Sterile Precautions - Dr Imran

8/2/2019 Sterile Precautions - Dr Imran

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Sterile Precautions


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Wound infection

results from

bacterial

contamination


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What is the source of bacterialcontamination of surgical wounds?

1- Endogenous (from the patient himself):

Patients skin flora(skin preparation)

Patients viscera(colon preparation before resection)

2- Contamination from air in the O.R. :

3- Direct contamination:

Personnel circulation in the O.R.

O.R. ventilation.

Instruments, punctured gloves.


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The Theatre

The aim is to reduce the number of theorganisms in the air of the O.R. to a minimum.


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Clean and dirty areas should be separated &well demarcated.

Trafficking ofpersonnel should bekept to a minimumthrough the sterilearea.

Doors of the theatre

and the O.R. shouldbe closed.


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O.R. air quality control

Exogenous wound contamination is mainly air born.

1-Reduce

the numberof individualsin thetheatre.

Pickup other mistakes.


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2- Avoid excess movementof individuals in thetheatre.


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3- Doorsshould be

closed.


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4- Air vents should not be obstructed.


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Ideal situation:

controlled ventilation with air filters

(changing the air of the theatre 20 times / hour)

This is important in orthopedic surgerywere air is the main source of wound

contamination.


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Instruments


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Instruments

Cleaninginstruments

(removal ofcontamination)isan essential stepbeforesterilization(destroyingmicroorganisms)


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Definitions

Sterilisation Disinfection

Completedestruction of all

viablemicroorganisms

including spores &viruses.

Solid instruments

Reduces the numberof viable

microorganisms

Skin & delicateinstruments


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Sterilisation

by steam

Autoclaves

It kills vegetative bacteria (includingTB), viruses (e.g. Hepatitis)& heatresistant spores.


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Autoclaves

Organisms arekilled by thecombined effectofpressure,moist heat&time.

Temp. Press. Time

134 C 30 lb/in2 3 min.

121 C 15 lb/in2 15 min.


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Unwrapped instruments can besterilised in small autoclaveswithin

the theatre.

This is suitable to sterilise instrumentswhen accidentally dropped.


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Monitoring of adequate sterilisation

Chemical indicators

Before After


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Chemical indicators


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Sterilisation by Ethylene

Oxide Gas

For heat

sensitivematerials

includingelectricalequipments.


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Sterilisation by Ethelene Oxide Gas

Ethylene Oxide reacts

with organic debris

(serum) forming toxic

compounds, so dont use

it with contaminatedequipments (ventilator

equipments)


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Sterilisation by Hot Air

ovenCompared to moist steam sterilisation it

is less efficient.

It does not cause corrosion, so it is used

for instruments with fine cutting edges(opthalmic instruments).


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Sterilisation with

gama rays

Industrial process used to steriliselarge batches of similar products,

such as syringes, catheters andintravenous cannulas.


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Disinfection(reduce the number of the viable organisms)

Levels

High

Spores,bacteria &viruses.

Medium

Bacteria &viruses

Low

Bacteria &weak viruses.


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Disinfection

The efficacy of disinfection depends on:

The nature of the microorganism.

The load of the microorganism.

Duration of exposure to the agent.

The temperature.


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Disinfection

Boiling water(100 c for 5 minutes)

Low temperature steam(73 c for 20 minutes)

Formaldehide gas(in air tight cabinet at 50 c)


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Disinfection with

Glutaraldehyde solution (2%)Kills mostbacteria &

viruses.Used forEndoscopes

Toxic; shouldbe washed.


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Theater Staff

Personnel with infected skinlesionsor upper respiratorytract infectionmust beexcluded from the O.R. team.


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To decrease the bacterial count

in the air of the O.R.You should change your normalclothes to clean O.R. linen before

entering the theater.

Cotton gowns cannot serve as abarrier(cotton pores are 100 um insize while skin scales are 5-60 um)


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Wrong


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Wrong


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Caps & Masks

Protects the wound fromorganisms (in the oropharynx).

Offers protection to the wearer.


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Caps & Masks

Wrong Wrong


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Caps & Masks

Wrong Right


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Scrubbing

PovidoneIodine orchlorhexidine

soap, for 3-5minutes.


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Scrubbing

Use thebrushfor thenails.


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Scrubbing

Wrong


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Scrubbing

Dry your

hands

What is wrong?

Streetclothes


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Gloves

Offers atwo-way

protection


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Preoperative PatientPreparation

Short preoperative hospital stay(reduces inoculation by hospital resistantorganisms).

Preoperative showering.

Shaving (as it causes skin lacerations)should be done in the morning ofsurgery to avoid skin inoculation by

hospital organisms.


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Patients skin preparation

In the ward:

Wash the skin of the operation sitewith soap impregnated detergent(Povidone Iodine or Chlorhexidine)

Iodine may cause skin allergy. (Takehistory, Patch test)


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Povidone Iodine or Clohexidine paint.

In the O.R.


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Allow the

solution todry for

maximum

bacterialreduction.

Wrong

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Sterile Precautions - Dr Imran