intrument processing

1. Maintaining Sterility During A
Surgical Procedure
HOW TO CREATE AND MAINTAIN A STERILE SURGICAL
FIELD
ASHLEY BRAMAN, LVT AND BRITTANY WEEDEN, LVT
SEPTEMBER 2016- UVS CE LECTURE SERIES

2. TOPICS
▶Importance of sterility in surgery
▶Creating a sterile field
▶Maintaining a sterile field
▶Cleaning and sterilizing instruments

3. INTRODUCTION
▶ Sterilization
▶ Eliminating microorganisms with the use of physical or chemical agents
▶ Disinfectant
▶ A chemical that eliminates microorganisms on fomites such as tables and instruments
▶ Antiseptics
▶ Chemical applied to a living body to obstruct the growth of microorganisms (hand sanitizer)
▶ Asepsis
▶ The absence of microorganisms
▶ Contamination
▶ A break in sterility or asepsis
Sterility of a fomite is key to maintaining asepsis during surgery

4. YOUR GOALS
Two main goals:
▶ Protect your patient from pathogens
▶ Protect yourself from the patient’s pathogens
Make sure to
▶ Disinfect your skin as well as the patient’s skin
▶ Sterilize your instruments
▶ Limit the amount of people in the surgical suite
▶ Everyone follows protocol in maintaining sterility

5. METHODS OF
STERILIZATION
▶ Steam
▶ Gas
▶ Cold chemical
▶ Plasma
▶ Ionizing radiation

6. THE PREPARATION
ROOM
▶ This preparation area must be kept stocked!
▶ Impervious and easily cleaned
▶ Take your time
▶ Remove all hair
▶ Wet sinks are very helpful
▶ Vacuum
▶ Close to a controlled substance locked box or cabinet
▶ Perform a “dirty” scrub
▶ Keep yourself clean
▶ Wear gowns when prepping/shaving
▶ Change booties/ scrubs before entering the surgical suite

7. THE OPERATING ROOM
▶ Location
▶ Should have its own section of the hospital
▶ Out of general traffic flow
▶ Away from the chaos!
▶ Air Flow
▶ Move from least to greatest potential contamination
▶ Mild positive pressure
▶ Temperature
▶ Between 66-70 ˚ F with 50% humidity
▶ Keep your patient warm…Low temperatures make it tougher to fight off infection!
▶ Keep “furniture” and equipment in the surgery suite
▶ IV stands, sitting stools, anesthesia cart,
▶ electrosurgical unit, suction system, etc

8. PREPARING THE PATIENT
▶ Adjust the overhead lights first
(Keep the lights up high)
▶ Position the patient before scrubbing
▶ Chlorhexidine Scrub vs Iodine
▶Recommended by the CDC (except
ocular)
▶ Gas sterilize gauze and container
▶ Open and use sterile

9. PREPARING THE PATIENT
CONT.
▶ Scrubbing your patient
▶ 70% isopropyl alcohol and chlorhexidine or iodine scrub
▶ Use gauze sponges
▶ Avoid scrub brushes
▶ Vigorous scrubbing causes irritation or abrasions
▶ Gentle pressure in a circular motion away from proposed incision site
▶ Don’t rush!
▶ Scrub until dirt is visibly removed from skin using a 3 and 3 technique

10. SURGICAL ATTIRE
▶ Cap
▶ Covers 100% of hair
▶ Disposable
▶ Eye protection
▶ Mask
▶ Fits snug around mouth and nose
▶ Gown
▶ Water proof apron that’s sterile
▶ Disposable when possible
▶ Scrubs
▶ Cleaned daily
▶ Change if dirty before you enter surgical
suite
▶ Shoes
▶ No dirt or particles
▶ Booties
▶ No Jewelry

11. SURGICAL SCRUB
▶ Wash hands and forearms with warm water and hand soap
before starting your surgical scrub.
▶ Nails should be kept short (1-2mm) and free of nail polish
▶ Time dependent
▶ Scrub fingers, nails, hands, and forearms up to elbows
▶ Rinse fingertip to elbows
▶ Keep fingers elevated

12. Scrubbing-in
▶ A great video detailing the procedure for Scrubbing-
in is available on the DoveLewis Animal Hospital
website:
▶ https://www.atdove.org/video/scrubbing

14. Creating The Sterile Field in the
Operating Room
▶ Keep your OR organized
▶ Positioned for use in the OR
▶ Unopened supplies are easily accessible
▶ The items should be placed on clean, dry surfaces
▶ Draping in your patient
▶ Four quadrant “universal” drapes
▶ Use staples or towel clamps
▶ Patient Drape
▶ Covers table to past site of incision
▶ Clamp drape to table
▶ Make sure it does not slip

15. Once your sterile field is created…
Keep it Sterile
What parts of the surgical gown are sterile?
▶ The front of the gown from the chest to the level of the
sterile field
▶ Gown sleeves from 2 inches above the elbow to the cuff
What parts of the surgical gown are not considered sterile?
▶ Neckline
▶ Shoulders & Underarms
▶ Sleeve cuffs
▶ Gown back

16. What to do with your hands when
your standing idle?!
At all times the scrubbed
personnel should keep their hands
above their waist. If there is a
period of time your waiting and
unsure where to put your hands,
clasp them together in front of the
body above the waist.

17. How to Pass Items Into The Sterile
Field
▶ Open cloth packs starting with corners furthest away first
▶ Open instruments slowly and symmetrically
▶ Hold all edges securely
▶ Instruments must not touch the edges of the pouch when they are opened
▶ Heavy items should not be tossed onto the surgical table
▶ Pour solutions into a bowl slowly so there is no splashing
Remember no matter what an unsterile person should not cross into the sterile field!

18. How to Open and Hand Off a
Sterile Pack
▶ A great video detailing the procedure for opening a
sterile pack and passing items into the sterile field is
available on the DoveLewis Animal Hospital
website:
▶ https://www.atdove.org/video/Open-and-Hand-Off-
A-Sterile-Pack#.WBnZOrPvpJ0.link

19. Definite No’s In The Operating Room
▶ Sterile instruments that are questioned for sterility should be
considered contaminated
▶ Sterile personnel should never leave the sterile field
▶ Unsterile personnel should never walk between sterile fields or
reach over
▶ Sterile items should not be opened for multiple procedures at one
time
▶ Use caution with instruments that can penetrate the barrier in
your drapes
▶ Only necessary personnel should be in Operating Room

20. Inspect Packs For Sterility Prior To
Introducing Into The Sterile Field
▶Inspect packaging for holes, open seals or errors in
wrapping that will impact sterility
▶ Expiration dates
▶ Sterilization indicators

21. ▶ Ideally instruments and laundry should be cleaned within 20 minutes after use
▶ Cleaned manually
▶ Take apart all pieces (clean each piece individually)
▶ Brush
▶ Flush cannulated instruments
▶ Pipe Cleaners
▶ Ultrasonic Cleaner
▶ Allow instruments time to dry
▶ Apply lubricating spray
Cleaning: removing of gross
surface contaminates

22. Instrument Sterilization Options
The goal is to allow penetration of the sterilizing agent and maintenance of
sterility after sterilization occurs no matter which package type is used.
▶ Cloth woven and nonwoven
▶ Paper or plastic pouches
▶ Trays should be fenestrated
Some instruments may require double wrapping to maintain sterility.

23. Expiration Dates & Guidelines
4 weeks
6 months
2 months
▶ Double wrapped, two layer muslin packs
▶ Double wrapped, two layer muslin heat
sealed in dust covers after sterilization
▶ Double wrapped, two layer muslin,
tape sealed in dust cover after sterilization
▶ Double wrapped nonwoven barrier materials
▶ Paper/plastic peel pouches
6 months
1 year

24. Variables To Consider Regarding
Sterility Of Instrument Packs
▶ The type of packaging material that is used
▶ The number of times the pack is handled prior to use
▶ The number of personnel who have handled the pack
▶ Whether the pack is stored on an open or closed shelf
▶ The condition of the storage area
▶ Whether dust covers are used

25. Steam Sterilization
Relies on:
 Time
 T
emperature
 Pressure
Autoclave
 Instruments should be packed loosely
 Pouches should face the same direction
 Allow instruments to cool and dry before
handling
 Kept up to date on maintenance (every 6
months)

26. Indicators For Sterility
▶Mechanical
▶Chemical
▶Biological

27. Summary
▶ The principles of aseptic technique and implementation
of these policies is critical to keeping a continuous
CLEAN flow in the operating rooms.
▶ Creating and implementing these protocols and
techniques is a crucial step to ensuring surgical
success.
▶ Technicians and Assistants play a major role!
QUESTIONS?????