STERILE TECHNIQUE KEY CONCEPTSAND PRACTICES

1 STERILETECHNIQUE: KEYCONCEPTS ANDPRACTICES19641964 STERILETECHNIQUE: KEYCONCEPTS ANDPRACTICESSTUDY GUIDED isclaimerAORN and its logo are registered trademarks of AORN, Inc. AORN does not endorse any commercial company s products orservices. Although all commercial products in this course are expected to conform to professional medical/nursing standards,inclusion in this course does not constitute a guarantee or endorsement by AORN of the quality or value of such products or ofthe claims made by the responsibility is assumed by AORN, Inc, for any injury and/or damage to persons or property as a matter of product liability,negligence or otherwise, or from any use or operation of any standards, recommended PRACTICES , methods, products, instructions,or ideas contained in the material herein.

2 Because of rapid advances in the health care sciences in particular, independentverification of diagnoses, medication dosages, and individualized care and treatment should be made. The material containedherein is not intended to be a substitute for the exercise of professional medical or nursing content in this publication is provided on an as is basis. TO THE FULLEST EXTENT PERMITTED BY LAW, AORN,INC, DISCLAIMS ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDINGBUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT OF THIRD-PARTIES RIGHTS, AND FITNESS FOR A PARTICULAR publication may be photocopied for noncommercial purposes of scientific use or educational advancement.

3 The followingcredit line must appear on the front page of the photocopied document: STERILE TECHNIQUE : KEY CONCEPTS AND PRACTICESC opyright 2013 AORN, Inc. All rights reserved. Reprinted with , Inc2170 South Parker Road,Suite 400, Denver, CO 80231-5711 (800) 755-2676 produced by Cine-Med, Inc127 Main Street NorthWoodbury, CT 06798 Tel (203) 263-0006 Fax (203) 263-4839 INTRODUCTION ..5 MICROBIOLOGY Associated with Surgical Site for STERILE Research on the Role of Nonpathogenic TO REDUCE TRANSMISSIBLE OF SURGICAL GOWNS, GLOVES, ANDDRAPES ..9 Barrier OF STERILE TECHNIQUE WHEN GOWNING AND the Surgical Hand Scrub and Moving to the STERILE Area.

4 11 Donning the Gown and Assisted versus Open Assisted Indicator to Change DRAPES ..13 PREPARING A STERILE and timing of STERILE field preparation ..13 Segregation of TECHNIQUE for Bowel ITEMS TO THE STERILE Before and Delivery TECHNIQUE for Wrapped Peel Packages and Rigid Sterilization THE STERILE a STERILE and Correcting Breaks in STERILE IN AND AROUND THE STERILE to the STERILE Field and Number of of Hands and Levels and , TRAINING, ANDqUALITY : KEYCONCEPTS ANDPRACTICESS terile TECHNIQUE : Key Concepts and PracticesTABLE OF CONTENTS3 STERILETECHNIQUE: KEYCONCEPTS ANDPRACTICESPURPOSE/GOALThe purpose of this study guide and accompanying video is to provide information to perioperative staff members on keyconcepts and PRACTICES for establishing and maintaining a STERILE viewing the video and completing the study guide, the participant will be able to:1.

5 Define STERILE TECHNIQUE . 2. Identify the parameters of a STERILE field. 3. Describe PRACTICES that reduce the spread of infection when preparing or working in a STERILE Discuss the importance of monitoring the STERILE : KEYCONCEPTS ANDPRACTICESINTRODUCTIONS urgical site infections (SSIs) are among the most frequentcomplications in patients who undergo surgical or otherinvasive Centers for Disease Control andPrevention (CDC) has estimated that in the United States,290,000 SSIs occur annually, costing $3 to $8 billion dollarsand causing 13,000 The CDC further estimates that26 to 54% of these infections are TECHNIQUE means practicing specific procedures beforeand during invasive procedures to help prevent SSIs and otherinfections acquired in hospitals, ambulatory surgery centers,physicians offices, and all other areas where patients undergoinvasive practiced correctly, steriletechnique helps reduce microbial contamination of thesurgical site and decrease the number of microorganisms inORs and other clinical environments.

6 Creating, maintaining, and monitoring a STERILE field canimprove patient outcomes. Using STERILE TECHNIQUE whenpreparing, performing, or assisting with operative and otherinvasive procedures is essential to keeping an environmentsafe and preventing health care-associated infections inpatients and health care workers. Perioperative nurses and allother medical and surgical personnel involved in operativeand other invasive procedures should promote patient andworker safety by practicing correct STERILE TECHNIQUE and byidentifying, questioning, or stopping PRACTICES if they appearunsafe. MICROBIOLOGY REVIEWS terile TECHNIQUE aims to prevent microbial contamination andinfection, so we begin with a review of some basic aspects ofmicrobiology and some of the most important microbialpathogens found in hospitals and other settings whereoperative and other invasive procedures are , or microbes, are too small to be visualizedwith the naked eye.

7 They include bacteria, viruses, fungi,protozoa, and algae. Bacteria, fungi, protozoa, and algae arefurther classified by genus and species. Bacteria areadditionally categorized by their morphology (shape), motility(ability to move), reaction to various staining tests, and abilityto grow under aerobic versus anaerobic conditions and indifferent types of media. These categories help bacteriologistsand clinicians distinguish among diverse bacterial species. Many microbes are beneficial, and most bacteria arenonpathogenic ( , they do not cause disease).4 Pathogenicmicrobes particularly bacteria, viruses, and fungi causedisease by invading and multiplying inside other pathogens can cause serious and potentially fatal SSIsand other serious health care-associated infections.

8 Somepathogens colonize the skin, upper respiratory tract, orintestinal tract of asymptomatic carriers. Infected health careworkers can shed these microorganisms, putting patients atrisk, especially those who are immunocompromised orundergoing surgical or other invasive procedures. Pathogenic bacteria, viruses, and fungi also can developnumerous mechanisms of partial or complete resistance toantimicrobial drugs. These include spontaneous and inducedgenetic mutations as well as horizontal gene transfer, or thenon-reproductive sharing of genes that confer resistancebetween organisms of the same or different vastmajority of health care-associated infections are from drug-resistant organisms; and these infections increase morbidity,mortality, and health care costs.

9 Researchers estimate that inthe United States, antibiotic-resistant infections cause 8million additional hospital days and cost at least $21 billionevery Associated with SSIsBacteria cause most SSIs, but bloodborne viruses are also ofmajor following list describes some of the mostcommon and pathogenic microorganisms associated with SSIsand other health care-associated Staphylococcus aureusis shed from human nasal andthroat cavities. S. aureuscauses SSIs as well assystemic infections ( , septic arthritis, myocarditis,and pneumonia).5 Staphylococci can survive for longperiods in dust, clothing, air, and bedding.

10 Infectionsof methicillin- and vancomycin-resistant S. aureus(MRSA and VRSA) are associated with prolongedhospital stays and increased mortality rates. Colonized health care workers can transmit S. aureusto patients. In England, a prolonged outbreak ofMRSA in cardiac surgery patients from 2011 to 2012was linked to a single colonized health care workerwho had cared for all patients in the cultures of health care workers showed that anurse was colonized with a strain of levofloxacin-resistant MRSA that matched the outbreak MRSA strain based on three molecular typing techniques:spa-typing, pulsed-field gel electrophoresis (PFGE),and multi-locus variable-number tandem-repeatanalysis.