Surgical Asepsis

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 infections.

 

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.

 

Surgical Asepsis:

 

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 procedures.

 

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 use:

 

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 changed.

 

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.

 

The gloves may be wiped dry or hung on a rack and turned to dry the inside as well.

To prepare for sterilizing, dust the gloves well both inside and out with glove powder.

 

See that the roughened surface is on the outside (for better grip) then pair off the gloves.

 

Turn back the cuffs 5 cm and place a small pocket of glove powder just inside the right-hand glove.

 

Place 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.

 

For the surgeon and his assistant particularly, gowns should be made of close- woven material.

For all 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.

 

(iv) An 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 ironed.

 

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.

 

Caps, 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 theatre cap.

 

Surgical 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.

 

Requirements:

 

1. Running water.

 

2. Antiseptic soap or soap solution.

 

3. Sterile nail brush

 

4. Sterile towel.

 

Method:

 

1. Wear a clean cap and then a clean mask.

 

2. Note the time, the procedure should take 10 minutes.

 

3. Wet the hands up to the elbows under the running water.

 

4. 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.

 

5. After 30 seconds, rinse thoroughly.

 

6. 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.

7. Rinse the arms and other hands with forearms held up so that water does not run down from the elbows to the hands.

 

8. Dry on a sterile towel, starting with the hands and moving upwards.

 

5. Wearing sterile gowns and gloves:

 

Take 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.

 

Dust your hands with sterile powder, and put on the gloves. Hold the first glove by the turned back cuff, and slip it on.

Next 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' .

 

Handling 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 things unsterile.

 

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

The  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.

When 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.

Put 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.