STERILE TECHNIQUE

1. STERILE TECHNIQUE J.J.Nelson RN,CMA

2. What is Surgical Asepsis? • Procedures that maintain an area or object free of microorganisms. • Define Sterile: “Free from all organisms” • Define Contaminated: Organisms and pathogens are present • No room for error!!

3. Sterile Procedure • Work area must be clean, dry and uncluttered. • Sterile items: • Above your waist • Always in your vision • Held in front of your body (not touching clothing or any thing else)

4. What is a sterile field? Why do you need it? • An area free of • microorganisms • May be a sterile • towel or a sterile tray • May be the inside of • a sterile wrap • WHY DO WE NEED IT ????

5. Sterile Field RULES: • Never work across the sterile field • Always keep sterile items above waist and in vision • Never turn back to sterile tray/item • Two inch border around tray is considered contaminated • Move slowly and deliberately

6. Opening an sterile package • Three methods of adding a sterile item to a sterile field: • Drop technique • Mitten technique • Sterile gloves • To open a sterile package: • Ascertain the package is sterile • Hold with sealed edge TOWARD YOU • Only touch exterior of wrap (Tabs)

7. Precautions: • While performing drop technique the wrap is opened maintaining sterility of inside of wrap and item. The item is dropped onto sterile field without touching you, exterior of wrap of the outside perimeter of sterile field. Used most commonly for gauze pads, dressings and small items. • With mitten technique, a mitten is formed with the wrapper around the hand holding the item. Special care to maintain sterility of item and inside of wrap. DO NOT let the wrap drag onto the sterile field. Commonly used for bowls,drapes, linen and odd shaped items. • Transfer forceps, Using sterile gloves or transfer forceps remove item from container and place it on the sterile field. • Sterile Technique: Adding Items to Sterile Field - YouTube

8. Preparing a sterile tray • Once there is a sterile tray it must be maintained as sterile. So….. • Contaminated items stay off the tray • Solutions are poured without touching bowl or working over sterile field. • Drop, mitten and sterile gloves are used. • Dressings that are used last are applied to the tray first. • Follow all the “rules” • If contamination occurs….start over. HOW???

9. Opening Sterile Package, Preparing Sterile Tray • If contamination occurs…..you start over. • The item is either sterile or it is not sterile……there is no room for error. • http://www.youtube.com/watch?v=6sRRcngyvNM

10. Donning and Removing Sterile gloves • How in the heck do you put two sterile gloves on two non-sterile hands and keep the exterior of the gloves sterile????? • And why??? • Once gloves are correctly on your hands you may ONLY touch sterile items. • What if you need to move the tray? Or get more dressings (still wrapped) ?? Or your nose itches???

11. Assemble sterile glove and ascertain sterility • Remove jewelry, wash & dry hands • Open inner wrap handling only OUTSIDE of wrap. • Don first glove by grasping cuff (inside of glove) • Don second glove by grasping under cuff • Pull on second glove with extreme care not to touch exterior of second glove. (FLY your thumb) • Only touch sterile surfaces • If not in use keep fingers together in “prayer position” and away from body

12. http://www.youtube.com/watch?v=pAKZ3mdFIj4

13. Principles of Sterile Technique • Consider the environment • Can you do a sterile procedure in a dirty environment? • Plants in the room • Old food • Bedpan has been on the overbed table

14. When to use sterile technique • Invasive procedures • Urinary tract: catheterization • Lungs: tracheal suctioning • Breaks in the skin

15. Chronic wounds • Are contaminated wounds, therefore sterile is not required • However the clean technique should be meticulous • Use sterile if the patient is particularly vulnerable to infection; eg. Low WBC

16. 13:7 D Changing a Sterile Dressing • Surgeon change the dressing the first time. After that a doctors order is necessary to change the dressing. • If drainage is saturating the original dressing, additional dressings are added and surgeon is notified. • Exam gloves are used to remove the dressing. Only touching the exterior of dressing. Place dressing in bio bag • Using a prepared sterile tray and having donned sterile gloves clean the area around the wound. • Observe wound for S&S of infection or healing, color, amount, type of drainage.

17. Cleaning a circular or linear wound/incision ALWAYS WIPE CLEAN TO DIRTY

18. Changing a Sterile Dressing cont. • Remember to follow the “rules”. Such as when you toss the gauze pads in the bio bag you need to keep sterile gloves above waist. Do not turn back to tray. • If contamination occurs you start over. • Apply tape so it runs opposite the body movement. • Charting: • Blue or black ink • Date/military time • Procedure and location • Amount, color, type of drainage • How well patient tolerated procedure • Your first initial, last name and title • Leave no blank area

19. Sample Charting 10/21/2013 1440 Abdominal dressing changed. Small amount of clear serosanguineous drainage noted. Pt tolerated procedure well and states “feels much better today”. J. Nelson RN,CMA

20. Practice • Donning sterile gloves • Opening sterile packages • Setting up a sterile field • Adding liquid to a sterile field