anes 1502 - m13 ppt: cleaning and sterilization of instruments and equipment
TRANSCRIPT
Asepsis and Sterile TechniqueANES 1502
ANESTHESIA TECHNOLOGY FUNDAMENTALS
COLLEGE OF DUPAGE
Human microbe relationships
Indigenous microflora: microbes that live on the skin and inside human body
- “opportunistic pathogens”
- bacteria, fungi, viruses, and protozoa
- microflora=harmless, however, microflora + surgical wound = pathogen
Symbiosis
-Mutualism
-Commensalism
-Parasitism
Pathogen and Infection
Pathogens- microorganisms that cause infection
- commensal microbes: opportunistic by entering through a surgical skin incision
- nosocomial: UTI
- airborne viruses: common cold
Human-Microbe Relationships
Mutualism- both organisms benefit and depend on one another to a certain extent
Escherchia coli: in the colon, produces vit K
1) Synergism- 2 organisms work together to achieve a result neither could obtain alone
-Fusobacteria and spirochetes work together to cause trench mouth
Commensalism- one organism benefits but the other neither benefits nor is harm
-indigenous microflora on the skin can obtain nutrients but do not affect the skin
-competitive exclusion
Parasitism- one benefits and the host is harmed
-endoparasites-: intestinal worms
Pathogens associated with SSI
Bacteria
-prokaryotes, binary fission
Tuberculosis (TB)
-Mycobacterium tuberculosis: airborne droplet nuclei
-Precautions : wearing gloves, gowns, eyewear, and NIOSH approved respirators
Viruses
- nonliving particles that are completely reliant on the host cell for survival
-largest: 300nm -smallest: poliovirus-30nm
-Capsis: protein covering of DNA/RNA
-Capsomeres: the capsis is composed of protein molecules
-Nucleocapsid: nucliec acid-capsid combo
Pathogens- SSI
Emerging Infectious Diseases
-MDR: multidrug resistant strains
-Strain “W”
-viruses constantly mutate and evolve
-ebola virus, dengue virus, Lassa virus
Prions
- Prusiner 1982
-Creutzfeldt-Jakob disease (CDJ), scrapie (sheep disease)
Pathogens- SSI
Parasites
-unicellular and multicellular protozoan
-Helminths: round and flat
-tapeworm, flukes, and roundworms
-transmission: ingestions of contaminated food/water that contains the worm or eggs
-skin, fecal-oral contamination, arthropod bite
-protozoa-unicellular eukaryotes that are responsible for causing human diseases such as malaria and chronic sleeping sickness.
- amebas, flagellates, ciliates, coccidia, and microsporidia
-Entamoeba histolytica- cause of amebic dysentary
Pathogens-SSI
Fungi
-Mycology- study of fungi
- examples: yeast, mushrooms, and molds
-Mycoses- fungal diseases
-Zygomycosis- bread mold
-rhinocerebral zygomycosis
- increased organ transplants and immunosuppressive drugs and antibiotics
-plastic surgery and bone transplant
Methods of Transmission
Primary agent: bacterium, virus, fungi, or parasite
SSI: acquired at time of surgery, than after
-environmental and endogenous
Personnel-WEAR PROPER OR ATTIRE!
Environment
Fomites- inanimate object that harbors microorganisms.
The Patient
Factors that increase SSI
Age
Obesity
General Health
Nasal Carriers of S. aureus
Remote Infections
Pre-op Hospitalization
Factors of SSI
Preexisting illness and related treatment
Pre-op hair removal
Type of procedure
Duration of procedure
Surgical conscience
Is the practice of strict adherence to aseptic technique by ALL surgical team members, which includes, YOU, the SURGICAL TECHNOLOGIST!
Honesty, moral integrity, responsibility
Need the ability to recognize and correct breaks in aseptic technique
If there is hesitation and/or unable to admit = there is no place for you in the OR
THERE CAN BE NO COMPROMISE OF ASEPTIC TECHNIQUE
STANDARD PRECAUTIONS
Basic terminology
Antiseptic
Asepsis
Bacteriocidal
Bacteriostatic
Bioburduen
Contamination
Cross-contamination
Terminology cont’d
Decontamination
Disinfectant
Event-related sterility
Fomite
Fungicide
Infection
Nosocomial
Terminology
Pathogen
Resident flora
Sepsis
Spore
Sporicide
Sterile
Sterile field
Terminology
Sterile technique
Sterilization
Strike-through contamination
Surgically clean
Terminal disinfection
Terminal sterilization
Transient flora
Vector
Virucide
Principle of Asepsis
Principle 1: sterile field is created for each procedure
Principle 2: sterile team member must be appropriately attired prior to entering sterile field
Principle 3: movement in and around the sterile field must not compromise the sterile field
Principle 1
Time
Instrument sets, peel packs and wrappers
Chemical indicators
Sterile edges
Opening packages
Items that fall below table edges
Questionable sterility
Causes of contamination
Principle 2
Sterile portion of gown
Sterile portion of table
Proper technique with arms and hands
Surface for gowning and gloving
Sitting during surgery
Platform standing
Principle 3
Sterile to sterile
Sterile individuals keep within sterile area
Nonsterile to nonsterile
Characteristics of Bacteria
Morphology: size, shape and arrangements of bacteria
Morphology
Coccobacilli
Morphology
Bacillus- rod shape
Spirilla- spiral shape
L-Form- bacteria that lose normal shape (environmental)
Growth and Motility
Varies with agar medium
Rate
Flagella
Cilia
Nutritional/02 Requirements
Classifications: ex) oxygen, carbon, nitrogen
- obligate aerobes
-microaerophiles
-obligate anaerobes
-facultative anaerobes
-aerotolerant anaerobes
-capnophiles
Pathogenicity
Ability to cause disease
- release of exotoxins and endotoxins
- release of enzymes
- presence of a protective capsule
- attachment to host cell
Metabolism, proteins, & genetics
Metabolism is the secretion of waste products
Proteins specific to bacterial species
DNA is unique to each bacteria species
Staining
Simple
Gram
Acid-fast
Spore forming
Bacterial species capable of forming spores
Unfavorable conditions = cell is enclosed in a protein capsuleto
High survival
NOT REPRODUCTION
Difficult to destroy
Disinfection, decontamination, & sterilization
Disinfection: process in which most but NOT ALL the microorganisms on INANIMATE are destroyed
-Decontamination
Antisepsis: process in which most but NOT ALL microorganisms on ANIMATE surfaces are destroyed
-Antiseptic: solutions
-Sterilization: destruction of ALL microorganisms, including SPORES, on inanimate surfaces
Disinfection principles and disinfecting agents
Cleaning physical removal of blood and body fluids, as well as BIOBURDEN, from inanimate objects.
Disinfection
-high, intermediate, and low levels
Sterilization
-steam, chemical agents, high velocity electron bombardment, and ultraviolet radiation
-critical, semi-critical, and noncritical
Disinfectant efficiency
Concentration level of disinfectant solution
Number and type of microbes present
Physical factors of the solution
- temperature
- water hardness
- pH level
- exposure time
ALWAYS FOLLOW MANUFACTURER’S INSTRUCTIONS!
High Level Disinfectant Compounds
Glutaraldehyde/Cidex
pH: 7.5-6.5
Best overall disinfectant/liquid sterilant
Complete immersion in liquid
Endoscopes
Shelf life of 14 days/28 days
High Level Disinfectant Compounds
Sodium hypochlorite
Household bleach
Disinfectant for surfaces, floors, and equipment
CDC recommended on blood and body fluid spills
Intermediate Level Disinfectant Compound
Phenol Carbolic acid
Large areas and general basis
Quaternary Ammonium Compounds “quats”
Bactericidal, fungicidal, pseudomonacidal
Not sporicidal or tuberculocidal
Common: benzalkonium chloride, dimethyl benzyl ammonium chloride and the newer, diakyl quat
Alcohol Isopropyl and ethyl alcohol: diluted 60-70%
Bactericidal, virucidal, fungicidal, tuberculocidal, NOT sporicidal
Environmental decontamination
Role: minimize microbial counts in the OR environment
Surfaces and characteristics
Pre-op, intra-op and post-op
Standard precautions and PPE
Environmental services
Decontamination practices in the OR
-pre, intra, post, or between
Terminal cleaning
Weekly cleaning
Dirty cases
Surgical Instrument Decontamination Process
ALL ITEMS USED ON STERILE FIELD AND/OR ON OPEN TISSUE MUST BE STERILIZED!
Decontamination is the first step Cleaning
Disinfected
Lubricated (if necessary)
Sorted
Reassembled
Wrapped
Sterilized
Stored properly
Cleaning
Presoaking in basin Sterile water
Enzymatic solution
Proteolytic enzymatic cleaner
Lipolytic enzymatic cleaner
Detergent solutions
Table 7-8
Rinsed and dried
Chelation, enzymatic, emulsification, and solubilization
Table 7-9
Manual cleaning
1. Instruments immersed in a solution. Friction will loosen organic material. With stainless steel: back and forth motion; circular can scatch.
2. Rinse in distilled water. NO TAP WATER!
3. AVOID spotting the instruments, so DRY!
Decontamination
Washer-sterilizer
Washer decontaminator
Ultrasonic washer
Considerations:
Use of tray- perforated/wire mesh
Heavier instruments place on the bottom
Hinges left open
Disassemble any instrument
Concave surfaces should be placed upside down
Washer decontaminator
“WD”
DOES NOT INCLUDE STERILIZING PHASE
Purpose: allow hands off processing
Considered “clean”
Washer sterilizer
“WS”
Stainless steel and heat tolerated items
MUST BE CLEAN BEFORE USE!
Stainless steel must not be placed near other metals = fusion
Use free rinsing, low sudsing, neutral pH detergent
NOT USED DIRECTLY ON PATIENTS NOT A BIOLOGICALLY MONITORED PROCESS
Types of WS machines
Tunnel like chmaber
Horizontal/cabinet type
Gravity cycle of 270 degrees
Ultrasonic cleaner
After instruments are placed in WD or WS, they’re place in the ultrasonic cleaner
Removes small organic particles, or places that cannot be reached
Box locks, serrations, and ratchets
Cavitation
High frequency sound waves
Molecules are forced in a rapid motion which form bubbles
Implosion occurs to create a vacuum, dislodging particles
Metal mesh trays
Each cycle last 4-5 minutes
Special Care
Items with lumens
Rigid and flexible endoscopes
Lubrication
“milking”