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Veterinary Surgical Nursing. PRINCIPLES OF ASEPSIS. Asepsis. A-sepsis To be “ without infection ” But not necessarily without presence of all infectious organisms Doing enough to prevent routine infections. Varying degrees of asepsis. Antiseptic - PowerPoint PPT Presentation
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PRINCIPLES of ASEPSIS
Veterinary Surgical Nursing
PRINCIPLES OF ASEPSIS
PRINCIPLES of ASEPSIS
Asepsis
• A-sepsis– To be “without infection”– But not necessarily without presence of all
infectious organisms– Doing enough to prevent routine infections
PRINCIPLES of ASEPSIS
Varying degrees of asepsis
• Antiseptic– Degree of kill achieved on living biological surfaces
• Povidone iodine• Chlorhexidine
• Disinfectant – Degree of kill achieved on inanimate surfaces (floors, walls,
equipment)• Bleach• Quaternary ammonium compounds
• Sterilising agent– Full kill achieved with sterilising agent (if properly used)
• Steam heat• Dry heat• Ionising radiation• Ethylene oxide • Glutaraldehyde
PRINCIPLES of ASEPSIS
Introduction
• Wounds of all types are prone to contamination and the eventual development of sepsis or infection.
• Nowadays, most people expect to survive surgery, however until this century the mortality rate for even simple procedures was high due to wound infections and shock.
PRINCIPLES of ASEPSIS
Antisepsis
• Antisepsis means the killing of micro-organisms within living tissue. (eg treating a contaminated wound).
• In 1865 the surgeon, Lister, introduced the concept of antisepsis by applying a mild solution of carbolic acid (phenol) to wounds and dressings circumventing, in many cases, the need to amputate limbs because of infection.
PRINCIPLES of ASEPSIS
1865
• Joseph Lister– Reduced surgical mortality rates
from 50% to 15% – Sprayed carbolic acid around operating
theatres and onto wounds
PRINCIPLES of ASEPSIS
Aseptic technique
• Aseptic technique means establishing conditions that prevent the contamination of surgical wounds. As a veterinary nurse you play a crucial role in its implementation and maintenance.
• In practice it is not possible to totally eliminate micro-organisms falling into the wound. However, there is a level of contamination which, when exceeded, will lead to infection. This level will vary between animals and is dependant on the competency of their immune system. This may be impaired by factors such as concurrent disease (eg renal failure, drugs, stress and tissue trauma at the site of the wound).
PRINCIPLES of ASEPSIS
Sources of infection
• Environment (incl equipment)• Patient• Personnel
PRINCIPLES of ASEPSIS
Environmental Sources
• Room and its contents • Atmosphere • Surgical equipment
PRINCIPLES of ASEPSIS
Patient Sources
• Skin• Cavities
– Alimentary tract– Respiratory tract– Urogenital tract
• Patient-sourced infection may be– Direct (via contact) – Indirect (via blood or lymph stream)
PRINCIPLES of ASEPSIS
Personnel Sources
• Clothing • Hands, Hair • Exhaled gases
PRINCIPLES of ASEPSIS
‘Sterile Field’
• Any areas draped – e.g. anything green– But also paper/plastic drapes– Gowns– Also gloves, instruments, swabs, saline– Includes areas vertically above these fields
PRINCIPLES of ASEPSIS
Wound contamination
Clean A surgical wound made under aseptic conditions. There is no break into a contaminated area such as the respiratory or gastrointestinal tract.
Clean-contaminated
Where a contaminated area is entered but without spillage or spread of contamination (i.e. respiratory, gastrointestinal or urogenital tract)
Contaminated Where there is spillage from a viscus or severe inflammation is encountered, but no infection present. Open fresh traumatic wounds e.g. HBC or animal bite.
Dirty Infection where there is pus present or viscus perforation spilling pus. Traumatic wound containing devitalised tissue or foreign bodies
PRINCIPLES of ASEPSIS
GOLDEN RULESOF ASEPSIS
PRINCIPLES of ASEPSIS
Confinement
• Surgical team members remain within sterile area– Movement out of the sterile area may
encourage cross contamination
• The entry of personnel into operating theatre greatly increases (x100) the number of air borne particles
PRINCIPLES of ASEPSIS
Talking
• Talking is kept to a minimum– Talking releases moisture droplets laden
with bacteria
PRINCIPLES of ASEPSIS
Movement
• Movement in the operating room or by personnel is kept to a minimum
• Only necessary personnel should enter the operating room– Movement may cause turbulent airflow and
result in cross contamination
PRINCIPLES of ASEPSIS
Areas Over sterile field
• Non-scrubbed personnel do not reach anywhere over sterile fields– Dust, lint or other carriers of bacteria may
fall on sterile field
PRINCIPLES of ASEPSIS
Face each other
• Scrubbed team members face each other and the sterile field at all times– A team members back is not considered
sterile even if wearing a wrap-around gown
PRINCIPLES of ASEPSIS
Sterile equipment
• Equipment used during surgery must be sterilised– Unsterile instruments may be a source of
cross-contamination
PRINCIPLES of ASEPSIS
Handling sterile equipment
• Only scrubbed personnel handle sterilised equipment– Risk of cross-contamination
PRINCIPLES of ASEPSIS
Doubtful instrument sterility
• If sterility of an item is questioned it is considered contaminated
PRINCIPLES of ASEPSIS
Table height
• Sterile tables are only considered sterile at table height– Items hanging over the table edge are
considered non-sterile because they are out of the surgeons vision
PRINCIPLES of ASEPSIS
Gowns
• Gowns are sterile from mid chest to waist and from gloved hand to 5 cm above the elbow– Back of a gown not considered sterile even
if wrap-around
PRINCIPLES of ASEPSIS
Moisture proof drapes
• Drapes covering instrument tables and patient should be moisture proof– Moisture carries bacteria from a non-sterile
surface to a sterile surface (“strike-through” contamination) – can happen within a minute
PRINCIPLES of ASEPSIS
Packet edges
• If a sterile object touches the sealing edge of the pouch that holds it during opening, it is considered contaminated– Sealed edges are not sterile
PRINCIPLES of ASEPSIS
Damaged or wet wrappers
• Sterile items within a damaged or wet wrapper are considered contaminated– Contamination by perforation or moisture
“strike through”
PRINCIPLES of ASEPSIS
Body posture
• Do not fold hands into the axillary region or dangle on sides– Rather clasp hands in front of the body
above the waist
PRINCIPLES of ASEPSIS
Seating
• If the surgical team begins surgery sitting then they should remain seated until surgery completion– Surgery field only sterile from table height
to chest; movement from sitting to standing may bring bacteria onto sterile field
PRINCIPLES of ASEPSIS
Scheduling
• Schedule contaminated surgery last– Abscesses– Bite wounds– Dentals
PRINCIPLES of ASEPSIS
More ideal principles
• Staff shower before surgery• Scrub suits used• Positive pressure ventilation of
theatre• Sterile air flows away from sterile
field
PRINCIPLES of ASEPSIS
The End