Reproductive System, Reproductive System,

Medical School of Universitas Padjadjaran, Medical School of Universitas Padjadjaran,

Bandung Bandung
2005 2005
MR!" "orporate MR!" "orporate
Interactive Training CD for Medical Students Interactive Training CD for Medical Students
Reproductive System Reproductive System
Module : Module :
Infection Prevention: A- and Antiseptic Techniques
Infection Prevention: A- and Antiseptic Techniques
in Surgical Setting
in Surgical Setting
Production #eam$
Production #eam$

Director : Kiki Lukman, MD, MSc, FINACS (Dig.)

Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.)

Main contributor : Kiki Lukman, MD, MSc, FINACS (Dig.)

!a"at #uc$i"at, MD, FINACS (Dig.)
%arko Karna&i$ar&'a, MD, FINACS (Dig.)
Nur$a"at (man, &r., Sp)*K)D
Lia +aibuan, MD
Nina K. ,oetri -., SKp,
Da&ang Sunar"a AMK
De&" #una&i AMK,
A.ia #a$mi AMK,

/&itoria. -eam : Kiki Lukman, MD, MSc, FINACS (Dig.)

Cating : Kiki Lukman, MD, MSc, FINACS (Dig.)

Artitic : MI#*C Corporate

,ro&uction : Me&ica. Sc$oo. o0 (ni1erita ,a&'a&'aran

)an&ung
"redits
"redits

Specia. t$ank to:

Centra. 2perating -$eatre (nit o0

+aan Sa&ikin 3enera. +opita.
nfection Prevention Module
nfection Prevention Module
ntroduction
nfection control
%ntiseptic techni&ues
'perating #heater
%septic techni&ues
ntroduction
ntroduction

(escription

')jectives
(escription
(escription

In0ection ,re1ention in Surgica.

Setting i one o0 important
pre1enti1e met$o& in or&er to
ac$ie1e in0ection contro. in c.inica.
an& urgica. practice.
')jectives
')jectives

-$e aim o0 t$i met$o& are :

-o minimi4e urgica. ite in0ection

-o protect $ea.t$ peronne.

-o impro1e woun& $ea.ing

-o minimi4e &iabi.it", morbi&it", 5

morta.it"

-o re&uce t$e cot o0 $opita. care

Speci0ic Learning 2b'ecti1e :
Speci0ic Learning 2b'ecti1e :

To describe the definition and history of

sterilization, disinfection, decontamination,
anti and a - septic techniques

To describe si! methods of sterilization

To describe three categories of surgical

instruments

To describe " rules of aseptic techniques

Speci0ic Learning 2b'ecti1e :
Speci0ic Learning 2b'ecti1e :

To perform aseptic techniques correctly,

including #P$%:

Applying surgical attire

&and 'ashing

Surgical scrubbing

(loving

Surgical (o'ning
De0inition:
De0inition:

Sterilization : Processes by 'hich all pathogenic

) non pathogenic microorganisms, including
spores, are *illed

+isinfection: ,hemical or physical process of

destroying all pathogenic microorganisms,
e!cept spore bearing ones- used for inanimate
ob.ects, but not on tissues
De0inition:
De0inition:
+econtamination : Process or method by 'hich all
contaminated materials that can cause diseases are
removed
Aseptic techniques : /ethods by 'hich contamination
'ith microorganisms is prevented
Antiseptic techniques: Prevention of sepsis by the
e!clusion, destruction, or inhibition of gro'th and
multiplication of microorganisms from body tissues and
fluids
nfection "ontrol
nfection "ontrol

%$" $ou.& we app." a an& antieptic

tec$ni6ue 7
+itorica. backgroun& :
+itorica. backgroun& :

Ignas Sammel'eis #0101 - 01"$%

Puerperal fever increased maternal mortality
&and scrub 'ith chlorinated-lime solution prior to
e!amination
2ather of nosocomial infection

3ouis Pasteur #01"4%

+iscover the process of fermentation by microorganisms
(erm theory: against spontaneous generation theory
+itorica. backgroun& :
+itorica. backgroun& :

5oseph 3ister #01"$%

6se carbolic acid solution on surgical dressing in

the operating room mortality #3isterization%

2ather of modern surgery #Antiseptic technique%

7rnst 8on 9ergmann #011"%

Introduced :steam sterilizer;
9asic of sterilization aseptic technique
3ater: :pressure ) vacuum steam sterilizer; 'as developed
Met$o& o0 In0ection contro.
Met$o& o0 In0ection contro.

Anti eptic tec$ni6ue

Deign an& tra00ic pattern o0 t$e

operating t$eatre

Aeptic tec$ni6ue
%nti septic techni&ues
%nti septic techni&ues
Steri.i4ation
Steri.i4ation

The ob.ective of modern surgery

2or inanimate ob.ects

Problem :

Some items are not heat resistance

-ec$ni6ue o0 Steri.i4ation
-ec$ni6ue o0 Steri.i4ation

Physical:

&eat

<adiation= ultraviolet ray

9oiling 'ater

6ltrasound

,hemical:

3iquid

(as
+eat Steri.i4ation
+eat Steri.i4ation

+ry :

,ommonly cause damage

2or po'der, oils, and .elly

/oist :

Steam

&igh pressure spores

8acuum constant temperature

Autoclave
C$emica. Steri.i4ation
C$emica. Steri.i4ation

(enerally as disinfection

/echanism of action :
Protein coagulation
7nzyme denaturation in cells
3ysis

+epend on : number of microorganisms, soiling,

concentration, and temperature
So.ution
So.ution

5odium and 5odophor

(ood bactericide, but irritant
/i!ture : povidone-.odine 04>

Alcohol Solution of ?4> or @4>

(lutaraldehyde #2ormaldehyde Sol in Alcohol A>%

Spores are *illed 'ithin B hours
So.ution
So.ution

&e!achloropene #&alogenated phenol%

9acterio-static, particularly (ram #C% bacteria

2or scrubbing

,hlorhe!idine gluconate

9actericide : (ram #C% ) #-%

(ood for antiseptic

3a Steri.i4ation
3a Steri.i4ation

2ormaldehyde

7thilene-o!ide

- propionolactone
)oi.ing %ater
)oi.ing %ater

/ild boiling

8igorous boiling

/ore active, if A> sodium-carbonate or 4,0 > sodium-

hydro!ide being added
-$e 2perating -$eater
-$e 2perating -$eater
Sterile
core
"lean
*one
#ransitional
*one
Restricted area
Semi +
Restricted
%rea
S
C
R
U
B

S
U
I
T
-ra00ic pattern o0 2perating -$eatre
-ra00ic pattern o0 2perating -$eatre

-$e ue o0 aeptic princip.e re6uire

regu.ation o0 tra00ic an& 0.ow pattern o0 t$e
peronne., patient, e6uipment, an& upp.ie in
operating t$eatre

Aim : to protect t$e a0et" an& pri1ac" o0

patient an& t$e c.ean.ine an& integrit" o0 t$e
en1ironment.
unretricte& area
unretricte& area

/.e1ator

Corri&or
outi&e
urgica.
uite
unretricte& area
unretricte& area

/ntrance

#eception
&ek

,atient
uite
-ranitiona. 8one (9i&eo)
-ranitiona. 8one (9i&eo)

Locker
room

Dreing
room
C.ean 8one (9i&eo)
C.ean 8one (9i&eo)

Surgica.
uite an&
corri&or

Steri.e core
Scrub Area (9i&eo)
Scrub Area (9i&eo)
Steri.e Core (9i&eo)
Steri.e Core (9i&eo)
,utting on urgica. attire
,utting on urgica. attire

In t$e emi 5 retricte& area:

Scrub uit : $irt 5 trouer

+air co1ering: urgica. cap:$oo&

Mak : &ipoab.e: re*ueab.e

3ogg.e (optiona.): protecti1e e"ewear

S$oe co1er
are compu.or"
Surgica. attire
Surgica. attire

Ma.e
peronne.

Fema.e
peronne.

,eronne.
wit$ 1ei.
Surgica. Intrument in t$e 2perating -$eatre
Surgica. Intrument in t$e 2perating -$eatre

,ritical items :

Sterile, because of being used for penetrating

s*in or mucosa

Semi critical items :

In contact 'ith s*in or mucous membrane

Don critical items :

%septic techni&ues
%septic techni&ues
Aeptic tec$ni6ue
Aeptic tec$ni6ue
0 <ules at clean zone
A Procedures in sterile area
B Tal* as necessary
E <estrict unnecessary movements
$ Sterile instruments, remove non sterile one
" Avoid ) <eplace 'et surgical
drapes=to'els
+an& wa$ing
+an& wa$ing

In&ication:

)etween patient contact

)e0ore per0orming or aiting wit$ in1ai1e

proce&ure

)e0ore taking care o0 particu.ar." uceptib.e

patient

)e0ore an& a0ter touc$ing woun&

Imme&iate." a0ter g.o1e are remo1e&

+an& wa$ing
+an& wa$ing
)e0ore an& a0ter per0orming teri.e proce&ure
A0ter contact wit$ b.oo& or bo&" ubtance, mucou
membrane, oi.e& .inen, wate, or contaminate&
e6uipment.
)etween tak at &i00erent bo&" ite on t$e ame
patient to pre1ent cro contamination

A0ter taking care o0 in0ecte& patient

A0ter touc$ing contaminate& inanimate ource

+an& wa$ing
+an& wa$ing

,reparation

-$e proce&ure
Surgica. Scrubbing ,roce&ure
Surgica. Scrubbing ,roce&ure
,urpoe:
,urpoe:

-o remo1e &ebri an& tranient organim

0rom t$e nai., $an&, an& 0orearm.

-o re&uce t$e rei&ent microbia. count to a

minimum.

-o in$ibit rapi& reboun& growt$ o0

microorganim.
,urpoe:
,urpoe:

-o minimi4e t$e re*growt$ o0 microorganim

0or t$e .engt$ o0 t$e proce&ure.

-o re&uce t$e number o0 microorganim on

$an&

-o re&uce contamination o0 t$e operati1e ite

b" recogni4e& or unrecogni4e& break in
urgica. g.o1e.
,reparation:
,reparation:
#ecogni4ing g.o1e i4e
#ecogni4ing g.o1e i4e
Actua. proce&ure:
Actua. proce&ure:
Stroke tec$ni6ue
Stroke tec$ni6ue

#ining $an& 5
arm

Scrubbing wit$
antieptic o.ution

#ining arm

Scrubbing wit$
bru$ or ponge

#ining arm

Scrubbing wit$
antieptic o.ution

Dr"ing arm
Actua. proce&ure:
Actua. proce&ure:
Fi1e minute tec$ni6ue
Fi1e minute tec$ni6ue
3owning
3owning

-$e goa.:

to enure a a0e, protecti1e, an&

aeptic en1ironment to t$e patient an&
t$e urgica. team.
3owning 5 c.oe& g.o1ing tec$ni6ue
3owning 5 c.oe& g.o1ing tec$ni6ue

+rying hands 'ith

sterile to'el

Applying go'n

,losed gloving
technique
-$e 0ina. tep o0 t$e aeptic
tec$ni6ue be0ore per0orming urger".

Steri.e g.o1e are worn to permit t$e
wearer to $an&.e teri.e upp.ie or
tiue o0 t$e operati1e woun&.
Steri.e g.o1e etab.i$ a $ie.& t$at
protect t$e patient 0rom contamination
b" 0.ora 0rom t$e $an& o0 $ea.t$ care
worker.

2pen tec$ni6ue
"losed techni&ue
"losed techni&ue
Skin preparation
Skin preparation

-$e goa.:

to c.eane t$e kin an& bring bot$ t$e

rei&ent an& tranient bacteria. count to an
irre&ucib.e minimum, t$ere0ore re&ucing t$e
rik o0 woun& contamination an& ube6uent
urgica. ite in0ection.

per0orme& 'ut be0ore t$e urgica.

inciion $a been per0orme&.
Skin preparation
Skin preparation

Skin painting

Skin &raping
#ea&" 0or urger"
#ea&" 0or urger"
3own an& g.o1e remo1a.
3own an& g.o1e remo1a.
A0ter urger":

3own, 3.o1e
remo1a.

Simu.taneou
remo1a.