons who enter the surgical suite are expected to follow the rules

established to maintain these barriers

Environment (continued)

Surgical departments have dress and behavior protocols that are strictly enforced.

* wear comfortable cloths* supportive shoes (no clogs, sandals or cloth shoes)* meticulous personal hygiene (shower before

reporting to work)* jewelry, long fingernails, artificial fingernails and

polish are prohibited * open skin lesions or a care worker that has an acute

infection.

Surgical “ ZONES”

There are three zones designated in the surgical suite to help decrease the

incidents of infection:

ZONE 1: Unrestricted Zone – persons may enter in street clothing

ZONE 2: Semirestricted Zone– persons dressed in scrub dress

with hair covered and shoes covered may enter

ZONE 3: Restricted Zone – only persons wearing scrub suits, hair coverings, shoe covers, and masks are allowed.

Environment (continued)

If a surgical or invasive procedure is in progress:* The doors to that area are kept closed* Only persons directly involved with the procedure may be present* Persons directly involved with the operation are dressed in

sterile gowns and gloves. Must proceed from the unrestricted zone of the operating suite into the semirestricted zone go into a dressing area, don a scrub suit,

and tuck the blouse of the suit into the pants or wear a scrub blouse

that is close to the body.

Surgical Team

Each individual performs a specific function that forms the OR team (invasive procedure team)

This team is described as a symphony orchestra, with

each person an integral entity in unison and harmony with his/her colleagues for a

successful accomplishment of the expected outcomes.

Procedure/Surgical Patient Care

At no other time is a patient so well attended as during a surgical/interventional procedure. a surgeon

one or two assistants a surgical technologist

an anesthesia providera circulating nursevarious staff support

---- ALL SURROUND THE PATIENT

Surgical Team (Continued)

The OR team is subdivided, according to the functions of its members, into sterile and nonsterile.Sterile Team Members:

* scrub their hands and arms, don a sterile gown and gloves over proper attire, and enter the sterile field.

* function within a limited area.* to establish a sterile field, all items necessary for the surgical

/interventional procedure are STERILE. TEAM MEMBER:

* SURGEON:* SURGICAL ASSISTANT:* PHYSICIAN ASSISTANT:* SCRUB NURSE:* CERTIFIED SURGICAL TECHNOLOGIST:

Surgical Team (continued)

Nonsterile Team Members:* DO NOT enter the sterile field: they function outside and around it.* They assume responsibility for maintaining sterile technique during

the surgical/interventional procedure, but they handle supplies and equipment that are not considered sterile.

* Follow the principles of aseptic technique, in keeping the sterile team supplied, provide direct patient care, and respond to any requests

that may arise during the procedure.

Team Members:* ANESTHESIA PROVIDER:* CIRCULATOR:* RADIOGRAPHER:* OTHERS:

Proper Surgical Attire

Surgical Attire (continued)

Opening Sterile Pack

Opening Sterile Pack

Surgical Scrub

Surgical Scrub (continued)

Scrub (continued)

(Continued)

Sterile Gowning

Sterile Gowning

Sterile Gloving

Sterile Gloving

Sterile Gloving

FYI

Removing Old Dressings

Mask Protection

Mask (continued)

KNOW HOW TO OPEN STERILE PACKAGE

Sterile Tray

(Contiuned)

RULES FOR STERILE TRAY

When table tops are to be used as areas for creating a sterile field, they must be cleaned and a sterile drape be placed over them.

If the sterility of an item is questionable, it is not to be considered sterile.

Any sterile instrument or sterile area that is touched by a nonsterile object or person is considered contaminated by microorganisms.

Once a sterile field has been prepared, it must not be left unattended, because it can be contaminated and presumed to be sterile

An unsterile person never reaches across a sterile field. A sterile person does not lean over an unsterile area A sterile field must be created just before use. The edges of a sterile wrapper is not considered sterile, and must

not touch a sterile object.

Sterile Tray (continued)

A sterile person must remain within the sterile area, he must not

lean on tables / walls /. When pouring sterile solutions, place the lid face up ward and

do not touch the inside of the lid. Pour off a small amount of

solution before the remainder is pored onto the sterile container.

FYI: Placing a container at the edge of a sterile field to pour sterile liquid prevents an unsterile person from reaching across the sterile field.

Adding Sterile Objects to a Sterile Tray

Continued

Continued

Surgical Scrub

Continued

Continued

Sterile Gowning and Gloving

Skin Prep

Continued

Continued

Draping for Sterile Procedure

Removing Sterile Dressing

Removing Dressings

Continued

FYI (removal of dressing)

If a sterile dressing is to be removed and reapplied there must be an order from the physician in charge of the patient. All dressing must be treated as if they are contaminated,

because drainage from wounds may harbor pathogenic microorganisms.

Before removing a dressing, the radiographer must obtain the following:

* plastic bag* bag closure* clean gloves* drape sheet

Dressings (continued)

Reapplying Dressings

Continued

FYI (applying dressing)

Sterile technique must be used when applying a dressing. Explain procedure. Create a sterile field (towel/drape). And use it as a sterile field

on which to place the sterile dressings . Make sure dressings are dropped on to the sterile field without contaminating them. Prepares the tape. Cleanse the skin around the wound Don sterile gloves Clean around the wound with sterile solution Dispose of soiled material in appropriate container (be careful

not to contaminate sterile gloves). Allow skin to dry and apply sterile dressing.

Examples of Radiographic Invasive Procedures

MyelogramsArthrogramsHysterosalpingographyLymphangiograpySialographySubstractionVCUG and CystogramsLumbar PuncturesHerniograms

Methods of Disinfection

Articles or surfaces that can not be sterilzed in the OR / Special Procedure

areas must be DISINFECTED – tables, walls and equipment used un the areas of invasive procedure.

Skin around the area to be penetrated is also DISINFECTED.*when skin is disinfected the solutions used are called

ANTISEPTIC The term disinfectant, means that as many microorganisms

are removed as possible are eliminated from the surface area by physical or

chemical means. Spores are often NOT destroyed by disinfection.

Levels of Disinfectant

Levels:High LevelIntermediate LevelLow Level

See/Know; TABLE: Commonly Used Disinfectant

Physical methods of disinfecting are boiling in

water and UV irradiation.

Methods of Sterilization

Removal of microorganisms and their spores must be complete

or the article is NOT sterile.See Table: Common Methods Used with a brief description of each:

*Steam Under Pressure*Chemical Sterilization*Ethylene Oxide