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Aseptic Techniques (procedures)

Aseptic Techniques (procedures)

• Definition
• Aseptic technique is a set of specific practices and procedures
performed under carefully controlled conditions with the goal of
minimizing contamination by pathogens
Aseptic Techniques

• Prerequisite Knowledge

• Principles of asepsis
• Surgical scrub
Aseptic Techniques

• Principles of aseptic technique

Aseptic: The complete absence of lining microorganisms

Methods to achieve sterility or asepsis:

• Chemical methods (e.g. gas sterilization)
• Physical methods (e.g. autoclaving)
Aseptic Techniques
• Aseptic technique is based on the fundamental
principle that the infection is introduced into the body from
the outside
• Therefore, perform all procedures using a method that
prevents the introduction of bacteria into a surgical wound
Aseptic Techniques

• Operating Room
The operating room (OR) should provide an environment that
is free of bacterial contamination as possible

The minimum size recommended for an OR is usually20 by 20

feet, which allow space for:
► Gowning of the operative team
► Draping the patient
► And movement of the other personals, without contaminating
of sterile areas
Aseptic Techniques

• Operating Room
* The concept of separating clean traffic to dirty traffic is
theoretically sound but has not been shown to lower wound
infection rates

* Studies suggest that the redispersal of bacteria from the OR

floor into the air is very low

• Appropriate ventilation rapidly clears bacteria from the air,

• and the degree of floor contamination should not increase
infection rates
• Operating Room
The very low concentrations of airborne particulate matter and
bacterial in most OR are achieved by changing room air 20
to 25 time each hour.►►►►
► And passing inflow air through a high-efficiency
particulate air (HEPA) filter which efficiently remove
Aseptic Techniques

• Patients
• Wound infections that occur in clean operations are often
caused by staphylococci or other bacteria form a source in
the patient such as:
• the skin or
• nares

Preparation of the patient’s skin before an incision is one of

the most important methods of decreasing infection
Aseptic Techniques

• Patients
• It is effective to have the shower with antibacterial preparation the night before
elective procedures

• Hair removal should be employed only when the hair may interfere with the
performance of the procedure

• Shaving the patient with razor the night before operation has been associated with
a relative high wound infection rate
Aseptic Techniques

• Patients
• The risk of infection is decreased by shaving the patient in
the operating room immediately before the procedure or in
the setting by using a depilatory cream or electric clippers

• The most commonly used antimicrobial agents for intact

antisepsis are iodophors (e.g. Betadine)
Aseptic Techniques

• Patients
• Skin Cleansing
• The most commonly accepted technique in cleansing the
patient’s skin is to begin with the area where the incision is to
be made and to consider this as the cleanest portion of the
area of operation

• The contaminated sponge stick should never be returned to

the cleansing solution
Aseptic Techniques
• Remember
• 1. The procedure must be done in a sterile field from
which all bacteria have been excluded, if possible

• The inadvertent use of unsterile items may introduce

contaminants into the wound

• Items of uncertain sterility must be considered unsterile

Aseptic Techniques
• The circulating nurse should check:
• the package integrity
• the expiration date and
• the chemical process indicator
• before dispensing a sterile item
2. Gown worn by the surgical team are considered sterile at the
front, from chest to the level of the sterile field

• The sleeves are also considered sterile from to inches above the
elbow to the stockinet cuff

• The cuff should be considered unsterile because it tends to collect

moistures and is not an effective bacterial barrier

• Therefore, the sleeve cuffs should always be covered by sterile

Aseptic Techniques
• Other areas of gown that should be considered unsterile
are the:
• neck
• shoulders
• areas under the arms and
• back

• These areas may become contaminated by perspiration

or by collar and shoulder surfaces rubbing together during
head and neck movement

• The back of the gown is not sterile it cannot be observed by

the scrubbed person and protected from contamination
Aseptic Techniques
• 3. Sterile drapes are used to create sterile field
• Only the top surface of the draped table is considered
Aseptic Techniques

• Any item that extends beyond the sterile boundary is

considered contaminated and cannot brought back onto the
sterile field

• A contaminated item must be lifted clear of the operative field

without contacting the sterile surface and must be dropped
with minimum handling to an unsterile area, or receptacle
Aseptic Techniques

• 4 After a sterile package or container is opened, the edges are

considered unsterile

• ► the edge of bottle cap is considered contaminated once the cap has
been removed from the bottle

• ► The sterility of the contents cannot be ensured if the cap is replaced

on the bottle
Aseptic Techniques

• 5. Whether a sterile barrier is permeated, it must be

considered contaminated

• Obvious contamination occurs from direct contact between

sterile and unsterile objects
Aseptic Techniques

Other less apparent modes of contamination are the:

* filtration of airborn microorganisms through materials

* The passage of liquid materials
* The undetected perforations in materials
6. Sterile fields should be prepared as close as possible
to the scheduled time of use
Aseptic Techniques
• Patient Position
• Patient position should:

• Ensure optimum exposure and access of the operative

• Sustain body alignment
• Maximize circulatory and respiratory function
• Not compromise neuromuscular structure
Aseptic Techniques
• Surgeon
• Operating Room Attire
• Comfortable closed in shoes (preferably operating room

• Eat breakfast , and use restroom before the session begins!

Aseptic Techniques
• Surgeon
• Operating Room Attire
• No jewellery or nail polish

• Short, clean nails

Aseptic Techniques
• Surgeon
• Operating Room Attire
Protective eyewear/ Face shields

Hat/ Cap: hair tucked in

Mask facing out, tied securely

• Remember:
► Masks should cover the nose and mouth

► Fitting snugly across the bridge of the nose

► At the edge of the cheeks under the chin

• Footwear: If available

►► Now Ready for operating room

• Surgeon
• Review of surgical scrub
* Scrub time: 5 min for the first scrub of the day, and 3 min
for each subsequent scrub

• Hand and forearms are to be held out from scrub clothes

• Hand to be at higher level than elbows at all the time

• Scrub solution is applied to hands

* Each nail is cleaned under running water with nail stick

Aseptic Techniques
• Surgeon
• Review of surgical scrub
Each nail is scrubbed against palm of opposite hand

• Each finger is then scrubbed in all 4 sides

* Back of the hand and palm is scrubbed from base of fingers

to wrist
Aseptic Techniques
• Surgeon
• Review of surgical scrub
Small overlapping circles are used to scrub from wrist to 2 -3
cm above elbow

Hand and forearms are rinsed from finger-tip to elbow

Hand drying
• Drying towel is lifted up away from the sterile field without
dripping water into that field

• Bent forward at the waist, fingers and hand are dried

thoroughly, then the same part of towel is used to dry
remainder of forearm

• The other end of the towel is then used to dry the other
hand and forearm
Aseptic Techniques
• Gowning
• The sterile gown is lifted out of it sterile wrapper without

• The individual then moves into an area where the gown may
be opened without contamination of gown

• The gown is held away from the body and unfolded so that
the inside is toward the wearer
• Gowning
• The hands are slipped into the gown while keeping them away from the body at and
shoulder level

• The hand are advanced up the sleeves of the gown to the proximal end of the cuffs

• Gloving is performed by the closed or opened method

• Gowning
• The surgeon then hands the sterile right tab of the gown the
scrub nurse, turns left 280º and then takes back this tab

• He/Her then ties this to the other sterile tab to wrap the
Aseptic Techniques
• Gloving
• Closed method
• In this technique the scrubbed nurse assists the
scrubbed individual with gloving
Aseptic Techniques
• Gloving
• Open method
Aseptic Techniques
• Removal of dirty gown and gloves
• This is recommended to prevent contact with the soiled outer
layer of gloves and gown and mask

• The waist tie is untied by the surgeon

• The surgeon turn away from the circulating nurse to allow

him/her to undo the back closure of the gown

• The surgeon then grasps a shoulder of the gown and pulls it

inside out off one gloved arm
• pulls that sleeve off leaving the glove on, but with the cuff now
Aseptic Techniques

• Removal of dirty gown and gloves

• This step is repeated with the other arm

• The gown is pulled off completely, held away from the body,
and placed into the appropriated linen container

• The gloved finger of one hand are placed under the everted
cuff of the cotrolateral glove. The glove is pulled off and
inverted at the same time

• The everted cuff on the remaining glove is then grasped the

bare free fingers of the other hand and is pulled off in the
same way
Aseptic Techniques

• Removal of dirty gown and gloves

• The surgeon then goes back to the scrub area and removes his/her
mask, taking care to touch only the ties at the back (A new mask
should be worn for each case)

• The arms should then be watched carefully