1. The document discusses concepts of medical and surgical asepsis including types of microorganisms that cause infection, types of infections, and factors that influence susceptibility. 2. It describes the differences between medical and surgical asepsis and outlines techniques used in each including cleaning, disinfecting, and sterilization methods. 3. The document provides details on proper surgical scrub technique which takes 5 minutes and includes washing with antimicrobial soap, scrubbing under the nails, and proper drying and gowning procedures to maintain sterility in the operating room.

1. Dr. Farooq Ahmed Rana
MBBS, FCPS, FRCS Eng
Assistant Professor
Surgical unit III
SIMS/SHL

2. Learning objectives
 Explain the concepts of medical and surgical asepsis.
 Identify types of microorganisms causing infections.
 Identify types & signs of localized and systematic
infections.
 Identify risks for nosocomial infections.
 Explain chain of infection.

3.  Identify factors influencing a microorganism's capability
to produce an infectious process.
 Identify measures that break each link in the chain of
infection.
 Principles of Surgical Asepsis.
 The OR scrub.

4. Asepsis and Antiseptics
Asepsis is the freedom from disease-causing microorganisms.
To decrease the possibility of transferring microorganisms
from one place to another, asepsis is used.
 Aseptic techniques are those aimed at minimising infection
 Asepsis usually involves
 The use of sterile instruments
 The use of a gloved no touch technique
 Antisepsis is the removal of transient microorganisms from
the skin and a reduction in the resident flora

5. History
 1847 - Semmelweis identifies surgeons hands as route
of spread of puerperal infection
 1865 - Lister introduces hand and wound asepsis with
the use of carbolic acid
 1880 - von Bergmann invents the autoclave

6. There are two basic types of
Asepsis
Medical & Surgical asepsis.

7. 1. Medical Asepsis
Includes all practices intended to
confine a specific microorganism to a
specific area, limiting the number,
growth, and transmission of
microorganisms.

8. In medical asepsis, objects are
referred to as clean, which means
the absence of almost all
microorganisms, or dirty (soiled,
contaminated), which means likely
to have microorganisms, some of
which may be capable of causing
infection.

9. Methods in Medical Asepsis
 Hand hygiene
 Carry linens away from your body
 No linens on floor
 Cover mouth when sneezing
 Do not raise dust
 Do not shake linens
 Clean to dirty
 Transmission precautions

10. 2. Surgical Asepsis or Sterile
Technique, refers to keep an area or
object free of all microorganism, it
includes practices that destroy all
microorganisms and spores. Surgical
asepsis is used for all procedures
involving the sterile areas of the body.

11. Sepsis
is the state of infection and can take
many forms, including septic shock.

12. Types of
microorganisms
causing infections

13. 1. Bacteria can live and be transported
through air, water, food, soil, body
tissues and fluids, and inanimate objects.
2. Viruses (causes the common cold)
hepatitis, herpes, and human
immunodeficiency virus.
3. Fungi include yeasts and molds.
Candida albicans
4. Parasites They include protozoa such
as the that causes malaria.

14. Types of infection

15. A local infection is limited to the
specific part of the body where
the microorganisms remain.
If the microorganisms spread and
damage different parts of the
body, it is a systemic infection.

16. When a culture of the person's blood
reveals microorganisms, the
condition is called bacteremia.
When bacteremia results in systemic
infection, it is referred to as
septicemia.

17. Acute infections generally appear
suddenly or last a short time.
A chronic infection may occur
slowly, over a very long period,
and may last months or years.

18. Nosocomial infections
Classified as infections that are
associated with the delivery of health
care services in a health care facility.
Nosocomial infections can either
develop during a client's stay in a
facility or manifest after discharge.

19. The incidence of nosocomial
infections is significant. Major sites
for these infections are the
respiratory and urinary tracts,
the bloodstream, and
wounds.

20. Factors that contribute to nosocomial
infection risks are invasive
procedures, medical therapies, the
existence of a large number of
susceptible persons, inappropriate
use of antibiotics, and insufficient
hand washing after client contact and
after contact with body substances.

21. 4. Method of transmission
There are three mechanisms

22. A. Direct transmission
Involves immediate and direct transfer of
microorganisms from person to person through
touching, biting, kissing, or sexual intercourse.
Droplet spread is also a form of direct transmission.

23. B. Indirect transmission
Material objects, such as toys, soiled clothes,
cooking or eating and surgical instruments, or
dressing, water, food, blood, serum, and plasma.
Animal or flying.

24. C. Air born transmission
may involve droplets or dust.

25. 5. Portal of entry
Before a person can become infected,
microorganisms must enter the body.
The skin is a barrier to infectious
agents; however, any break in the skin
can readily serve as a portal of entry.

26. 6. Susceptible Host
A susceptible host is any person
who is at risk for infection.
A compromised host is a person at
"increased risk“.

27. Factors Increasing
Susceptibility to Infection
1. Age influence the risk of infection.
2. Heredity influences the development of infection.
3. The nature, number, and duration of physical and
emotional stressors can influence susceptibility to
infection.

28. 4. Resistance to infection depends on adequate nutritional
status.
5. Some medical therapies predispose a person to infection.
For example, radiation treatments for cancer, some
diagnostic procedures may also predispose the client to an
infection.

29. Cleaning, Disinfecting, and
Sterilizing
The first links in the chain of infection, the etiologic agent
and the reservoir, are interrupted by the use of
antiseptics (agents that inhibit the growth of some
microorganisms) and
disinfectants (agents that destroy pathogens other than
spores) and by sterilization.

30. Cleaning
Cleanliness inhibits the growth of
microorganisms. When cleaning visibly
soiled objects, nurses must always wear
gloves to avoid direct contact with
infections microorganisms.

31. Disinfecting
A disinfectant is a chemical preparation,
such as phenol or iodine compounds,
used on inanimate objects .
Disinfectants are frequently caustic and
toxic to tissues.
An antiseptic is a chemical preparation
used on skin or tissue .

32.  Disinfectants and antiseptics often
have similar chemical components, but
the disinfectant is a more concentrated
solution .

33. Antiseptic Agents
 Rapid Action
 Broad Sectrum
 Persistent effect
 Safety
 Acceptibilty
Alcohol, Chlorhexidine, Triclosan , Iodine, Iodophores
Binds to Stratum Corneum.

34.  Alcohol > Denaturing of Protein
 Chlorhexidine > Disruption of Cell wall
 Triclosan > Disruption of cell wall
 Iodine/ Iodophores > Oxidation / Substitution
of free Iodine

35. When disinfecting articles,
nurses need to follow agency
protocol and consider the
following:

36. 1. The type and number of infectious organisms.
2. The recommended concentration of the disinfectant
and the duration of contact.
3. The temperature of the environment.
4. The presence of soap. Some disinfectants are
ineffective in the presence of soap or detergent.

37. 5. The presence of organic materials, the presence of
saliva, blood, pus can readily inactive many
disinfectants.
6. The surface areas to be treated. The disinfecting
agent must come into contact with all surfaces and
areas.

38. The basic principles of
surgical asepsis

39. 1. All objects used in a sterile field must be
sterile.
2. Sterile objects become un-sterile when
touched by un-sterile objects.
3. Sterile items that are out of vision or
below the waist level of the nurse are
considered unsterile.

40. 4. Sterile objects can become unsterile by
prolonged exposure to airborne
microorganisms.
5. Fluids flow in the direction of gravity.

41. 6. Moisture that passes through a sterile
object draws microorganisms from un-
sterile surfaces above or below to the
sterile surface by capillary action.

42. 7. The edges of a sterile field are considered
un-sterile.
8. The skin cannot be sterilized and is un-
sterile.

43. Personal Protective Equipment
 Gloves
 Gown
 Mask
 Protective Eyewear

44. Surgical Asepsis… Precautions
 Sterile can touch only sterile
 Do not spill on a sterile field
 Hold objects above waist
 Do not reach over field
 Do not turn back on field
 Outer 1 inch is considered sterile
 If in doubt, treat as contaminated

45. There Is No Compromise with
Sterility
It’s Considered Sterile or
Unsterile.

46. The OR Scrub

47. The Surgical Scrub
 Definition.
 The surgical scrub is the process of removing as many
microorganisms as possible from the hands and arms by
mechanical washing and chemical antisepsis before
participating in a surgical procedure.
 Despite the mechanical action and the
chemical antimicrobial component of the
scrub process, skin is never sterile.

48. The Methodology of the Scrub

49. The Timed Method
 All surgical scrubs are 5 minutes in length.
 All are performed using a surgical scrub brush and an
antimicrobial soap solution.

50. Surgical Scrub Procedure
1. Wet the hands and
forearms
2. Apply antiseptic agent
from the dispenser to the
hands.
3. Wash the hands and arms
thoroughly to 2 inches
above the elbows, several
times. Rinse thoroughly
under running water with
the hands upward,
allowing water to drip
from the flexed elbows.

51. 4. Take a sterile brush or
sponge (from a package or
dispenser) and apply an
antiseptic agent ( if it is
not impregnated in the
brush). Scrub each
individual finger,
including the nails, and
the hands, a half minute
for each hand.

52. 5. Hold the brush in one hand
and both hands under
running water, and clean
under the fingernails with a
disposable plastic nail
cleaner. Discard the
cleaner after use.
6. Again scrub each
individual finger, including
the nails and the hands
with the brush, half a
minute for each hand.

53. The Final Rinse
1. Be sure to keep both arms
in the upright position
(careful not to touch the
faucet!) so that all water
flows off the elbows and
not back down to the
freshly scrubbed hands.
Bring arm through the
water once, starting with
the fingers, then pull the
arm straight out. Do not
let water run down to
hands, must drip off
elbows

54. 7. Rinse the hands and brush, and discard the
brush.
8. Reapply the antimicrobial agent and wash the
hands and arms, applying friction to the
elbows, for 3 minutes. Interlace the fingers to
clean between them.
9. Rinse the hands and arms as described in the
previous slide.

55. Drying the Hands and Arms
1. Reach down to the
opened sterile package
containing the gown,
and pick up the towel.
Be careful not to drip
water onto the pack. Be
sure no one is within
arm’s reach.
2. Open the towel full-
length, holding one end
away from the nonsterile
scrub attire. Bend
slightly forward.

56. 3. Dry both hands thoroughly
but independently. To dry
one arm, hold the towel in
the opposite hand and,
using the oscillating motion
of the arm, draw the towel
up to the elbow.
4. Carefully reverse the towel,
still holding it away from the
body. Dry the opposite arm
on the unused end of the
towel.

57. Gowning and Gloving Techniques
1. Reach down to the
sterile package and lift
the folded gown
directly upward.
2. Step back away from
the table into an
unobstructed area to
provide a wide margin
of safety while
gowning.
3. Holding the folded
gown, carefully locate
the neckline.

58. 4. Holding the inside front of
the gown just below the
neckline with both hands,
let the gown unfold, keeping
the inside of the gown
toward the body. Do not
touch the outside of the
gown with bare hands.
5. Holding the hands at
shoulder level, slip both
arms into the armholes
simultaneously.

59. 6. The circulator brings the
gown over the shoulders by
reaching inside to the
shoulder and arm seams.
The gown is pulled on,
leaving the cuffs of the
sleeves extended over the
hands. The back of the
gown is securely tied or
fastened at the neck and
waist, touch the outside of
the gown at the line of ties or
fasteners in the back only.

60. Gloving by the Closed Glove
Technique
1. Using the right hand and keeping it within the
cuff of the sleeve, pick up the left glove from the
inner wrap of the glove package by grasping the
folded cuff.

61. 2. Extend the left forearm
with the palm upward.
Place the palm of the glove
against the palm of the left
hand, grasping in the left
hand the top edge of the
cuff, above the palm. In
correct position, glove
fingers are pointing toward
you and the thumb of the
glove is down

62. 3. Grasp the back of the
cuff in the left hand
and turn it over the
end of the left sleeve
and hand. The cuff of
the glove is now over
the stockinette cuff of
the gown, with the
hand still inside the
sleeve.

63. 4. Grasp the top of the
left glove and
underlying gown
sleeve with the
covered right hand.
Pull the glove on over
the extended right
fingers until it
completely covers the
stockinette cuff.

64. 5. Glove the right
hand in the same
manner, reversing
hands. Use the
gloved left hand to
pull on the right
glove.

65. Gloving the Right Hand

66. Scrubbing, Gowning, and Gloving Complete

67. Questions for Discussion
1. What would you do if, during your OR experience, you
accidentally touched an unsterile object with your sterilely
gloved hand?
2. What would you do if, while scrubbing, you accidentally
touched the faucet?
3. Is it OK to prepare a sterile field an hour before the
scheduled surgical case and leave the room to set up
another OR room? Why or why not?
4. What should you do if you notice a break in sterile
technique by another member of the OR team that they
may/or may not be aware of?