Aseptic techniques

• Antiseptic or antimicrobial agent: Chemicals

that are applied to the skin or other living
tissue to inhibit or kill microorganinsm,
reducing the bacterial count
• Disinfectant / Asepsis: Chemicals that destroy
or inactivate microorganisms on inanimate
objects, such as instruments or surfaces
• Selection of antimicrobial agents for skin
preparation is based on
• Patient’s sensitivity (history of allergy)
• Skin condition at operative site (wound… etc.,)
• Site of the operation e.g. mucous membrane
• Alcohol, Iodine
• Hand hygiene
• Skin preparation for injections
• Skin preparation for intravascular devices
• Skin preparation before surgery
 Skin Preparation Prior to Surgical
Procedures
• Purpose
– To minimize the number of microorganisms on the skin
or mucous membrane by:
• Washing with soap and water
• Applying an antiseptic
– Start from the operative site and working outward
in a circular motion for several inches.
• But do not shave hair at the operative site (if necessary, trim
hair close to skin surface immediately before surgery)

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 Surgical Antiseptics
Skin preparation
• Assessment and documentation of operative site is made
before the skin is surgically prepared for
• skin integrity
• Presence of lesions –moles, warts, rashes…..etc
Skin preparation requires consideration of :-
– length of initial incision
– Requirements to extend initial incision and/or make additional
incisions
– Drain sites required
– Drape fenestration size
– Preservation of skin integrity
– Maintenance of aseptic technique
– Reduction of hazards

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 Aseptic Instrument Processing

Instrument Decontaminate
Processing

High-Level
Clean Disinfect
Sterilize
Chemical
Boil
High-pressure steam Steam
Dry heat Chemical

6 Dry/Cool and Store

Decontamination makes inanimate objects safer
to be handled by staff before cleaning.
Cleaning physically removes all visible dust, soil,
blood or other body fluids from
inanimate objects
High-level disinfection eliminates all
organisms (bacteria, viruses, fungi and
parasites) except some endospores.
Sterilization eliminates all organisms including
bacterial endospores.
 Table 10-3: Effectiveness of Methods for Processing Instruments
Method Effectiveness End Point
(kill or remove
microorganisms)
Decontamination Kills HBV and HIV 10-minute soak
and most
microorganisms
Cleaning (water Up to 50% Until visibly clean
only)
Cleaning (water and Up to 80% Until visibly clean
soap)
High-Level 95% (does not Boiling, steaming, or
Disinfection inactivate some chemical for 20 minutes
endospores)
Sterilization 100% High-pressure steam,
dry heat, or chemical
 High-level disinfection
A) Boiling
• Boil instruments for 20 minutes.
• Always boil instruments in a pot with a lid.
• Start timing when the water begins to boil.
• Do not add anything to the pot after timing
begins.
• Air-dry before use or storage
B) Steaming
• Steam for 20 minutes.
• Be sure there is enough water in the bottom pan for the
entire steam cycle.
• Bring water to a rolling boil.
• Start timing when the steam begins to come out from under
the lid, (80oC [176oF] for 10 minutes)
• Do not add anything to the pan after timing starts.
• Air-dry and store instruments in covered steamer pans.
• A simpler, less expensive, and gentler process than boiling for
plastic (e.g., syringes and MVA canulae) or rubber items
• Distillate is pure steam, unlike boiling water that contains
calcium and other elements.
C) Chemical
• Chlorine solution 0.1%
– Safe for stainless and plated instruments
– Concentrated solutions >0.5% can corrode metals
• Formaldehyde 8%
– Vapors are irritating (staff should wear appropriate
PPE)
– A potential carcinogen
– Do not mix with chlorine (can produce dangerous gas)
• Alutaraldehyde 2-4%
– Less irritating but still needs to in well ventilated area
• Hydrogen peroxide 6%
• Highly corrosive and should not be used to disinfect
copper, aluminum and zinc
• Loses potency rapidly when exposed to heat and light,
N.B. - Chemical disinfectants should be stored in a cool, dark area,
- Never store chemicals in direct sunlight or in excessive heat
– Soak for 20 minutes,
– Rinse thoroughly with boiled water three times,
– Air-dry before use and storage.
 Sterilization
A) Autoclave (High-Pressure Steam) :
• 121°C (250ºF); 106 kPa (15 lbs/in2) pressure & adequate moist:
• 20 minutes for unwrapped items
• 30 minutes for wrapped items
• Allow all items to dry before removing.
B) Oven (Dry Heat Sterilization) :
• 170°C (340°F) for 1 hour, or 160°C (320°F) for 2 hours
• Dry heat sterilization takes longer than steam sterilization
because the steam speeds up the penetration of the heat.
C) Chemical Sterilization
• Chemical sterilization is an alternative for items that would
be damaged if subjected to steam or dry heat sterilization.
• Glutaraldehyde and formaldehyde are sterilants if used for
the appropriate time.
• Glutaraldehyde and formaldehyde are not readily
inactivated by organic materials
 Allow items to soak (10 hours in glutaradehyde or 24 hours
in formaldehyde).
 Remove objects from the solution with sterile forceps,
rinse all surfaces three times with sterile water, and air-dry.
 Store objects in a sterile container with a tight-fitting lid
 Monitoring Sterilization Procedures
• Biological indicators:
• Steam sterilizers: Bacillus stearothermophilus, weekly
and as needed
• Dry-heat sterilizers: Bacillus subtilis, weekly and as
needed
• Mechanical indicators: Provide a visible record of the time,
temperature, and pressure of that cycle. The indicator is usually a
printout or graph from the sterilizer, but it can also be a log of
time, temperature, and pressure kept by the person responsible
for the sterilization process that day.

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 Monitoring Sterilization Procedures
Chemical indicators:
• Include tape or labels, which monitor time, temperature, and
pressure for steam sterilizers, and time and temperature for dry-
heat sterilizers. These indicators should be used on the inside and
outside of each package or container.
• External indicators are used to verify that items have been
exposed to the correct conditions and that the specific pack has
been sterilized.
• Internal indicators are placed inside a pack in the most difficult
area to be reached by the steam or heat. It shows whether the
item has been sterilized.

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 Storage of a Sterile Package
• All sterile items should be stored in an area and manner
whereby the packs or containers will be protected from
dust, dirt, moisture, animals, and insects.

• The storage area is best located next to or connected to

the place where sterilization occurs, in a separated
enclosed area with limited access that is used only to
store sterile and patient care supplies.

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