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This lesson will define surgical asepsis, outline the different types of sterilization procedures, and go over the important concept of maintaining a surgical (sterile) conscience.

Surgical Asepsis

Although it helps to keep just about everything clean, sometimes clean is just not good enough. Such is the case when performing invasive procedures on the body, those that involve penetrating or entering the body. In these instances we need to utilize surgical asepsis and the very similar concept of sterile technique.

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Surgical asepsis refers to a method of utilizing sterile equipment and supplies, ones that have been treated in such a way that all living organisms once found on them have been killed. This means very hardy spores are killed as well. Sterile technique is a method that’s used to prevent contamination during an invasive procedure.In this lesson, we’ll go over some of the core concepts related to surgical asepsis, and when the sterile technique should be used.

Sterilization

In turning to surgical asepsis, you are going to be using equipment and supplies, such as gloves and surgical instruments, which have been sterilized. This means all the living organisms have been killed. There are different types of sterilization techniques, including:

  • Autoclaving, which uses steam under pressure to kill all microorganisms
  • Ionizing radiation, the use of chemicals to sterilize some kinds of medical equipment
  • The use of ethylene oxide gas to kill all pathogens

The Sterile Conscience

When using sterile technique, you need to keep three very basic but extremely important things in mind, no matter what. Sterile + sterile = sterile. Sterile + unsterile = contaminated.

And, obviously, unsterile + unsterile = contaminated.By contaminated, I mean the potential for the presence of pathogenic, or disease causing, organisms is there. This means that if a sterile object touches another sterile object, both remain sterile. If the sterile item touches something unsterile, like your skin, blood or a piece of unsterile equipment, even if it looks clean, then the previously sterile object is no longer sterile.Note how I said your skin.

Remember, skin is never sterile. I could care less how often you washed it and for how long. Human tissues are never considered to be sterile. So, if any unprotected part of your body touches a sterile piece of equipment, the equipment is considered to be contaminated.

Now that you know this, I need you to understand another extremely critical component of surgical asepsis. That is the concept of surgical or sterile conscience, being acutely aware of potential or actual contamination of a sterile field or object and taking the necessary steps to remedy the situation. The terms surgical conscience and sterile conscience are pretty much the same, but surgical conscience is a bit broader in scope as it includes the legal, professional and moral responsibility to patients and colleagues to properly use the principles of surgical technology and asepsis in order to make intelligent, knowledgeable and sometimes courageous decisions, all in order to benefit the patient.

Now, the obvious part of the sterile conscience is, for instance, replacing a contaminated instrument with a sterile one. The problem is that sometimes you may be the only person who knows that contamination has occurred. Maybe you even caused that contamination by accident. In these scenarios it’s of utmost importance that you be honest about the contamination.

It’s okay. Everyone makes mistakes. It’s one thing to make an honest mistake; it’s another thing to cover it up.

The former is just that: an honest mistake. The latter can prove deadly to the patient.And secondly, always put the patient’s safety above anything else, including your own embarrassment or convenience. That is to say: it may seem inconvenient to correct the error, but it actually is never so. You must be responsible about caring for your patients, and in a surgical setting this starts with the concept of a sterile conscience.

It may mean even having to start the procedure over, but that’s what may need to be done in order to ensure the safety of the patient.

When to Use Sterile Technique

The big question should be: when do I use sterile technique? A physician may not tell you when, and it’ll be up to you to decide. You should use the sterile technique in the following instances, some of which overlap:

  • Any procedure that exposes a body cavity or enters a blood vessel.
  • When a procedure calls for the use of a piece of equipment that enters a normally sterile body cavity.

    An example is inserting a catheter into a vein, injecting a medication into subcutaneous tissue or putting a catheter into the bladder.

  • When using any sharp objects like needles and scalpel blades.
  • When caring for patients who have broken skin, be it due to a laceration or a burn or something else.

Lesson Summary

Surgical asepsis is a method of utilizing sterile equipment and supplies, ones that have been treated in such a way that all living organisms once found on them have been killed, and the sterile technique is a method that’s used to prevent contamination during an invasive procedure.I need you to take away several important points about these two topics.

Sterile + sterile = sterile. Sterile + unsterile = contaminated. Unsterile + unsterile = contaminated. Skin is never sterile. Note your surgical or sterile conscience, being acutely aware of potential or actual contamination of a sterile field or object and taking the necessary steps to remedy the situation.And use the sterile technique in the following instances:

  • Any procedure that exposes a body cavity or enters a blood vessel.
  • When a procedure calls for the use of a piece of equipment that enters a normally sterile body cavity.
  • When using any sharp objects like needles and scalpel blades.
  • When caring for patients who have broken skin.

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