Personal Protective Equipment (PPE)

All body fluids and substances should be considered as potentially infectious; the use of PPE will minimise your exposure to these substances. PPE is required routinely in the following situations:

Where the potential risk of exposure to body fluids, secretions and excretions whether or not they contain visible blood.

1.Any contact with non-intact skin.

2.Contact with mucous membranes.

The WPHS Act 1995 make it the hospitals responsibility to provide PPE that complies with relevant Australian Standards. PPE required for standard precautions includes:

3.The use of gloves. They are not a substitute for handwashing, and hands should be washed following glove removal, gloves are changed between patients, or when punctured or torn.

4.Facial protection, eyewear, surgical mask, or face shield. Masks should be chosen considering the type of exposure, for example, High filtration laser mask. Masks are only effective when worn in the correct manner, ie. Secured across the nose and mouth by all tapes, and changed at regular intervals. They should never be left to hang around the neck, once worn they should be removed and handled only by the tapes and discarded directly into the rubbish bins.

5.The use of impermeable aprons or gowns.

Aseptic Technique

The term asepsis means that infectious agents are eliminated. (The prefix 'a' meaning without, and 'sepsis' the presence of pathogenic microorganisms). These techniques are used to reduce the risk of infection by minimising the number of pathogenic organisms people are exposed to. Basic cleanliness assists in this goal.

Aseptic technique is the practice adopted by perioperative personnel to minimise the patients risk of exposure to exogenous microorganisms while the body's natural defences are breached during surgery or other procedures.

The technique is used for activities within and around the sterile field. The sterile field includes the area immediately surrounding the draped patient, the sterile surgical personnel, sterile instrument trolleys, and equipment.

Activities that create and maintain a sterile field include the wearing of proper theatre attire, correct handwashing methods, gowning, and gloving methods, correct selection and use of surgical drapes and sterilisation of surgical instruments. Other activities include environmental cleaning and adequate traffic control to limit personnel numbers in theatre-

Unscrubbed personnel shall:

•Avoid leaning over the sterile field.

•Maintain appropriate distance from the sterile field at all times (approximately 30 cm's).

•Refrain from moving between two sterile fields.

•Move sterile draped equipment by holding vertical uprights below the level of the drape.

•Keep movement in the OR to a minimum (ACORN Standards, 2010) as excessive air movement causes increased air movement and microbial shedding is a potential source of microorganisms that can contaminate the surgical field. Ensure all doors to the operating room remain closed except for the movement of staff, equipment and the patient.

The following factors increase the risk of a patient acquiring an infection

•Healthcare facilities group together significant numbers of people with a variety of illnesses.

•The patient is directly exposed to a large number of health carers.

•Certain diseases, because of the effect on the body, increase the risk of infection.

•Antibiotic use is widespread, increasing the possibility of resistant strains of microbes.

•Trauma, surgery, intravenous lines, catheters, injections, and respiratory support bypass natural defences creating an entry point for microbes.

•Certain drugs suppress the immune system making it easier for microbes to invade.

•Babies, small children and elderly people are more susceptible.

•Implanted devices such as orthopaedic and vascular prosthesis are risk factors because they are foreign to the body.

•Stress, debility, malnutrition, and immobility will increase susceptibility to infection.

Skin Preparation

As the patients skin is the most common source of bacteria that causes surgical wound infections, preparation of the skin in the operating room prior to incision is one of the most important methods of reducing infection. An antimicrobial solution may be used with a disposable scrubbing brush over the operating site and dried with a sterile cloth. The sterile personnel may then prep the skin. The choice of solution depends on the condition of the skin, surgeon's preference, and the patient's allergies.

Preoperative Shave

Today the routine practice is not to remove hair unless it is excessive and interferes with access to the operative area.

If necessary, however, excess hair should be removed as near to the time of the surgical procedure as possible because of the bacteria count in any nicks and scratches caused by a razor. Studies have shown that patients shaved in the operating room have lower infection rates than those who are shaved the night before. Clippers are the preferred method of hair removal.

Each doctor will have his/her own preference regarding the method and timing of hair removal and should be checked prior to surgery.

Theatre Orderlies can perform shave if given a directive from medical or nursing staff.

Surgical Conscience

One of the major factors in creating and maintaining a sterile and aseptic environment is a health care worker's surgical conscience. This type of conscience is an internal value system that motivates correct performance in adhering to aseptic technique whether you are alone or being observed. An example of this is when you accidentally touch a sterile draped trolley with no one else witnessing it; you would approach one of the nurses to bring her awareness to this. It requires honesty and strength of character as it may result in a delay in operating time but it is of extreme importance for the patient outcome and will ultimately reflect positively upon how others see you.