Question

Critical Thinking

Surgical asepsis refers to the practices that keep objects and areas sterile (free from all living microorganisms). As such, surgical asepsis is crucial to minor office surgeries, as pathogenic microorganisms could enter the patient’s body and cause disease. Maintaining surgical asepsis is an essential responsibility of the MA. When does surgical asepsis come into play in a medical office? What are some specific circumstances when it is employed? What should be done if surgical asepsis is broken?

Answer 1

History and invention importance of aseptic procedures: Louies pasture is the father of modern bacteriology, originally as a chemist, undertook the work on faulty fermentation of wine which was seriously affected the industry, he devised various methods of sterilisation namely steam steriliser (100 degree centigrade), autoclave (120 degree centigrade) or hot air oven (160 degree centigrade). He applied all these techniques to sterilise the all industrial equipments. The last technique of his work is pasteurisation.

Lord Lister is the father of antiseptic surgery, deeply interested for the prevention of postoperative sepsis, he could realise that microorganisms so prevalent in atmosphere might be responsible for post operative inflammation and suppurations. In 1867, his followed his ideas by using carbolic acid as a spray on the wound or during operation, there was a striking reduction of post operative sepsis.

This was a marvellous achievement and replacement of antiseptic surgery by aseptic surgery which made it possible to avoid the despondence of laudable pus into the security of asepsis.

Definition and types of asepsis: The term asepsis is defined as the environment,worked area,procedures should not be a cause of transmission of infection, by applying various fundamental sterilisation procedures to minimise the chance of infection transmission.

Types of asepsis: broadly we can classified to easy understand, these are two types:

1. Medical asepsis,

2. Surgical asepsis.

Objective of Medical asepsis and Surgical asepsis: In asepsis procedures we can take care about various offices like Medical Office where practitioner serve his duties for his clients, that environment should be free from microorganisms , ER, Laboratory, radiology , surgery departments should free from infections, to achieve this Healthcare providers, nurses, OpD staff all the personal should follow the CDC guidelines like

1. Skin Hygiene, with soap and water, antiseptic agents ( alcohols and Iodophors, Chlorhexidine), spore forming organisms not effective with antiseptic agents, hence proper use of gloves is required to prevent the spread of infection,

2. Protective barriers: like gloves, gowns, masks and eye shields provide a physical impediment to the transmission of infectious agents in blood and body fluids,

3. The sterile gloves must be worn for following procedures like

- central venous catheterisation,

- peripherally inserted central catheters,

- arterial catheterisation,

- placement of drainage catheters in a closed space ( pleural, pericardial or peritoneal cavities),

4. Masks and other barriers : the face masks are two types, they are Surgical and respiratory masks

5. the greatest risk in surgical procedures are Blood born infections like HIV, hepatitis B virus, and HCV infection, these all acquired by occupational risks by Needle stick injuries, surgical knife injury etc.

   Hence in surgical asepsis every one in the team should concern about personal as well as patient saftey in the sense of spreading infection. In surgical asepsis must be give prophylactic antibiotics to patients, clean the environment with standard physical and chemical methods of sterilisation of operative surgical instruments and Operation table, maintain personal hygiene and wear all personal protective equipment for team and client. The surgical instruments are mainly sterilised by Dryheat with hot air oven and moist heat with stem sterilisers under atmospheric pressure at about 100 degree centigrade. Use autoclave for high pressure sterilisation required. Fumigate the operation theatres with chemical agents like formaldehyde.

In case of breaking of Surgical asepsis; In post operative stage, if the patient get fever suspect of wound may be infective by infectious agents, hence pre operative procedures should sterilise all the dressing materials, suture materials and take care about minor procedures like Urinary catheter, iv catheter insertion, placement of nasogastric tube, gastronomic tube, drainage catheter placements should be done in a aseptic manner,

- admister appropriate antibiotics and antivirals and anti fungal agents to treat the infections,

- MICU and SICU should be follow standard protocols to prevent the transmission of infection,

- administer vaccines in case of appropriate and administer immune booster.

Note : If you suspect any chance of exposure to organisms should be taken Post exposure prophylaxis.

Summary of the Topic : surgical asepsis is done by maintain personal hygiene, sterile all the surgical equipments, surgical instruments, surgical dressing materials, and sterile the operation theatre pre and post surgery. Should follow CDC guidelines for prevention and administration of antibiotics, antivirals, antifungals and vaccines in case of breaking the chain asepsis and take appropriate post exposure prophylaxis without fail, should not neglect at minor procedures also, in any Procedure follow standard guidelines formulated by CDC.