Asespsis technique

1. Operating Room (OR)
RLE

2. The Surgical Team
Who are they?

3. A team of highly trained professionals with a wide range of
specialties who is present to offer comprehensive patient
care.

4. The Surgeon
• responsible for the patient, as they are
the ones who made the decision to operate
on the patient in the first place, and they
are the ones in charge.
• Requests the surgery
• Provides consent, history and physical exam
• Communicates exact procedure, operative
side and special needs prior to surgical case
• Assists in positioning the patient
• Performs the surgical procedure.

5. Anesthesiologist
• other attending physician in the room, and can
generally be thought of as second in command.
• The anesthesiologist takes part in all 3 phases of
surgery: before, during, and after.
• Assesses patient’s risk for receiving anesthesia
• Assesses need for appropriate anesthetic during
the surgical procedure
• Communicates equipment needs to the circulating
nurse

6. The First Assist
• the person helping the surgeon perform the case,
also scrubbed into the sterile surgical field.
• a resident, physician assistant (PA), nurse
practitioner (NP), certified surgical assistant (CSA),
or medical student.
•It’s their responsibility to assist the surgeon
in performing the procedure, which includes
a lot of retracting, suctioning, and
performing other supportive measures for
the surgeon.

7. The Scrub Nurse
• The scrub nurse is also scrubbed in the surgical field,
and is the one rub preparing, organizing, and providing
the various surgical tools and instruments to the
surgeon and first assist during the case.
•gathers the necessary supplies, including the sets of
surgical instruments
•first one to scrub in and set up a sterile surgical field
•helping the surgeon and assistants with their sterile
gown and gloves.

8. The Circulating Nurse
• the point person in helping assist the surgical
team outside of the sterile surgical field.
• Along with the scrub nurse, they are also
responsible for gathering supplies, sterile
equipment, and toolsets needed for surgery and
anesthesia.
• manage the documentation at the computer
before and during the case,
• verifying the patient’s ID, who all is in the room,
• getting the patient comfortable with warming
blankets, and the like.

9. Medical device company
representative
Sometimes surgeons will have a
representative from a company that
makes medical equipment in the
operating room. Such equipment
might be artificial joints, spine
stabilizers, or pacemakers. The
representative can help the surgeon
with sizing and function of the
equipment.

10. Appropriate Operating
Room Attire

11. Learning Objectives
• Identify the components of appropriate OR
attire worn in specific areas of the surgical
suite
• Identify the components of personal
protective equipment (PPE) donned before
performing surgical hand cleansing
• Identify the sterile parameters of a surgical
gown
• Demonstrate the correct procedure in
performing surgical hand scrubbing
•

14. Purpose & Definition
• Effective barriers that both prevent the dissemination of
microorganisms to patients and protect personnel from
blood and body substances of patients
• 2-pc pantsuit, head cover, mask and shoe covers
• Sterile gown & gloves (sterile team members at the sterile
field)
• PPE(eyewear & other protective items for anticipated
exposure to blood and body fluids)

17. Considerations for Appropriate
Attire
• Only approved, freshly laundered attire intended for use in
the OR is worn within the semi-restricted and restricted
areas.
• OR attire should not be worn outside the OR suite or
outdoors.
• Personal hygiene is emphasized.
– Not permitted in the OR suite: person with acute infections,
cuts, burns, or lesion
– Fingernails should be kept short
– Jewelry should be removed
– Facial make-up should be minimal
– Eyewear or spectacles should be wiped with a cleaning solution
– Identification badges should be secured
– Hand hygiene
– Comfortable, supportive, ski-proof shoes

21. TRUE or FALSE
• Briefcases, backpacks and other
personal items are allowed to be taken
into the semi-restricted or restricted
areas.

22. CORRECT or WRONG
• Mask maybe worn
dangling at any time

23. The photo is WRONG.
• The filter portion of a surgical
mask harbors bacteria collected
from the nasopharyngeal airways
• The contaminated mask may
cross contaminate the scrub attire
top when the mask is worn
hanging around the neck

24. CORRECT or WRONG
• OR scrubs should not be worn in
the hospital facility outside of the
OR area without a clean lab coat
or appropriate cover up over
them.

25. • Evidence shows that lab coats can
be contaminated with large numbers
of pathogenic microorganisms
• Lab coats are not always discarded
daily after use or laundered on a
frequent basis

26. A YES or a NO?

27. • There is a body of
evidence that supports
covering the hairs &
ears due to the fact that
hair and skin can
harbor bacteria that
can be dispersed into
the operating room
environment

31. Components of Appropriate
Attire
• Body cover: fit snugly; changed as soon as possible
whenever it becomes wet or visibly soiled
– Those who will not be sterile team members should wear
longsleeved jackets with front closures over a scrub suit

32. Components of Appropriate
Attire
• Head cover: cap first before the scrub suit
– Facial and head hair is completely covered
– Hair is long: bouffant-style hat
– Reusabe cloth cap: freshly laundered daily

33. Components of Appropriate
Attire
• Shoe covers: protect from blood and fluid
– Protective gloves to change shoe covers
– Removed before entering the dressing room area and must be
removed before leaving the OR suite

34. Components of Appropriate
Attire
• Mask (breathing, talking, sneezing, & coughing)
– Protection from bloodborne pathogens that may splash or
spray toward the nose or mouth
– worn at all times in the restricted area of the OR suite
– Worn over both the nose and the mouth
– Sneezing???
– Hands should be washed with antimicrobial soap before and
after cleaning the nose and applying a new mask

35. • To prevent cross-infection, personnel should follow these
steps:
1. Handle the mask only by the strings, Hand hygiene
should be performed anytime the mask is handled.
2. Never lower the mask to hang loosely around the neck,
never place the mask on top of the head, and never place
the mask in a pocket.
3. Promptly discard the mask into the proper receptacle on
removal. Remask with a fresh mask between patients.
4. Change the mask frequently. Do not permit the mask to
become wet. Limit talking to a minimum.

37. Components of Appropriate
Attire
• Personal Protective Equipment (PPE)
– Aprons: full-front barrier; disposable plastic
• Against liquids & cleaning agents
• Lead aprons: against radiation exposure during procedures (full
body cover, vest, or skirt style
– Gloves: handle any materials or items contaminated by blood &
body substances
• Sterile gloves for sterile tea members & for all invasive
procedures
• Discarded after use
• Avoid opening doors, using a keyboard, or adjusting monitor
settings while wearing soiled gloves
• Double gloving: 1st pair is colored gloves (indicator glove)
• Wash hands after gloves are removed
– Eyewear: blood or body substances splash into the eyes
• Face shield: splash, spray, or splatter to the eyes or face
• Decontaminated or discarded promptly

39. Surgical Gown
• Worn over the scrub suit ; enter the sterile field
• Prevents contamination between the bearer and the field and
differentiates sterile from non-sterile team members
• Resistant to penetration by fluids and blood & should be comfortable
without producing excessive heat buildup
• Reusable and disposable gowns
• Sterilized, but the back nor any area below the level of the sterile field is
unsterile
• Sterile gloves must cover the cuffs of the gown completely to prevent
contamination of the sterile field

40. Surgical Gloves
- Handle sterile supplies and tissues of the surgical site
- Inspected for damage or wetness
- Inner sterile paper wrap protects the sterility of the gloves when they
are removed from the peel-pack outer wrap
- Absorbable dry cornstarch: facilitate donning and prevent adhesion
of the glove surfaces
- If punctured or torn, changed immediately to prevent escape of
microorganisms from the wearer’s skin and seepage of blood & body
substances from the patient into the glove

42. Surgical Hand Hygiene
– Surgical scrub
– Removing as many microorganisms as possible from the skin
of the hands and arms before donning sterile surgical attire
– Automatic sensor/ foot or knee operated faucets
– Protective eyewear should be worn

43. – Purpose:
• Decrease the number of resident microorganisms on skin to an
irreducible minimum
• To keep the population of microorganisms minimal during the
surgical procedure by suppression of growth
• To reduced the hazard of microbial contamination of the surgical
wound by skin flora

44. Recommendations for surgical
hand preparation
• Remove ring, wrist-watch and bracelets.
Artificial nails are prohibited
• Sinks should be designed to reduce the risk
of splashes
• If hands are visibly soiled, wash hands with
plain soap before surgical preparation.
Remove debris from underneath fingernails
using a nail cleaner, preferably under
running water.

45. • Surgical hand antisepsis should be
performed (antimicrobial soap or alcohol-
based handrub) before donning sterile
gloves
• Scrub hands and forearms for 2-5 minutes
(using antimicrobial soap)
• Alcohol-based handrub
– Sufficient to keep hands and forearms wet
– Allow hands and forearms to dry thoroughly
before donning sterile gloves

46. Antimicrobial Skin-cleansing
Agents
– Clorhexidine gluconate (CHG)
– Idophors
– Triclosan
– Alcohol
– Hexachlorophene
– parachlorometaxylenol

51. Return demonstration
• Return demonstration on Surgical hand
hygiene
– August 18 PM

52. Gowning & Gloving
– Purpose:
• Exclude skin as a possible contaminant and to create a barrier
between the sterile and non-sterile areas
• The gown protects the patient and the wearer from cross
contamination
– General Considerations
• The scrub person gowns and gloves from a surface separate
from the main sterile field using the closed-gloving method and
then gowns and gloves the surgeon and the rest of the sterile
team using the open-assisted or closed-assisted gloving
method.
• Gown packages preferably are opened on a separate table from
other packages to avoid any chance of contamination from
dripping water.
• Splashing water on scrub attire during the surgical scrub should
be avoided because moisture may contaminate the sterile gown.

53. Gowning & Gloving
– Drying the hands and arms with a sterile towel

55. Gowning & Gloving Techniques
– Don the gown before the gloves (closed-gloving or open
gloving technique
– Assisted-open gloving technique
– Gowning Self

60. Closed
gloving

65. Cuff of glove completely covers cuff of
gown

69. Open gloving technique
• the scrubbed person extends the hands all the way through the
cuffs and sleeves.
• The hands are totally exposed outside the cuffs

71. Assisted-gloving technique

72. Assisted-gowning

73. Removing a contaminated gown

74. Removing contaminated gloves

77. Assignment:
• Create a pocket card of the surgical
instruments.
• Briefly define or describe the different
classifications of instruments.
• For each classification, provide a photo of
the instruments.
• Submit: August 24, 2022

78. Classification of Instruments
– Dissecting and cutting instruments
• Scalpels
• Knives
• Scissors: tissue scissors, suture scissors, wire suture scissors,
Joseph nasal scissors, Potts angled scissors, Lister bandage
scissors, tenotomy scissors
• Blunt dissectors
– Grasping and Holding instruments
• Delicate forceps- bishop eye or forceps
• Adson forceps - Lahey forceps
• Bayonet forcep - Tenaculum
• Smooth tissue forceps - Bone holders- Lambotte bone
• Toothed tissue forceps or forceps with teeth
• Allis forcep
• Babcock forceps
– Debulking instruments
• Biopsy forceps
• Curettes
• Snares

79. • Clamping & occluding instruments
– Hemostatic clamps
– Hemostats
– Crushing clamps: Haeney clamp, hysterectomy clamp, Ochsner &
Kocher clamps
• Retracting & exposing instruments
– Manual retractors: appendiceal retractor, Volkmann rake retractors,
double-ended Army-navy retractor, Eastmann retractor, Mayo
retractor
– Hooks
– Self-retaining retractors: Weitlaners, Gelpi, Balfour, O’Sullivan-
O’Connor

80. • Viewing instruments
– Speculums: Auvard & Graves vaginal speculum
• Closure & approximation instruments
– Needle holders: Crile, Haeney, Mayo Hegar needle holder
• Small needle holders: Webster smooth jaw needle holder, Derf snub-
jaw needle holder, Ryder narrow tip needle holder
– Tungsten carbide jaws
– Staplers

81. Passing of Instruments

83. Scalpels and Handling

85. Technique on how to put the
surgical blade:

87. How to remove the blade:

89. Scissors & Handling

90. Forceps & Handling

92. Retractors & Handling

94. Needle Holders & Handling

99. Principles of Asepsis
• Scrubbed persons function within a sterile
field.
• Sterile drapes are used to create a sterile
field.
• All items used within a sterile field must be
sterile
• All items introduced onto a sterile field
should be opened, dispensed, and
transferred by methods that maintain sterility
and integrity

100. • A sterile field should be maintained and
monitored constantly
• All personnel moving within or around a
sterile field should do so in a manner to
maintain the sterile field
• The edge of anything that encloses sterile
contents is not considered sterile
• Sterile persons keep within the sterile area
• Non-sterile persons keep away from sterile
area

101. • Moisture may cause contamination
• Destruction of integrity of microbial barriers
result in contamination