Surgical asepsis refers to procedures used to keep objects and areas free from microorganisms. The principles of surgical asepsis include always facing the sterile field, keeping sterile equipment above waist level, not speaking over sterile fields, and avoiding contact between sterile and non-sterile items. Procedures like surgical hand scrubbing, donning sterile gowns and gloves aim to eliminate pathogens. The surgical hand scrub involves washing arms and hands with antimicrobial soap for 5 minutes using specific techniques. Donning a sterile gown involves unfolding the gown without touching the floor and inserting arms while keeping hands above elbow level. Applying and removing sterile gloves is done using closed techniques to maintain sterility and prevent contamination.

1. SURGICAL ASEPSIS
Prepared by,
K.THILAGAVATHI,M.Sc(N).,
Lecturer

2. SURGICAL ASEPSIS
 Refers to the procedures used to keep the
object or areas sterile or completely free
from micro organisms.
 In surgical asepsis all practices are
directed to the elimination of both
pathogenic and nonpathogenic microorganisms.

3. Principles in surgical asepsis
Principles
Always face the sterile field.
Do not turn back or side on a
sterile field
Rationale
Sterile objects which are out of
vision are considered
questionable and their sterility
cannot be guaranted.
Keep sterile equipment above
Waist level and table level are
your waist level or above table considered margins of safety
level.
and will promote maximum
visibility of the sterile field.
Do not speak, sneeze and
cough over a sterile field.
To prevent or droplet infection.
Never reach across sterile
field
When a nonsterile object is held
above a sterile object, Gravity
causes micro organisms to fall
into the sterile field.

4. Principles
Rationale
Keep the unsterile objects
Micro organisms may be
away from the sterile field. transferred whenever a non
sterile object touches a
sterile field.
Keep the sterile field dry
Micro organisms do not pass
easily through a dry surface.
The edge of the sterile
field is considered
unsterile.
Proximity to a contaminated
area makes sterilty doubtful.
Handle liquids cautiously
near the sterile field or
prevent drapes or wrappers
from becoming wet.
When a liquid wets it
connects a nonsterile field
with a sterile field.

5. Principles
Rationale
Each sterile supply should
To ensure sterility.
be clearly labeled as to its
contents, time and date of
sterilization.
Never assume that a
object is sterile. Always
check the sterility
expiration date.
Avoid sweeping and dusting
when the sterile objects
are opened.
Sterility of an object
wrapped in paper or cloth
becomes doubtful after 4
weeks.
Micro –organisms travel in
the dust particles
Put on mask, Wash hands,
put on gowns and gloves
before handling sterile
supplies.
To prevent contamination.

6. PROCEDURES INCLUDED IN
SURGICAL ASEPSIS
 Surgical hand scrub
 Donning a sterile gown
 Applying and removing a sterile
gloves

7. 1.Surgical hand scrub
Purpose :
Remove as many micro organisms
from the hands as possible before the
sterile procedure.

8. 1.SURGICAL HAND
SCRUB

9. Equipment
 Warm running water
 Antiseptic Soap Solution
 Hand brush stored in a sterile
container
 Transferring forceps
 Sterile towel

10. Steps of the procedure
1.Makesure fingernails are short,clean,healthy.Nail
polish should be removed.
2.Remove jewelries(Rings, Bracelets).
3.Apply personal protective equipment(PPE) includes
surgical shoe covers,Cap,Facemask
and protective eyewear.

11. 4.Open disposable brush impregnated with
antimicrobial soap
5.If no disposable brush is not available/some
hospital use brush sterilized and stored in the
small bin.

12. 6.Use a transferring forceps to
pick up the brush from the
sterile bin.
7. Turn on the water and
adjust the flow so that the
water is warm. Warm
water removes less of the
protective oil of the skin
than hot water®.
8.Wet hands and arms. Keep
hands above elbows
Rationale: Movement of water
and dirt will flow from hands
to less clean areas thus
preventing contamination of
the hands during scrub.

13. 9.Wet scrub brush or apply antibacterial soap if not
already impregnated in the brush.
10.Anatomic timed scrub: Starting with fingertips, scrub
each anatomic area (Nail, fingers each side and web
space,palmar,dorsal surface and Forearm) for around 5
minutes.

14. 11.Scrub vigorously using vertical strokes in a
circular manner. Repeat with other hand.
Rationale: Ensures that all surfaces will be
systematically scrubbed to remove transient
and resident micro organisms.
12.Counted brush stroke method: Starting
finger tips, scrub each anatomic area for the
designated number of strokes. Scrub
vigorously using vertical strokes.

15. 13.Rinse hands thoroughly under warm running
water, holding hands upward. This is to allow water
to drain towards the flexed elbows.
Rationale : Prevents contamination of the hands
from dirtier areas. Remember do not touch
anything before and after rinsing hands.
Touching non sterile objects would mean the
surgical scrub need to be repeated.

16. 14.Keep hands held upward to allow water to
drip from the hands to elbow.
15.Dry hands with a sterile towel.

17. 2.Donning a sterile gown

18. 2.Donning a sterile gown
Purpose :
To apply entire necessary to safely
carryout sterile procedures usually in the
operating room and delivery room.

19. Donning a sterile gown
1.Grasp folded sterile gown at the neckline
and step away from the sterile field.
Allow gown to gently unfold, being careful
that does not touch the floor. The inside of
the gown is towards the user.
Rationale: Maintains sterility of the gown
and positions it for donning.

20. 2.Holding the arms at the shoulder level, grasp
the sterile gown just below the neckband near
the shoulders and slide arms in the sleeves
until the fingers are at the end of the cuffs
but not through the cuffs.
Rationale : The finger remain in the cuffs to
protect the sterility of the gown and
prepared for closed gloving.

21. 3.Have someone tie the back of the gown
,taking care that only the ties are touched
and not the sides of the gown.
Rationale: Maintains sterility of the gown.
Gowns are considered sterile in front of
the shoulders sterile from 2 inches above
the elbow to the wrist.

23. 3.APPLYING AND REMOVING
STERILE GLOVES

24. Donning a glove
Purpose :
Prevent transfer of micro organisms
from hands to sterile objects or open
wounds.

25. A.Applying gloves
1.With fingers still within the cuff of the gown, open
the inner sterile glove package and pick up the first
glove by the cuff, using the nondominant hand.
Rationale :Maintains the sterility of the gloves.
2.Position the glove over the cuff of the gown so the
fingers are in alignment and stretch the entire glove
over the cuff of the gown, being careful not to touch
its edge. Finger remain within the cuff of the gown.

26. 3.Use the sterile gloved hand to pick up the second
glove, placing it over the cuff of the gown of the
other hand and repeat the glove application
process.
4.Adjust gloves for comfort and fit, taking care to
keep gloved hands above waist level at all times.
Rationale : If gloved hands fall below the waist
level,there are no longer Sterile.

27. B.Removing gloves:
1.Wash gloved hands first.
2.With dominant hand,grasp outer surface of non
dominat glove just below thumb. Peel off glove
insideout,without touching exposed wrist.
Rationale :After use, outer surface of gloves is
contaminated and could transfer micro organisms to
the nurse’s wrist.

28. 3.Placed ungloved hand under thumb side of second
cuff and peel off the fingers holding first glove
inside second glove. Discard into appropriate bin
Rationale: Folding contaminated glove surfaces
toward the inside minimize the chance to
transfer of micro organisms. Use glove to glove
skin to skin technique when removing gloves.
4.Wash hands before and after removing gloves to
prevent contamination of hands.