Introduction to the Operating Room
LESSON 1: ORIENTATION
1-22
Section IV. ASEPTIC TECHNIQUE/INFECTION CONTROL
1-22. INTRODUCTION
a. Discussion. The term asepsis means the absence of any infectious agents. All things that come into contact with a wound should be free from all microorganisms (sterile) or as free as possible for the protection of the patient. In order for the OR specialist to understand the reason for doing many procedures in a way, he needs to know the principles of aseptic technique. These principles serve as a guiding factor in the performance of all tasks in a surgical suite, including the routine cleaning or housekeeping procedures.
b. Importance. Aseptic (sterile) technique is essential in an OR. Sterile technique is of such great importance that it may be abandoned only during an event such as cardiac arrest in a patient, in which case immediate resuscitative procedures take precedence since the time element is vital to successful treatment (refer to para 1-21c(1)). Even when cardiac arrest occurs, the decision to sacrifice sterile technique is the surgeon's. The enlisted OR specialist should never abandon sterile technique except upon order by the surgeon. Such strictness in the maintenance of sterile technique is necessary because freshly cut, living tissue can become infected easily. Therefore, it is essential that the OR specialist and all other members of the OR team know the common sources of microorganisms in an OR and the means by which these organisms reach the sterile field to contaminate it. Team members must know how to prevent contamination of a sterile field.
c. Responsibility for Maintenance. The maintenance of sterile technique is the responsibility of everyone having duties or even being in the OR during an operative procedure.
(NOTE: Sterile technique cannot be maintained unless practiced by all team
members.)
Asepsis may be thought of as a chain, which is as strong as its weakest link.
d. Surgical Conscience. (Knowledge and Application of Principles of Aseptic Technique). A "surgical conscience" is the foundation upon which the skill and techniques employed by the OR specialist are built. He must know and apply the principles of sterile technique. Breaks in technique may allow the entrance of infectious organisms that the tissues cannot destroy. Even a so-called "mild" infection will delay a patient's recovery, and a "mild" infection may quickly become a severe one. Thus, any infection is potentially a threat to the life of a patient. The OR specialist should be acutely aware that antibiotics are no substitute for sterile technique and should follow the principles of such technique painstakingly. The specialist--and all other teams members--should never be reluctant to admit a possible break in technique, even if there is doubt about it. Any part of the sterile field, including the sterile gowns and gloves of team members, should be replaced with fresh, sterile items if any doubt arises as to their sterility.
e. Sources of Contamination. In order to control infection, there must be control over the sources of contamination. Bacteria are present in the air, water, food, man-made objects, skin, mucous membranes, nose, throat, and soil. In the OR, there are specific sources of possible contamination, which are a constant threat to an open incision. These should be recognized and controlled. These sources of contamination are:
(1) Members of the OR team (their clothing, breath, skin, hair, and so forth).
(2) The patient.
(3) All items used in the wound and on the sterile setup.
(4) Dust in the air.
(5) Other personnel, including visitors, in the OR.
