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STERILE TECHNIQUE FOR THE SONOGRAPHER Jessy Farris MHS RVT RPhS Clinical Training & Accreditation Manager Vein Clinics of America – Division of Quality OUTLINE • SECTION I Healthcare Associated Infections • SECTION II Hand Hygiene • SECTION III Sterile Technique • SECTION IV Personal Protective Equipment SECTION I: HEALTHCARE ASSOCIATED INFECTIONS HCAI DEFINITIONS Asepsis: • The absence of germs or infection • Procedures requiring aseptic technique include: • Ambulatory phlebectomy • Endovenous thermal ablation procedures • Sclerotherapy • Mixing medications and filling syringes BSI (Primary Bloodstream Infection): • Leading, preventable infectious complication • Has a negative impact on patient outcomes Universal Standard Precautions for Preventing Transmission of Bloodborne Infections • Guideline approach to infection control developed by the CDC • The handling of all human blood and certain human body fluids should be treated as if known to be infectious for HIV, Hepatitis B and C, and other bloodborne pathogens HCAI: HEALTHCARE ASSOCIATED INFECTIONS • Also known as nosocomial infections • Infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present at the time of admission or visit Handwashing: Clean Hands Saves Lives. (2013, December 11). Retrieved August 8, 2016 from http://www.cdc.gov/handwashing/when-how-handwashing.html HCAI: HEALTHCARE ASSOCIATED INFECTIONS • HCAI occur in 1 of 25 hospitalized patients ever day • HCAI surpass auto accidents by 200% annually • Impact of HCAI: • • • • • More serious patient illness Prolonged hospital stays Long-term disability Excess death High additional financial burden to facilities and patients • Cost of HCAI in the US $6.5billion annually • It is estimated that at least 50% of HCAI can be prevented Handwashing: Clean Hands Saves Lives. (2013, December 11). Retrieved August 8, 2016 from http://www.cdc.gov/handwashing/when-how-handwashing.html EFFECT OF HCAI • Patients • HCAI are preventable • HCAI claim the lives of 75,000 patients • HCAI affect more than 700,000 patients each year • Healthcare Professionals and Providers • Guilt, stress, fear • Disciplinary action, loss of licensure • Medical Organizations (clinics, hospitals) • Losing public trust • Additional Spending: • HAI treatments and patient lawsuits $33 billion per year of direct additional hospital cost • Insurance Providers • Paying additional cost for HAI associated treatment $6.5billion/year • Aim is prevention The most common mode of transmission of pathogens is via HANDS SOLUTION: Hand Hygiene SECTION II: HAND HYGIENE HAND HYGIENE DEFINITIONS HAND HYGIENE • Performing hand washing, • Antiseptic hand wash, alcohol-based hand rub • Surgical hand hygiene/antisepsis HAND WASHING • Washing hands with plain soap and water • Washing hands with water and soap or other detergents containing an antiseptic agent ALCOHOL-BASED HAND RUB • Rubbing hands with an alcohol-containing preparation • Hand washing or using an alcohol-based hand rub before operations by surgical personnel WORLD HEALTH ORGANIZATION: HAND HYGIENE INITIATIVE CENTERS FOR DISEASE CONTROL: HAND HYGIENE INSTRUCTIONS COMMONLY MISSED AREAS SECTION III: STERILE TECHNIQUE STERILE FIELD Sterile Field • • • • Area surrounding the patient and the site of the procedure that requires more than a clean area Must be kept free of microorganisms Created by using sterile drapes to drape the work area and patient Required for procedures where more risks exist for a possible bloodstream infection such as: – Ambulatory phlebectomy, and – Endovenous laser ablation (ELA) STERILE FIELD: ELA PROCEDURES • Classified by insurers and state regulations as a surgical procedure • CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections • Policies, protocols, practices based on the AORN and CDC Guidelines as well as state regulations • Maximum sterile barrier precautions during catheter insertion • Use of a cap, mask, sterile gown, sterile gloves and a sterile drape • Appropriate sterile cleaning prep of surgical area • 50/50 mixture of chlorohexidine and isopropyl alcohol used for cleaning • Allow mixture to air dry prior to catheter insertion • Maintaining the integrity of sterile fields STERILE FIELD: ADDITIONAL TIPS/REMINDERS • Don fresh/clean gloves following procedure, prior to touching surfaces outside the sterile field • US unit, cabinets, drawers, the sink, bandages, etc. • If using sterile blue towel to wipe down the patient’s leg: • Do not place towel in the sink to wet • Hold towel beneath the faucet, with clean gloves STERILE FIELD: WHAT IS & WHAT IS NOT STERILE STERILE: • Gloved hands • Front of gown from below the neck to the waist • Top of sterile field (table and bed) to edge NOT STERILE: • Face, mask, hat • Gown below waist and at back • Below the table/bed’s edge LASER ABLATION (ELA): SET UP LASER ABLATION (ELA): SET UP • Second monitor adjusted • US map in view • Table set up at appropriate height and tilt SECTION IV: PERSONAL PROTECTIVE EQUIPMENT PPE: APPROPRIATE & REQUIRED USE • HAT • Bouffant hat worn by those with long hair with hair tucked into hat • Surgeon cap can be worn by those with short hair • Worn when prepping for and performing sterile procedures • MASK • Mask should cover all facial hair, nose and mouth • If glasses are fogging, use anti-fog mask or anti-fog spray/wipes • Worn when prepping for and performing sterile procedure • Worn by patients or staff who are ill and contagious in the office • STERILE GLOVES • Make sure you are wearing correct size • Too small (uncomfortable and can rip) / Too large (lose fine dexterity) • Worn when prepping for and performing sterile procedures • STERILE GOWN • Gown is secured (by assistant) at the neck, at the back and using exterior ties around waist. Do not reach these areas on your own as your hands will become unsterile. • Must be worn when prepping for and performing sterile procedures PPE: APPROPRIATE & REQUIRED USE • LASER SAFETY GLASSES • Must be worn by all present in the procedure room during ELA procedure • Patient, physician, sonographer, observer, MA, etc. • Laser light is invisible to the naked eye and travels faster than the speed of the blink of an eye • Direct exposure to laser beam will cause eye damage, up to and including blindness • If glasses fog, use anti-fog mask, spray, or wipes • Glasses must be inspected prior to all use to ensure they aren’t damaged • Cracked, scratched lenses, and frames • Glasses should be cleaned using mild soap and water TRANSDUCER/PROBE COVERS STERILE TRANSDUCER COVERS • Must be used during sterile procedures (ELA) • When applying the probe cover, make sure sterility is maintained • When applying probe cover, make sure it is intact and adequate gel is present (under cover) to minimize air bubbles ADDITIONAL NOTES • When removing probe covers, it is best to use your hands or a hemostat (if rubber bands are used) to remove rubber bands, not scissors • Make sure you are careful when removing cover so that you do not in turn contaminate the probe • Always wear clean gloves when applying probe cover • Always wear gloves when removing soiled probe cover WHEN NOT TO USE PPE • Do not use PPE when it is damaged • Do not wear PPE (gloves, gowns) in public areas • Do not wear same PPE when in contact with more than one patient • Do not wear the same gloves to complete multiple tasks • For example: If you are in the process of assisting with ultrasound-guided procedures and need additional supplies, remove gloves, sanitize hands, obtain supplies and don fresh gloves Additional Note: • Be mindful of what surfaces you touch while wearing contaminated gloves • Paper towel roll, light switches, walls, countertops, charts, drawers, cabinets, door handles, etc. THANK YOU! Fort Worth, TX