SUR 111SUR 111Lecture 2Lecture 2

Terminology Related to Terminology Related to Asepsis and Sterile Asepsis and Sterile TechniqueTechnique

Review and learn the terms in table 7-1 Review and learn the terms in table 7-1 page 143page 143

You must be familiar with these termsYou must be familiar with these terms

Pathogens & InfectionPathogens & Infection

PathogenPathogen Any microorganism that is capable of causing an Any microorganism that is capable of causing an

infectioninfection InfectionInfection

Microorganism in a particular placeMicroorganism in a particular place Presence of or multiplication of microorganismsPresence of or multiplication of microorganisms NOTNOT necessarily causing problems necessarily causing problems

DiseaseDisease Showing signs or symptoms due to microorganisms Showing signs or symptoms due to microorganisms

ARE ARE causing problemscausing problems

InfectionInfection

Nosocomial InfectionNosocomial Infection Hospital acquired infectionHospital acquired infection

Surgical Site InfectionSurgical Site Infection (SSI) (SSI) Infection that is the direct result of surgeryInfection that is the direct result of surgery Primarily caused by patient’s own normal flora (endogenous)Primarily caused by patient’s own normal flora (endogenous) Can be caused by breaks in aseptic techniqueCan be caused by breaks in aseptic technique Is a type of nosocomial infectionIs a type of nosocomial infection 25% of all nosocomial infection25% of all nosocomial infection Typically do not become evident until after patient is Typically do not become evident until after patient is

discharged from hospitaldischarged from hospital Note table 7-3 page 134 for pathogens associated with SSIs Note table 7-3 page 134 for pathogens associated with SSIs

and their percentage ratesand their percentage rates

Sources of Microbial Sources of Microbial TransmissionTransmission

PersonnelPersonnel EnvironmentEnvironment Patient Patient

Pathogens associated Pathogens associated with SSIswith SSIs

BacteriaBacteria Escherichia coliEscherichia coli

Resides normally in lumen of intestines = resident floraResides normally in lumen of intestines = resident flora If gets outside of intestinal lumen will cause infection (peritonitis) If gets outside of intestinal lumen will cause infection (peritonitis)

that is life threateningthat is life threatening Staphylococcus aureusStaphylococcus aureus

Resides on your skin = resident floraResides on your skin = resident flora Can reside in your nares (nostrils)Can reside in your nares (nostrils) Most commonly transmitted pathogen in the operating roomMost commonly transmitted pathogen in the operating room

Mycobacterium tuberculosisMycobacterium tuberculosis Causes disease tuberculosisCauses disease tuberculosis Airborne pathogen transmitted by droplet nuclei (you can breath it)Airborne pathogen transmitted by droplet nuclei (you can breath it) Known affected surgical patients require special masksKnown affected surgical patients require special masks

Spore Producing BacteriaSpore Producing Bacteria

BacillusBacillus and and Clostridium Clostridium genuses genuses Are spore producersAre spore producers Highly resistant Highly resistant Bacillus stearothermophilusBacillus stearothermophilus and and Bacillus subtilisBacillus subtilis are the are the

biological indicators utilized in sterization to test that biological indicators utilized in sterization to test that autoclaves and ethylene oxide sterilization techniques are autoclaves and ethylene oxide sterilization techniques are working to destroy all microorganisms and their spores working to destroy all microorganisms and their spores (sterilization)(sterilization)

B. stearothermophilusB. stearothermophilus (steam sterilization) (steam sterilization) Notice Notice steastea beginning in beginning in steastearothermophius to help rothermophius to help

remember it’s for remember it’s for steasteam autoclavesm autoclaves

B. subtilisB. subtilis (ethylene oxide or EtO) (ethylene oxide or EtO)

Viruses Viruses

Reliant on host cell for survivalReliant on host cell for survival Viruses are the biggest risk health care Viruses are the biggest risk health care

workers faceworkers face Note table 7-4 page 145 for viral Note table 7-4 page 145 for viral

pathogenspathogens

Prevention of Staff Prevention of Staff Imposed SSIsImposed SSIs

Human error/breaks in sterile techniqueHuman error/breaks in sterile technique Must be documented if occurMust be documented if occur Failure to recognize and correct a breach in Failure to recognize and correct a breach in

sterile technique is wrong as it is negligencesterile technique is wrong as it is negligence Surgical conscienceSurgical conscience

Basis for practice of strict adherence to sterile Basis for practice of strict adherence to sterile technique that involves honesty and moral integrity technique that involves honesty and moral integrity and must be upheld by all surgical team members at and must be upheld by all surgical team members at all timesall times

There can be NO compromise of sterile techniqueThere can be NO compromise of sterile technique

Environment Environment

FomiteFomite Inanimate objects on which microbes may resideInanimate objects on which microbes may reside

OR furniture, your scrubs, your hair, your shoes, contaminated solutions, OR furniture, your scrubs, your hair, your shoes, contaminated solutions, contaminated dressing supplies such as tape that is reusedcontaminated dressing supplies such as tape that is reused

Reason all operating rooms are cleaned after every surgical Reason all operating rooms are cleaned after every surgical procedureprocedure

Airborne Airborne Laminar flow system (air moves from vents in ceiling out vents in near Laminar flow system (air moves from vents in ceiling out vents in near

the floor)the floor) Result of laminar flow is positive pressure (air is moving down so if a Result of laminar flow is positive pressure (air is moving down so if a

door is opened the air rushes out the door not in the room)door is opened the air rushes out the door not in the room) 20 air exchanges per hour in an operating room via HEPA filters, 20% 20 air exchanges per hour in an operating room via HEPA filters, 20%

of those being fresh air.of those being fresh air.

Patient Patient

Most SSIs are contracted through the Most SSIs are contracted through the patient’s own endogenous or normal florapatient’s own endogenous or normal flora

Preoperative prophylaxis with antibiotics Preoperative prophylaxis with antibiotics reduces risk of SSIsreduces risk of SSIs

Risk Factors for SSIsRisk Factors for SSIs

AgeAge ObesityObesity General physical healthGeneral physical health Nasal carriers of Nasal carriers of S.aureusS.aureus Remote infections (infections Remote infections (infections

going on in another part of the going on in another part of the body at time of surgery)body at time of surgery) Ex. Yeast infection present Ex. Yeast infection present

and patient is having surgery and patient is having surgery in the groin areain the groin area

Preoperative hospitalization Preoperative hospitalization (reason most surgeries are (reason most surgeries are performed the day of performed the day of admission)admission)

Smoking Smoking MalnutritionMalnutrition DiabetesDiabetes Malignancy (cancer)Malignancy (cancer) ImmunosuppressionImmunosuppression Preoperative hair Preoperative hair

removalremoval Procedure type or Procedure type or

wound classification (see wound classification (see page 293)page 293)

Procedure duration Procedure duration

Principles of AsepsisPrinciples of Asepsis

1.1. A sterile field is created for each A sterile field is created for each surgicalsurgical

procedureprocedure See pages 153-155See pages 153-155

Principles of AsepsisPrinciples of Asepsis

2.2. Sterile team members must be Sterile team members must be appropriately attired prior to entering appropriately attired prior to entering the sterile fieldthe sterile field

See pages 154-155See pages 154-155

Principles of AsepsisPrinciples of Asepsis

3.3. Movement in and around the sterile Movement in and around the sterile field must not compromise the sterile field must not compromise the sterile fieldfield

See page 155See page 155