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Chapter 57
Surgical Asepsis
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Asepsis, cont.
• Dirty: any object that has not been cleaned or sterilized for
removal of microorganisms
• Contaminated: anything that is not sterile
• Clean: medical asepsis
– Devoid of all gross contamination
– Free of many microorganisms
• Sterile: surgical asepsis
– Free of all microorganisms
– Many body parts are clean-not sterile:skin, mouth, GI
tract, upper resp. tract
– Sterile body parts: abdominal cavity or ovary, uterus
– Areas like GU system are susceptible to infection even
though bladder is sterile
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Disinfection
• Disinfection
– The process that results in the destruction of most
pathogens but not necessarily their spores.
• Methods
– Use of alcohol wipes, a hexachlorophene or
chlorhexidine gluconate soap scrub, or a povidoneiodine scrub, surgical hand scrub
– Phenol or chlorine is used to disinfect floors and
surfaces.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterilization
• Sterilization
– The process of exposing articles to steam heat
under pressure or to chemical disinfectants long
enough to kill all microorganisms and spores.
– Client usually takes home items such as
washbasins, mouth care utensils, and incentive
spirometers-these are not reused
• Methods
– Autoclave (uses steam at 18 pounds of pressure at
a temperature of 125 C for 15 minutes), chemical
disinfectants, radiation, and gas sterilization
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medical Asepsis
• Medical asepsis or clean technique
• The purpose of maintaining medical asepsis is to
prevent the spread of disease from one person to
another.
– Handwashing
– Standard Precautions
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Surgical Asepsis
• Surgical asepsis or sterile technique
– All microorganisms and spores are destroyed
before they can enter the body.
– Used when administering parenteral medications
and performing surgical and other procedures such
as urinary catheterization
– Often, clean technique (medical asepsis) is
performed using sterile supplies.
– Sterile to clean, dirty, or contaminated becomes
contaminated.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Technique
• Sterile technique is used to prevent the spread of
infection
– Supplies used for surgical and other sterile
procedures
– Anything that either touches an open wound or skin
break, enters a sterile body cavity, or punctures the
skin
– Surgical towels or drapes are packaged, secured with
special masking tape, labeled, and sterilized.
– Never touch sterile articles with unsterile articles!
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Concept
• Sterile to sterile remains sterile.
• Sterile to clean or dirty becomes contaminated.
• Always think before you touch anything.
– Do not touch sterile articles with unsterile articles
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Educating the Client
• Client and family teaching
– Demonstrate the skill to be performed.
– Ask the client and family to demonstrate the skill
before discharge.
– Explain how to recognize problems or complications.
– Describe when to seek medical care immediately.
– If indicated, make a referral for home care nursing
follow-up.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Technique in Nursing
• Do not touch anything after sterile gloves or gown have
been put on.
• Reaching over a sterile field contaminates the sterile area.
• If a sterile wrapper or mask becomes wet, they are no
longer sterile.
• When wearing sterile gloves, perform a sterile procedure.
• A person’s back is not sterile. Skin can only be made
clean, not sterile.
• When in doubt, consider the objects in question to be
contaminated.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Technique in Nursing
• The inside of the gown is not sterile, someone else must
tie the strings on the gown.
• Any part of the gown below the waist and above the
nipple line is contaminated!
• Be sure to keep the hands between the waist and the
nipple levels whenever sterile gloves are worn!
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Technique
• Hair covering
• Surgical mask and eye protection
• Sterile gown
• Sterile gloves
– Open gloving
– Closed gloving
– Removal of sterile or nonsterile gloves
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Procedures Requiring Sterile Technique
• Some procedures include:
– Care of the indwelling catheter
– Surgical intervention and invasive procedures
– Sterile dressing change
– Suture and staple removal
– Administration of parenteral medications
– Venipuncture and management of IVs
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Urinary Catheterization
• Procedure of inserting a tube (a catheter) through the
urethra into the bladder to remove urine
• Sterile procedure
• Catheter sizes: 14-16 Fr. (usually)
• Insert 2-3 inches in female; 5-7 in male or until urine is
visualized
• Straight catheter
– Used for one sample only and removed
• Retention catheter (eg, Foley catheter)
– Indwelling catheter (remains in the bladder)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Catheterization
• Coude tip catheter is used in males if there is prostate
enlargement or in the female if abnormal placement of
the urinary meatus is suspected
• No more than 750-1000 ml of urine can be safely
removed from the bladder at any one time, particularly if
the client has retention or distention for a long period.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Urinary Catheterization
• Self-catheterization
• Catheterizing the female client
– The side-lying position
• Catheterizing the male client
• Caring for the client after catheterization
• Removing the retention catheter
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring for the Client After Catheterization
• Reposition to ensure comfort
• Signal cord within reach
• Balloon of indwelling catheter inflated
• Catheter tubing secured externally
• Patient teaching
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring for the Client
After Catheterization, cont.
• Drainage tubing extends straight down from bed level to
bag (straight drainage)
– Extra tubing placed on bed with client—allows
movement
– Attach drainage apparatus to bed frame (not the
side rails)
• Maintain sterility
• Removing the retention catheter
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Alert
• A catheter is never cut for removal.
• This could cause the catheter to be pulled back into the
urethra or bladder.
• In that case, surgical removal would probably be
necessary.
• This would also be a source for introducing pathogenic
organisms into the urinary bladder.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins