Asepsis in Surgery - Essay Example

? Asepsis in Surgery Leah Cuneo My MD1866 My Teacher Sappe 10/16 Asepsis in Surgery Introduction Asepsis is a “technique to produce agerm-free environment to protect patients from infection” (Markovitch, 2005, p. 58). It is “used for any procedure that might introduce infection into the body and is essential for surgery---even minor procedures” (Markovitch, 2005, p. 58). Markovitch (2005, p. 58) elaborated that “asepsis is achieved by ensuring that all people who come into contact with the patient scrub their hands and wear sterilized gowns with disposable masks and gloves.” In addition, the operating room air and equipment must also be clean (Markovitch, 2005). Asepsis is targeted at eliminating the possibility of infection while anti-sepsis is the use of chemicals to destroy germs already in the body or wound (Markovitch, 2005). UK’s National Health Service (2009) on Asepsis Surgery The United Kingdom National Health Service (2009, p. 3) defined asepsis as “the prevention of microbial contamination during invasive procedures or management of breaches in the skin’s integrity.” Literally, asepsis means “without microorganisms” (UK National Health Service, 2009, p. 3). Further, the NHS pointed out that an aseptic technique “ensures that only uncontaminated objects/fluids make contract with sterile/susceptible sites, minimizing the risks of exposure to potentially pathogenic organisms” (United Kingdom National Health Services, 2009, p. 9). In contrast, the “clean technique is a modified aseptic technique where the basic principle of an aseptic technique is used and clean gloves, clean field and non sterile solutions are used” (United Kingdom National Health Services, 2009, p. 3). Based on the United Kingdom National Health Service (2009, p. 4-7), we can derive twelve principles followed in aseptic surgery. The first principle is the principle of non-touch or the principle that even if the hands are washed, the hands must not touch the sterile equipment or the patient. Non-touch can be achieved by using forceps or sterile gloves (United Kingdom Health Service, 2009). The second principle is the preparation of the equipment, environment, and patient for the aseptic procedure. This can involve cleaning and drying the patient body areas that will be affected by surgery. It also means ensuring that equipment and solutions are sterile and undamaged before use. According to the United Kingdom National Health Service (2009), any equipment including gloves that are contaminated must be discarded and replaced before use. The third principle is the use of “sterile of sterile equipment for the procedure, which has been stored appropriately until use” (United Kingdom National Health Service, 2009, p. 5). The fourth principle is the “avoidance of direct contact with the susceptible site” (United Kingdom National Health Service, 2009, p. 5). The fifth principle is “effective hand hygiene” that involves the decontamination of the doctors hands with an alcohol hand rub and most importantly with observation of a twelve-step procedure for hand decontamination adopted in 2008 (United Kingdom National Health Service, 2009, p. 5-6). The sixth principle is correct handling by doctors of sterile gloves: only the wrist end must be touched and the outer surface of the gloves must not be contaminated. The seventh principle is maintaining asepsis all throughout the medical procedure like surgery. The eighth principle is the use of appropriate clothing. The United Kingdom National Health Service prescribes, for example, that clinical staff must have “sleeves that are short or rolled back, no wrist jewelry/watches, no false nails and no stoned rings” (United Kingdom National Health Service, 2009, p. 5). The ninth principle is the use of effectively cleaned equipment and appropriate personal protective equipment. The tenth principle is the separation of wastes between domestic and clinical wastes. The eleventh principle is the observation and documentation of the medical procedure carried out. Finally, the last or twelfth principle is the safe disposal of equipment at the end of the procedure. The United Kingdom National Health Service Guideline of 2009 recognized that situations sometimes do not full sterility or full asepsis. In these cases, the United Kingdom National Health Services had conceded that clean rather than aseptic procedures can be followed where clean gloves can substitute for sterile gloves and potable tap water can be used to cleanse a wound. Pear (2007) on Asepsis Surgery The work of Pear (2007) attempted to identify “the patient risk factors and best practices for surgical site infection prevention.” Unfortunately, however, Pear’s article did not address anything on her topic. Instead her 2007 paper merely covered the four wound classifications (clean, clean-contaminated, contaminated, and dirty wound), an inappropriate surgical site infection definitions (because the definitions used the definitions of the American Society of Anesthesiologists which do not appear to be the authority on infection), the T point or operation time for common surgical procedures, the surgical infection rates based on the type of the surgery (colon, vascular, cholecystectomy, and organ transplant), and surgical site infection rates based on the risks indicated by the National Nosocomial Infection Surveillance (NNIS) Risk Index. Nevertheless, Pear’s 2007 article indicated that despite the application of asepsis in surgery or surgical procedures in United States hospitals, there is an infection rate associated with each type of surgical procedure and risk index. Thus, despite Pear’s failure to discuss the topic identified by the title of her article, Pear’s 2007 article actually communicated a very important insight. Rotstein (2006) on Asepsis Surgery Meanwhile, the material of Rotstein (2006) appears to have a very uncompromising perspective on asepsis or aseptic technique. According to Rotstein (2006, p. 4), asepsis or the aseptic technique is “the complete absence of living organisms” and there are two methods to achieve "sterility” or asepsis: the chemical and physical methods. Rotstein (2006) has seven principles for asepsis or aseptic technique. The first principle is that “the procedure must be done in a sterile field from which all bacteria have been excluded, if possible” (Rothstein, 2006, p. 4). Rotstein’s second principle is that gowns worn by the surgical team must be sterile from the chest to the level of the sterile field. The third principle is the use of sterile drapes to create a sterile field. Rotstein fourth principle is that “items should be dispensed to a sterile field by methods that preserve the sterility of the items and the integrity of the sterile field” (2006, p. 4). Rotstein’s fifth principle on the pattern of motion for a surgical team is “from sterile to sterile areas and from unsterile to unsterile areas” (2006, p. 5). The sixth principle is that “whenever a sterile barrier is permeated, it must be considered contaminated” (Rotstein, 2006, p. 5). Rotstein’s last or seventh principle is that “sterile fields should be prepared as close as possible to the scheduled time of use” because of risks of contamination (2006, p. 5). Other than the seven principles, Rotstein (2006) prescribed several other rules covering patient positioning, medical attire and grooming, scrub, hand drying, gowning and gloving, removal of dirty gown/gloves/masks, use of antiseptics, preparation of patient’s skin, handling of instruments, loading a knife, blade removal, and basic instruments to make available in promoting asepsis in surgery. For example, the patient for surgery must acquire a body position that enhances “optimum exposure and access to the operative site” (Rotstein, 2006, p. 5). Medical personnel should wear comfortable closed shoes, must have no jewelry, nail polish, and they must have short clean nails (Rotstein, 2006, p. 6). In addition, Rotstein prescribed that medical personnel must have their hair tucked in and their duckbill mask must face outwards and be tied securely. Rotstein’s (2006) prescribed the surgical scrubs in the following manner: five minutes for the first scrub of the day and three minutes for the next scrub; hands must be held out from the scrubbing clothes when scrubbing; hands are to be higher than the elbows, the scrub solution is to be applied to the hands; each nail is to be cleaned under running water with a nail stick, each nail is to be scrubbed against the palm of the opposite hand, each finger is to be scrubbed on all four sides at five strokes per side; the back of the hand must be scrubbed from the base of the fingers to the wrist; small overlapping circular scrubbing is used to scrub from the wrist to about two inches from the elbow; and hands and forearm are rinsed from the finger tip. In drying the hands, Rotstein’s (2006) prescription is that the towel is lifted up and away from the sterile filed without dripping water; bending forward at the waist; drying the hands, fingers, and forearm thoroughly; and the other end of the towel is used to used to dry the other hand. Linens are to be thrown to the linen hamper and garbage into the garbage bag (Rotstein, 2006, p. 6). In gowning, Rotstein’s prescription is lift the sterile grown from its wrapper without contamination; dressing must be done in an area where the gown is not contaminated; the gown must be held away from the body so that the inside is turned toward the person who would wearing the gown; the hands are slipped while the gown is kept from the body at shoulder level; and the surgeon must hand the “sterile right tab of the gown to the scrub nurse, turns left 280 degrees and then takes back” the tab. Rotstein’s (2006) recommended procedure for gloving is via the closed or open method and specific procedures are prescribed for the removal of dirty gown, gloves, and mask. Specific types of antiseptic and disinfectant are recommended and specific protocols for skin preparation are specified. There are also recommended procedures for instrument handling and loading a knife handle. Rotsein procedures appear comprehensive enough with regard to asepsis and we are reminded by Wilson (2006, p. 112) that a new surgical technology “is not necessarily a better one.” Conclusion Based on the materials that I have covered, it appears that Rotstein (2006) has the best discussion and set of guidelines for asepsis in surgery. It may be best to refer to the Rotstein material for guideposts on how asepsis may be implemented. Most likely, the United States has a set of guidelines just like the United Kingdom and that are better than what Pear (2007) had discussed but, unfortunately, I was not able to immediately locate the said set of guidelines. References Cuschieri, A., Grace, P., Darzi, A., Borley, N., and Rowley, D. (2003). Clinical Surgery. Massachusetts: Blackwell Publishing Company. Marcovitch, H. (2005). Black’s medical dictionary. 41st ed. London: A & C Black Publishers Ltd. Pear, S. (2007). Patient risk factors and best practices for surgical site infection prevention. Managing Infection Control, March, 56-64. Scottsdale, Arizona: Workhouse Publishing LLC. Rotstein, L. (2006). Aseptic technique. University of Toronto, Canada: Technical Skills Curriculum. Retrieved 14 October, from http://www.utoronto.ca/ssc/SSC101.pdf Ribaric, G., Kofler, J., and Jayne, D. (2011). Stapled hemorrhoidopexy, an innovative surgical procedure for homorrhoidal prolapse: Cost-utility analysis. Croats Medical Journal, 52, 497-504. Retrieved 14 October 2011, from http://www.ncbi.nlm.nih.gov/pubmed/21853544 United Kingdom National Health Service. (2009). Asepsis: Principles and guidelines. United Kingdom Health Services. Retrieved 14 October 2001, from http://www.calderdale.nhs.uk/fileadmin/files/Public_Information/Publication_Scheme/IC/Asepsis_09.pdf Wilson, C. (2006). Adoption of new surgical technology. British Medical Journal, 332, 112-114. Retrieved 14 October 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326944/pdf/bmj33200112.pdf Read More