SURGICAL SCRUB AND STERILITY
Sterility and asepsis
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Refers to absence of infectious material or infection
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Critical to reducing infection rates in modern surgery
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Benefits include:
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Eliminates pus, blood, foreign particles and dirt left behind that could lead to dangerous complications for the next patient requiring surgery where the medical practitioner uses the instrument
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It decreases bioburden -- the number of non-sterilized bacteria living on a surface
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It prevents the corrosion of expensive and highly precise tools that have delicate pivots and hinges
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It removes the breeding ground for the surviving germs
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It ensures the safe transport of equipment needing to be packed and assembled for sterilization or disinfection
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Instrument care
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Instruments should be inspected prior to packing for sterilisation
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Scissor blades, forceps, haemostats and needle holders should be checked to make sure they do not have nicks and that they meet properly
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Hinges of instruments should be lubricated with lubricant solution such as instrument milk
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Instrument milk is water- and steam-soluble so that only a thin film of lubricant is left on the instrument
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The instrument should be dipped in this solution for approximately 30 seconds
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The hinge of a surgical instrument should never be lubricated with oils or grease as this combined with autoclave ​cause stiffness.​
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When instruments are ​severely stained, they may be sent to a commercial polisher for buffing
Methods of sterilisation
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Steam autoclave
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​Steam at 100 ° C can destroy vegetative forms of bacteria, but spores may be resistant regardless of the length of time exposed
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Sterility achieved at:
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Pressure of 15 PSI (2 atmospheres), the temperature of steam is 121 °C for 15 minutes
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Pressure of 20 PSI, the temperature of steam is 126 °C for 10 minutes
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Pressure of 29.4 PSI, the temperature of steam is 134 °C for 3 minutes
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Relatively low turnover time:​ an approximate 15-minute heat-up time, a 15-minute exposure time, and a 5- to 15-minute cool-down time
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Dry Heat Sterilization
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​Dry heat is a strong but slow technique requiring high temperatures and time
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Sterility achieved at:
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Temperature of steam is 170 °C for 1 hour
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Temperature of steam is 160 °C for 2 hours
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Temperature of steam is 150 °C for 2.5 hours
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Temperature of steam is 140 °C for 3 hours
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Temperature of steam is 121 °C for 6 hours
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Since no humidity is involved, there is less possible corrosion and dulling of surgical instruments
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The main drawback to dry heat sterilization is the fact that heat-sensitive materials cannot be autoclaved - cloth, paper, plastic commonly used to package sterilised instruments
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Chemical Sterilization
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​Sterilization commonly involving the use of ethylene oxide gas
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Requires elaborate equipment and prolonged exposure time
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Method of choice for instruments that cannot be subjected to heat
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Ethylene oxide is mutagenic and toxic
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Other chemicals used for sterilisation:
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​Ozone
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Hydrogen peroxide
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Bleach
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Plasma Gas Sterilizers
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​Uses low temp hydrogen peroxide-based gas plasma inside a chamber
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Oxygen and water are the remainder of this process and make these sterilizers safe for both the environment and medical staff
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Costly
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Vaporized Hydrogen Peroxide (VHP) Sterilizers
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​Removes humidity from within an enclosure, and a generator rapidly injects VHP to reach an ideal concentration for sterilizing equipment
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The process is then reversed by the generator, which breaks down the vapor into eco-friendly elements
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VHP sterilization has a low cycle time, which results in having the capability to sterilize high volume batches of equipment
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Scrubbing, gowning and gloving
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Before each operation, all members of the surgical team will scrub
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Scrubbing:
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Remove all​ jewellery and trim nails
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Use soap, a brush (on the nails and fingertips) and running water to clean thoroughly around and underneath the nails
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Scrub your hands and arms up to the elbows
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After scrubbing hold up your arms to allow water to drip off your elbows
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Turn off the tap with your elbow
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Dry hands with sterile towel and make sure than towel does not become contaminated​
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Hold your hands and forearms away from your body and higher than your elbows until you put on sterile gown and gloves
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After scrubbing:​
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Put on gown without touching the outside of the gown, keeping your hands inside the cuffs
- Get an assistant to tie up the gown from the back
- If double gloving, choose a glove half size larger than your usual for the first glove
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Still keeping hands in the sleeve, open the inner glove pack, turning it so that the fingers point towards you
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Take the left hand glove, grasping the free edge of the glove cuff between left fingers and thumb through the material of the cuff of the gown , so that the end of the hand does not protrude from the end of the sleeve
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Gripping the opposite free glove cuff edge from within the cuff of the right gown sleeve, between thumb and fingers, peel back the glove over the left hand allowing it to slide into the glove
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Pull the glove down over the hand and allow the fingers to emerge from the sleeve into the finger holes of the glove
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Repeat the same with the other side
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Finally, pass the sterile tab of the gown to your assistant, who will pass the tie round for you to tie in a bow at the side
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At the end of the procedure, the gown and gloves should be removed using a technique to avoid contamination of yourself or other people in theatre
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