Asepsis means absence of disease producing organisms. The
microorganisms of different types are present everywhere in our environment and
in the human body. The purpose of medical asepsis is to prevent by all means of
cross-infections from one patient to another, including communicable disease
The purpose of surgical asepsis is to prevent by all means
of infections of the wounds of surgical patients, infection of the uterus
during and after delivery, and infection that could be introduced by invasive
procedures such as catheterisation, injections and infusions.
This means keeping objects and areas ' sterile' free from
all organisms. Surgical asepsis (Sterile technique) is used in the operating
room, delivery room, in doing surgical dressings and many other invasive
The nurse must thoroughly understand the principle of
surgical asepsis. She must be reliable in always keeping to these principles.
She must know about the use and care of the masks, gloves and gowns, the proper
technique of hand washing for surgical procedures and the sterilizing and
handling of sterile equipments.
Masks, gloves and gowns for surgical
1.Masks: A facemask is worn when doing any sterile surgical procedures. The purpose of the mask in
surgical nursing is to prevent any germs from the person' s respiratory tract
from being breathed up on the wound or sterile articles.
The mask should cover both nose and mouth of the wearer.
It is made of two or more layers of material, either in
rectangular or nosebag shape, with tapes to tie at the back of head.
While being worn, the face piece should not be touched.
If it becomes wet with sweat or by sneezing, it should be
Do not speak more than necessary during surgery.
A fresh mask should be worn for each procedure.
The mask should neither be suspended around the neck nor put
into the pocket.
After use, remove the mask, hold it by the tapes, and place
it straight into antiseptic solution.
At the end of each day, the used masks should be washed,
dried, then folded with tapes outside and sterilized ready for use again.
In some hospitals, disposable masks are worn.
2.Gloves: Surgical gloves in various sizes are made of special thin rubber so that the surgeon may
not lose the sense of touch.
In clean operations they are worn to protect the patient,
but in infected cases they protect the wearer also.
After use, gloves should be washed in cold water and then
with soap and water.
By filling the glove with water holes can be detected.
gloves may be wiped dry or hung on a rack and turned to dry the inside as well.
for sterilizing, dust the gloves well both inside and out with glove powder.
the roughened surface is on the outside (for better grip) then pair off the
the cuffs 5 cm and place a small pocket of glove powder just inside the
pair of gloves in a glove pocket marked with the correct size. Disposable
gloves are now in use.
3. Gowns: Steam sterilized theatre gowns are worn by the scrubbed-up operating team, to prevent
contamination of the sterile field by the contact with clothing or skin.
Unsterile but clean gowns are often worn by those persons in the operating room
who are not scrubbed up.
the surgeon and his assistant particularly, gowns should be made of close-
those scrubbed up, the gowns must have sleeves, which are long enough to fit
under the gloves at the wrists.
All the gowns fasten at the back.
unsterile helper ties the tapes without touching the outside of the sterile gown.
After use, gowns are soaked in cold water if blood stained,
then hung to dry and sent to the laundry, or well washed in hot soapy water and
Gowns to be sterilized must be folded and rolled up in such
a way that only the inner surface is handled by the scrubbed up persons.
They are packed in drums or bundles ready for autoclaving.
clothing and footwear: In the
operating theatre, there must be no
risk of introducing dust and dirt, especially any soil that may contain tetanus
organisms. Therefore every person entering must wear clean clothing, and put on
clean theatre slippers or canvas shoes.
These must be removed on leaving the theatre.
The hair must be completely covered by means of a clean
hand-scrub: In all surgical work it is important
to keep the hands and nails clean.
Nails must be cut or filed very short.
The surgical hand scrub is necessary for the surgeons and
those assisting at an operation, and for sterile procedures.
It must be realized that hands can never be made sterile
except by wearing sterile gloves.
Antiseptic soap or soap solution.
Sterile nail brush
Wear a clean cap and then a clean mask.
Note the time, the procedure should take 10 minutes.
Wet the hands up to the elbows under the running water.
Apply soap to make a good lather, and look it into the hands and arms, adding
small amounts of water but not enough to remove the lather.
After 30 seconds, rinse thoroughly.
Apply more soap and this time uses the brush. Pay special attention to the
nails, fingertips and between fingers. Add more water in small amounts
frequently but keep the lather, with more soap also. After the nails, fingers
and hand, work up the arm, scrubbing gently with circular motions and following
at the elbow. Repeat for the other arm.
Rinse the arms and other hands with forearms held up so that water does not run
down from the elbows to the hands.
Dry on a sterile towel, starting with the hands and moving upwards.
Wearing sterile gowns and gloves:
hold of the gown at arms length with your scrubbed up hands, unroll, and slip
arms into the smaller, asking a helper to the tapes at the back. Both you and
the helper must be very careful not to touch the outside of the gown.
your hands with sterile powder, and put on the gloves. Hold the first glove by
the turned back cuff, and slip it on.
insert the gloved fingers under the cuff of the second glove and slip it on.
The cuff of each glove is then unfolded and pulled completely over the sleeve
end of the gown. These must be no gap at the wrist, and the nurse must not
touch the bare skin nor inside of glove or gown when scrubbed up.
The first scrubbed up person may help others by holding the
sterile gloves for them to slip in their hands. When scrubbed up, the nurse
must remember to touch only sterile things. The instrument table and whole
field of operation is draped with large sterile clothes and towels. Helpers who
are not scrubbed up may help to bring sterile suppliers to the tables, keeping
to the outside and using ' Cheatle forceps' .
of Sterile articles:
Always wear a mask when handling sterile articles.
Sterilized articles must be kept in sterile containers or on
sterile towels, and kept covered till used. Never allow contact of unsterile
with sterile articles.
Make sure there is no dampness, as this could make the
Never allow any unsterile article including the arms and
hands to pass a sterile field.
Never touch the inside of a package or container with your
fingers. Use the cheatle forceps.
To pull a cork from a bottle of sterile fluid, take care not
to contaminate the inner part neither of the cork nor inside the rim of the
bottle. Replace it carefully.
When lifting a cover from a sterile container bring it down
with the inner side up and then replace it without delay.
To carry a sterile bowl or other container, hold it with
your hands underneath, and do not touch the rim.
Rules for use of cheatle forceps
sterile jar holding the forceps must be
cleaned, re-sterilized and filled with
fresh antiseptic lotion daily. The cheatle forceps should be cleaned and autoclaved or boiled.
in use, keep the forceps at elbow level and pointed downwards because if you
lift it upwards the solution may run on to your hand and then back to the
forceps, making it unsterile.
the forceps back into the jar immediately after use. Replace carefully without
touching the rim of the jar. If the forceps becomes contaminated, it must be
re-sterilized before being put back into the jar.