Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate

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Reproductive System,Medical School of
Universitas Padjadjaran, Bandung2005MIR-C
Corporate
Interactive Training CD for Medical
Students Reproductive System Module Infection
Prevention A- and Antiseptic Techniques
in Surgical Setting
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Production Team

• Director Kiki Lukman, MD, MSc, FINACS (Dig.)
• Script writer Kiki Lukman, MD, MSc, FINACS
  (Dig.)
• Main contributors Kiki Lukman, MD, MSc, FINACS
  (Dig.)
• Yayat Ruchiyat, MD, FINACS (Dig.)
• Warko Karnadihardja, MD, FINACS (Dig.)
• Nurhayat Usman, dr., SpB-KBD
• Lisa Hasibuan, MD
• Nina K. Poetri T., SKp,
• Dadang Sunarya AMK
• Dedy Rusnadi AMK,
• Alia Rahmi AMK,
• Editorial Team Kiki Lukman, MD, MSc, FINACS
  (Dig.)
• Casting Kiki Lukman, MD, MSc, FINACS (Dig.)
• Artistic MIR-C Corporate
• Productions Medical School of Universitas
  Padjadjaran
• Bandung

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Credits

• Special thanks to
• Central Operating Theatre Unit of Hasan Sadikin
  General Hospital

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Infection Prevention Module
Introduction
Infection control
Antiseptic techniques
Operating Theater
Aseptic techniques
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Introduction

• Description
• Objectives

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Description

• Infection Prevention in Surgical Setting is one
  of important preventive methods in order to
  achieve infection control in clinical and
  surgical practices.

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Objectives

• The aims of this method are
• To minimize surgical site infection
• To protect health personnel
• To improve wound healing
• To minimize disability, morbidity, mortality
• To reduce the cost of hospital care

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Specific Learning Objectives

• To describe the definition and history of
  sterilization, disinfection, decontamination,
  anti and a - septic techniques.
• To describe six methods of sterilization.
• To describe three categories of surgical
  instruments
• To describe 6 rules of aseptic techniques

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Specific Learning Objectives

• To perform aseptic techniques correctly,
  including (P5)
• Applying surgical attire
• Hand washing
• Surgical scrubbing
• Gloving
• Surgical Gowning

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Definition

• Sterilization Processes by which all pathogenic
  non pathogenic microorganisms, including
  spores, are killed.
• Disinfection Chemical or physical process of
  destroying all pathogenic microorganisms, except
  spore bearing ones used for inanimate objects,
  but not on tissues.

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Definition

• Decontamination Process or method by which all
  contaminated materials that can cause diseases
  are removed.
• Aseptic techniques Methods by which
  contamination with microorganisms is prevented.
• Antiseptic techniques Prevention of sepsis by
  the exclusion, destruction, or inhibition of
  growth and multiplication of microorganisms from
  body tissues and fluids.

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Infection Control
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• Why should we apply a and antiseptic techniques ?

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Historical backgrounds

• Ignas Sammelweis (1818 - 1865)
• Puerperal fever ? increased maternal mortality
• Hand scrub with chlorinated-lime solution prior
  to examination.
• Father of nosocomial infection.
• Louis Pasteur (1860)
• Discover the process of fermentation by
  microorganisms
• Germ theory against spontaneous generation
  theory.

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Historical backgrounds

• Joseph Lister (1865)
• Use carbolic acid solution on surgical dressing
  in the operating room ? mortality ?
  (Listerization)
• Father of modern surgery (Antiseptic technique)
• Ernst Von Bergmann (1886)
• Introduced steam sterilizer
• Basic of sterilization ? aseptic technique
• Later pressure vacuum steam sterilizer was
  developed

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Methods of Infection control

• Anti septic techniques
• Design and traffic patterns of the operating
  theatre
• Aseptic techniques

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Anti septic techniques
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Sterilization

• The objective of modern surgery
• For inanimate objects
• Problem
• Some items are not heat resistance

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Techniques of Sterilization

• Physical
• Heat
• Radiation/ ultraviolet ray
• Boiling water
• Ultrasound
• Chemical
• Liquid
• Gas

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Heat Sterilization

• Dry
• Commonly cause damage
• For powder, oils, and jelly
• Moist
• Steam
• High pressure ? ? spores ?
• Vacuum ? constant temperature
• Autoclave

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Chemical Sterilization

• Generally as disinfection
• Mechanism of action
• Protein coagulation
• Enzyme denaturation in cells
• Lysis
• Depend on number of microorganisms, soiling,
  concentration, and temperature.

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Solutions

• Jodium and Jodophor
• Good bactericide, but irritant
• Mixture povidone-jodine 10
• Alcohol Solution of 70 or 90
• Glutaraldehyde (Formaldehyde Sol. in Alcohol 2)
• Spores are killed within 3 hours

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Solutions

• Hexachloropene (Halogenated phenol)
• Bacterio-static, particularly Gram () bacteria
• For scrubbing
• Chlorhexidine gluconate
• Bactericide Gram () (-).
• Good for antiseptic

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Gas Sterilization

• Formaldehyde
• Ethilene-oxide
• ?- propionolactone

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Boiling Water

• Mild boiling
• Vigorous boiling
• More active, if 2 sodium-carbonate or 0,1
  sodium-hydroxide being added

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The Operating Theater
Clean Zone
S C R U B S U I T
Sterile core
Transitional Zone
Restricted area
Semi Restricted Area
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Traffic patterns of Operating Theatre

• The use of aseptic principles requires
  regulation of traffic and flow patterns of the
  personnel, patient, equipment, and supplies in
  operating theatre
• Aims to protect the safety and privacy of
  patients and the cleanliness and integrity of the
  environment.

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unrestricted area

• Elevators
• Corridors outside surgical suite

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unrestricted area

• Entrance
• Reception desk
• Patient suite

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Transitional Zone (Video)

• Locker room
• Dressing room

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Clean Zone (Video)

• Surgical suite and corridors
• Sterile core

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Scrub Area (Video)
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Sterile Core (Video)
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Putting on surgical attire

• In the semi restricted area
• Scrub suit shirt trousers
• Hair covering surgical cap/hood
• Masks disposable/ re-useable
• Goggle (optional) protective eyewear
• Shoe covers
• are compulsory

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Surgical attire

• Male personnel
• Female personnel
• Personnel with veil

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Surgical Instruments in the Operating Theatre

• Critical items
• Sterile, because of being used for penetrating
  skin or mucosa
• Semi critical items
• In contact with skin or mucous membrane
• Non critical items

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Aseptic techniques
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Aseptic techniques

1. Rules at clean zone
2. Procedures in sterile area
3. Talk as necessary
4. Restrict unnecessary movements
5. Sterile instruments, remove non sterile one
6. Avoid Replace wet surgical drapes/towels

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Hand washing

• Indications
• Between patient contacts
• Before performing or assisting with invasive
  procedures
• Before taking care of particularly susceptible
  patients
• Before and after touching wounds
• Immediately after gloves are removed

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Hand washing

• Before and after performing sterile procedures
• After contact with blood or body substances,
  mucous membranes, soiled linen, waste, or
  contaminated equipment.
• Between tasks at different body sites on the same
  patient to prevent cross contamination
• After taking care of infected patient
• After touching contaminated inanimate sources

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Hand washing

• Preparation

• The procedure

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Surgical Scrubbing Procedure
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Purposes

• To remove debris and transient organisms from the
  nails, hands, and forearms.
• To reduce the resident microbial count to a
  minimum.
• To inhibit rapid rebound growth of
  microorganisms.

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Purposes

• To minimize the re-growth of microorganisms for
  the length of the procedure.
• To reduce the numbers of microorganisms on hands
• To reduce contamination of the operative site by
  recognized or unrecognized breaks in surgical
  gloves.

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Preparation
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Recognizing glove sizes
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Actual procedure Strokes technique

• Rinsing hands arms
• Scrubbing with antiseptic solution
• Rinsing arms
• Scrubbing with brush or sponge
• Rinsing arms
• Scrubbing with antiseptic solution
• Drying arms

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Actual procedure Five minute technique
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Gowning

• The goal
• to ensure a safe, protective, and aseptic
  environment to the patient and the surgical team.
  

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Gowning closed gloving techniques

• Drying hands with sterile towel
• Applying gown
• Closed gloving technique

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• The final step of the aseptic techniques before
  performing surgery.
• Sterile gloves are worn to permit the wearer to
  handle sterile supplies or tissues of the
  operative wound.

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• Sterile gloves establish a shield that protects
  the patient from contamination by flora from the
  hands of health care workers.

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• Open technique

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Closed technique
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Skin preparation

• The goals
• to cleanse the skin and bring both the resident
  and transient bacterial counts to an irreducible
  minimum, therefore reducing the risk of wound
  contamination and subsequent surgical site
  infection.
• performed just before the surgical incision has
  been performed.

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Skin preparation

• Skin painting
• Skin draping

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Ready for surgery
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Gown and gloves removal

• After surgery
• Gown, Gloves removal
• Simultaneous removal