Question

 1. You are a student assigned to observe in the operating room. During the preparations for the surgery, you notice that the healthcare provider touches the sterile field before donning sterile gloves. What, if any, action will you take? 

2. You are assigned to teach a patient with bladder problems how to perform self-catheterizations at home. The  health-care provider tells you to teach the patient to do this using medical asepsis rather than surgical asepsis.

 What is the rationale for such an order?

 3. You are preparing to enter the operating room for clini- cal observation. List, in order, the steps you will take to make yourself as sterile as possible before entering the operating suite.

Answer 1

1 Maintaining the sterile field within the operating room (OR) is the responsibility of every healthcare worker (HCW) in that room. The sterile area is considered the area fee from infection and all the sterilised equipments which required for surgery is placed in this area. The sterile person can only enter to this area and others are not allowed to enter this area. If out persons other than sterile persons can put the needed equipments to the sterile table only if they wear sterile gloves. If they touches the area without wearing sterile gloves is considered to be undterile.

So the needed action is replace the equipment which become unsteriled and also give instructions regarding sterile techniques and procedure to the health care provider.

2 A catheter-associated urinary tract infection (CAUTI) is one of the most common infections.

Indwelling catheters are the cause of this infection. An indwelling catheter is a tube inserted into your urethra. It drains urine from your bladder into a collection bag. You may need a catheter if you have had surgery or cannot control your bladder function, and there is a need to closely monitor how much urine your kidneys are producing.

Bacteria or fungi may enter your urinary tract via the catheter. There they can multiply, causing an infection.

There are a number of ways infection can occur during catheterization. For example:

• the catheter may become contaminated upon insertion
• the drainage bag may not be emptied often enough
• bacteria from a bowel movement may get on the catheter
• urine in the catheter bag may flow backward into the bladder
• the catheter may not be regularly cleaned

Sterile insertion and removal techniques can help lower the risk of a CAUTI. Daily catheter care is required as well. Catheters shouldn’t be left in longer than needed, as longer use is associated with a higher risk of infection.

By using surgical asepsis the chance for getting infection is reduced.

3

Steps	Additional Information
1. Bring all required supplies to the OR. Sterilize or disinfect them as required.	This step prevents the need to unnecessarily leave the restricted area. Movement in the OR should be kept to a minimum to avoid contamination of sterile items or persons.
2. State the purpose of your visit to OR personnel and show your ID.	This step allows for clear communication with the health care team.
3. Artificial nails should not be worn, and nail polish should be fresh (not more than four days old) and not chipped.	Artificial nails, extenders, and chipped nail polish harbour more microorganisms than hands and can potentially contaminate the sterile area.
4. Remove all jewellery. Wedding bands may be permitted under agency policy.	Jewellery harbours additional microorganisms and must be removed prior to a surgical hand scrub.
5. Don surgical attire (top and bottom). Surgical attire must be worn only in the surgical area. Tuck top into pants.	Surgical attire must be worn only in the surgical area to avoid contamination outside the surgical area.
6. Cover shoes according to agency policy.	Shoe covers will protect work shoes from accidental blood or body fluid spills in the OR. Shoe covers must not be worn outside the OR area.
7. Perform a surgical hand scrub according to agency policy.	Surgical hand scrubs reduce the bacterial count on hands prior to applying sterile gloves. Hands are kept above waist at all times.
8. Prior to entering the restricted or semi-restricted area: Apply mask. Apply head covering to cover earrings, beard, and sideburns. Once in the OR, introduce yourself to the surgical staff and inquire about the sterile area and non-sterile areas.	Mask must cover nose, mouth, and chin for a proper seal. Mask should be changed if it becomes wet or soiled. A surgical mask or N95 mask may be required, depending on whether the patient is on additional precautions. Knowing what area is sterile/non-sterile will prevent accidental contamination of sterile fields and delays in surgery. Sterile persons/area The sterile field should be created as close as possible to the time of use. Covering sterile fields is not recommended. Sterile areas should be continuously kept in view. An unguarded sterile field is considered contaminated. Sterile persons should keep well within the sterile area. Sterile persons should pass each other back to back or front to front. A sterile person should face a sterile area to pass it and stay within the sterile field. Non-sterile person/area A non-sterile person should stay at least one foot away from the sterile field, and face the sterile field when passing it. A non-sterile person should not walk between two sterile fields or reach over the sterile field.