2. Principles of Surgical Assepsis and Aseptic Techniques.pdf

April, 2024 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assis. Prof. of EMCCN)
PRINCIPLES OF SURGICAL ASEPSIS AND
ASEPTIC TECHNIQUES
Dep’t of Emergency & Critical Care Nursing
College of Health and Medical Sciences
Haramaya University
1

Outline
❑Introduction
❑Purpose
❑Principles of Aseptic Technique
❑Procedure for Aseptic Technique
❑Crating and Maintenance of sterile field
❑References

Objective
❑At the end of this Session, the learners will be able to:
►Purpose
►Identify Principles of Aseptic Technique
►describe procedure for Aseptic Technique
►describe preparation and maintenance of sterile field
►describe maintenance of sterile field
►identify necessary materials & supplies for preparation & maintenance of the sterile field
►identify basic principles of asepsis and sterile field
►prepare sterile field
►maintain sterile field

Introduction
❑Aseptic technique
►is often applied to the underlying principles of infection control
❑Purpose
►The aims of aseptic technique are
▪ To prevent the introduction of pathogens to the wound
▪ To prevent the transfer of bacteria from one service user to another
▪ To prevent staff from acquiring infection from the service user.
▪ To prevent direct contact with body fluids and cross infection
The important principles are that the open wound should not come into contact with any item that is not sterile
and that any items that have been in contact with the wound may be contaminated and should be discarded
safely or decontaminated appropriately.

Indications of using aseptic technique
❑The policy and procedure must be followed by all healthcare professionals
involved in:
►Wounds healing by primary intention (before surface skin has sealed)
►Intravenous cannulation
►Urinary catheterization
►Suturing
►Vaginal examination during labour
►Medical invasive procedure.

Principles of Aseptic Technique
❑ The principles of sterile technique are applied under the following conditions:
►In preparation for an invasive procedure by
▪ sterilization of necessary materials & supplies.
►In preparation of the sterile team to handle sterile supplies and intimately contact the
surgical site by
▪ scrubbing, gowning, and gloving.
►In the creation and maintenance of the sterile field, including
▪ skin preparation and draping of the patient.
►In the maintenance of asepsis throughout the surgical procedure.
►In terminal sterilization & disinfection at the conclusion of the surgical procedure.

❑Aseptic technique evolved through
❑the refinement of surgical technique,
❑the use of a controlled env’t,
❑precise housekeeping methods, and
❑aseptic precautions to protect patients and personnel from infection.
►Open the sterile pack, taking care not to contaminate the contents
►Using Operation Room Attire
►Using PPE
►Surgical Scrubbing
▪ Wash hands or disinfect clean hands with an alcohol handrub

❑Need for Aseptic Technique
►Strict aseptic technique is needed at all times in an OR.
►Freshly cut living tissue can become infected easily.
►Sterile technique is the responsibility of everyone in the OR.

Operation Room Attire
❑ Attires
► are clothes don or worn by each member of the OR staff
► Basic OR attires include:-
▪ Cape or hood – used for covering the hair
▪ Mask – used for covering of mouth & nose
▪ T-shirts and trousers- for covering the trunk and lower body parts
▪ Shoes- for covering the feet
❑ Purpose
► To provide effective barriers that prevent the dissemination of MOs to the pt and/or from the pt.
► to prevent dissemination of MOs from sebaceous glands, sweat glands, hair follicles as well as other body orifices.
❑ General Principles:
► Each operating room department should have a specific complete written policy.
► Only approved clean OR attire worn with in restricted area of OR suites.
► The OR attire is not worn outside of OR suite.
► Eye glasses should be wiped with tissue wet with antiseptic solution.
► Comfort table supportive shoes should be worn to relieve fatigue.
► Personal hygiene must be re-emphasized.
► No, person with acute infection allowed to visit OR.

Components of OR Attire and PPE
❑Body cover
❑Mask
►muslin – 40%
►Muffin – 99%
❑Head cover/caps
❑Foot cover/shoes
❑Goggles
❑Gloves
❑Mackintosh/plastic apron
❑PPE should include
►Hair cover
►Eye protection
►Fluid-resistant facemask
►Fluid-resistant gown
►Gloves
►Shoe covers or Boots

Gloves
❑Types of Gloves
►Sterile/HLD surgical glove
►Clean examination glove
►Utility/heavy duty gloves
►Elbow length gloves
❑Elbow Length Gloves
►Are Used During:-
▪ Vaginal deliveries.
▪ Cesarean section.
▪ Manual removal of placenta.
▪ Large volume of blood/body fluids contact.
▪ Cut the four fingers of gloves completely
off
▪ sterilize or disinfect 2-3 pairs of cut off
(finger less) gloves.
❑When to Double Gloves
►The procedure that involves contact with
large amounts of blood/body fluids.
►Orthopedic procedure in sharp bone
fragments, wire sutures and other sharps.
►Surgical gloves when re-used.
►Surgical procedures lasting >45 minutes.

Gloves
❑ Some Do’s and Don’ts about gloves
►Do – wear the correct size gloves
►Do – change s- gloves every 45 minutes ’
►Do – keep finger nails trimmed moderately short.
►Do – pull the gloves up over cuffs of gown
►Do – use water soluble hand lotions
►Don’t – oil based hand lotions or creams.
►Don’t – use latex gloves if you have allergy.
►Don’t – store gloves that are cracked.
►Don’t -reprocess gloves that are cracked.
►Don’t –reprocess exam gloves for reuse.

Surgical Scrubbing
❑Definition:-
►process of removing as many MOs as possible from the hands and arms by mechanical
washing & chemical antisepsis before participating in an operative procedure.
❑ Purpose
►To remove soil, debris natural skin oil, MOs from the hands and fore arms of the
surgical team/sterile team.
►To decrease the no of MOs on skin to an irreducible minimum.
►To reduce the hazards of microbial contamination of the operative wound by skin flora.
►To keep the population of the MOs minimal during the operative procedure by
suppression of growth.

Surgical Scrubbing……
❑ Before a surgical operation
►Alcohol hand rub
►Routine hand wash 10-15 seconds
►Aseptic procedures 1 minute
►Surgical wash 3-5 minutes
❑ General preparations
►Skin & nails should be kept clean.
►Finger nails – not pass beyond finger tip.
►Finger nail polishing avoided.
►Artificial devices should not cover natural finger
nails.
►No open wounds, bleeding or weeping
►No jewelry
►No watch
►No long nails
►No nail polish
►No false nails
►No cracked skin

July, 2021 © Haramaya University, CHMS,
Introduction to OR Technique
By:- Ame Mehadi (BSc, MSc)
Before You Wash
Bad
Good
Jewelry and Watch
❑ It is hard to clean under your jewelry or watch
❑ Bacteria and dirt can sit under your jewelry or watch
❑ Remove jewelry to ensure a complete clean

Nail Polish and False Nails
Bad
Good
If it is less than 4 days old you can keep it on
Nail Length
Bad
Good

Good preparation
Skin Integrity (condition)
❑No jewelry
❑No watch
❑No nail polish
❑No false nails
❑No long nails
❑No cracked skin
❑You are now ready to wash
❑Bad
❑Cuts, breaks and weeping
can spread infection
❑Good
❑No open wounds,
bleeding or weeping

Surgical Scrubbing…cont’d
❑Procedures
►Pre-operative surgical antisepsis consists of three processes.
▪ Hand hygiene
▪ Gloving of the surgical team
▪ Applying antiseptic agent to the surgical site
❑Methods
►Two methods:
▪ The counted brush-stroke method
▪ The time scrub method
❑ Length of surgical scrubbing depends on:
►The frequency of scrubbing.
►The agent used.
►The method used.

Procedures of Surgical Scrubbing
❑ Do not scrub if you have an infection.
❑ Make sure all hair is covered and that you are protected
from splashes.
❑ Remove jewelry (rings, watches, and bracelets)
❑ Wash hands thoroughly around nails, b/n fingers and
forearms to the elbow with soap, brush/sponges, running
water.
❑ Clean nails with nail cleaner.
❑ Scrub hands, arms up to elbows.

Procedures ……
❑ Rinse hands and fore arms with water.
❑ After scrubbing, hold up arms to allow water to drip off elbows.
❑ Apply antiseptic agent to all surface of hands and forearm.
❑ Rinse hands and fore arms with clean water.
❑ Turn off tap with elbow.
❑ Hold hands, forearms away from body and higher than elbows and
don’t touch any surface until putting on sterile gown and gloves.
❑ Dry hands from distal to proximal with sterile towel, make sure towel
does not become contaminated.
❑ Put sterile surgical gown, then gloves on both hands after drying hands.

Gowning & gloving
❑ The sterile gown is put on immediately after the surgical scrub.
❑ General consideration
►The scrub person gowns and gloves himself.
►Gown packages opened on separate table.
►Avoid splashing water on scrub attire.
❑ Place arms through sleeves.
❑ Have a non-scrubbed assistant pull gown over shoulders so hands go
through sleeves
❑ Assistant will tie back of gown
►The circulator assists gowning.

Gowning
By Ame M.

❑don immediately after gowning.
❑Easiest to have someone who is already gowned
and gloved to assist.
❑Techniques - two types
►Closed Vs Open
Surgical Gloving

GLOVING without Assistance
❑ Open sealed package of sterile gloves before scrubbing, gowning;
place inner package on sterile surface.
❑ Once gowned, take cuff of left glove with rt hand (1);
►make sure thumb in correct position
❑ Slide glove onto left hand, wriggle fingers slightly to help
❑ Only touch inside of glove, cuff with bare hands
❑ Slide fingers of gloved left hand into cuff of rt glove (2)
❑ Pull glove onto rt hand in similar fashion to placing left glove (3)
❑ Ensure that cuffs cover ends of both gown sleeves (4)

Precautions when Gloving/Degloving
❑ Do not allow your skin to touch the outer surface of the
glove.
❑ Keep your fingers inside the sleeve of the gown until the
glove is on.
❑ If contamination occurs, both gown and gloves must be
replaced.
❑ Gloves are removed after the gown using a glove-to-glove,
then skin-to-skin technique.

Skin Preparation and Draping of Surgical Site
❑ SKIN PREPARATION
►Before operation, wash surgical site, surrounding area with soap, water;
particularly wash debris from injuries.
►Prepare skin with antiseptic solution; start in center, move to periphery.
►This area should be large enough to include entire incision, adjacent
working area.
►Solution should remain wet on skin for at least two minutes.
►Chlorhexidine gluconate & iodine preferable to alcohol as less irritating
to skin.
❑ Procedure
►Expose only the skin area to be prepared.
►Wear sterile gloves.
►Place towels above and below to protect gloved hand from touching
the blanket.
►Wet the sponge with antiseptic agent but squeezed out.
►Scrub the skin.
►Discard the sponge after reaching the periphery.

DRAPING
❑ is" the procedure of covering pt and surrounding areas with a sterile barriers to create and
maintain sterile field during operation.“
❑ done after scrubbing, gowning, gloving
❑ only operative field (prepped area) and areas necessary for anesthesia left uncovered.
❑ Drapes secured with towel clips at each corner.
❑ Proper draping exposes only the surgical site, which decreases the risk for infection.
❑ Types of Drapes:
► Towels
► Laparotomy sheet
► Stockinet
► Ortho pack sheet

DRAPING

June, 2021 © Haramaya University, CHMS,
Basic First Aid and Emergency Care
Principles of Sterile Field
Making & Maintaining Sterile Field

❑ Sterile technique is the basis of modern surgery.
❑ Patient is the center of the sterile field.
❑ Persons in sterile attire touch only sterile articles.
❑ Persons in sterile attire preparing a sterile field or draping an un-sterile surface always
face the area being prepared.
❑ Persons in sterile attire do not turn their backs to a sterile field.
❑ Gloved hands are protected while draping by making a cuff with the drape.
❑ Persons in sterile attire do not lean or reach over un-sterile surfaces.
❑ Persons in non-sterile attire only touch non-sterile articles.
❑ Persons in non-sterile attire avoid reaching over or touching the sterile field when
delivering sterile supplies to the sterile field.

❑ Hands are not placed under the arms in the axillary region.
❑ Non sterile persons maintain a safe distance from sterile areas.
❑ Scrub persons perform all work on the sterile surface of the table.
❑ Tables draped with sterile drapes are sterile only at table level.
❑ Materials that hang over the edge of the sterile field are not considered sterile and are
discarded.
❑ Items that fall below the level of the sterile field are not brought back onto the sterile
field.
❑ Articles that drop below the umbilical level of the gown are discarded.
❑ Gown is considered sterile from the level of the umbilicus to the axillary level in front.
❑ Sleeves are considered sterile to two inches above the elbow.

❑ Back of the gown is not considered sterile.
❑ Areas of the gown outside the specified boundaries do not touch the sterile field or sterile
articles.
❑ Edges of containers enclosing sterile items are not considered sterile once the container is
opened.
❑ Corrective measures are to be instituted immediately if contamination occurs.
❑ If there is any doubt as to the sterility of an item or surface, it is considered contaminated.
❑ Strict adherence to the recommended practices of sterile technique reflects the surgical
conscience of the perioperative team and is mandatory for the safety of the patient and
personnel in the env’t.
❑ Unsterile personnel handle only unsterile equipment.

Sterile Field …….
❑Sterile tables are sterile only at table height.
❑Gowns are sterile in front from the axillary line to the waist, and the sleeves to 2-3
inches above the elbow.
❑The edges of anything that encloses sterile contents are considered unsterile.
❑Moisture carries bacteria from a non sterile surface to a sterile surface.
❑A wide margin of safety must be maintained b/n the sterile and unsterile field.
❑Contaminated items should be removed immediately from the sterile field.
❑The sterile field is created as close as possible to the time of use.
❑Destruction of the integrity of microbial barriers results in contamination.
❑Sterile persons keep contact with sterile areas/goods to a minimum.
❑Some operative areas cannot be sterile.

Sterile Field …….
❑ All materials that enter the sterile field must be sterile.
❑ Sterile team members must wear only sterile gowns & gloves and they keep well within
the sterile field.
❑ Unsterile persons don’t reach over sterile surfaces.
❑ Talking during surgery is kept to a minimum
❑ Bacteria travel on airborne particles and will enter the sterile field with excessive air
mov’t & currents.
❑ Therefore, movement is kept to a minimum during surgery.
►Sterile team members face each other.
►They face the sterile field.
►Sterile personnel handle only sterile equipment.

By:- Ame Mehadi (BSc, MSc-EMCCN)
OPENING A STERILE PACKAGE
❑ Opening outermost top flap away from the body without
reaching over the sterile field
❑ Opening left side flap away from the center
❑ Opening right side flap
❑ Opening bottom flap toward the nurse’s body and folding
it backward, to prevent it from reentering the sterile field
❑ Dropping sterile contents on the sterile field, keeping at
least 2 inches from the edge of the sterile drape.
❑ Pouring sterile solution into sterile cup without touching
the sterile field and without splashing.

References
❑ Berry & Kohn: Introduction to Operating Room Techniques, 3rd Edition (The Blakiston Division, McGraw-Hill
Book Company, 1966)
❑ Abebaw Eredie: Operating Room Technique LECTURE NOTES For Nursing Students, Ethiopia Public Health
Training Initiative, USAID, 2008.
❑ A Guide to Operating Room Technique by Irene Gregory, June 1969.
❑ Introduction to the Operating Room U.S. Army Medical Department Center and School Fort Sam Houston,
Texas 78234-6100, 100th Edition.
❑ Emergency and Essential Surgical Care (EESC) programme www.who.int/surgery
❑ Internet sources

2. Principles of Surgical Assepsis and Aseptic Techniques.pdf

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