Transcript Unit 3, part 2 - Workforce Solutions

Unit 3 - Infection Control:
Aseptic and Nonaseptic Techniques
Chapters 16-18
Infection Control
Chapter 16
Infection Control in
Healthcare
Awareness has increased since rise of AIDS
epidemic
 Infection control standards have become more
stringent
 Health care workers have a responsibility to
protect themselves and others from acquiring
diseases
 Standard Precautions and isolation techniques
help healthcare workers prevent transmission
of disease

Microorganisms
o
Pathogen
o
o
Infection
o
o
o
Microorganism known to produce disease
Establishment and growth of a microorganism on or in a
host
Many unidentified pathogens that produce newly
recognized diseases
Four major groups of microorganisms
o
o
o
o
Bacteria
Fungi
Viruses
Parasites
Microorganisms
o
Some species produce disease, others not harmful, or
are even useful
o
Determining pathogenicity
o
Natural flora in one area of body may produce infection in
another area
o
o
EX: E. coli – natural flora of the intestinal tract; causes urinary
tract infection if it gains entrance to the urinary bladder
Ability to find susceptible body tissue to invade
o
Staphylocci on skin surface; can cause infection if enters lungs
Microorganisms
o
Small number of microbes may be harmless;
increasing levels may become pathogenic
o
Resident (natural) flora – microbes that live
in the body at all times in a quantity that is
usually stable
o
Transient flora – acquired by contact with an
object on which they are present
Bacteria
o
o
o
Colorless, microscopic, one-celled organisms
without a nucleus (Procaryotes)
Reside in a host in a group called a colony.
Morphology – Classification of bacteria by size
or shape; determined by “gram staining”
o
o
o
Cocci (spheres)
Bacilli (rods)
Spirals
Bacteria
o
May also be classified according to divisions
o
o
o
o
Diplococci = groups of two
Streptococci = chains
Staphylocci = grapelike bunches
Must be stained to be seen under a microscope
o
o
o
Gram-positive = take the stain
Gram-negative = do not take the stain
Acid-fast = resistant to colorization by acid alcohol
Bacteria
o
Endospores
o
o
o
o
Protective coat formed when conditions for survival
become unfavorable
“Survival mode”; dormant
Encase the genetic material in the cell & protect it
for many years
When conditions improve, endospore germinates
and bacterial cell grows and replicates
Viruses
Minute microorganisms that cannot be
visualized under an ordinary microscope
o Smallest microorganisms known to produce
disease in humans
o Have either DNA or RNA, never both
 Must invade a host cell in order to survive &
reproduce
o
Viruses
o
o
o
Viral infection occurs when virion (virus particle)
attaches to host cell and inserts its genetic
material, then takes control.
Uses genetic machinery of the host cell to
reproduce
Environment must be favorable for multiplication
o
o
o
Poor nutritional status of host
Increased levels of stress in host
Excessive use of drugs or alcohol
Viruses
o
Viruses can lay dormant or latent for a period of time
o
Dormancy
o
o
o
“Sleeping”, but very much alive and destructive
Invade nerve ganglia and leave genetic material in a latent phase
after an acute infective period
Remains there until the body is under some type of stress
o
o
Examples:
o Herpes simplex (cold sore)
o Varicella (chickenpox virus—shingles)
Other examples of viruses:
o
o
Common cold
Infectious mononucleosis
Viruses

Classified by
Genetic composition
 Shape or size
 Symmetry
 The host it infects
 The type of disease it produces
 Its target cell and immune properties

Fungi
o
Macroscopic
o
o
Mushrooms, puff balls
or Microscopic
o
Medically important pathogenic
fungi:
o
o
o
Yeasts, molds
Hygrocybe lanecovensis
Larger than bacteria
Eukaryotic cells (have nucleus)
requiring an aerobic
environment to live & reproduce
Aspergillus, 400x
Fungi
o
Yeasts
o
o
o
o
One-celled forms of fungi
Reproduce by budding
Used commercially to produce
beer, wine, bread
Molds (mycelia)
o
o
o
Multicellular colonies
Reproduce by spore formation
Used in production of antibiotic
drugs, enzymes for medical use,
food production
Diseases caused by Fungi
o
Superficial infection
o
o
Cutaneous infection
o
o
o
Involves hair, nails, skin
Ex. Tinea pedis (athlete’s foot), ringworm
Subcutaneous infection
o
o
Ex: Tinea nigra causes discoloration of skin
Enters host resulting from some trauma to the skin
Systemic infection – most serious
o
o
Enters circulation
Can be fatal
Parasites

Organisms that live on or in other organism
at the expense of the host
Protozoa – unicellular; neither plant nor animal;
eucaryotic; motile
 Larger than bacteria
 Lack a cell wall
 Classified according to motility

 Amoeboid
 Flagella
(protein tail)
 Cilia (hairlike projections)
 Sporozoans (nonmotile)
Parasites
o
Examples of protozoan
infections:
o
Trichomonas vaginalis
o
o
STD which infects both male
and female hosts
Plasmodium vivax
o
Causes malaria
The protozoan
parasite
Trypanosoma
brucei causes
a severe
disease known
as sleeping
sickness
How do we get infected?
o
Six steps must occur from contact with
infectious agent until the disease is
apparent:
1.
2.
3.
4.
5.
6.
Encounter
Entry
Spread
Multiplication
Damage
Outcome
Encounter
o
Microorganisms are typically
encountered through the environment
o
o
Congenital infections are passed through
the placenta to unborn child
Some microorganisms are normally
found in the body; some cause disease
Entry
o
Infectious microbes can be
o
o
o
Ingested (via contaminated water/food)
inhaled (pneumonia) or
via penetration
o
o
o
Ex. Using flagella to penetrate (syphilis)
Mosquito bites (malaria, West Nile virus)
Breaks in the skin
Spread
o
o
o
o
The propagation of the
infectious organism
Most important barrier is
the host’s immune system
Location of entry
influences
Methods of spread:
o
o
o
Contact
Droplet
Vector
Multiplication
o
Infectious agents must multiply for
the host to be impacted
o
Incubation period – time it takes for
agents to overcome the host’s
defenses.
Damage
o
o
Direct vs. Indirect
Direct
o
o
o
Cell death caused by destruction of host cells
Cell death caused by toxins or poisons
secreted by the infectious agent
Indirect
o
o
Growth of the microbe can cause obstruction
in a major organ system
Can alter the metabolism of the host
o
Ex. botulism
Outcome
1.
The host gains control of the infectious
agent and eliminates it
2.
The infectious agent overcomes the
hosts immunity to cause disease
3.
The host and infectious agent
compromise and live together
Chain of Infection
o
Four factors present in the spread of
disease.
1.
2.
3.
4.
Host
Infectious microorganism
Mode of transportation
Reservoir
Human Host
o
Human body
provides a
favorable
environment
o
o
o
o
Contains
nourishment for
infectious agents
Temperature
pH
Body fluid
Infectious
Microorganisms

Include:
Bacteria
 Viruses
 Fungi
 Protozoa

Mode of Transmission
o
Exogenously – from outside the body
o
Transmission can be through
o
Direct host-to-host contact (touching)
o
o
o
o
Indirect host-to-host contact
o
o
o
Ex. Hand holding, kissing, coughing, sexual contact
STDs, staph infections
Microbes often carried in body fluids (mucus, blood etc)
Vector - EX: mosquito, flea, tick (Lyme disease)
Fomite – an inanimate object that has been in contact with an
infectious agent
o EX: food, water, radiographic table, latex gloves
Droplet contact – contact with infectious secretions that come from
the conjunctiva of the eye, nose, or mouth of host as he/she
coughs, sneezes, or talks
o Droplets can travel 3 – 5 feet
Mode of Transmission
o
Endogenously – from inside the body
o
o
o
Infected with organisms already present within
the body (normal flora)
Usually infects a different area of the body
Staphylococci present on the skin can infect
deeper tissues (laceration)
Reservoir
o
The site where an infectious organism can stay
alive and from which transmission can occur.
o
o
People serving as a reservoir are called carriers.
o
o
o
o
EX. People, animals inanimate objects
Carrier doesn’t display disease symptoms but can
infect others (Typhoid Mary)
Animals (mad cow disease)
Insects (malaria)
Inanimate objects (contaminated linen)
Nosocomial Infections
o
o
Infections acquired in the course of medical
care
Hospital patients have a greater sensitivity to
infection
o
o
o
o
Compromised
Immunosuppressed
5% of all hospital patients will acquire a
nosocomial infection.
It is the 8th leading cause of death in the U.S.
Sources of
Nosocomial Infections
o
Iatrogenic infection
o

Environment





Nosocomial infection that results from a particular
treatment or therapeutic procedure (physician-caused)
Air contaminated with infectious agents
Other patients with infectious diseases
Contaminated instruments
Medical personnel
Therapeutic regimen


Anitmicrobial therapy
Immunosuppressive and cytotoxic drugs
Sources of
Nosocomial Infections

Equipment





Catheters
IV tubing
Respiratory therapy equipment
Gastrointestinal tubes
Contamination during medical procedures




Dressing changes
Catheter insertion
Invasive procedures
Surgical instruments
Increasing Factors
o
Urinary tract
o
o
o
o
Most common site of nosocomial infection
Post-op wound infections
Respiratory tract
Early removal of urinary catheters, IV
catheters, and other types of invasive
treatment devices recommended to
reduce incidence of nosocomial infections
Factors of Susceptibility for
Nosocomial Infection
o
Age
o
o
Heredity
o
o
o
congenital & genetic factors
Nutritional status
o
o
very young, elderly
malnourishment, obesity
Stress
Inadequate rest & exercise
o
Non-efficient eliminations & circulation
Factors of Susceptibility for
Nosocomial Infection
o
Personal habits
o
o
Health History
o
o
smoking, drugs/alcohol, unsafe sexual practices
diabetes, heart disease, children who have not
been immunized
Inadequate defenses
o
broken skin, burns, trauma,
immunocompromised persons
Transmission of Infection
o
Infectious agent
o
o
o
o
o
o
Pathogenicity – ability to cause disease
Virulence – ability to grow and multiply with speed
Invasiveness – ability to enter tissues
Specificity – attraction to a particular host
Environment in which the pathogenic
microbes can live an multiply (susceptible
host)
Portal of exit from reservoir
Elements Needed To
Transmit Infection
o
o
o
Vehicle transmission – by contaminated food,
water, drugs, or blood
Airborne transmission – evaporated droplets
of disease microorganisms suspended in air
for long periods of time; inhaled by
susceptible host
Vectors – insect or animal carriers of disease
; deposit diseased microbes by stinging or
biting human host
Blood-borne Pathogens
o
o
Disease-causing microorganisms that may be present in
human blood or body fluids.
Two most serious:
o
HBV – Hepatitis B virus
o
o
o
o
HIV – Human immunodeficiency virus
o
o
o
o
o
Primarily affects the liver
Symptoms: flu-like symptoms, jaundice
Test positive 2-6 weeks after symptoms develop
Primarily affects the immune system
Responsible for AIDS
Symptoms: weight loss, fatigue, glandular pain and swelling, muscle and
joint pain, night sweats.
Long latent period (up to 10 years)
Others:
o
Hepatitis C, Hepatitis D, Syphilis
Viral Hepatitis
o
o
o
o
Hepatitis A & hepatitis E – transmitted by
fecal-oral route
Others – transmitted by blood or body fluid
contacts
Health care workers most often contract
hepatitis B from needle-stick injuries
Susceptible to HVB and HVC
o
o
o
Persons who share contaminated needles
Persons who have multiple sex partners
Hemophiliacs
Infection Control:
Microbial Control Within the Host.
o
Inherent defenses of the body
o
o
o
o
o
Normal Microbial Flora (balance)
Chemotherapy (Drugs)
o
o
o
Intact skin & mucous membranes
Body secretions (mucus, acidic urine, tears,
sweat)
Phagocytes
Static – inhibit microbial growth
Cidal – kills susceptible microbes
Immunization
Infection Control:
Environmental Control
o
Recommendations and Guidelines come from:
o
o
o
o
U.S. Dept. of Heath & Human Services (HHS)
Centers for Disease Control and Prevention (CDC)
U.S. Dept. of Labor’s Occupational Safety and
Health Administration (OSHA)
World Health Organization (WHO) – International
Environmental Control
o
o
Controlling infection or breaking the cycle
of infection – duty of all health care
workers
Asepsis – freedom from infection
o
o
Medical asepsis – microorganisms have been
eliminated through the use of soap, water,
friction, and disinfectants
Surgical asepsis – microorganisms and their
spores have been completely destroyed by
means of heat or by a chemical process
Environmental Control:
Chemical Methods
o
Disinfection - Removal by mechanical and
chemical processes of pathogenic
microorganisms from objects or body
surfaces
o
o
o
o
o
but frequently not their spores,
Antiseptic – used in reference to body surfaces
Bacteriostatic – stops bacterial growth
Bacteriocidal – kills bacteria
Items are disinfected when they cannot
withstand the sterilization process, or when it
is not practical
Environmental Control:
Disinfection
o
Effectiveness of chemical disinfectants depends
on:
o
o
o
o
o
Concentration
Temperature
Time of exposure,
Types/numbers of microbes
Nature of the object/person being treated
Environmental Control:
Physical Methods
o
Heat is the most frequently used method of
sterilization.
o
o
o
o
o
o
Moist heat is more effective than dry heat
Moist heat = heat under pressure; requires use of an
autoclave (250o F @ 15 lb/in2 for 15 minutes)
Dry heat requires use of an oven (320oF for 120 minutes)
Pasteurization – requires moderate heating followed by
rapid cooling (kills heat-sensitive organisms)
Freezing – can kill some organisms; NOT a reliable form
of sterilization
UV light – is used to control airborne contaminants
Environmental Control:
Physical Methods
o
o
Barriers are one of the
simplest methods of
microbial control
(PPE – Personal Protective
Equipment)
o
Gloves
o
o
o
o
Worn when contact with
blood/body fluids is anticipated
Gowns (fluid repellent)
Masks
Protective eyewear/Face
shields
Hand Washing
aka. Medical Asepsis
o
o
o
o
o
o
Single most important means of preventing the
spread of infection.
A chemical and physical process
Wash / sanitize hands before and after each patient
contact (even if gloves have been worn)
Wash hands with soap and water if hands are
visibly soiled
Use of hand sanitizers is permissible if not
Cover any exposed break in the skin with
waterproof bandage
Standard Precautions
o
o
o
Used at all times when caring for a patient
Based on the assumption that every patient
has the potential for having an infectious
disease
Used when coming in contact with:
o
o
o
o
o
Blood & body fluids
Secretions
Excretions
Mucous membranes
Non-intact skin
Dress in the Workplace
o
o
o
o
Short fingernails – no acrylic nails
Closed toe shoes
Limited amount of jewelry
Freshly laundered clothing
o
o
o
Was uniforms separate from family laundry
Short sleeves recommended
Wear a protective gown when it is possible
that blood or body fluids will contaminate
clothing
Hair
o
o
o
Major source of
staphylococcal
contamination
Should be shampooed
frequently
Wear hair short or in a
way that keeps it up and
away from your clothing
and the patient
Personal Protective Equipment
(PPE’s)
Eye Protection
o
o
When splattering of
blood or body fluids is
possible, wear goggles
to protect eyes from
becoming contaminated
Keep hands away from
eyes so that infection is
not introduced into
them
Gloves
o
o
Wear disposable,
single-use gloves any
time you feel that you
might touch a patient’s
blood or body
substances
Wash hands BEFORE
and AFTER donning
gloves!
Needle Recapping
o
NEVER use two hands to
recap a needle!
o
o
o
o
800,000 needle stick injuries
to healthcare workers annually!
Use “scoop” technique or
NERD (needle recapping
device)
All “sharps” should be
disposed of in a sharps
(puncture resistant)
container
Cleaning &
Proper Waste Disposal
o
o
Pillow cases and linens should be changed after
each use by a patient
Radiographic table and imaging equipment should
be cleaned with disinfectant after each patient use
o
o
Clean least soiled areas first, then move to more soiled
areas (10% bleach solution)
Discard items if they have fallen on the floor
Transmission-based
Precautions
o
o
o
Used in addition to standard precautions
Used to prevent the spread of highly
infectious diseases between infected persons
and the healthcare providers
3 specific routes of transmission
o
o
o
Airborne
Droplet
Contact
Airborne Precautions
o
o
Microbes are spread on evaporated droplets that
remain suspended in air or carried on dust particles
in the air
Particles may be inhaled by persons in that room
o
o
Examples include: Tuberculosis, Varicella (chicken pox),
rubeola (measles)
Requires
o
o
o
Negative air-pressure isolation room
Mask upon entry into room (special mask for TB)
Mask for patient during transport within the hospital
Droplet Precautions
o
o
Contaminated droplets are placed in the air
when patient sneezes, coughs, or talks
Contaminated droplets are inhaled or
internalized by uninfected person (no more
than 3 feet)
o
Examples include: Influenza, pneumonia
Droplet Precautions
o
Requires
o
o
o
o
Private room or
A room with another person infected with same
disease or
A room where beds are at least 3 feet away
Mask for any procedure that requires less than 3
feet in proximity to the infected patient
Contact Precautions
o
o
Direct contact – susceptible person actually touches
an infected person’s body surface in an area where
infectious microbes are present
Indirect contact – susceptible person touches or
comes into contact with an object that has been
contaminated with infectious microbes
o
o
Fomites – contaminated objects
Examples include:
o
MRSA (methicillin-resistant Staphyloccus aureus, hepatitis
A, impetigo, varicella and varicella zoster
Contact Precautions
o
Requires
o
o
o
Private room or room
with another person with
same disease
Gloves upon entrance
into room
Wearing a gown if there
is a possibility of
touching patient or items
in room
Protective or
Reverse Isolation
Negative-pressure air flow – prevents
pathogenic microorganisms from flowing
out of the isolation room
 Patient who is highly susceptible to
becoming infected require isolation
precautions to protect them from becoming
infected

Disinfection
o
Responsibility to prevent the spread of infection
o
o
o
o
o
If patient is coughing and sneezing, provide tissues
and a place to dispose of them
Instruct patient to cough or sneeze into tissues
Wear gown, mask, gloves if necessary
Disinfect table and anything in radiographic room
the patient touched
Wash hands
Aseptic Techniques
Chapter 16
Surgical Asepsis
o
Medical asepsis
o
o
o
Removal or destruction of infected matreial
Ex: Hand washing
Surgical asepsis (Aseptic technique)
o
o
Complete removal of microorganisms & their spores
from the surface by means of heat or chemical
action
Invasive procedures require use of surgical aseptic
techniques
o
Ex: angiography, arthrorography, hysterosalpingography,
radiography in surgery
Draping for a
Sterile Procedure
o
Sterile drapes placed around area of skin that
has been prepared
o
o
o
o
o
o
Establishes a sterile field
Limits area exposed to environment
Fenestrated drape – opening over surgical site
Sterile packages must be clean and dry
Check for expiration date
Once drapes are in place, they must not be
moved; underside contaminated by patient’s
skin
Opening
Sterile Packs
o
Cloth-Wrapped Packs
o
o
o
o
Wash hands before handling
Lines on tape change color if pack has been
correctly sterilized
Place pack on clean tabletop with sealed end
toward you
Commercial (disposable) Packs
o
o
o
Wrapped in paper or plastic wrappers
Read directions on packaging for opening
Never cut packs open or piece with a sharp object
Surgical Scrub
o
Purpose
o
o
To remove as many microorganism as
possible from the skin of the hands & lower
arms by mechanical & chemical means and
running water
Must put on lead apron before beginning
scrub!
Surgical Scrubbing
o
o
o
Preparatory cleaning of skin of hands
and forearms to reduce the # of
microorganisms prior to donning sterile
gloves.
Requires scrubbing with soap and water
using a nail brush.
Two methods:
o
o
Numbered stroke method
Timed scrub
Surgical Scrubbing
o
o
o
o
o
o
o
Use scrub brushes, antiseptic soap, & nail
cleaners
Remove all jewelry
Wash fingers, hands & arms above elbow
Clean under nails
Scrub sides of each finger, between fingers,
back & front hand for 2 minutes; 3” above
elbows for 1 minute
Keep hands higher than elbows
Dry
Sterile Gowning
& Gloving
o
o
o
Self-gowning vs. gowning another person
Gown AFTER scrubbing
Self-Gowning
o
o
o
o
o
Grasp gown & remove it from table
Step away from table; gown will be folded inside out
Hold gown away from body, and allow it to unfold
without touching the floor
Open gown & hold it by the shoulder seams; place both
arms into armholes & wait for assistance
Assistant will place gown over shoulders & tie back of
gown
o
After the gown is on ONLY THE SLEEVES
AND FRONT OF THE GOWN ABOVE THE
WAIST ARE CONSIDERED STERILE!!!
o
Once in sterile gown and gloves, persons
must pass each other BACK TO BACK!
Sterile Gowning
& Gloving
o
o
Self-gloving vs. Gloving another
person
Self-Gloving – open technique
o
o
o
Glove dominant hand first
Pick up right glove with left hand at the
folded cuff & slide right hand into glove,
leaving the cuff folded down
When glove is over hand, leave it & pick
up left glove with gloved right hand
under fold. Pull glove over hand & cuff
of gown
Sterile Gowning & Gloving
o
Closed Gloving
o
o
Restricted for use when sterile gown has
already been put on & hands remain
enclosed within cuffs of the gown
With nondominant hand covered by the
gown sleeve cuff, pick up the right glove
& place it palm-side down on the palm of
your right hand (covered with cuff);
fingers of glove pointed toward elbow
Sterile Gowning & Gloving
o
o
Grasp cuff of glove through the gown
with your right hand. Your covered left
hand pulls the glove over your right
hand, gently inserting fingers into finger
spaces of the glove. Be certain cuff of
glove covers the cuff of the gown
Proceed with other hand in similar way

Gloving another person
Sterile Procedures
Tracheostomies
Urinary Catheters
Chest Tubes
Intravenous &
Intraarterial Lines
Changing Dressings
o
o
o
o
o
Must not remove or reapply dressings
without physician’s order
Must be to able to remove dressings without
contaminating wound or yourself
All dressings must be treated as
contaminated
Standard precautions/gowns & gloves should
be worn.
Sterile technique should be used
Tracheostomies
o
o
o
o
o
An incision in the trachea; can be permanent
or temporary
Purpose: provides an airway needed due to
upper-airway obstruction
Always covered with a dressing
Should not be touched except under sterile
conditions
Patient cannot talk; communication can be a
challenge
Chest Tubes

Purpose: to remove fluid blood or air from
the pleural cavity.

Assists in re-inflating collapsed lungs
Attached to a collection chamber (providing
drainage)
 Chest radiographs often used to check for
placement of chest tubes

Chest Tubes
o
o
Care must be taken so tube is not
dislodged.
Drainage system must remain BELOW the
incision AT ALL TIMES!
Urinary Catheters
Catheter is inserted into the urinary bladder
using aseptic technique.
 Purpose: to drain urine from the bladder

Relieve retention of urine or bypass obstruction
 Irrigate the bladder
 Permit accurate measuring of urine output
 Relieve incontinence


Two types:
Foley (has a retention balloon)
 Straight type

Urinary Catheters
o
Care must be taken not to pull out when
moving or transporting the patient
o
Drainage bag must be kept below the
bladder
Intravenous and
Intra-arterial Lines
o
o
o
AKA. Central venous and arterial lines
Sterile technique is required for both when
lines are placed.
Central venous lines
o
o
o
o
ex. for introduction of fluids/medications
measurement of central venous pressure;
Swan-Ganz (measure heart pumping ability)
Arterial lines
o
o
For drawing blood
Measuring pressure
Pacemakers
o
o
o
Using sterile technique, it is
inserted under the patient’s
skin to regulate the heart
rate
Subclavian vein is accessed
to insert guidewire.
Fluoroscopy and chest
radiography are used to
confirm correct placement of
the wire
Skin Preparation for Sterile
Procedures
o
o
o
o
Required before any invasive procedure
Remove oils, dirt, and as many
microorganisms as possible before the
procedure
Prevents contamination of the operative
site to reduce risk of infection
Hair is a contaminant
Skin Preparation for Sterile
Procedures
o
Mechanical methods
o
Hair removal
o
o
o
By physician’s order
Depilatory agent, electric clipper, safety edge razor
Friction scrub with antiseptic soap & water
o
o
•
Ask patient if he or she is allergic to iodine or any other
antiseptic solutions
Prepackaged prep trays – include basins, sponges, sterile
towel, & antiseptic solutions
o Solutions – iodophor, chlorhexidine gluconate
Skin prep – sterile procedure; must don sterile gloves
Skin Preparation for Sterile
Procedures
o
Chemical method
o
o
o
After mechanical methods, paint with antiseptic
solution
Destroys remaining microbes & deters further
microbial growth
Circular motion beginning at the center &
working outward
The Surgical Environment
o
Unrestricted zone
o
o
Semi-restricted zone
o
o
Persons may enter in street clothing
Must wear surgical scrubs, surgical cap,
& shoe covers
Restricted zone
o
Must wear surgical scrubs, cap, shoe
covers, & mask
The Surgical Environment
o
Strict rules
o
o
o
Jewelry, long fingernails, artificial fingernails, &
polish prohibited – harbor microorganisms
Hair must be secured back in surgical cap
Health care worker with acute infection or
open skin lesion must not enter the surgical
suite
The Surgical Environment
o
o
o
o
o
o
Change into surgery scrubs
Place shoe covers over shoes
Put on surgical cap to cover all hair
(hood for beard)
Cover pierced ear studs with cap
Remove all jewelry
Fingernails must be short
The Surgical Environment
o
Masks must be worn in restricted
areas
o
o
o
o
o
Protects patient from droplet
contamination
Protects health care worker from airborne
pathogens during surgical procedure
Must cover nose & mouth
Wear only for one procedure & then
discard
Be constantly aware of which areas
are sterile
o
o
Any break in sterile technique increases
patient’s susceptibility to infection
Never reach over a sterile area
The Surgical Environment
o
o
o
Doors must always be kept
closed; traffic in & out of
rooms should be controlled
Conversation must be kept
to a minimum
Radiographic equipment
must be cleaned before
bringing into surgery or
leave dedicated equipment
there
The Surgical Environment
o
Lead aprons
o
o
o
To be worn during fluoroscopy
or if team is unable to protect
themselves while radiographic
exposures are being taken
should be put on before scrub
has begun
Place mask on face so that it
covers nose & mouth
o
Do not touch mask after being
placed, easily contaminated
What is wrong
with this
picture??????
The Surgical Environment
o
Responsibility for protecting
yourself & all persons in the OR
from radiation
o
Must be knowledgeable of areas
that are sterile & protecting
them & the patient during your
work
o
Responsible for making certain
radiographic equipment is clean
& dust-free
Nonaseptic Techniques
Chapter 18
Nasogastric NG Tubes
o
Inserted through the
nasopharynx into the
stomach.
o
Used for decompression
or removal of gas and
fluids from stomach.
o
Can be used for feeding
Nasogastric Tubes




Salem sump tube (Lt) Levin tube (Rt)
Placement is often verified using fluoroscopy
Sometimes connected to suction or clamped
off
Take care when moving or transporting pt.
Urinals & Bedpans

Male urinals



Bedpans



Metal or plastic
Disposable or resterilizable
Metal or plastic
Disposable or resterilizable
Fracture pan
Enemas



Cleansing enemas are
typically performed prior
to diagnostic studies of
the colon.
Typically used in
conjunction with
purgatives (laxatives)
Often requires dietary
restrictions too


Low residue
NPO after midnight
Barium Enema


Performed to study
the lower GI tract
radiographically
Plain tip vs. inflatable
cuff (retention cuff)



Maximum inflation –
30-90 ml air
Be sure to deflate
BEFORE removing!
Barium Sulphate is
instilled into the bowel
Barium Enema
Single Contrast
Double (Air) Contrast
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