a. General.

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 operating room specialist to understand the reason for doing many procedures in a certain 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 operating room.

Sterile technique is of such great importance that it may be abandoned only during an event such as cardiac arrest in a patient where immediate action makes the difference between life and death. 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 operating room and the means by which these organisms reach the sterile field to contaminate it. Also, 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 operating room during an operative procedure.

Sterile technique cannot be maintained unless practiced by all team members. Asepsis may be thought of as a chain that 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 the principles of sterile technique and he must apply them. 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 there is no substitute for sterile technique and he should, therefore, follow the principles of such technique painstakingly. The specialist, and all other team 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 operating room, there are specific sources of possible contamination that are a constant threat to an open incision. They should be recognized as such and controlled. These sources are:

(1) Members of the operating room team (their dress, breath, skin, etc.).

(2) The patient.

(3) All items used in the wound and on the sterile setup.

(4) Dust in the air.

(5) Other personnel in the operating room.