sur 111 lecture 2. terminology related to asepsis and sterile technique review and learn the terms...
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SUR 111SUR 111Lecture 2Lecture 2
Terminology Related to Terminology Related to Asepsis and Sterile Asepsis and Sterile TechniqueTechnique
Review and learn the terms in table 7-1 Review and learn the terms in table 7-1 page 143page 143
You must be familiar with these termsYou must be familiar with these terms
Pathogens & InfectionPathogens & Infection
PathogenPathogen Any microorganism that is capable of causing an Any microorganism that is capable of causing an
infectioninfection InfectionInfection
Microorganism in a particular placeMicroorganism in a particular place Presence of or multiplication of microorganismsPresence of or multiplication of microorganisms NOTNOT necessarily causing problems necessarily causing problems
DiseaseDisease Showing signs or symptoms due to microorganisms Showing signs or symptoms due to microorganisms
ARE ARE causing problemscausing problems
InfectionInfection
Nosocomial InfectionNosocomial Infection Hospital acquired infectionHospital acquired infection
Surgical Site InfectionSurgical Site Infection (SSI) (SSI) Infection that is the direct result of surgeryInfection that is the direct result of surgery Primarily caused by patient’s own normal flora (endogenous)Primarily caused by patient’s own normal flora (endogenous) Can be caused by breaks in aseptic techniqueCan be caused by breaks in aseptic technique Is a type of nosocomial infectionIs a type of nosocomial infection 25% of all nosocomial infection25% of all nosocomial infection Typically do not become evident until after patient is Typically do not become evident until after patient is
discharged from hospitaldischarged from hospital Note table 7-3 page 134 for pathogens associated with SSIs Note table 7-3 page 134 for pathogens associated with SSIs
and their percentage ratesand their percentage rates
Sources of Microbial Sources of Microbial TransmissionTransmission
PersonnelPersonnel EnvironmentEnvironment Patient Patient
Pathogens associated Pathogens associated with SSIswith SSIs
BacteriaBacteria Escherichia coliEscherichia coli
Resides normally in lumen of intestines = resident floraResides normally in lumen of intestines = resident flora If gets outside of intestinal lumen will cause infection (peritonitis) If gets outside of intestinal lumen will cause infection (peritonitis)
that is life threateningthat is life threatening Staphylococcus aureusStaphylococcus aureus
Resides on your skin = resident floraResides on your skin = resident flora Can reside in your nares (nostrils)Can reside in your nares (nostrils) Most commonly transmitted pathogen in the operating roomMost commonly transmitted pathogen in the operating room
Mycobacterium tuberculosisMycobacterium tuberculosis Causes disease tuberculosisCauses disease tuberculosis Airborne pathogen transmitted by droplet nuclei (you can breath it)Airborne pathogen transmitted by droplet nuclei (you can breath it) Known affected surgical patients require special masksKnown affected surgical patients require special masks
Spore Producing BacteriaSpore Producing Bacteria
BacillusBacillus and and Clostridium Clostridium genuses genuses Are spore producersAre spore producers Highly resistant Highly resistant Bacillus stearothermophilusBacillus stearothermophilus and and Bacillus subtilisBacillus subtilis are the are the
biological indicators utilized in sterization to test that biological indicators utilized in sterization to test that autoclaves and ethylene oxide sterilization techniques are autoclaves and ethylene oxide sterilization techniques are working to destroy all microorganisms and their spores working to destroy all microorganisms and their spores (sterilization)(sterilization)
B. stearothermophilusB. stearothermophilus (steam sterilization) (steam sterilization) Notice Notice steastea beginning in beginning in steastearothermophius to help rothermophius to help
remember it’s for remember it’s for steasteam autoclavesm autoclaves
B. subtilisB. subtilis (ethylene oxide or EtO) (ethylene oxide or EtO)
Viruses Viruses
Reliant on host cell for survivalReliant on host cell for survival Viruses are the biggest risk health care Viruses are the biggest risk health care
workers faceworkers face Note table 7-4 page 145 for viral Note table 7-4 page 145 for viral
pathogenspathogens
Prevention of Staff Prevention of Staff Imposed SSIsImposed SSIs
Human error/breaks in sterile techniqueHuman error/breaks in sterile technique Must be documented if occurMust be documented if occur Failure to recognize and correct a breach in Failure to recognize and correct a breach in
sterile technique is wrong as it is negligencesterile technique is wrong as it is negligence Surgical conscienceSurgical conscience
Basis for practice of strict adherence to sterile Basis for practice of strict adherence to sterile technique that involves honesty and moral integrity technique that involves honesty and moral integrity and must be upheld by all surgical team members at and must be upheld by all surgical team members at all timesall times
There can be NO compromise of sterile techniqueThere can be NO compromise of sterile technique
Environment Environment
FomiteFomite Inanimate objects on which microbes may resideInanimate objects on which microbes may reside
OR furniture, your scrubs, your hair, your shoes, contaminated solutions, OR furniture, your scrubs, your hair, your shoes, contaminated solutions, contaminated dressing supplies such as tape that is reusedcontaminated dressing supplies such as tape that is reused
Reason all operating rooms are cleaned after every surgical Reason all operating rooms are cleaned after every surgical procedureprocedure
Airborne Airborne Laminar flow system (air moves from vents in ceiling out vents in near Laminar flow system (air moves from vents in ceiling out vents in near
the floor)the floor) Result of laminar flow is positive pressure (air is moving down so if a Result of laminar flow is positive pressure (air is moving down so if a
door is opened the air rushes out the door not in the room)door is opened the air rushes out the door not in the room) 20 air exchanges per hour in an operating room via HEPA filters, 20% 20 air exchanges per hour in an operating room via HEPA filters, 20%
of those being fresh air.of those being fresh air.
Patient Patient
Most SSIs are contracted through the Most SSIs are contracted through the patient’s own endogenous or normal florapatient’s own endogenous or normal flora
Preoperative prophylaxis with antibiotics Preoperative prophylaxis with antibiotics reduces risk of SSIsreduces risk of SSIs
Risk Factors for SSIsRisk Factors for SSIs
AgeAge ObesityObesity General physical healthGeneral physical health Nasal carriers of Nasal carriers of S.aureusS.aureus Remote infections (infections Remote infections (infections
going on in another part of the going on in another part of the body at time of surgery)body at time of surgery) Ex. Yeast infection present Ex. Yeast infection present
and patient is having surgery and patient is having surgery in the groin areain the groin area
Preoperative hospitalization Preoperative hospitalization (reason most surgeries are (reason most surgeries are performed the day of performed the day of admission)admission)
Smoking Smoking MalnutritionMalnutrition DiabetesDiabetes Malignancy (cancer)Malignancy (cancer) ImmunosuppressionImmunosuppression Preoperative hair Preoperative hair
removalremoval Procedure type or Procedure type or
wound classification (see wound classification (see page 293)page 293)
Procedure duration Procedure duration
Principles of AsepsisPrinciples of Asepsis
1.1. A sterile field is created for each A sterile field is created for each surgicalsurgical
procedureprocedure See pages 153-155See pages 153-155
Principles of AsepsisPrinciples of Asepsis
2.2. Sterile team members must be Sterile team members must be appropriately attired prior to entering appropriately attired prior to entering the sterile fieldthe sterile field
See pages 154-155See pages 154-155
Principles of AsepsisPrinciples of Asepsis
3.3. Movement in and around the sterile Movement in and around the sterile field must not compromise the sterile field must not compromise the sterile fieldfield
See page 155See page 155