CST Chapter 9 The principles and practice of aseptic technique

The methods used to achieve the goal of asepsis are called _______________.

"doing and thinking"

Sterile field

An area that includes the draped patient, all sterile tables, and sterile equipment in the immediate area of the patient. The patient is the center of the sterile field.

Strike-through contamination

An event in which fluid from a nonsterile surface penetrates the protective wrapper of a sterile item, causing it to become contaminated.

Sterile item

Any item or medical device that has been exposed to a process that destroys all microbes, including spores.

Sharps

Any objects that can penetrate the skin and have the potential to cause injury and infection, including but not limited to needles, scalpels, broken glass, and exposed ends of dental wires.

Physical barrier

In surgery, a barrier that separates a sterile surface from a nonsterile surface. Examples are sterile surgical gloves, gowns, and drapes. A physical barrier, such as a clean surgical cap, prevents a bacteria-laden surface, such as the hair, from shedding microorganisms.

Scrubbed personnel

In surgery, members of the surgical team who work within the sterile field. Also called sterile personnel.

Non sterile personnel

In surgery, team members who remain outside the boundary of the sterile field and do not come in direct contact with sterile equipment, sterile areas, or the surgical wound. The circulator, anesthesia care provider, and radiographic technician are examples of nonsterile team members.

Antiseptics

Chemical agents approved for use on the skin that inhibit the growth and reproduction of microorganisms.

Sterility

A state in which an inanimate or animate surface harbors absolutely no viable microorganisms.

Surgical conscience

In surgery, the ethical motivation to practice excellent aseptic technique to protect the patient from infection. Surgical conscience implies that the professional practices excellent technique regardless of whether others are observing.

The term for the area under the fingernails is

B. Subungal

_____________ is a way of making decisions and acting on proven methods.

A. Evidence- based practice

_________ are worn to reduce contamination of the surgical field by loose hair and dandruff from the scalp.

b. head coverings

Containment and confinement

A foundational concept of aseptic technique in which sterile and nonsterile surfaces are separated by physical barriers or distance (space).

Surgical hand scrub

A specific technique for washing the hands before donning a surgical gown and gloves before surgery. The scrub is performed with timed or counted strokes using detergent-based antiseptic. The surgical hand scrub is designed to remove dirt, oils, and transient microorganisms and reduce the number of resident microorganisms.

Handwashing

A specific technique used to remove soil, debris, and dead cells from the hands. Hand washing with an antiseptic also reduces the number of microorganisms on the skin.

Case Studies: Look at the picture and answer the following questions about the actions of the surgical technologist. A. The surgical technologist has just opened one side of her sterile table. What are her next three actions? (Be specific)

Action one: open the other side of the table being careful not to move the drape across the surface. Action two: Prepare the ring stand and basin. Unfold the the basin away from you then from side to side until you unfold in front of you. Be careful of the wall and other tables. Keep 12-18 inches away otherwise known as the distance barrier. Action three: prepare gloves and gown on mayo stand. Remove gown from plastic and place on stand. Unfold carefully like before being aware of the 1 inch margin of contamination. Pop the gloves on the gown away from the 1 inch contamination area.

Gross contamination

Contamination of a large area of tissue by a highly infective source.

Double gloving is preferred over single gloving because _______________.

Double gloving has been shown to reduce the risk of glove failure, which increases with surgical time and prolonged handling of tissues and supplies.

Transient flora

Microorganisms that do not normally reside in the tissue of an individual. Transient microorganisms are acquired through skin contact with an animate or inanimate source colonized by microbes. Transient flora may be removed by routine methods of skin cleaning.

Case studies 2: Answer the following questions about evidence based practice. A. What is evidence based practice? B. Why is it so important to the surgical technologist? C. How can you practice evidence-based practice every day? D. Who is responsible for ensuring that EBP is being conducted?

It's a practice based on science and evidence rather than opinion or tradition. B. It's logical and uses data rather than conjecture. C. Ask questions like why a technique is being used, what the rationale is behind a procedure, and what is the best way to accomplish a task? D. I am.

Aseptic technique

Methods or practices in health care that reduce infection.

Resident flora

Microorganisms are normally present in specific tissues. Resident flora are necessary to the regular function of these tissues or structures. Also called normal flora.

Before opening a sterile pack, the scrub should also check the outside package for the:

b. integrity

Open gloving technique is used for ________________.

Open gloving is used during sterile procedures that do not require a sterile gown, such as preoperative skin preparation of the patient, assisting in minor skin procedures, catheterization, and when a scrubbed member changes a glove without changing his or her gown.

Surgical site infection (SSI)

Postoperative infection of the surgical wound. The goal of surgical skin preparation is to prevent postoperative wound infection.

Items wrapped in _____________ are delivered directly to the scrub by grasping the top edges of the wrapper and peeling the wrapper apart to reveal the sterile item.

b. sealed pouches

A process meant to reduce the number of micro organisms on the skin to an absolute minimum.

b. surgical scrub

Brushes must be sterile

b. surgical scrub

Items exposed (opened) to the surgical field are considered ___________ after they have been exposed to the air or to a patient's tissue.

Surgically clean

Can be timed.

b. surgical scrub

Counted stroked.

b. surgical scrub

Asepsis

The absence of pathogenic microorganisms on an animate surface or on body tissue. Literally, asepsis means "without infection", whereas sepsis literally means "with infection". In surgery, asepsis is a state of minimal or zero pathogens. Asepsis is the goal of many surgical practices.

Chemical barrier

The barrier formed by the action of an antiseptic; it not only reduces the number of microorganisms on a surface, but also prevents recolonization (regrowth) for a limited period.

Contamination

The consequence of physical contact between a sterile surface and a nonsterile surface in surgery resulting in the potential or actual transfer of microbes from one surface to another.

Sterile objects are contained or confined to avoid contact with ____________ objects.

nonsterile

Sterile gowning and gloving takes place immediately after __________________.

preparation of the hands and arms for a surgical procedure.

Closed gloving technique is used when ________________.

preventing contact between skin and the outside of the sterile glove.

The primary purpose of shoe covers is to ________________.

protect the wearer and prevent the tracking of blood and other body fluids outside the surgical suite.

____________, ____________, and ______________ are the three types of hand hygiene practiced in the operating room.

The routine hand wash, the handrub with antiseptic, and the traditional surgical scrub.

Scrub

The scrubbed surgical technologist or nurse assisting in surgery. Also refers to the surgical hand scrub performed before surgery.

Where is the sterile field? What is the center of this area?

The sterile field is the physical area starting with the surgical incision (patient) at the center. It extends to include patient drapes, sterile instrument tables and any draped equipment.

Describe when a surgical technologist might choose to use a bouffant's cap a surgeon's cap?

The surgical technologist wears bouffant caps to reduce contamination of the surgical field by loose hair and dandruff from the scalp. The scalp and hair are a rich source of Staphylococcus aureus and other bacteria, which proliferate under surgical caps. Logically, using the cap during any and all surgeries is ideal.

Surgical hand rub

The systematic application of antiseptic foam or gel on the hands before gowning and gloving for a sterile procedure. The surgical handrub may be used as an alternative to the traditional hand scrub under certain conditions.

Double gloving

Wearing two pairs of gloves, one over the other, to reduce the risk of contamination as a result of glove failure or puncture.

The surgical scrub extends to:

a. 2 inches above the elbow

What are the four objective of aseptic technique discussed in the text?

a. containment b. confinement c. reduction d. elimination of microorganisms

A scrub suit must be changed if it:

a. contaminated by blood or body fluid

__________ occurs when the surgeon's gloved hand accidentally touches the non sterile edge of the surgical drape.

a. contamination

OSHA mandates the use of ________ or ________ as part of it's blood-borne pathogen standard to protect workers exposed to splashing by blood and other potentially infectious materials (OPIM)

a. protective eyewear/ face shield

What operating room furniture should the basin set be placed on before opening?

a. ring stand

The _______ is worn by both sterile and non-sterile surgical personnel in the perioperative environment.

a. scrub suit

Event related

a. the principles of aseptic technique

The application of an approved antiseptic to all surfaces of the hands and fingers.

a. the principles of aseptic technique

At the close of the case, gown and gloves are removed:

b. by removing the gown first and then gloves

What operating room furniture should the large pack be placed on before opening?

c. back table

_________of any kind is a potential source of pathogens.

c. jewelry

In the surgical scrub, which of the following comes first?

c. scrubbing the nail beds

The ethical and professional motivation that regulates a professional's behavior regarding disease transmission is known as ________________.

c. surgical conscience

Ethyl or isopropyl alcohol combined with skin emollients

c. surgical rub

Should be used only when no soil is visible on the hands

c. surgical rub

All of the following are correct about pouring solution on the sterile field, except:

c. when pouring sterile liquids, do not empty the entire container away from the sterile field

If any doubt exists about the sterility of an item, it should be considered _______________.

contaminated

The sterile towel, gown, and gloves should be opened on a clean surface away from where sterile instruments and other equipment has been opened to prevent ___________________.

contamination

The traditional surgical scrub is performed in place of the hand rub following __________________.

contamination of the hands or arms by potentially infectious body fluids.

Long-sleeved cover jackets are worn by the ___________.

d. All of the above surgeon scrub circulator (especially)

After an item has been sterilized, it's sterility is maintained by ___________.

d. aseptic technique

___________ is based on surgical conscience: that is, the ethical and professional motivation that regulates a professional's behaviors regarding disease transmission.

d. aseptic technique

When changing from street clothes to a scrub suit for entering the operating room, the surgical technologist puts on which of the following items first?

d. head covering

Which of the following is not an example of EBP?

d. lab coat

What operating room furniture should the instrument tray be placed on prior to opening?

d. prep stand

The ________ is designed to prevent the shedding of skin particles and hair into the environment and to protect the wearer from contact with soil and body fluids.

d. scrub suit

At the end of the shift, the surgical technologist may place the scrub suit in his or her locker if:

d. the surgical technologist must never place the scrub suit in their locker at the end of a shift.

When sterile supplies have been opened, the sterile setup is vulnerable to contamination. Once the sterile supplies have been opened, (check all that apply):

d. they must be continuously monitored to ensure sterility

________ are worn anytime surgical staff leave the department temporarily.

e. cover gowns/lab coats

_______ are often worn by non sterile perioperative personnel, for comfort and to prevent contamination of the surgical field through bacterial shedding from the arms.

f. non-sterile jackets

_______ are made of a lint free synthetic material that is woven loosely enough to allow the breath to pass through effectively but tightly enough to filter 99% of particles of 5 micrograms or larger.

g. masks

Perioperative personnel should wear _________ that are comfortable and easy to keep clean and that protect the wearer against foot injury.

h. shoes and covers

A gown should be changed during surgery if _________________.

it is contaminated or penetrated by blood or other fluids.

The surgical hand rub is performed in place of a traditional surgical scrub except when ____________________.

the hands and arms are grossly soiled or have come in contact with body fluids.

When gloving another person, you should open the glove, grasp the upper edges and offer it with the palm of the glove facing ______________.

the person you are gloving.

Home laundered head caps are not sanctioned by any infection control agency because ____________________

they are a potential source of contamination. People often put them into lockers or wash them after several days.

Masks must be worn in all restricted areas of the operating room. They should not be worn dangling around the neck at any time because ________________.

they present a significant source of contamination.

If a surgical team member contaminates their glove during surgery, the circulator will remove it. This is done by offering the contaminated hand with the palm facing _________________.

upward