Asepsis · WET-ASEP-05 · STD-05 · Operating theatre · Electrocautery · Sterilisation room

Sterility protocol

Two operating theatres with separate purposes, airlocks, instrument sterilisation with biological and chemical monitoring, and an audited flow of materials, all following fixed, written procedures.

STD-05 · Sterility protocol6 zones · 10 steps

Process owner

Medical lead / veterinarian responsible for surgery and infection control

Participants

Operating surgeons, anaesthetists, veterinary technicians, assistants, sterilisation room staff, cleaning staff

Purpose

Preventing surgical site infections and breaks in the chain of sterility by standardising the organisation of space, patient preparation, team conduct and the flow of materials

Scope

All surgical, orthopaedic, dental, endoscopic and invasive procedures that require aseptic conditions

Where it applies

Operating theatre, Electrocautery, Sterilisation room

Start

Preparation of the theatre, materials and patient for the procedure

End

Completion of decontamination and instrument processing, release of the theatre, and full recording of the flow of materials

Documents

Sterilisation cycle log, load record, log of biological and chemical indicators, theatre inspection record, procedure record, non-conformity report

System records

Load number, date and time, steriliser, programme, cycle parameters, person responsible, inspection results, LOT numbers of packs and implants, incidents

Procedure workflow

Procedure STD-05 · ASEPSIS — Sterility protocol — is intended for a multi-specialty small animal practice. It covers the organisation of the theatres, preparation of the patient and the team, sterilisation, and an auditable flow of sterile material.

An effective aseptic protocol requires a combination of mechanical monitoring of the cycle, chemical indicators and regular biological monitoring. A chemical indicator confirms that the pack has been exposed to the process, whereas a biological indicator is the method that directly assesses how effectively resistant micro-organisms are destroyed.

Rules that apply

The operating theatres have separate purposes, e.g. a theatre for clean/elective procedures and a theatre for infected or dirty procedures, or those with a high risk of contamination.

Staff, patients, instruments and waste move in one direction only: dirty material → washing and decontamination → packing → sterilisation → sterile storage → operating theatre. Dirty material must not cross paths with clean or sterile material.

Airlocks serve to limit uncontrolled movement between the general area, the clean area and the operating area. The theatre door should be kept closed during a procedure.

Every sterile pack must be traceable: contents, date, load number, steriliser/programme, the person who packed it, chemical indicator and release-for-use status.

An instrument, pack or implant without confirmed sterility status is treated as non-sterile.

Every breach of asepsis is an event that requires immediate action, an entry in the records and a risk assessment by the surgeon.

Zones and flow of materials

DirtyPurpose: Receiving instruments after a procedure, sorting, initial decontamination, washingRequirements: Personal protection, sharps containers, no clean or sterile material

CleanPurpose: Drying, inspection, maintenance, assembling sets and packingRequirements: Clean work surfaces, a separate place for washed material, checking that sets are complete

Sterilisation roomPurpose: Loading, sterilisation, cooling and release of the loadRequirements: Log of parameters, separation of loads awaiting release from released ones, checking of indicators

Sterile storePurpose: Storage of released packsRequirements: Dry, clean, no crushing or moisture; the “first in, first out” rule

Operating theatrePurpose: Performing proceduresRequirements: Controlled movement, only materials released for use, ongoing maintenance of asepsis

Infected / dirty theatrePurpose: Contaminated or infected proceduresRequirements: A separate schedule, dedicated equipment or full decontamination after use

Sequence

Preparing the operating theatre

Check cleanliness: surfaces, floor, table, lights, anaesthetic machineAvailability of disinfectants, personal protective equipment and sterile setsCheck the electrocautery unit: cables, pedal, electrode, neutral plateOrganic soiling removed before disinfection

Preparing the team

Only essential staff in the theatreClean surgical clothing, cap, mask, footwearSurgical hand scrub/disinfection, sterile gown and glovesChange gloves after perforation or soiling

Preparing the patient

Confirm identity, procedure and side in line with STD-03Clipping close to the time of the procedure, without skin traumaPreparing the field with an antiseptic, allowing it to dry before drapingPositioning without the field touching non-sterile surfaces

Receiving and using sterile material

Check the packaging: integrity, moisture, label, chemical indicatorA doubtful pack = non-sterile, to be reprocessedOpened by a non-sterile person, keeping to the boundary of the fieldMaterial under constant observation once opened

Maintaining asepsis during the procedure

Only sterile instruments and materialsSurfaces below waist level or outside the field = non-sterileImmediate replacement in case of a breach, with documentationChange gloves and instruments when moving from dirty → clean

After the procedure

Securing the instruments, transport in a closed containerSafe transport of sharp instrumentsDisposal of waste in line with the procedureCleaning and disinfecting the theatre between patients, entry in the inspection record

Washing, decontamination and inspection of instruments

Decontamination and washing before sterilisationPersonal protective equipment appropriate to the riskRinsing, drying, function check: box locks, joints, bladesDamaged instruments withdrawn from use

Packing and labelling

Sets appropriate to the type of procedureLabel: name, date, person packing, load number, indicatorAn internal chemical indicator in every packNo overloading of packs or of the steriliser

Sterilisation and release of the load

Sterilisation according to the manufacturer's instructions and an approved programmeRecording: date, device, programme, parameters, inspection resultCooling and drying before movingRelease of the load only after the status has been confirmed

Biological monitoring and action in case of non-conformity

Biological test at least once a week and after incidentsA positive/inconclusive result = critical non-conformitySteriliser taken out of use immediatelyReturn to service after the cause has been removed and a test has passed

The procedure describes the practice's standard of care; the details of the assessment of a particular patient are decided by the lead veterinarian.

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