Answers to Case Studies
No. The number of people moving through operating theaters and the surrounding processing areas should be kept to a minimum to reduce microbial contamination. Signs limiting access to these areas should be posted, and entrance to the surgical area should be restricted to authorized personnel.
No. It is not acceptable to have a sterile tray or table next to or in front of a window that is open at the top or bottom. Keeping an operating theater cool is important, not only for the comfort of the client and surgical team, but also to reduce the number of bacteria in the room--however, the integrity of the sterile field should never be compromised. In addition, the amount of airflow during surgical procedures should be minimized. If the operating theater cannot be air-conditioned, ceiling fans or open windows are acceptable only if the following conditions are met:
- Fans are kept clean and blades are wiped frequently with a damp cloth
- Windows have intact, tight mesh screens and can be opened frorm the top
If opening a window is necessary, Teresa should rearrange or remove some of the furnishings so that her sterile table is not near a window.
No. Shaving is no longer recommended for surgical/incision sites because research has shown that shaving actually increases the risk of postoperative infections. If hair must be removed, it is best to cut it with scissors. Also, Nurse Pensri should wait 2 minutes before wiping off the excess antiseptic solution, since iodophors require several minutes for maximum effectiveness. The incision site should first be washed with soap and water if the client has not already done this at home or in the clinic.
No. Antiseptics are for use on the skin and should not be used on inanimate objects. Instruments and other items should always be stored dry after processing and should never be stored soaking in solutions. Instead, the instruments should be sterilized or high-level disinfected and then stored dry until use. (See the module on Instrument Processing for more information.)
No. Iodine is very irritating to mucous membranes and should not be used in the vagina or on the cervix. An iodophor would be the best choice, with a product containing chlorhexidine being the second choice. Remember that there is a small potential for irritation when products containing chlorhexidine are used in the genital area, including the vagina and the cervix.
No. Benzalkonium chloride, a quaternary ammonium, is a disinfectant and thus should not be used as an antiseptic. In addition, it becomes easily contaminated, is slow-acting in killing microorganisms, and is inactivated by cotton gauze. Appropriate options would be povidone iodine, chlorhexidine, or alcohol.
Also, cotton balls should not be left soaking in an antiseptic solution, since repeated dipping of forceps or fingers into the container to pick up the cotton balls will contaminate both the solution and the remaining cotton balls. Store cotton balls and antiseptic solutions separately.
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