Chapter 57 Surgical Asepsis

1. Chapter 57Surgical Asepsis

2. Asepsis, cont. • Dirty: any object that has not been cleaned or sterilized for removal of microorganisms • Contaminated: anything that is not sterile • Clean: medical asepsis • Devoid of all gross contamination • Free of many microorganisms • Sterile: surgical asepsis • Free of all microorganisms • Many body parts are clean-not sterile:skin, mouth, GI tract, upper resp. tract • Sterile body parts: abdominal cavity or ovary, uterus • Areas like GU system are susceptible to infection even though bladder is sterile

3. Disinfection • Disinfection • The process that results in the destruction of most pathogens but not necessarily their spores. • Methods • Use of alcohol wipes, a hexachlorophene or chlorhexidine gluconate soap scrub, or a povidone-iodine scrub, surgical hand scrub • Phenol or chlorine is used to disinfect floors and surfaces.

4. Sterilization • Sterilization • The process of exposing articles to steam heat under pressure or to chemical disinfectants long enough to kill all microorganisms and spores. • Client usually takes home items such as washbasins, mouth care utensils, and incentive spirometers-these are not reused • Methods • Autoclave (uses steam at 18 pounds of pressure at a temperature of 125 C for 15 minutes), chemical disinfectants, radiation, and gas sterilization

5. Medical Asepsis • Medical asepsis or clean technique • The purpose of maintaining medical asepsis is to prevent the spread of disease from one person to another. • Handwashing • Standard Precautions

6. Surgical Asepsis • Surgical asepsis or sterile technique • All microorganisms and spores are destroyed before they can enter the body. • Used when administering parenteral medications and performing surgical and other procedures such as urinary catheterization • Often, clean technique (medical asepsis) is performed using sterile supplies. • Sterile to clean, dirty, or contaminated becomes contaminated.

7. Sterile Technique • Sterile technique is used to prevent the spread of infection • Supplies used for surgical and other sterile procedures • Anything that either touches an open wound or skin break, enters a sterile body cavity, or punctures the skin • Surgical towels or drapes are packaged, secured with special masking tape, labeled, and sterilized. • Never touch sterile articles with unsterile articles!

8. Key Concept • Sterile to sterile remains sterile. • Sterile to clean or dirty becomes contaminated. • Always think before you touch anything. • Do not touch sterile articles with unsterile articles

9. Educating the Client • Client and family teaching • Demonstrate the skill to be performed. • Ask the client and family to demonstrate the skill before discharge. • Explain how to recognize problems or complications. • Describe when to seek medical care immediately. • If indicated, make a referral for home care nursing follow-up.

10. Sterile Technique in Nursing • Do not touch anything after sterile gloves or gown have been put on. • Reaching over a sterile field contaminates the sterile area. • If a sterile wrapper or mask becomes wet, they are no longer sterile. • When wearing sterile gloves, perform a sterile procedure. • A person’s back is not sterile. Skin can only be made clean, not sterile. • When in doubt, consider the objects in question to be contaminated.

11. Sterile Technique in Nursing • The inside of the gown is not sterile, someone else must tie the strings on the gown. • Any part of the gown below the waist and above the nipple line is contaminated! • Be sure to keep the hands between the waist and the nipple levels whenever sterile gloves are worn!

12. Sterile Technique • Hair covering • Surgical mask and eye protection • Sterile gown • Sterile gloves • Open gloving • Closed gloving • Removal of sterile or nonsterile gloves

13. Procedures Requiring Sterile Technique • Some procedures include: • Care of the indwelling catheter • Surgical intervention and invasive procedures • Sterile dressing change • Suture and staple removal • Administration of parenteral medications • Venipuncture and management of IVs

14. Urinary Catheterization • Procedure of inserting a tube (a catheter) through the urethra into the bladder to remove urine • Sterile procedure • Catheter sizes: 14-16 Fr. (usually) • Insert 2-3 inches in female; 5-7 in male or until urine is visualized • Straight catheter • Used for one sample only and removed • Retention catheter (eg, Foley catheter) • Indwelling catheter (remains in the bladder)

15. Catheterization • Coude tip catheter is used in males if there is prostate enlargement or in the female if abnormal placement of the urinary meatus is suspected • No more than 750-1000 ml of urine can be safely removed from the bladder at any one time, particularly if the client has retention or distention for a long period.

16. Urinary Catheterization • Self-catheterization • Catheterizing the female client • The side-lying position • Catheterizing the male client • Caring for the client after catheterization • Removing the retention catheter

17. Caring for the Client After Catheterization • Reposition to ensure comfort • Signal cord within reach • Balloon of indwelling catheter inflated • Catheter tubing secured externally • Patient teaching

18. Caring for the Client After Catheterization, cont. • Drainage tubing extends straight down from bed level to bag (straight drainage) • Extra tubing placed on bed with client—allows movement • Attach drainage apparatus to bed frame (not the side rails) • Maintain sterility • Removing the retention catheter

19. Nursing Alert • A catheter is never cut for removal. • This could cause the catheter to be pulled back into the urethra or bladder. • In that case, surgical removal would probably be necessary. • This would also be a source for introducing pathogenic organisms into the urinary bladder.