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Reproductive System, Reproductive System, Medical School of Universitas Padjadjaran, Medical School of Universitas Padjadjaran, Bandung Bandung 2005 2005 MIR-C Corporate MIR-C Corporate Interactive Training CD for Medical Students Interactive Training CD for Medical Students Reproductive System Reproductive System Module : Module : tion Prevention: A- and Antiseptic Tec tion Prevention: A- and Antiseptic Tec in Surgical Setting in Surgical Setting
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Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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Page 1: 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

Page 2: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 3: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

CreditsCredits

Special thanks to:Central Operating Theatre Unit of

Hasan Sadikin General Hospital

Page 4: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Infection Prevention Module Infection Prevention Module

Introduction

Infection control

Antiseptic techniques

Operating Theater

Aseptic techniques

Page 5: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

IntroductionIntroduction

Description Objectives

Page 6: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

DescriptionDescription

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

Page 7: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 8: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 9: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Specific Learning Specific Learning Objectives :Objectives :

To perform aseptic techniques correctly, including (P5):

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

Page 10: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 11: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 12: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Infection ControlInfection Control

Page 13: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Why should we apply a and antiseptic techniques ?

Page 14: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 15: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 16: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Methods of Infection Methods of Infection controlcontrol

Anti septic techniques

Design and traffic patterns of the operating theatre

Aseptic techniques

Page 17: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Anti septic techniquesAnti septic techniques

Page 18: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

SterilizationSterilization

The objective of modern surgeryFor inanimate objectsProblem :

– Some items are not heat resistance

Page 19: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Techniques of Techniques of SterilizationSterilization

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

Chemical:– Liquid– Gas

Page 20: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Heat SterilizationHeat Sterilization

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

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

Page 21: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 22: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 23: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

SolutionsSolutions

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

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

Page 24: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Gas SterilizationGas Sterilization

FormaldehydeEthilene-oxide- propionolactone

Page 25: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Boiling WaterBoiling Water

Mild boiling Vigorous boiling

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

Page 26: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

The Operating Theater The Operating Theater

Sterilecore

Clean Zone

Transitional Zone Restricted area

Semi – Restricted Area

SCRUB SUIT

Page 27: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 28: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

unrestricted areaunrestricted area

Elevators

Corridors outside surgical suite

Page 29: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

unrestricted areaunrestricted area

Entrance

Reception desk

Patient suite

Page 30: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Transitional Zone Transitional Zone (Video)(Video)

Locker room

Dressing room

Page 31: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Clean Zone (Video)Clean Zone (Video)

Surgical suite and corridors

Sterile core

Page 32: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Scrub Area (Video)Scrub Area (Video)

Page 33: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Sterile Core (Video)Sterile Core (Video)

Page 34: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 35: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Surgical attireSurgical attire

Male personnel

Female personnel

Personnel with veil

Page 36: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.
Page 37: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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 :

Page 38: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Aseptic techniquesAseptic techniques

Page 39: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 40: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.
Page 41: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 42: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 43: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Hand washingHand washing

Preparation The procedure

Page 44: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Surgical Scrubbing Surgical Scrubbing ProcedureProcedure

Page 45: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 46: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 47: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Preparation:Preparation:

Page 48: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Recognizing glove sizesRecognizing glove sizes

Page 49: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 50: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Actual procedure: Actual procedure: Five minute techniqueFive minute technique

Page 51: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

GowningGowning

The goal:

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

Page 52: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Gowning & closed gloving Gowning & closed gloving techniquestechniques

Drying hands with sterile towel

Applying gown

Closed gloving technique

Page 53: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

– 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.

Page 54: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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

Page 55: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Open technique

Page 56: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Closed techniqueClosed technique

Page 57: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

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.

Page 58: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Skin preparationSkin preparation

Skin painting

Skin draping

Page 59: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Ready for surgeryReady for surgery

Page 60: Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate Interactive Training CD for Medical Students Reproductive.

Gown and gloves Gown and gloves removalremoval

After surgery:

Gown, Gloves removal

Simultaneous removal