LAv sector de Sant Andreu DADeS De LA
Subfase 2. Època baiximperial (segles iv v dC)
8. Javier a rCe , Gisela r iPoll , «Transformación y final de las villae en occidente (siglos IV-VIII):
PRACTICE RATIONALE
7.1
Establishing an Aseptic Environment
7.1.1 An aseptic environment must be established and maintained in order to create a sterile field 7.1.2 All OR doors shall remain closed at all times except to allow for the procurement of
supplies, receiving patients and admittance of personnel.
7.1.3 Traffic shall be kept to a minimum.
7.1.4 The number of air exchanges must adhere to the provincial building code. This rate is dependent on the ratio of fresh air to recirculated air exchanges.
7.1.5 The ambient temperature should be maintained between 20°C - 23°C (68° F- 73° F).
The humidity should be maintained between 30% and 60 % (Rothrock, 2011 p. 67; CSA Z314.8- 08)
7.2 Establishing the Sterile Field
7.2.1 All flat surfaces shall be dry and dust-free prior to the placement of a sterile bundle or drape.
An aseptic environment requires control of the parameters of air exchange and air currents, dust control, temperature and humidity in order to keep microbial growth to a minimum.
An aseptic environment is enhanced by positive pressure in the room moving the air out into the corridor and taking any particulate matter with it.
Traffic into and out of the room increases the potential of contamination from increased air turbulence in the room.
Microbial growth and static electricity are reduced if temperature and humidity are kept within acceptable parameters.
Moisture may cause strike-through and contaminate the sterile field. Dry, clean surfaces reduce the risk of strike-through.
7.2.2 Sterile drapes used to establish a sterile field shall be impermeable to liquids including blood and body fluids.
Sterile impermeable drapes establish an aseptic barrier.
7.2.3 Only the working surface of a draped area shall be considered sterile.
The drape below the working surface is not under direct vision of the surgical team and is not considered sterile. The table top serves as a demarcation line between sterile and non-sterile.
PRACTICE RATIONALE 7.3.1 Supplies shall be opened as close as possible to
the surgical start time
The potential for contamination increases with time. Dust and other particles, stirred up by movement of personnel, can settle on horizontal surfaces (AORN, 2010, p. 94).
7.3.2 All items added to the sterile field shall be assessed prior to opening for sterility by checking for wrapper integrity, and changed chemical indicators (external and internal). The contents of packages with questionable wrappers or indicators shall be considered unsterile.
If there is any doubt about the sterility of an item it shall be considered contaminated. Indicator tape assures personnel that the item has been exposed to the sterilization process, it does not guarantee sterility.
7.3.3 Items which display a manufacturer's expiry date shall be considered unsafe for use after that date.
Frequently expiry dates refer to the degradation of the product or a component of the product after the specified date.
7.3.4 Peel-packages shall be opened carefully to prevent tearing the package. The sterile boundary of a peel-open package is the inner edge.
Only the inner border of the heat seal is considered sterile. Torn packages are considered unsterile.
7.3.5 Large bundles or packages shall be opened on a flat surface.
Large and/or heavy items are difficult to open aseptically while being held in the circulator’s hand. 7.3.6 Sterility and integrity shall be maintained when
opening, dispensing and transferring items to the sterile field.
Methods of transfer include, but are not limited to the following:
- place the item on the edge of the sterile instrument table with the inside of the wrapper everted and securedover your hand. Never reach over the sterile field and shake an item from its package; - expose the contents so the scrub person
can remove the item from the wrapper or package by using a forcep or by grasping the item; and
- items shall not be flipped.
Protects the sterile field from potential contamination
Flipping creates air turbulence. It also creates the potential for device contamination or damage (Phillips, 2007).
7.3.7 Sterile supplies shall be handled as little as possible.
Increased handling increases the potential for contamination and prolongs set-up time.
7.3.8 Items that have been dropped on the floor or that are compressed, torn, or wet shall be considered to be contaminated and they shall
Dropping items wrapped in woven materials and paper could force air and contaminants through the wrapper; therefore such dropped items shall not be
PRACTICE RATIONALE be repackaged and reprocessed or discarded
(CSA Z314.3-09).
used. (IAHSCMM, 2007).
Paper has not been shown to have greater strike- though resistance than fabric.
7.3.9 Once a patient has entered the theatre where sterile supplies have been opened, those supplies shall be discarded/dismantled in the event that surgery is cancelled.
Potential for cross-contamination will be prevented.
7.3.10 When a bottle of sterile solution is opened, the contents of the bottle shall be dispensed and the remainder discarded.
Re-application of sterile caps is a questionable technique as the pour spout and cap may have been contaminated. The edge of a container is considered contaminated after the contents have been poured; therefore, the sterility of the contents cannot be ensured if the cap is replaced (AORN, 2010, p.94). 7.3.11 When pouring solutions, care shall be taken to
avoid splashing. The solution should be poured in a slow steady stream. The scrub nurse should hold the receptacle away from the table or set it near the edge of the table. The circulating Registered Nurse shall not reach over the sterile field when pouring.
Droplets, which have splashed on unsterile areas, may roll back on to the sterile field.
7.4
Maintaining the Sterile Field
7.4.1 Opened sterile supplies/set-up shall not be left unattended. They shall be continuously monitored for possible contamination.
Sterility of unattended items cannot be ensured without direct observation. Event-related sources of possible contamination can occur at any time. These include personnel, airborne contaminants, liquids and insects.
7.4.2 Unsterile persons shall not reach over the sterile field.
Invisible shedding of skin laden with microorganisms may contaminate the field.
7.4.3 Sterile persons shall not reach over unsterile areas.
Contamination of the sterile gown or gloves may occur.
7.4.4 Sterile persons shall stay within the sterile field. Sterile persons shall not walk around or go outside the theatre.
7.4.5 The scrub team should remain close to, and face the sterile field. Movement shall be between sterile areas only. If position changes are necessary, scrubbed personnel shall pass face to face or back to back. When changing positions, the scrub personnel should avoid changing levels; they either sit or stand. Hands shall be kept above waist level.
The back of the sterile gown is considered unsterile. To maintain sterility, scrub persons should not allow their hands or any sterile item to fall below the level of the sterile field (Rothrock, 2011, p. 86).
PRACTICE RATIONALE
7.4.6 Talking should be kept to a minimum. Talking increases droplet formation and forces moisture droplets to be dispersed into the air. Talking also causes friction between the mask and the skin increasing shedding.
7.4.7 Unsterile health care team members shall remain at least 30cm (1 ft.) from the sterile field.
Movement is from unsterile to unsterile areas. They should not pass between sterile fields.
Protection of the sterile field is enhanced by limited activity and direct vision.
7.4.8 The sterile set-up shall not be covered. Removing a table cover without contaminating the sterile area cannot be done because the drape below the level of the tabletop is considered contaminated, and the cover would touch the sterile tabletop during removal (Phillips, 2007).
7.4.9 Cover unsterile equipment with sterile barriers before placing them over or in the sterile field. 7.4.10 Breaks in aseptic technique shall be
monitored, documented and corrective action taken as soon as safely possible.
The documentation indicates to infection control what may have been a potential source of a surgical site infection, and allows them to follow the patient postoperatively.
7.5
Sterile Storage
7.5.1 Sterile supplies shall be stored in a separate protected area.
Dust, traffic, excess handling, and exposure to water sources increase the risk of contamination.
7.5.2 Separate and protected areas for sterile supplies shall be:
- on open or closed shelves (shelves being at least 20 - 25 cm [8 - 10 in.] from the floor and at least 45 cm [18 in.] from the ceiling);
- controlled for humidity, temperature and ventilation ( See Establishing an Aseptic Environment Section 2, 7.1.4 – 7.1.5); and - traffic restricted (CSA Z314.3-09). 7.5.3 An item shall be considered contaminated if
there is any doubt about its sterility.
Sterility is event related rather than time related. Event related sterility is multifactorial including, but not limited to:
- type of wrapper used;
- the number of times a package is handled; and
- the use of dust covers. 7.5.4 Manufacturer's recommendations and
suggested expiration dates shall be followed.
The manufacturer’s expiration date printed on the package indicates the maximum time the
PRACTICE RATIONALE
manufacturer can guarantee product stability and sterility on the basis of test data (Fuller, 2005, p. 133). Hospital liability/ risk management issues are prevented by following manufacturer’s directives. 7.5.5 Sterile supplies shall be rotated on a first in
first out system (FIFO). For example, stock to the right, take from the left or stock to the back, take from the front).
Rotation of sterile goods reduces the number of handlings and facilitates the practice that the older product is used first. Dates shall be used as a method to rotate materials.
7.6. Storing and Transporting Clean and Sterile Surgical/Medical Devices
7.6.1 The perioperative Registered Nurse Local, provincial, and national shall ensure the storage and transportation of clean regulatory bodies recognize and sterile surgical/medical devices is in support the use of CSA Standards. compliance with CSA Z314.15-10
REFERENCES
Association of PeriOperative Registered Nurses. (2010). Perioperative standards and recommended practices. Denver: Author.
Canadian Standards Association. (2009). Z314.3-09. CAN/CSAEffective sterilization in health care facilities by the steam process. Toronto: Author.
Canadian Standards Association (2009)
Gruendemann, B. & Mangum, S. (2001). Infection prevention in surgical settings. Toronto: W.B. Saunders. International Association Healthcare Central Services Material Management (2007). Central Services Technical Manual. Author. http://iahcsmm.org/
Phillips, N. (2007). Berry & Kohn’s operating room technique. (11th ed.) Toronto: Mosby. Rothrock, J. (2011). Alexander’s Care of the Patient in Surgery. (14th ed.). St. Louis: Mosby.
BIBLIOGRAPHY
Fry , Donald E., Fry, Rosemary V. (2007). SSI: the Host Factor. AORN Journal, 86(5), 801-814.
McBride, Tara., Beamer, Jennifer. (2007). Pre-operative patient preparations in the prevention of surgical site infections. Canadian Operating Room Nurses Journal, 25(4).