surgical asepsis

1. SURGICAL ASEPSIS
 Prepared by,
 Jerenett Joy Mahinay
 Lalaine Solis
 Aldrin Bangcal
 Kristel Angela Pilongo
 Susanne Vincoy

2. SURGICAL ASEPSIS
 REFERS TO THE PROCEDURES USED TO KEEP THE OBJECT OR AREAS
STERILE OR COMPLETELY FREE FROM MICROORGANISM.
 IN SURGICAL ASEPSIS ALL PRACTICES ARE DIRECTED TO THE
ELIMINATION OF BOTH PATHOGENIC AND NONPATHOGENIC
MICROORGANISMS.
STANDARD PRECAUTION
Standard precautions
 Standard precautions are a set of infection control practices that healthcare
personnel use to reduce transmission of microorganisms in healthcare settings.
 Standard precautions protect both healthcare personnel and patients from contact
with infectious agents.
Standard precautions include:
hand hygiene- this is the most important and basic preventive technique for
interrupting the infectious process. Wash hands before patient care after touching
blood, body fluids, secretions, excretions and contaminated items, immediately after
gloves are removed; between patient contacts, and which otherwise indicated.

3. Personalprotective equipment
Mask, eye protectionand face shields
Wear a mask and eye protection, or face shield, during procedures that are likely to
generate splashes or sprays of blood, bodily fluids, secretions, and excretions.
Personalprotective equipment
Gloves
you should use new gloves when hands may become contaminated with blood, body
fluids, excretions, or secretions or when touching mucous membranes or non-intact
skin, or contaminated surfaces or objects.
 Remove gloves after caring for a patient do not wear the same gloves for more than
one patient
 Do not reuse or wash gloves
 Don’t forget hand hygiene after removing gloves. Gloves are not replacement for
hand hygiene

4. Personalprotective equipment
Gowns
 Wear a gown during procedures that are likely to generate splashes or sprays of
blood, bodily fluids, secretions, or excretions.
 Secure gown appropriately.
 Remove a soiled gown as soon as possible, and practice hand hygiene after removing
the gown.
Personalprotective equipment
Shoe cover
Protective coverings for shoes worn by surgical personnel working in a
sterile environment in order to minimize contamination.

5. Personalprotective equipment
Surgicalcap
Surgical caps are used to protect both the medical professional and the patient.
The surgical cap is in place to prevent hazardous bodily fluids from splashing onto the
doctor or nurse’s hair and head. They are also used to prevent hair from affecting the
vision of the medical professionals.
PRINCIPLES
 A STERILE OBJECT REMAINS STERILE WHEN TOUCHED ONLY BY
ANOTHER STERILE OBJECT
 ONLY STERILE OBJECT MAY BE PLACED ON STERILE FIELD
 AN OBJECT HELD BELOW A PERSON’S WAIST IS CONTAMINATED
 A STERILE OBJECT BECOMES CONTAMINATED BY PROLONGED
EXPOSURE TO AIR
 WHEN STERILE COMES IN CONTACT WITH A WET CONTAMINATED
SURFACE THE STERILE OBJECTOR FIELD BECOME CONTAMINTED
 FLUID FLOWS IN DIRECTION OF GRAVITY
 EDGES OF STERILE FIELD OR CONTAINER ARE CINSIDERED TO BE
CONTAMINATED

6. PRINCIPLES IN SURGICAL ASEPSIS
PRINCIPLES RATIONALE
Always face the sterile field. Do not turn
back or side on a sterile field
Sterile objects which are out of vision are
considered questionable and their sterility
cannot be guaranteed
Keep sterile equipment above your waist
level or above table level
Waist level and table level are considered
margins of safely and will promote
maximum visibility of the sterile field
Do not speak, sneeze and cough over a
sterile field.
To prevent or droplet infections
Never reach across sterile field When non sterile object is held above a
sterile object, gravity causes micro
organisms to fall into the sterile field
Keep the unsterile objects away from the
sterile field
Micro organisms may be transferred
whenever a non sterile object touches a
sterile field
Keep the sterile field dry Micro organisms do not pass easily through
a dry surfaces
The edge of the sterile field is considered
unsterile
Proximity to contaminated area makes
sterility doubtful
Handle liquids caustiously near the sterile
field or prevent drapes or wrappers from
becoming wet
When a liquid wets it connects a non sterile
field with a sterile field
Each sterile supply should be clearly labeled
as to its contents, time and date of
sterilization
To ensure sterility
Neverassume that a object is sterile. Always
check the sterility expiration date
Sterility of an object wrapped in paper or
cloth becomes doubtful after 4 weeks
Avoid sweeping and dusting when the sterile
objects are opened
Micro organisms travel in the dust particles
Put on mask, wash hands, put on gowns and
gloves before handling sterile supplies
To prevent contamination

7. TRANSMISSION PRECAUTION
Types
 Contact precautions
 Droplet precautions
 Airborne precautions

8. Contactprecautions
Apply to patients with any of the following conditions and/or disease
 Presence of stool incontinence (may include patients with norovirus, rotavirus, or
clostridium difficile)
 Draining wounds
 Uncontrolled secretions
 Pressure ulcers or presence of ostomy tubes and/or bags draining body fluids
 methicillin-resistant staphylococcus aureus(MRSA)
 Presence of generalized rash or exanthems
 Perform hand hygiene before touching patient and prior to wearing gloves
 Personal protective equipment (PPE) use:
 Wear a gown if substantial contact with the patient or their environment is
anticipated
 Perform hand hygiene after removal of PPE; note: use soap and water when hands
are visibly soiled (e.g. blood, body fluids), or after caring for patients with known or
suspected infectious diarrhea (clostridium difficile, norovirus)
 Clean/disinfect the room and surroundings
 Donning e upon room entry and discarding before exiting the patient room is done
to contain pathogens, especially those that have been implicated in transmission
through environmental contamination (e.g. vancomycin resistant enterococci
Clostridium difficile, noroviruses, and other intestinal tract pathogens; Respiratory
synctial virus)
 Provide a private room- if possible otherwise in multi-patient rooms, 3 feet spatial
separation between beds is advised to reduced the opportunities for inadvertent
sharing items between the infected/colonized patient and other patients

9. Droplet precautions
Apply to patients known or suspected to be infected with a pathogen (more than 5
microns) that can be transmitted by droplet route; these include, but are not limited
to:
 Respiratory viruses (e.g. influenza, parainfluenza virus, adenovirus, respiratory
synctial virus, human metapneumovirus)
 For first 24 hours of therapy;: neisseria meningitides, group A streptococcus
 A single patient room is preferred
 When a single-patient room is not available, do cohorting (keeping the patient with
an existing roommate with a spatial separation of more than 3 feet)
 Healthcare personnel wear a mask (a respirator is not necessary) for close contact
with infectious patient; the mask is generally donned upon room entry
 Patients on droplet precautions who must be transported outside of the room should
wear a mask if tolerated and follow respiratory hygiene/cough etiquette*. Minimize
the patient transfer/transportation
 If substantial spraying of respiratory fluid is anticipated, gloves and gown as well as
goggles (or face shield in the place of goggles) should be worn
 Perform hand hygiene before and after touching the patient and after contact with
respiratory secretions and contaminated objects/materials; note: use soap and water
when hands are visibly soiled (e.g. blood, body fluids)
 Clean and disinfect the room

10. RESPIRATORY/ COUGH ETIQUETTE
 Cover your mouth and nose with a tissue when coughing or sneezing
 Use the nearest waste receptacle to dispose of the tissue after use
 Perform hand hygiene (e.g. hand washing with non-antimicrobial soap and water,
alcohol-based hand rub, or antiseptic hand wash) after having contact with
respiratory secretions and contaminated objects/materials.

11. Airborne precautions
Apply to patients known or suspected to be infected with pathogen than can be transmitted
by airborne route; these include, but are not limited to:
 Tuberculosis
 Measles
 Chickenpox (until lesions are crusted over)
 Localized (in immunocompromised patient) or disseminated herpes zoster (until
lesions are crusted over)
 Place the patient immediately in an airborne infection isolation room (AIIR)
 PPE use:
 Wear a fit-tested n-95 or higher level disposable respirator, if available, when caring
for the patient; the respirator should be donned prior to room entry and removed
exiting room*
 If substantial spraying of respiratory fluids is anticipated, gloves and gown as well
as goggles face shield should be worn
 Perform hand hygiene before and after touching the patient and after contact with
respiratory secretions and/or body fluids and contaminated objects/materials; note:
use soap and water when hands are visibly soiled (e.g. blood, body fluids)
 Instruct patient to wear a facemask when exiting the exam room, avoid coming into
close contact with other patients, and practice respiratory hygiene and cough
etiquette
 once the patient leaves, the room should remain vacant for generally one hour
before anyone enters; however, adequate wait time may vary depending on the
ventilation rate of the room
 If staff must enter room during the wait time, they are required to use respiratory
protection
 Minimized the patient transfer/transport
 Clean and disinfect the room accordingly
 Whenever possible, non-immune healthcare workers should no care for patients
with vaccine-preventable airborne diseases (e.g. measles, chickenpox, and smallpox)

12. CHAIN OF INFECTION
Chain of infection
Chain of infection is a process of infection that begins when an agent leave its reservoir
through portal of exit and is conveyed by mode of transmission then enters through an
appropriate portal of entry to infect a susceptible host.
CHAIN OF INFECTION CYCLE

13. INFECTIOUS AGENT OR CAUSATIVE AGENT
 These are any microorganism than can cause a disease such as a bacteria, virus,
parasites, fungus. Reasons that the organism will cause an infection are virulence
(ability to multiply and grow), invasiveness (ability toenter tissue), and
pathogenicity (ability to cause disease).
 Any organism is capable of causing infection if all the links/components are present.
Bacteria -are present inside us, on us and around us in our environment.
 Resident flora- bacteria present inside us, helps in digestion of food. (Unharmful)
 Transient flora-bacteria which we get from environment
 Air, drinking water, food, dust, clothes etc.
 Harmful
 Get activated when meet favorable environment
Viruses
 Respiratory infections influenza, cold etc.
 GI infections- norovirus
 Others- HIV, hepatatis etc.
Parasites
 Present in environment.
 Affects people with weak immune system.
 Example – malaria, tape worm infection etc.

14. Reservoir
 It is the place where the microorganism resides, thrives, and reproduces, i.e,. Food,
water, toilet seat, elevator buttons, human feces, respiratory secretions etc.
Portal Of exit
 It is the place where the microorganism leaves the reservoir, such as the respiratory
tract (nose, mouth), intestinal tract (rectum via stool), urinary tract, or blood and
other body fluids.

15. Mode of transmission
 Mode of transmission is the means by which an organism transfer from one carrier
to another by either direct transmission or indirect transmission.
Contact transmission- direct and indirect
 Contact transmission is the most common route of transmission of organisms in
healthcare settings.

16. Droplet transmission
 Droplet should come in contact with mucus membrane directly or indirectly
through sneezing, coughing, taking etc. examples of droplet transmission include
influenza, meningitis etc.
Airborne transmission
 There are three common disease that are transmitted through the airborne route;
chickenpox (varicella), tuberculosis, and measles.

17. Vector transmission
 Vector transmission occurs when an insect or animal transmits disease to humans
e.g. malaria and dengue fever etc.
Portal of entry
 The opening when an infectious disease enters the host’s body such as mucus
membranes, open wounds, or tubes inserted in body cavities like urinary catheters
or feeding tubes.

18. Susceptible host
 It is a person who is at risk for developing an infection from the disease. Factors
include young people and elderly people, chronic disease such as diabetes or asthma,
conditions that weaken the immune systemlike HIV, certain types of medications,
invasive devices like feeding tubes, and malnutrition.

19. BREAKING OF INFECTIOUS CYCLE

20. 1. Control or elimination of infectious agent
 Cleaning, disinfection and sterilization of contaminated objects significantly reduce
and often eliminate microorganism. It includes 4 steps
1. Cleaning-it is removal of all soil from objects and surface.
2. Asepsis – it is absence of pathogenic microorganism. It is of 2 types medical and
surgical asepsis
3. Disinfection-it is process of killing microorganisms, spores are not involved.
4. Sterilization- it is process of killing microorganisms and their spores.
 Clean contaminated objects (reduces the number of organisms)
 Perform disinfection and sterilization (kills or inactivates organisms).
 Use antiseptics to inhibit growth.
 Uses antiseptic agents/antimicrobial agents.

21. Control or elimination of reservoir
 Eliminate source of body fluids and drainage
 Bathe with soap and water
 Change soiled dressings
 Remove standing water on bedside tables.
 Cover bottles of used solutions
 Maintain patency of surgical wound drains
 Empty and rinse suction bottles
 Empty drainage bags every shift
 Place syringe and uncapped needles in moisture-resistant, puncture-proof
containers
 Limit contact with persons with infection or exposedto infection
3. Control of portal of exit
 Cover your mouth and nose with tissue, when coughing or sneezing
Dispose the used tissue in the garbage can, immediately after use.

22. 4. Control of transmission
 Reduce microorganisms spread
 Wash hands
 Use personal set of care items for each client
 Avoid shaking bed linens or clothes
 Discard any item that touches the floor
Hand hygiene moments
 Before touching the patient
 Before clean/aseptic procedure
 After body fluid exposure risk
 After touching a patient
 After touching patient surroundings

23. 7 steps to hand washing
1. Rub palms together
2. Run the back of both hands
3. Interlace fingers and rub hands together
4. Interlock fingers and rub the back of fingers of both hands
5. Rub thumb in a rotating manner followed by the area between index finger and
thumb for both hands
6. Rub fingertips on palm for both hands
7. Rub both wrist rotating manner

24. Control of portal entry
 Skin mucous membrane- maintain skin and mucous membrane integrity, use
proper hygiene measures.
 Clean wound sites thoroughly. Disposed of used needles in proper receptacles.
 Urinary- keepall drainage systems closedand intact.
 Discard facial tissues, wound dressings, and other body excreta without touching
Protectionof susceptible host
 Provide adequate nutrition
 Ensure adequate rest
 Promote body defenses against infection
 Provide immunization
 Maintenance of hygiene
 Use of personal protective equipments like gloves, gowns, shoe cover, mask and cap

25. REFERNCES
http://www.slideshare.net
www://www.registerednursing.org
opentextbc.ca
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