Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Reproductive System,Reproductive System,Medical School of Universitas Padjadjaran, Medical School of Universitas Padjadjaran, BandungBandung20052005

MIR-C CorporateMIR-C Corporate

Interactive Training CD for Medical StudentsInteractive Training CD for Medical StudentsReproductive SystemReproductive System

Module : Module :

Infection Prevention: A- and Antiseptic TechniquesInfection Prevention: A- and Antiseptic Techniques

in Surgical Settingin Surgical Setting

Production Team:Production Team:

Director : Kiki Lukman, MD, MSc, FINACS (Dig.) Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.) Main contributors : Kiki Lukman, MD, MSc, FINACS (Dig.)

Yayat Ruchiyat, MD, FINACS (Dig.) Warko Karnadihardja, MD, FINACS (Dig.) Nurhayat Usman, dr., SpB-KBD

Lisa Hasibuan, MD Nina K. Poetri T., SKp, Dadang Sunarya AMK Dedy Rusnadi AMK, Alia Rahmi AMK,

Editorial Team : Kiki Lukman, MD, MSc, FINACS (Dig.) Casting : Kiki Lukman, MD, MSc, FINACS (Dig.) Artistic : MIR-C Corporate Productions : Medical School of Universitas Padjadjaran

Bandung

CreditsCredits

Special thanks to:Central Operating Theatre Unit of

Hasan Sadikin General Hospital

Infection Prevention Module Infection Prevention Module

Introduction

Infection control

Antiseptic techniques

Operating Theater

Aseptic techniques

IntroductionIntroduction

Description Objectives

DescriptionDescription

Infection Prevention in Surgical Setting is one of important preventive methods in order to achieve infection control in clinical and surgical practices.

ObjectivesObjectives

The aims of this method are :

– To minimize surgical site infection– To protect health personnel– To improve wound healing– To minimize disability, morbidity, &

mortality– To reduce the cost of hospital care

Specific Learning Objectives :Specific Learning Objectives :

To describe the definition and history of sterilization, disinfection, decontamination, anti and a - septic techniques.

To describe six methods of sterilization.To describe three categories of surgical

instrumentsTo describe 6 rules of aseptic techniques

Specific Learning Specific Learning Objectives :Objectives :

To perform aseptic techniques correctly, including (P5):

– Applying surgical attire– Hand washing– Surgical scrubbing– Gloving– Surgical Gowning

Definition:Definition:

– Sterilization : Processes by which all pathogenic & non pathogenic microorganisms, including spores, are killed.

– Disinfection: Chemical or physical process of destroying all pathogenic microorganisms, except spore bearing ones; used for inanimate objects, but not on tissues.

Definition:Definition:

– Decontamination : Process or method by which all contaminated materials that can cause diseases are removed.

– Aseptic techniques : Methods by which contamination with microorganisms is prevented.

– Antiseptic techniques: Prevention of sepsis by the exclusion, destruction, or inhibition of growth and multiplication of microorganisms from body tissues and fluids.

Infection ControlInfection Control

Why should we apply a and antiseptic techniques ?

Historical backgrounds :Historical backgrounds :

Ignas Sammelweis (1818 - 1865)– Puerperal fever increased maternal mortality– Hand scrub with chlorinated-lime solution prior to

examination.– Father of nosocomial infection.

Louis Pasteur (1860)– Discover the process of fermentation by microorganisms– Germ theory: against spontaneous generation theory.

Historical backgrounds :Historical backgrounds :

Joseph Lister (1865)– Use carbolic acid solution on surgical dressing in

the operating room mortality (Listerization)– Father of modern surgery (Antiseptic technique)

Ernst Von Bergmann (1886)– Introduced “steam sterilizer”– Basic of sterilization aseptic technique– Later: “pressure & vacuum steam sterilizer” was developed

Methods of Infection Methods of Infection controlcontrol

Anti septic techniques

Design and traffic patterns of the operating theatre

Aseptic techniques

Anti septic techniquesAnti septic techniques

SterilizationSterilization

The objective of modern surgeryFor inanimate objectsProblem :

– Some items are not heat resistance

Techniques of Techniques of SterilizationSterilization

Physical:– Heat– Radiation/ ultraviolet ray– Boiling water– Ultrasound

Chemical:– Liquid– Gas

Heat SterilizationHeat Sterilization

Dry : – Commonly cause damage– For powder, oils, and jelly

Moist :– Steam– High pressure spores – Vacuum constant temperature– Autoclave

Chemical SterilizationChemical Sterilization

Generally as disinfection Mechanism of action :

– Protein coagulation– Enzyme denaturation in cells– Lysis

Depend on : number of microorganisms, soiling, concentration, and temperature.

Solutions Solutions

Jodium and Jodophor– Good bactericide, but irritant– Mixture : povidone-jodine 10%

Alcohol Solution of 70% or 90%

Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%)– Spores are killed within 3 hours

SolutionsSolutions

Hexachloropene (Halogenated phenol)– Bacterio-static, particularly Gram (+) bacteria– For scrubbing

Chlorhexidine gluconate– Bactericide : Gram (+) & (-).– Good for antiseptic

Gas SterilizationGas Sterilization

FormaldehydeEthilene-oxide- propionolactone

Boiling WaterBoiling Water

Mild boiling Vigorous boiling

More active, if 2% sodium-carbonate or 0,1 % sodium-hydroxide being added

The Operating Theater The Operating Theater

Sterilecore

Clean Zone

Transitional Zone Restricted area

Semi – Restricted Area

SCRUB SUIT

Traffic patterns of Operating Traffic patterns of Operating TheatreTheatre

The use of aseptic principles requires regulation of traffic and flow patterns of the personnel, patient, equipment, and supplies in operating theatre

Aims : to protect the safety and privacy of patients and the cleanliness and integrity of the environment.

unrestricted areaunrestricted area

Elevators

Corridors outside surgical suite

unrestricted areaunrestricted area

Entrance

Reception desk

Patient suite

Transitional Zone Transitional Zone (Video)(Video)

Locker room

Dressing room

Clean Zone (Video)Clean Zone (Video)

Surgical suite and corridors

Sterile core

Scrub Area (Video)Scrub Area (Video)

Sterile Core (Video)Sterile Core (Video)

Putting on surgical Putting on surgical attireattire

In the semi & restricted area:

– Scrub suit : shirt & trousers– Hair covering: surgical cap/hood– Masks : disposable/ re-useable– Goggle (optional): protective eyewear– Shoe covers

are compulsory

Surgical attireSurgical attire

Male personnel

Female personnel

Personnel with veil

Surgical Instruments in the Operating Surgical Instruments in the Operating TheatreTheatre

Critical items :– Sterile, because of being used for penetrating

skin or mucosa

Semi critical items :– In contact with skin or mucous membrane

Non critical items :

Aseptic techniquesAseptic techniques

Aseptic techniquesAseptic techniques

1. Rules at clean zone

2. Procedures in sterile area

3. Talk as necessary

4. Restrict unnecessary movements

5. Sterile instruments, remove non sterile one

6. Avoid & Replace wet surgical drapes/towels

Hand washingHand washing

Indications:

– Between patient contacts– Before performing or assisting with invasive

procedures– Before taking care of particularly susceptible

patients– Before and after touching wounds– Immediately after gloves are removed

Hand washingHand washing

– Before and after performing sterile procedures

– After contact with blood or body substances, mucous membranes, soiled linen, waste, or contaminated equipment.

– Between tasks at different body sites on the same patient to prevent cross contamination

– After taking care of infected patient

– After touching contaminated inanimate sources

Hand washingHand washing

Preparation The procedure

Surgical Scrubbing Surgical Scrubbing ProcedureProcedure

Purposes:Purposes:

– To remove debris and transient organisms from the nails, hands, and forearms.

– To reduce the resident microbial count to a minimum.

– To inhibit rapid rebound growth of microorganisms.

Purposes:Purposes:

– To minimize the re-growth of microorganisms for the length of the procedure.

– To reduce the numbers of microorganisms on hands

– To reduce contamination of the operative site by recognized or unrecognized breaks in surgical gloves.

Preparation:Preparation:

Recognizing glove sizesRecognizing glove sizes

Actual procedure: Actual procedure: Strokes techniqueStrokes technique

Rinsing hands & arms

Scrubbing with antiseptic solution

Rinsing arms Scrubbing with

brush or sponge Rinsing arms Scrubbing with

antiseptic solution Drying arms

Actual procedure: Actual procedure: Five minute techniqueFive minute technique

GowningGowning

The goal:

– to ensure a safe, protective, and aseptic environment to the patient and the surgical team.

Gowning & closed gloving Gowning & closed gloving techniquestechniques

Drying hands with sterile towel

Applying gown

Closed gloving technique

– The final step of the aseptic techniques before performing surgery.

– Sterile gloves are worn to permit the

wearer to handle sterile supplies or tissues of the operative wound.

– Sterile gloves establish a shield that protects the patient from contamination by flora from the hands of health care workers.

Open technique

Closed techniqueClosed technique

Skin preparationSkin preparation

The goals: – to cleanse the skin and bring both the

resident and transient bacterial counts to an irreducible minimum, therefore reducing the risk of wound contamination and subsequent surgical site infection.

performed just before the surgical incision has been performed.

Skin preparationSkin preparation

Skin painting

Skin draping

Ready for surgeryReady for surgery

Gown and gloves Gown and gloves removalremoval

After surgery:

Gown, Gloves removal

Simultaneous removal