Transcript 1500_Farris_EB5R7x

STERILE TECHNIQUE
FOR THE SONOGRAPHER
Jessy Farris MHS RVT RPhS
Clinical Training & Accreditation Manager
Vein Clinics of America – Division of Quality
OUTLINE
• SECTION I  Healthcare Associated Infections
• SECTION II  Hand Hygiene
• SECTION III  Sterile Technique
• SECTION IV  Personal Protective Equipment
SECTION I:
HEALTHCARE ASSOCIATED INFECTIONS
HCAI DEFINITIONS
Asepsis:
• The absence of germs or infection
• Procedures requiring aseptic technique include:
• Ambulatory phlebectomy
• Endovenous thermal ablation procedures
• Sclerotherapy
• Mixing medications and filling syringes
BSI (Primary Bloodstream Infection):
• Leading, preventable infectious complication
• Has a negative impact on patient outcomes
Universal Standard Precautions for Preventing Transmission of Bloodborne Infections
• Guideline approach to infection control developed by the CDC
• The handling of all human blood and certain human body fluids should be treated as if known
to be infectious for HIV, Hepatitis B and C, and other bloodborne pathogens
HCAI:
HEALTHCARE ASSOCIATED INFECTIONS
• Also known as nosocomial infections
• Infection occurring in a patient during the process of care in a hospital or other
health-care facility which was not present at the time of admission or visit
Handwashing: Clean Hands Saves Lives. (2013, December 11). Retrieved August 8, 2016 from http://www.cdc.gov/handwashing/when-how-handwashing.html
HCAI:
HEALTHCARE ASSOCIATED INFECTIONS
• HCAI occur in 1 of 25 hospitalized patients ever day
• HCAI surpass auto accidents by 200% annually
• Impact of HCAI:
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More serious patient illness
Prolonged hospital stays
Long-term disability
Excess death
High additional financial burden to facilities and patients
• Cost of HCAI in the US  $6.5billion annually
• It is estimated that at least 50% of HCAI can be prevented
Handwashing: Clean Hands Saves Lives. (2013, December 11). Retrieved August 8, 2016 from http://www.cdc.gov/handwashing/when-how-handwashing.html
EFFECT OF HCAI
• Patients
• HCAI are preventable
• HCAI claim the lives of 75,000 patients
• HCAI affect more than 700,000 patients each year
• Healthcare Professionals and Providers
• Guilt, stress, fear
• Disciplinary action, loss of licensure
• Medical Organizations (clinics, hospitals)
• Losing public trust
• Additional Spending:
• HAI treatments and patient lawsuits $33 billion per year of direct additional hospital cost
• Insurance Providers
• Paying additional cost for HAI associated treatment $6.5billion/year
• Aim is prevention
The most common mode of transmission of pathogens is via
HANDS
SOLUTION: Hand Hygiene
SECTION II:
HAND HYGIENE
HAND HYGIENE DEFINITIONS
HAND HYGIENE
• Performing hand washing,
• Antiseptic hand wash, alcohol-based hand rub
• Surgical hand hygiene/antisepsis
HAND WASHING
• Washing hands with plain soap and water
• Washing hands with water and soap or other detergents containing an antiseptic agent
ALCOHOL-BASED HAND RUB
• Rubbing hands with an alcohol-containing preparation
• Hand washing or using an alcohol-based hand rub before operations by surgical personnel
WORLD HEALTH ORGANIZATION:
HAND HYGIENE INITIATIVE
CENTERS FOR DISEASE CONTROL:
HAND HYGIENE INSTRUCTIONS
COMMONLY MISSED AREAS
SECTION III:
STERILE TECHNIQUE
STERILE FIELD
Sterile Field
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Area surrounding the patient and the site of the procedure that requires more than a clean area
Must be kept free of microorganisms
Created by using sterile drapes to drape the work area and patient
Required for procedures where more risks exist for a possible bloodstream infection such as:
– Ambulatory phlebectomy, and
– Endovenous laser ablation (ELA)
STERILE FIELD:
ELA PROCEDURES
• Classified by insurers and state regulations as a surgical procedure
• CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections
• Policies, protocols, practices based on the AORN and CDC Guidelines as well as state regulations
• Maximum sterile barrier precautions during catheter insertion
• Use of a cap, mask, sterile gown, sterile gloves and a sterile drape
• Appropriate sterile cleaning prep of surgical area
• 50/50 mixture of chlorohexidine and isopropyl alcohol used for cleaning
• Allow mixture to air dry prior to catheter insertion
• Maintaining the integrity of sterile fields
STERILE FIELD:
ADDITIONAL TIPS/REMINDERS
• Don fresh/clean gloves following procedure, prior to touching
surfaces outside the sterile field
• US unit, cabinets, drawers, the sink, bandages, etc.
• If using sterile blue towel to wipe down the patient’s leg:
• Do not place towel in the sink to wet
• Hold towel beneath the faucet, with clean gloves
STERILE FIELD:
WHAT IS & WHAT IS NOT STERILE
STERILE:
• Gloved hands
• Front of gown from below the neck to the waist
• Top of sterile field (table and bed) to edge
NOT STERILE:
• Face, mask, hat
• Gown below waist and at back
• Below the table/bed’s edge
LASER ABLATION (ELA): SET UP
LASER ABLATION (ELA): SET UP
• Second monitor adjusted
• US map in view
• Table set up at appropriate
height and tilt
SECTION IV:
PERSONAL PROTECTIVE EQUIPMENT
PPE:
APPROPRIATE & REQUIRED USE
• HAT
• Bouffant hat worn by those with long hair with hair tucked into hat
• Surgeon cap can be worn by those with short hair
• Worn when prepping for and performing sterile procedures
• MASK
• Mask should cover all facial hair, nose and mouth
• If glasses are fogging, use anti-fog mask or anti-fog spray/wipes
• Worn when prepping for and performing sterile procedure
• Worn by patients or staff who are ill and contagious in the office
• STERILE GLOVES
• Make sure you are wearing correct size
• Too small (uncomfortable and can rip) / Too large (lose fine dexterity)
• Worn when prepping for and performing sterile procedures
• STERILE GOWN
• Gown is secured (by assistant) at the neck, at the back and using exterior ties around waist. Do not reach these
areas on your own as your hands will become unsterile.
• Must be worn when prepping for and performing sterile procedures
PPE:
APPROPRIATE & REQUIRED USE
• LASER SAFETY GLASSES
• Must be worn by all present in the procedure room during ELA procedure
• Patient, physician, sonographer, observer, MA, etc.
• Laser light is invisible to the naked eye and travels faster than the speed of the
blink of an eye
• Direct exposure to laser beam will cause eye damage, up to and including
blindness
• If glasses fog, use anti-fog mask, spray, or wipes
• Glasses must be inspected prior to all use to ensure they aren’t damaged
• Cracked, scratched lenses, and frames
• Glasses should be cleaned using mild soap and water
TRANSDUCER/PROBE COVERS
STERILE TRANSDUCER COVERS
• Must be used during sterile procedures (ELA)
• When applying the probe cover, make sure sterility is maintained
• When applying probe cover, make sure it is intact and adequate gel is present (under cover) to minimize air bubbles
ADDITIONAL NOTES
• When removing probe covers, it is best to use your hands or a hemostat (if rubber bands are used) to remove
rubber bands, not scissors
• Make sure you are careful when removing cover so that you do not in turn contaminate the probe
• Always wear clean gloves when applying probe cover
• Always wear gloves when removing soiled probe cover
WHEN NOT TO USE PPE
• Do not use PPE when it is damaged
• Do not wear PPE (gloves, gowns) in public areas
• Do not wear same PPE when in contact with more than one patient
• Do not wear the same gloves to complete multiple tasks
• For example: If you are in the process of assisting with ultrasound-guided procedures and
need additional supplies, remove gloves, sanitize hands, obtain supplies and don fresh gloves
Additional Note:
• Be mindful of what surfaces you touch while wearing contaminated gloves
• Paper towel roll, light switches, walls, countertops, charts, drawers, cabinets, door handles, etc.
THANK YOU!
Fort Worth, TX