Define antisepsis
- Use of antiseptics to eliminate microorganisms
- Systematic washing and scrubbing hands/forearms/elbows
Purpose of scrubbing process?
Destroy transient microorganisms and inhibit growth of resident microorganisms
Define transient antisepsis
- Microorganisms that are introduced to the skin by contact
- Mechanical scrubbing removes most
What type of scrubbing removes most transient microorganisms?
Mechanical
Define resident antisepsis
- Microorganisms whose natural habitat is the skin
- Exist in large numbers under nails, hair follicles, sweat glands
- This is why sterile gloves are used
Purpose of sterile gloves?
To avoid resident microorganisms
Which microorganisms are gram negative and positive?
Resident microorganisms
What factors may alter effectiveness of surgical scrub?
- Prep before cleansing
- Choice of antiseptic solution
- Cleansing method
- Duration of cleansing
Why isn’t nail polish allowed in OR?
Polish can hide dirt/debris in subungual space
What antiseptic solution was found to have greater residual antimicrobial activity?
Alcoholic chlorhexidine
Which substances are more effective in removing microorganisms on hands than povidone iodine?
Biguanides (chlorohexidine gluconate)
Types of scrubbing methods
Timed or counted strokes
8 steps of handwashing
- Palm to palm
- Between fingers
- Back of hands
- Base of thumbs
- Back of fingers
- Fingernails
- Wrists
- Rinse and wipe dry
What should NOT be combined with alcohol surgical handrub sequentially?
Surgical hand antimicrobial soap (but hand washing does need to be performed before the first surgical hand scrub of the day using nail pick)
What does first scrub of the day consist of?
Hand washing followed by timed or stroke counted surgical scrub
What do scrubs after the first one of the day consist of?
Can include handrub technique but may vary per surgeon or hospital
How long should scrubbing last?
CDC and AORN state 2-6 mins is as effective as 5 mins
Describe powders in gloves
- Acts as glove lubricant
- “Powder granuloma” is a post op complication
- Powder falling out can become a vehicle for microorganisms throughout entire OR suite
- Gloves are usually wiped after they are put on and before approaching sterile field
When is closed gloving used?
When initially donning sterile gown and gloves
Why can’t closed gloves be used in subsequent gloving?
Cuffs of gown collect moisture and become damp (become considered unsterile)
Why shouldn’t sterile gloved fingers be criss-crossed?
May cause micro tears in the gloves
Describe ebola gowning
Caution when DOFFING (as opposed to donning)
