Relative To Your Own Health And Safety

• You should be neatly and cleanly dressed at all times when in patient areas. Should you spill blood or body fluids on yourself, obtain a clean garment promptly.


• For your own protection, obey the following rules when in patients' rooms:


• Do not sit on beds.


• Do not carry your overcoat into patients, rooms.


• Do not eat in patients’ rooms.


• Do not smoke in patients’ rooms.


• Do not carry open food containers in the elevators.


• Do not eat or smoke in the elevators.


• Handwashing is to be completed before and after each patient visit, and before and after each procedure.


• There shall be no eating or smoking in patient care areas, including the Operating Rooms, Delivery Rooms, Intensive Care Units, Nurseries, Dialysis unit, Emergency Room, and Special Care Units.


• If you are knowingly exposed to a communicable disease at home or in the hospital, report to the Student Health Service immediately, for care and/or clearance before going onto a patient unit. If you are told of a possible exposure, and are referred to the Health Service, please go promptly.


• Wear gloves at all times to draw bloods or to do treatments. Report all accidents or needle sticks to the Student Health Service for care and follow up.


• Do not put pencils, needles or other such items in your mouth.

Relative to the Health and Safety of Others

• Specimens and slides should be clean, labelled and covered before they are transported from the patient area. Bloody or dirty tubes and slides must be cleaned before you take them anywhere or leave them for someone else to transport. All specimens should be handled as if they were contaminated.


• Any equipment used should be removed from the patient’s bedside and properly disposed of or cleaned by the person using it.


• Studies have shown that 40% of needle stick injuries can be prevented if simple hospital guidelines given below are followed. Your cooperation is needed to prevent the spread of blood-borne diseases.


• Only dispose of sharps in the rigid needle disposal boxes provided for that purpose. Never put them in any other container. Sharps include needles and all disposable edged and pointed instruments. Needle disposal boxes should not be stored on the floor.


• Never bend needles after using them.


• Do not routinely recap needles after use. It is safer to dispose of them without recapping. If a needle must be recapped, for example for a blood determination, be extremely careful. Do not use two hands when recapping! Instead use the needle to scoop the needle sheath up off a flat surface or from a mechanical holding device.


• Only dispose of glass in the large containers in the utility rooms.

Pertaining to the Health and Safety of Patients

• Aseptic technique must be followed when doing dressings or procedures on patients. If you are unfamiliar with the techniques, please check with your supervisor or with a nurse before beginning the procedure.


• All lines and indwelling devises placed in percutaneously in patients should be sterile and handled aseptically to maintain sterility. All devices removed from patients should be considered contaminated and handled aseptically to avoid contamination of the handler. Information on the creation and maintenance of sterile fields can be found in the Bellevue Infection Control Manual, Chapter 4.

Aseptic Technique

• A sterile field is an organism-free area. It must include nearby furniture covered by sterile drapes and personnel must be properly attired.

Equipment

• Sterile tray with reusable supplies or sterile packages with disposable supplies; other sterile supplies as needed; antiseptic cleansing solution; gowns and gloves, sterile solutions; sterile basin(s); sterile drapes.

Essential Steps in Creating A Sterile Field

• All supplies should be assembled before starting the procedure.


• Extra supplies to replace any that may become contaminated should be available.


• If possible an assistant should stand by to procure additional supplies or to help during procedure.


• The sterilization tape, expiration date and integrity of sterile kits and packages are checked before opening. if outdated, damaged, wet or stained they are not used.


• Hands must be washed before opening sterile packages.


• Packs that fall to the floor are reprocessed and not picked up and used, even if no visible damage occurs.


• Supplies are opened on a clean flat dry area above waist level.


• The packages’ outermost flaps are opened away from the body. If the package has several flaps they are unfolded one at a time. The last flap is opened toward the body to avoid reaching over the sterile field.


• The inside of the wrapper except for a border along the edges is considered sterile and not touched.


• Other sterile supplies are added to the sterile field by peeling open wrappers (no tearing) and slipping gently onto sterile field. Items are presented so that the item does not pass over the edge of the package. Edges of pull-apart packages are considered unsterile.


• Hands are washed and gowns and gloves are donned (need for sterile gown depends on procedure and its extent). Some procedures require only sterile gloves.


• Sterile solutions are best poured with the help of another person. The ungloved assistant first pours and discards a small amount of solution, outside the sterile field, to clean the lip of the container. The sterile gloved person then sets or holds a sterile basin or container at the edge of the sterile field and the ungloved assistant pours the sterile solution into the sterile basin. The lips of containers should not touch each other when pouring.


• If pouring a sterile solution alone the cap is removed with ungloved hands being careful not to touch the inside of the cap. The cap must not be rested on its lip or placed in the sterile field. The bottle is held with bottle facing the palm and a few milliliters of solution are poured into a plastic cup or receptacle to eliminate contaminants around the lip (the contents of sterile solution bottles must be used or discarded because the cap cannot be replaced without contaminating the pouring edges.)


• The patient is draped using sterile technique without touching the patient or linens.

Other Points Relating To Sterile Fields

• Only the horizontal surfaces of the field or draped table are considered sterile. Items falling below the horizontal surface are considered contaminated.


• Only sterile items are used within a sterile field. A sterile object or field is contaminated if touched by an unsterile object.


• "Unsterile" (i.e.: unscrubbed and ungowned) persons do not walk between two sterile fields.


• A sterile field is prepared as closely as possible to the time of use and is not covered.


• A sterile field is not left unattended and the back is not turned away from the field. Sterile objects within the field are kept above the waist and in the line of vision.


• Sterile forceps or gloves are used to touch any object within a sterile field.


• When the lid of a sterile container is removed only the outside is touched. The lid is placed down inside up and kept free from contact with unsterile objects.


• Talking, coughing, sneezing or reaching over a sterile field are avoided.


• A wet sterile field is considered contaminated if the surface immediately below is unsterile.


• If the sterility of an item is in question it is considered unsterile and discarded.

Aseptic Technique For Medications

• Multiple dose vials of any substance are dated and initialed when the seal is broken. The vial is stored according to the recommendations of the manufacturer for the specific time indicated. The contents of the vial should be used before additional vials are opened. Such vials should be examined daily to determine proper dating and need to discard.
• Aseptic technique in withdrawing doses and transferring medication from vials is mandatory. Tops of multidose vials and injection ports of intravenous tubing sets are wiped with antibacterial solution (e.g. 70% alcohol, iodophor) before entering with a needle. It a vial is suspected of being contaminated it is discarded or the contents cultured if indicated clinically, e.g., if a patient has received an injection from the vial.