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ONCE UPON A GERM: OR ASEPSIS
ONCE UPON A GERM: OR ASEPSIS Introduction
o v e r the past 50 years in this country, operating room nurses have become the guardians of asepsis, working with the physician to create a safe environment in which to perform surgery. These nurses have often been called upon to consult with their colleagues in other patient care areas concerning the prevention or containment of infection. The operating room nurse knew the mechanics of the steam and dry heat sterilization processes because she carried them out every day. Choice of barrier materials was rather simplified. Muslin was the only draping and gowning material there was. Germicides and antiseptics concentrated on the gram positive organisms which were the primary pathogens of the time. But times have changed. The indiscriminant use of antibiotics has changed the microbial flora of the surgical wound infection. Manufacturers have produced a wide variety of barrier materials and have urged the operating room nurse to make some choices. The concern over the prevention of nosocomial, or hospital-acquired infections, has prompted the development of a new category of specialist-the infection control nurse, and he or she is frequently now in the operating room nurse’s former role as consultant. Hospital licensing and accrediting agencies have promulgated standards for infection control. Much of the thrust of these standards focuses on the patient undergoing surgical intervention. Meanwhile, graduates of schools of nursing have become less and less familiar with the principles and practices necessary to reduce the risk of infection for patients in the operating room. The nurse practicing in the operating room concentrated more and
more on direct patient care as ancillary personnel and other hospital departments moved in to do the “routine” work of sterilization and disinfection. The nurse lost track of not only the “how to’s’’ for these vital functions but also the scientific knowledge on which procedures are based. However, as the hospital environment becomes more crowded with patients, paraprofessionals and products, the nurse must have some basis for making choices which will facilitate the highest quality of care at the lowest price. In the area of aseptic practice, the nurse must be familiar with the basic biological, chemical and physical principles involved in the containment and destruction of microorganisms while at the same time safeguarding the human organisms and supplies and equipment involved. The professional judgments of the nurse must not be based upon ritualism from the past but on a sound grasp of the basics of sterilization, disinfection and aseptic technique.
Seminar Purpose The seminar will assist nurses practicing in the operating room to update their knowledge of aseptic practices so that they may critically evaluate the efficacy and efficiency of infection control procedures within their own operating room setting and to make constructive changes when needed. Framework For Seminar During this seminar, participants will exam the following methods of sterilization: steam under pressure, dry heat, gamma irradiation, ethylene oxide gas and liquid chemical. Emphasis will be placed on those
AORN Journal, July 1977, V o l 2 6 , N o I
189
methods most applicable for inhospital use. Most of the technical standards on aseptic practice as thus far developed by AORN will be used as the basic framework for discussion of hospital practices relating to infection control in the operating room. The effects of ritualism on judgments in this critical nursing arena will be explored with input from participants. Participants will be asked to critique various operating room situations for correctness in terms of aseptic principles, including practices within their own institution. The operating room nurses will be encouraged to share suggestions for remedying any deficiencies noted.
Objectives Upon completion of this seminar the participant will be able to: 1 . Operationally define the terms sterilization and disinfection. 2. Describe the logarithmic order of microbial death. 3. Define the term D-value. 4. Identify the mechanisms of microbial death in steam, dry heat, ethylene oxide, chemical and gamma irradiation sterilization. 5. Identify the conditions necessary for sterilization to occur in each of the above methods. 6. Discuss methods for determining whether the conditions necessary for sterilization are present with emphasis on their practicability for inhospital use. 7 . List the contingency factors which determine shelf life. 8. Compare and contrast various packaging materials with regard to bamer qualities. 9. Critique common operating room situations using the principles of asepsis. 10. List the sources of microbial contamination of the surgical wound. 1 1 . Discuss factors having a bearing on whether a surgical wound will become infected. 12. Analyze hidher own operating room 190
13.
14.
IS. 16.
17.
18.
19.
cleaning procedure for efficiency and efficacy. Analyze the efficiency and efficacy of hidher own operating room procedure for preoperative preparation of the patient’s skin. Analyze the efficiency and efficacy of hidher own surgical hand scrub procedure. Analyze the safety and efficiency of hislher institution’s operating room attire procedures. Discuss the effects of ritualism on aseptic practice. Identify sources for further information regarding products, procedures and practices. Describe the process of implementing a planned change. Discuss ways to facilitate the change process in order to overcome resistance.
Seminar Format Some of the material will be presented in a didactic manner to provide a common knowledge framework. Participants will be expected to discuss and actively share their own ideas and experiences regarding operating room procedures. Group activities will allow the nurse to critically examine the basis for these procedures and to make some judgments regarding their efficacy and efficiency. Audio-visual materials will be used to illustrate points in the discussion. There will be ample time for interchange of information between seminar leader and participants concerning controversial issues. Participants The seminar is planned for professional nurses working in the operating room whose daily practice requires expert knowledge of aseptic principles and practices and who are willing to act as change agents within their own hospital settings. Nurses from other specialty areas and departments are welcome although the focus will be o n conditions within the operating room.
AORN Journal, July 1977, V o l 2 6 , N o 1
Tentative Schedule First Day 8:oo a.m.- 8:30 a.m. 8 3 0 a.m.-12:00 noon
Final Registration
Introduction-Historical Overview Ritualism vs. Knowledgeable Practice Standards, What Are They and How T o Use Them Methods of Sterilization and Disinfection Monitoring Processes
130 p.m.- 4:30 p.m. Factcrn Affecting the Incidence of Surgical Wound Infections Principles of Asepsis Packaging Barrier Materials
Second Day 8:OO a.m.- I2:OO noon Attire & Traffic Skin Disinfection Housekeeping Procedures
120 p.m.- 4:30 p.m. Anesthesia Equipment and Otncr Problem Areas Change Theory and Methods of Implementation Continuing Controversies Suinmary and Evaluation Adjournment
Seminar Leaders Janet Schultz is Assistant Director of Education. AORN. Previously she was chairman. operating rooms and allied areas nursing, Indiana University Hospitals, Indianapolis, where she had the administrative responsibility for the nursing activities in 20 operating rooms, in three suites, three post-anesthesia recovery rooms, a 10-bed adult surgical intensive care unit. and an in-patient/out-patient urology clinic. Prior to this she was assistant director, OR and allied areas nursing, Indiana University Hospitals and director. OR nursing service, Kansas City College of Osteopathic Medicine, Kansas City. Janet has also held other OR staff positions. She received her BS degree in nursing with distinction at Indiana University School of Nursing, Indianapolis and has fulfilled all requirements except thesis for her master's degree in nursing with a major in nursing service administration and a minor in pediatric nursing.
Miss Schultz has contributed three chapters to a book entitled, Care of the Cardiac Surgicul Patient. She has a strong commitment to operating room nursing and is active in this important area of clinical practice. In addition, she has an excellent background in the area of aseptic practice and has had much experience in the teaching-learning process with adults. Her responsibilities with AORN include designing and implementing a hospital consultation service in the areas of operating room management and aseptic practice. She is the staff liaison to the Technical Standards Committee, Audio-visual Committee and Industry Collaboration Committee, all of which keep her well informed on current practices in the operating room. She is the principal author of the monthly AORN JOURNAL column, "The Experts Research: Q&A" and answers the bulk of the technical questions received at AORN Headquarters. These activities provide her with information on the knowledge needs of operating room nurses and have provided the stimulus for this seminar. As the Education Department staff expands, a co-leader will be named at a later date.
Continuing Education Recognition The Association of Operating Room Nurses is accredited by the Mountain Region Accrediting Committee of the American Nurse's Association as a provider and approval body for continuing education for nursing. Certificates of attendance are provided for all seminar participants. Each participant attending the entire seminar will receive 1.2 CEU. Those attending who do not participate for the entire time period will have the CEU adjusted on their certificates. Hotel Information Information for hotel reservations may be obtained from "Hotel Information" sections listed under other seminars.
AORN Journal, July 1977, Vol26, No 1
191
o v e r the past 50 years in this country, operating room nurses have become the guardians of asepsis, working with the physician to create a safe environment in which to perform surgery. These nurses have often been called upon to consult with their colleagues in other patient care areas concerning the prevention or containment of infection. The operating room nurse knew the mechanics of the steam and dry heat sterilization processes because she carried them out every day. Choice of barrier materials was rather simplified. Muslin was the only draping and gowning material there was. Germicides and antiseptics concentrated on the gram positive organisms which were the primary pathogens of the time. But times have changed. The indiscriminant use of antibiotics has changed the microbial flora of the surgical wound infection. Manufacturers have produced a wide variety of barrier materials and have urged the operating room nurse to make some choices. The concern over the prevention of nosocomial, or hospital-acquired infections, has prompted the development of a new category of specialist-the infection control nurse, and he or she is frequently now in the operating room nurse’s former role as consultant. Hospital licensing and accrediting agencies have promulgated standards for infection control. Much of the thrust of these standards focuses on the patient undergoing surgical intervention. Meanwhile, graduates of schools of nursing have become less and less familiar with the principles and practices necessary to reduce the risk of infection for patients in the operating room. The nurse practicing in the operating room concentrated more and
more on direct patient care as ancillary personnel and other hospital departments moved in to do the “routine” work of sterilization and disinfection. The nurse lost track of not only the “how to’s’’ for these vital functions but also the scientific knowledge on which procedures are based. However, as the hospital environment becomes more crowded with patients, paraprofessionals and products, the nurse must have some basis for making choices which will facilitate the highest quality of care at the lowest price. In the area of aseptic practice, the nurse must be familiar with the basic biological, chemical and physical principles involved in the containment and destruction of microorganisms while at the same time safeguarding the human organisms and supplies and equipment involved. The professional judgments of the nurse must not be based upon ritualism from the past but on a sound grasp of the basics of sterilization, disinfection and aseptic technique.
Seminar Purpose The seminar will assist nurses practicing in the operating room to update their knowledge of aseptic practices so that they may critically evaluate the efficacy and efficiency of infection control procedures within their own operating room setting and to make constructive changes when needed. Framework For Seminar During this seminar, participants will exam the following methods of sterilization: steam under pressure, dry heat, gamma irradiation, ethylene oxide gas and liquid chemical. Emphasis will be placed on those
AORN Journal, July 1977, V o l 2 6 , N o I
189
methods most applicable for inhospital use. Most of the technical standards on aseptic practice as thus far developed by AORN will be used as the basic framework for discussion of hospital practices relating to infection control in the operating room. The effects of ritualism on judgments in this critical nursing arena will be explored with input from participants. Participants will be asked to critique various operating room situations for correctness in terms of aseptic principles, including practices within their own institution. The operating room nurses will be encouraged to share suggestions for remedying any deficiencies noted.
Objectives Upon completion of this seminar the participant will be able to: 1 . Operationally define the terms sterilization and disinfection. 2. Describe the logarithmic order of microbial death. 3. Define the term D-value. 4. Identify the mechanisms of microbial death in steam, dry heat, ethylene oxide, chemical and gamma irradiation sterilization. 5. Identify the conditions necessary for sterilization to occur in each of the above methods. 6. Discuss methods for determining whether the conditions necessary for sterilization are present with emphasis on their practicability for inhospital use. 7 . List the contingency factors which determine shelf life. 8. Compare and contrast various packaging materials with regard to bamer qualities. 9. Critique common operating room situations using the principles of asepsis. 10. List the sources of microbial contamination of the surgical wound. 1 1 . Discuss factors having a bearing on whether a surgical wound will become infected. 12. Analyze hidher own operating room 190
13.
14.
IS. 16.
17.
18.
19.
cleaning procedure for efficiency and efficacy. Analyze the efficiency and efficacy of hidher own operating room procedure for preoperative preparation of the patient’s skin. Analyze the efficiency and efficacy of hidher own surgical hand scrub procedure. Analyze the safety and efficiency of hislher institution’s operating room attire procedures. Discuss the effects of ritualism on aseptic practice. Identify sources for further information regarding products, procedures and practices. Describe the process of implementing a planned change. Discuss ways to facilitate the change process in order to overcome resistance.
Seminar Format Some of the material will be presented in a didactic manner to provide a common knowledge framework. Participants will be expected to discuss and actively share their own ideas and experiences regarding operating room procedures. Group activities will allow the nurse to critically examine the basis for these procedures and to make some judgments regarding their efficacy and efficiency. Audio-visual materials will be used to illustrate points in the discussion. There will be ample time for interchange of information between seminar leader and participants concerning controversial issues. Participants The seminar is planned for professional nurses working in the operating room whose daily practice requires expert knowledge of aseptic principles and practices and who are willing to act as change agents within their own hospital settings. Nurses from other specialty areas and departments are welcome although the focus will be o n conditions within the operating room.
AORN Journal, July 1977, V o l 2 6 , N o 1
Tentative Schedule First Day 8:oo a.m.- 8:30 a.m. 8 3 0 a.m.-12:00 noon
Final Registration
Introduction-Historical Overview Ritualism vs. Knowledgeable Practice Standards, What Are They and How T o Use Them Methods of Sterilization and Disinfection Monitoring Processes
130 p.m.- 4:30 p.m. Factcrn Affecting the Incidence of Surgical Wound Infections Principles of Asepsis Packaging Barrier Materials
Second Day 8:OO a.m.- I2:OO noon Attire & Traffic Skin Disinfection Housekeeping Procedures
120 p.m.- 4:30 p.m. Anesthesia Equipment and Otncr Problem Areas Change Theory and Methods of Implementation Continuing Controversies Suinmary and Evaluation Adjournment
Seminar Leaders Janet Schultz is Assistant Director of Education. AORN. Previously she was chairman. operating rooms and allied areas nursing, Indiana University Hospitals, Indianapolis, where she had the administrative responsibility for the nursing activities in 20 operating rooms, in three suites, three post-anesthesia recovery rooms, a 10-bed adult surgical intensive care unit. and an in-patient/out-patient urology clinic. Prior to this she was assistant director, OR and allied areas nursing, Indiana University Hospitals and director. OR nursing service, Kansas City College of Osteopathic Medicine, Kansas City. Janet has also held other OR staff positions. She received her BS degree in nursing with distinction at Indiana University School of Nursing, Indianapolis and has fulfilled all requirements except thesis for her master's degree in nursing with a major in nursing service administration and a minor in pediatric nursing.
Miss Schultz has contributed three chapters to a book entitled, Care of the Cardiac Surgicul Patient. She has a strong commitment to operating room nursing and is active in this important area of clinical practice. In addition, she has an excellent background in the area of aseptic practice and has had much experience in the teaching-learning process with adults. Her responsibilities with AORN include designing and implementing a hospital consultation service in the areas of operating room management and aseptic practice. She is the staff liaison to the Technical Standards Committee, Audio-visual Committee and Industry Collaboration Committee, all of which keep her well informed on current practices in the operating room. She is the principal author of the monthly AORN JOURNAL column, "The Experts Research: Q&A" and answers the bulk of the technical questions received at AORN Headquarters. These activities provide her with information on the knowledge needs of operating room nurses and have provided the stimulus for this seminar. As the Education Department staff expands, a co-leader will be named at a later date.
Continuing Education Recognition The Association of Operating Room Nurses is accredited by the Mountain Region Accrediting Committee of the American Nurse's Association as a provider and approval body for continuing education for nursing. Certificates of attendance are provided for all seminar participants. Each participant attending the entire seminar will receive 1.2 CEU. Those attending who do not participate for the entire time period will have the CEU adjusted on their certificates. Hotel Information Information for hotel reservations may be obtained from "Hotel Information" sections listed under other seminars.
AORN Journal, July 1977, Vol26, No 1
191