SUR 111 Lecture 2

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SUR 111Lecture 2
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Terminology Related to Asepsis and Sterile
Technique

• Review and learn the terms in table 7-1 page 143
• You must be familiar with these terms

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Pathogens Infection

• Pathogen
• Any microorganism that is capable of causing an
  infection
• Infection
• Microorganism in a particular place
• Presence of or multiplication of microorganisms
• NOT necessarily causing problems
• Disease
• Showing signs or symptoms due to microorganisms
  ARE causing problems

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Infection

• Nosocomial Infection
• Hospital acquired infection
• Surgical Site Infection (SSI)
• Infection that is the direct result of surgery
• Primarily caused by patients own normal flora
  (endogenous)
• Can be caused by breaks in aseptic technique
• Is a type of nosocomial infection
• 25 of all nosocomial infection
• Typically do not become evident until after
  patient is discharged from hospital
• Note table 7-3 page 134 for pathogens associated
  with SSIs and their percentage rates

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Sources of Microbial Transmission

• Personnel
• Environment
• Patient

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Pathogens associated with SSIs

• Bacteria
• Escherichia coli
• Resides normally in lumen of intestines
  resident flora
• If gets outside of intestinal lumen will cause
  infection (peritonitis) that is life threatening
• Staphylococcus aureus
• Resides on your skin resident flora
• Can reside in your nares (nostrils)
• Most commonly transmitted pathogen in the
  operating room
• Mycobacterium tuberculosis
• Causes disease tuberculosis
• Airborne pathogen transmitted by droplet nuclei
  (you can breath it)
• Known affected surgical patients require special
  masks

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Spore Producing Bacteria

• Bacillus and Clostridium genuses
• Are spore producers
• Highly resistant
• Bacillus stearothermophilus and Bacillus subtilis
  are the biological indicators utilized in
  sterization to test that autoclaves and ethylene
  oxide sterilization techniques are working to
  destroy all microorganisms and their spores
  (sterilization)
• B. stearothermophilus (steam sterilization)
• Notice stea beginning in stearothermophius to
  help remember its for steam autoclaves
• B. subtilis (ethylene oxide or EtO)

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Viruses

• Reliant on host cell for survival
• Viruses are the biggest risk health care workers
  face
• Note table 7-4 page 145 for viral pathogens

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Prevention of Staff Imposed SSIs

• Human error/breaks in sterile technique
• Must be documented if occur
• Failure to recognize and correct a breach in
  sterile technique is wrong as it is negligence
• Surgical conscience
• Basis for practice of strict adherence to sterile
  technique that involves honesty and moral
  integrity and must be upheld by all surgical team
  members at all times
• There can be NO compromise of sterile technique

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Environment

• Fomite
• Inanimate objects on which microbes may reside
• OR furniture, your scrubs, your hair, your shoes,
  contaminated solutions, contaminated dressing
  supplies such as tape that is reused
• Reason all operating rooms are cleaned after
  every surgical procedure
• Airborne
• Laminar flow system (air moves from vents in
  ceiling out vents in near the floor)
• 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)
• 20 air exchanges per hour in an operating room
  via HEPA filters, 20 of those being fresh air.

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Patient

• Most SSIs are contracted through the patients
  own endogenous or normal flora
• Preoperative prophylaxis with antibiotics reduces
  risk of SSIs

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Risk Factors for SSIs

• Age
• Obesity
• General physical health
• Nasal carriers of S.aureus
• Remote infections (infections going on in another
  part of the body at time of surgery)
• Ex. Yeast infection present and patient is having
  surgery in the groin area
• Preoperative hospitalization (reason most
  surgeries are performed the day of admission)

• Smoking
• Malnutrition
• Diabetes
• Malignancy (cancer)
• Immunosuppression
• Preoperative hair removal
• Procedure type or wound classification (see page
  293)
• Procedure duration

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Principles of Asepsis

• A sterile field is created for each surgical
• procedure
• See pages 153-155

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Principles of Asepsis

• Sterile team members must be appropriately
  attired prior to entering the sterile field
• See pages 154-155

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Principles of Asepsis

• Movement in and around the sterile field must not
  compromise the sterile field
• See page 155