Aseptic
techniques
Definition of common
terms
• Sterile:- Refers to the condition of an object, or an
environment, which is free of all living cells, all viable
spores and all viruses and sub-viral agents capable of
replication.
• Asepsis:- The state in which potentially harmful
microorganisms are absent from particular tissues,
materials or environments;
• Antisepsis:- Use of chemical agents on skin or other
living tissue to inhibit or eliminate microbes.
Aseptic technique:- Precautionary measures taken to
prevent the contamination of cultures, sterile media
and/or the infection of persons, animals or plants by
extraneous microorganisms.
So this measure is a measure used for both asepsis and
sterility.
Aseptic technique includes
aseptic technique for surgical instruments and
aseptic technique for health professional who do the procedure
1. Aseptic technique for surgical instruments
• Depending on the procedure we may need
– sterile instruments or
– aseptic instruments.
• To attain this the following are important.
i. Disinfection:- Use of physical procedures or
chemical agents to destroy most microbial
forms; bacterial spores and other relatively
resistant organisms (e.g., mycobacteria, viruses,
fungi) may remain viable; disinfectants are
subdivided into high-, intermediate-, and low-
level agents
a) High-level disinfectant:- A germicide that kills all
microbial pathogens except large numbers of bacterial
spores. Used for certain types of instruments like endoscopies.
E.g. treatment of instruments by moist heat or H2O2.
b) Intermediate-level disinfectant:- A germicide that kills
all microbes except bacterial endospores.
Eg. Disinfecting laryngoscopes and speculum by alcohols .
c) Low-level disinfectant:- A germicide that kills most
vegetative bacteria and lipid-enveloped or medium-size
viruses.
Eg. quaternary ammonium compounds are used to treat
noncritical instruments and devices, such as BP cuffs, ECG
electrodes
ii. Sterilization:- Use of physical procedures or
chemical agents to destroy all microbial forms,
including bacterial spores. This is done for
instruments used for sterile part of our body.
Sterilization can be achieved by heat or
chemicals such as ethylene oxide.
2. Aseptic technique for health professional who
do the procedure.
• Generally health professional who do procedure in
operation room should follow the following aseptic
steps for prevention of infection
A. Entering the theatre:-
Any one entering the theatre must change OR
sandals and suit, Théâtre hat, mask and eye
protection should be fitted so that no hair is
exposed and you are protected from splash back.
B. Scrubbing:-
‘Scrubbing up’ is the process of washing the hands
and arms prior to donning a gown and gloves, to
minimize the microbial loads on parts of the surgical
staff that might come into contact with the patient.
Time spent scrubbing varies from unit to unit but as a
general rule surgeons in training should usually start
scrubbing before, and finish after, the senior surgeon.
Scrub technique
1. Preparation before scrubbing:
You should not scrub if you have an open wound or
an infection. (Uninfected cuts or abrasions can
be covered after a routine scrub-up process by
applying a sterile clear dressing before gloving.)
All jewelry on the hands should be removed.
2. The hands are then washed systematically, paying
special attention to the clefts b/n the fingers. This
should be carried out on at least two further
occasions, extending up the forearms to just below the
elbows.
After applying disinfectant (usually 2% chlorhexidine
gluconate or 7.5% povidone-iodine.), the arms are
washed from distal to proximal, with hands up and
elbows flexed to avoid/minimize any contamination
from the more proximal ‘unclean’ areas.
3. Following the final rinse the hands and arms should
be raised to face level, away from the body.
– This allows water to drop from the elbows.
4. The hands and arms should be dried using a sterile
towel for each side. Drying with each towel should
start with the fingers and work across the hand
and up the arm. The towel should then be discarded.
C. Gowning
• The folded gown is lifted away from the surrounding wrapping and
kept away from the trolley.
• The gown is grasped firmly at the neckline and allowed to unfold
completely, with the inside facing the wearer.
• The arms are inserted into the armholes simultaneously (the front
of the gown is not be touched with ungloved hands).
• Hands should stay inside the cuffs while gloving.
• The circulating theatre nurse should secure the gown at the neck
and waist.
• If a wrap-around type of gown is worn, these ties are secured with
the help of the circulating nurse once gloves are on.
D. Gloving
Gloves have two important functions. They prevent
contamination of the surgical wound and they also protect
the scrub team from the blood and body fluids of the patient.
Double gloving reduces the chance of a breach in this
protection and allows the outer gloves to be changed if
damaged. Double gloving is now a standard part of
‘universal precautions’ for minimizing the transmission
of human immunodeficiency virus (HIV) and hepatitis B & C
Once gowned and gloved, the hands must remain above
waist level at all times, and when not involved in a sterile
procedure the hands should be held together at chest
E. Patient-Skin antisepsis
Routine application of antiseptics to the skin should be
performed to reduce the burden of skin flora, although
bacteria in hair follicles and sebaceous glands
cannot be sterilized by preoperative antiseptic agents.
Preoperative skin cleansing with chlorhexidine -
alcohol or povidone-iodine is possible.
The cleansing of the skin should start at the incision
site, working outwards in continually expanding
circles away from the surgical site.
Draping of the operative area
Surgical draping involves covering with sterile barrier material,
‘drapes’, the area immediately surrounding the operative site.
Drape materials should resist penetration of microscopic
particles and moisture, limiting the migration of micro-organisms
into the surgical wound.
The purpose of surgical draping is to create and maintain a
protective zone of asepsis, called a ‘sterile field’, so that all
sterile items for the surgical procedure avoid touching any
unclean surface.
Drapes should be handled only by personnel wearing sterile
gloves and should be placed carefully and not disturbed
once placed.
reference
• Sabistons text book of surgery 21 ed
• Schwartz principle of surgery 11 ed
• www…
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