Reproductive System, Medical School of Universitas Padjadjaran, Bandung 2005 MIR-C Corporate

1. Interactive Training CD for Medical Students Reproductive System Module : Infection Prevention: A- and Antiseptic Techniques Reproductive System,Medical School of Universitas Padjadjaran, Bandung2005MIR-C Corporate in Surgical Setting

2. Production Team: • Director : Kiki Lukman, MD, MSc, FINACS (Dig.) • Script writer : Kiki Lukman, MD, MSc, FINACS (Dig.) • Main contributors : Kiki Lukman, MD, MSc, FINACS (Dig.) Yayat Ruchiyat, MD, FINACS (Dig.) Warko Karnadihardja, MD, FINACS (Dig.) Nurhayat Usman, dr., SpB-KBD Lisa Hasibuan, MD Nina K. Poetri T., SKp, Dadang Sunarya AMK Dedy Rusnadi AMK, Alia Rahmi AMK, • Editorial Team : Kiki Lukman, MD, MSc, FINACS (Dig.) • Casting : Kiki Lukman, MD, MSc, FINACS (Dig.) • Artistic : MIR-C Corporate • Productions : Medical School of Universitas Padjadjaran Bandung

3. Credits • Special thanks to: • Central Operating Theatre Unit of Hasan Sadikin General Hospital

4. Infection Prevention Module Introduction Infection control Antiseptic techniques Operating Theater Aseptic techniques

5. Introduction Description Objectives

6. Description • Infection Prevention in Surgical Setting is one of important preventive methods in order to achieve infection control in clinical and surgical practices.

7. Objectives • The aims of this method are : • To minimize surgical site infection • To protect health personnel • To improve wound healing • To minimize disability, morbidity, & mortality • To reduce the cost of hospital care

8. Specific Learning Objectives : • To describe the definition and history of sterilization, disinfection, decontamination, anti and a - septic techniques. • To describe six methods of sterilization. • To describe three categories of surgical instruments • To describe 6 rules of aseptic techniques

9. Specific Learning Objectives : • To perform aseptic techniques correctly, including (P5): • Applying surgical attire • Hand washing • Surgical scrubbing • Gloving • Surgical Gowning

10. Definition: • Sterilization : Processes by which all pathogenic & non pathogenic microorganisms, including spores, are killed. • Disinfection: Chemical or physical process of destroying all pathogenic microorganisms, except spore bearing ones; used for inanimate objects, but not on tissues.

11. Definition: • Decontamination : Process or method by which all contaminated materials that can cause diseases are removed. • Aseptic techniques : Methods by which contamination with microorganisms is prevented. • Antiseptic techniques: Prevention of sepsis by the exclusion, destruction, or inhibition of growth and multiplication of microorganisms from body tissues and fluids.

12. Infection Control

13. Why should we apply a and antiseptic techniques ?

14. Historical backgrounds : • Ignas Sammelweis (1818 - 1865) • Puerperal fever  increased maternal mortality • Hand scrub with chlorinated-lime solution prior to examination. • Father of nosocomial infection. • Louis Pasteur (1860) • Discover the process of fermentation by microorganisms • Germ theory: against spontaneous generation theory.

15. Historical backgrounds : • Joseph Lister (1865) • Use carbolic acid solution on surgical dressing in the operating room  mortality  (Listerization) • Father of modern surgery (Antiseptic technique) • Ernst Von Bergmann (1886) • Introduced “steam sterilizer” • Basic of sterilization  aseptic technique • Later: “pressure & vacuum steam sterilizer” was developed

16. Methods of Infection control • Anti septic techniques • Design and traffic patterns of the operating theatre • Aseptic techniques

17. Anti septic techniques

18. Sterilization • The objective of modern surgery • For inanimate objects • Problem : • Some items are not heat resistance

19. Techniques of Sterilization • Physical: • Heat • Radiation/ ultraviolet ray • Boiling water • Ultrasound • Chemical: • Liquid • Gas

20. Heat Sterilization • Dry : • Commonly cause damage • For powder, oils, and jelly • Moist : • Steam • High pressure   spores  • Vacuum  constant temperature • Autoclave

21. Chemical Sterilization • Generally as disinfection • Mechanism of action : • Protein coagulation • Enzyme denaturation in cells • Lysis • Depend on : number of microorganisms, soiling, concentration, and temperature.

22. Solutions • Jodium and Jodophor • Good bactericide, but irritant • Mixture : povidone-jodine 10% • Alcohol Solution of 70% or 90% • Glutaraldehyde (Formaldehyde Sol. in Alcohol 2%) • Spores are killed within 3 hours

23. Solutions • Hexachloropene (Halogenated phenol) • Bacterio-static, particularly Gram (+) bacteria • For scrubbing • Chlorhexidine gluconate • Bactericide : Gram (+) & (-). • Good for antiseptic

24. Gas Sterilization • Formaldehyde • Ethilene-oxide • - propionolactone

25. Boiling Water • Mild boiling • Vigorous boiling • More active, if 2% sodium-carbonate or 0,1 % sodium-hydroxide being added

26. The Operating Theater Clean Zone S C R U B S U I T Transitional Zone Sterile core Restricted area Semi – Restricted Area

27. Traffic patterns of Operating Theatre • The use of aseptic principles requires regulation of traffic and flow patterns of the personnel, patient, equipment, and supplies in operating theatre • Aims : to protect the safety and privacy of patients and the cleanliness and integrity of the environment.

28. unrestricted area • Elevators • Corridors outside surgical suite

29. unrestricted area • Entrance • Reception desk • Patient suite

30. Transitional Zone (Video) • Locker room • Dressing room

31. Clean Zone (Video) • Surgical suite and corridors • Sterile core

32. Scrub Area (Video)

33. Sterile Core (Video)

34. Putting on surgical attire • In the semi & restricted area: • Scrub suit : shirt & trousers • Hair covering: surgical cap/hood • Masks : disposable/ re-useable • Goggle (optional): protective eyewear • Shoe covers are compulsory

35. Male personnel Female personnel Personnel with veil Surgical attire

37. Surgical Instruments in the Operating Theatre • Critical items : • Sterile, because of being used for penetrating skin or mucosa • Semi critical items : • In contact with skin or mucous membrane • Non critical items :

38. Aseptic techniques

39. Aseptic techniques • Rules at clean zone • Procedures in sterile area • Talk as necessary • Restrict unnecessary movements • Sterile instruments, remove non sterile one • Avoid & Replace wet surgical drapes/towels

41. Hand washing • Indications: • Between patient contacts • Before performing or assisting with invasive procedures • Before taking care of particularly susceptible patients • Before and after touching wounds • Immediately after gloves are removed

42. Hand washing • Before and after performing sterile procedures • After contact with blood or body substances, mucous membranes, soiled linen, waste, or contaminated equipment. • Between tasks at different body sites on the same patient to prevent cross contamination • After taking care of infected patient • After touching contaminated inanimate sources

43. Preparation The procedure Hand washing

44. Surgical Scrubbing Procedure

45. Purposes: • To remove debris and transient organisms from the nails, hands, and forearms. • To reduce the resident microbial count to a minimum. • To inhibit rapid rebound growth of microorganisms.

46. Purposes: • To minimize the re-growth of microorganisms for the length of the procedure. • To reduce the numbers of microorganisms on hands • To reduce contamination of the operative site by recognized or unrecognized breaks in surgical gloves.

47. Preparation:

48. Recognizing glove sizes

49. Actual procedure: Strokes technique • Rinsing hands & arms • Scrubbing with antiseptic solution • Rinsing arms • Scrubbing with brush or sponge • Rinsing arms • Scrubbing with antiseptic solution • Drying arms

50. Actual procedure: Five minute technique