BASIC GUIDELINES FOR MAINTAINING SURGICAL ASEPSIS

All practitioners involved in the intraoperative phase have a responsibility to provide and
maintain a safe environment. Adherence to aseptic practice is part of this responsibility.
The 8 basic principles of aseptic technique are as follows:

1. All materials in contact with the surgical wound and used within the sterile field must be
sterile. Sterile surfaces or articles may touch other sterile surfaces or articles and remain
sterile; contact with unsterile objects at any point renders a sterile area contaminated.

2. Gowns of the surgical team are considered sterile from the front the chest to the level of
the sterile field. The sleeves are also considered sterile from 2 inches above the elbow to
the stockinette cuff.

3. Sterile drapes are used to create a sterile field. Only the top surface of a draped table is
considered sterile. During draping of a table or patient, the sterile drape is held well
above the surface to be covered and is positioned from front to back.

4. Items should be dispensed to a sterile field by methods that preserve the sterility of the
items and the integrity of the sterile field. After a sterile package is opened, the edges are
considered unsterile. The sterile supplies, including solutions, are delivered to a sterile
field or handed to a scrubbed person in such a way that the sterility of the object or fluid
remains intact.

5. The movements of the surgical team are from sterile to sterile areas and from unsterile to
unsterile areas. Scrubbed persons and sterile items contact only sterile areas; circulating
nurses and unsterile items contact only unsterile areas.

6. Movement around a sterile field must not cause contamination of the field. Sterile areas
must be kept in view during movement around the area. At least a 1-foot distance from
the sterile field must be maintained to prevent inadvertent contamination.

7. Whenever a sterile barrier is breached, the area must be considered contaminated. A tear
or puncture of the drape permitting access to an unsterile surface underneath renders the
area unsterile. Such a drape must be replaced.

8. Every sterile field should be constantly monitored and maintained. Items of doubtful
sterility are considered unsterile. Sterile fields should be prepared as close as possible to
the time of use.
 SURGICAL HAND SCRUB

Definition: It is a vigorous and lengthy cleaning of the skin of the hands and forearms with
water, antiseptic agent and scrub / sponge to create friction. It is called counted –
stroke scrub.

Equipment:

1. surgical cap
2. surgical mask
3. antimicrobial soap
4. plain scrub brush
5. sink with foot, knee or elbow control and high faucet
6. sterile towels (optional)

Purposes:
1. To remove dirt and skin oil from the hands and lower arms.
2. To reduce the count of microorganisms count to as near zero as possible.

Elements:
1. water 3. scrub or sponge
2. antiseptic agent 4. friction

Anatomical Timed Scrub Method

Area Time

1. Nails - 30 sec. ĉ brush

2. Fingers - 1 min. ĉ sponge
3. Palmar surface 15 sec. ĉ brush
4. Dorsal surface - 15 sec. ĉ sponge
5. Forearm , divided in half to 2 - 1 min. ĉ sponge
inches above elbow. - (30 sec. each half.)
6. Repeat process for each other hand

Counted Brush Stroke Method

Area Time
 1. Nails
2. Fingers , each side & web space.
3. Palmar surface.
4. Dorsal surface
5. Forearm , divided in half to 2” above
elbow.
6. Repeat process for other hand.
Procedure
Action
1. Check for completeness of supply.
2. Remove all pieces of jewelry,
including the wedding ring.
3. Trim nails if needed. No nail polish
or artificial nails should be worn.
4. Wear a surgical cap and a disposable
mask.
5. Stand before the sink keeping the
body away from it.
6. Turn on the faucet and adjust the
pressure using the foot, knee or
elbow control.
7. Holding your hands above your
elbow, wet the skin from the
fingertips down to the elbow.
8. Wet and apply approximately 1 tsp
of antimicrobial soap on the palm
using foot, knee or elbow control
and work up a lather.
9. When using a pre-packaged scrub
brush-sponge pad, open the package,
- 20 strokes ĉ brush
- 10 strokes ĉ sponge
- 10 strokes ĉ brush
- 10 strokes ĉ sponge
- 40 strokes each half ĉ sponge
Rationale
Prevents having to stop to obtain those
materials needed.
Jewelry harbors microorganism.
Microorganisms collect in chipped nail polish
and under artificial or long fingernails.
Provides a barrier to reduce the spread of
microorganisms from the hair or respiratory
tract.
The sink is considered to be contaminated.
Frees hands from touching anything this time.
The water should remain running.
Water splashed from the contaminated sink
may come in contact with your uniform, thus,
contaminating it.
Since the hands will be the cleanest area once
the scrub is completed it follows the principle
of allowing water to flow from the cleanest to
the most contaminated area.
Soap emulsifies skin oils and contaminants
and facilitates their removal.
Once the scrub has begun, the brush is never
put down until the scrub is complete as it
 remove the nail cleaner and clean would then be contaminated.
the nails and discard.
Remove the brush and discard the
wrapper. Do not put down the brush
once the scrub has begun.
If the brush or sponge is not
impregnated with the cleaning agent,
moisten the brush or sponge and
dispense the soap into it.

10. Using the brush, make 20 circular
strokes on the nails (starting with the
less dominant hand).
The scrubbing action loosens resident bacteria
and contaminants, thus facilitating their
removal.
Circular motion mechanically removes
microorganisms.

11. Scrub all skin surfaces using circular The scrubbing action loosens resident bacteria
strokes: and contaminants, thus facilitating their
a. each finger removal.
b. palm Circular motion mechanically removes
c. back of the hand microorganisms.
d. forearms (divide into 2 then 10
strokes on each of the 4 parts of the first
half of the forearm then another 10
strokes on each 4 parts of the second
half of the forearm paying extra
attention on the elbow)

12. After scrubbing the less dominant The brush contains lather that may contain
hand, rinse the brush and transfer it microorganisms. Rinsing will remove the
to the other hand. lather from the brush.

13. Continue the procedure on the

dominant hand following steps 8 to
10.

14. When the scrub is finished on the

dominant hand, drop the brush on
the sink.

15. With the use of foot, knee or elbow
control, turn on the faucet and rinse
the arms starting from the fingertips
to the elbow.
To avoid contamination of your hands.
Water should flow from the area of least
contamination to the area of most
contamination.
16. Turn off the water using the foot, To avoid contamination of your hands.
knee or elbow control.

17. Dry each hand and arm with Drying prevents irritation of the skin. Dry
opposite ends of the sterile towel, from the cleanest area to the more
working from the fingertips towards contaminated area.
the elbow.

18. Discard towel properly.

19. Position the hands and elbow above After surgical hand scrubbing, the hands are
the waist without touching any part considered to be surgically clean. Keeping it
of the scrub uniform. in your line of vision will prevent
contamination.

20. Enter the operating room using the Using this manner when entering the
back or the buttocks. Operating room will prevent contamination of
the scrubbed hands.
DONNING and REMOVING STERILE GLOVES
(Open Glove Technique)
 The sterile gloves provide a barrier between the nurse’s hands and the objects she
contacts. She is able to freely touch objects in a sterile field without fear of contamination.
When wearing sterile gloves, she should always remain conscious of which objects are sterile
and which are not.

Equipment:
A pair of sterile prepowdered gloves

Procedure

Action Rationale
To don gloves:

1. Perform thorough hand hygiene / Reduces number of microorganisms residing

scrub hands thoroughly. on surfaces of hands.

2. Remove carefully the outer package Prevents inner glove package from
wrapper by separately peeling accidentally opening and touching
apart the sides. contaminated objects.

3. Grasp inner package and lay it on a
clean flat surface just above waist
level. Open the package keeping
the gloves on the wrappers inside
surface.
Sterile objects held below your waist is
considered contaminated. Inner surface of
your glove package is considered sterile.

4. Identify right and left gloves. Each Proper identification of gloves prevents
glove has a cuff approximately 5 contamination by improper fit. Gloving of
cms. (2 inches) wide. Glove your dominant hand first improves your dexterity.
dominant hand first.

5. With thumb and first two fingers of Inner edge of cuff will lie against your skin
your non–dominant hand, grasp and that is not considered sterile.
edge of cuff of glove for dominant
hand. Touch only inside surface of
glove.

6. Carefully pull glove over your If glove’s outer surface touches your hand or
dominant hand, leaving a cuff and wrist, it is contaminated.
being sure that cuff does not roll up
to your wrist. Be sure that thumb
and fingers are in proper spaces.
7. With your gloved dominant hand, Cuff protects your gloved fingers. Sterile
slip your four fingers underneath touching sterile prevents glove
second glove’s cuff with the thumb contamination.
abducted.

8. Carefully pull second glove over

your non–dominant hand. Do not Contact of gloved hand with exposed hand
allow fingers and thumb of gloved results in contamination.
dominant hand to touch any part of
your exposed non dominant hand.

To remove gloves:

9. Use dominant hand to grasp the

opposite glove near cuff end on the Contaminated area does not come in contact
outside exposed area. Remove it by with hands or waist.
pulling it off, inserting it as it is
pulled, keeping the contaminated
area on the inside. Hold the
removed glove on the remaining
glove hand.

10. Slide fingers of ungloved hand

between the remaining glove and
wrist, remove it by pulling it off,
inverting as it is pulled keeping the
contaminated area on the inside
and securing the first glove inside
the second.
11. Discard gloves inside the wrapper
into the appropriate container and Proper disposal reduces risk for infection,
wash hands. transmission and contamination of othe
items. Handwashing reduces the spread of
microorganism.