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Flashcards in Aseptic technique Deck (66):
1

Asepsis (definition)

absence of microbes

2

Sterile (definition)

absence of living microorganisms (inanimate objects)

3

Surgically clean (definition)

destruction of all accessible microorganisms on the surface (living organisms=our patients)

4

contaminated (definition)

a surface or structure where microorganisms are present

5

What is considered a surgical site infection? (SSI)

infection from a surgical incision within 30 days of surgery

6

What is considered a surgical site infection if an implant was used?

1 year

7

What is the most common hospital acquired infection?

surgical infections

8

What are the possible consequences of surgical infections?

1. cost
2. morbidity
3. mortality--euthaniasia from cost

9

What can be sources of microbes for surgical site infection?

1. environment
2. patient
3. surgeon
4. surgical site--traumatic wound

10

What can be sources of microbes for surgical site infection?

1. environment
2. patient
3. surgeon
4. surgical site--traumatic wound

11

What are three ways to design the operating room to reduce infection risk?

1. clean, mixed and contaminated areas
2. designed OR for contaminated vs clean procedures
3. positive airflow--air flows from OR to corridors

12

What is the operating room cleaning protocol?

1. clean after each procedure and at start and end of the day
2. walls and tables easy to clean

13

Why should you limit traffic and personnel in the OR?

because +1 person =30% more infections

14

What are 5 methods of sterilization?

1. steam sterilization
2. gas (ethylene oxide)
3. plasma (H2O2) sterilization
4.

15

What are 5 methods of sterilization?

1. steam sterilization
2. gas (ethylene oxide)
3. plasma (H2O2) sterilization
4. ionizing radiation
5. cold chemical

16

How does steam sterilization work?

1. autoclave
2. steam under pressure 121 degrees for 15-30 minutes
3. coagulates proteins

17

What does steam sterilization (autoclave)

1. cleans instruments
2. correct packing, wrapping
3. proper positioning in unit

18

How does gas (ethylene oxide) sterilization work?

1. kills microbes by alkylation

19

How does gas (ethylene oxide) sterilization work?

1. kills microbes by alkylation of proteins

20

What is gas sterilization used for?

heat and moisture sensitive equipment

21

What are disadvantages of gas sterilization?

1. flammable, explosive gas
2. very toxic to personnel if exposed
3. long sterilization cycle
4. needs aeration before use

22

How does cold sterilization work?

1. glutaraldehyde used
2. submerge for 10-12 hours

23

What is cold chemical sterilization used for?

equipment sensitive to heat that can be submerged

24

Why must equipment that is cold sterilized be rinsed well?

it is irritating

25

What are disadvantages of cold chemical sterilization?

1. takes a long time
2. adverse health effects (resp, dermal)
3. do NOT use for any major procedure. will get infection. avoid if can

26

How do we know sterilization worked?

1. CLEAN instruments
2. chemical indicators BOT autoclave tape AND indicator strips
3. biological indicators: nonpathogenic spores (bacillus)--no growth

27

What are 6 general patient factors that influence surgery site infection

1. disease status (ASA classification)
2. nutritional status
3. age, gender? (male>female)
4. distant infection
5. very dirty-->bath and allow to dry
6. duration of hospitalization

28

What are 6 general patient factors that influence surgery site infection

1. disease status (ASA classification)
2. nutritional status
3. age, gender? (male>female)
4. distant infection
5. very dirty-->bath and allow to dry
6. duration of hospitalization

29

What are anesthesia patient factors that affect surgical site infection?

1. ASA classification
2. hypotension (perfusion)
3. peri-operative hypothermia (pefusion)
4. anesthetic drugs--older; propofol--lipid substrate--contaminated
5. total anesthesia time--immune function compromized

30

How much does risk of infection go up every hour the animal is under anesthesia

30%

31

What is the patient infection rate with clean wounds (surgical incision)?

2.5%

32

What is the patient infection rate with clean contaminated wounds (surgical incision into viscous organ)

4.5%

33

What is the patient infection rate with contaminated wounds?

7.3%

34

What is the patient infection rate with infected wounds?

18.1%

35

What is overall infection rate of wounds

5.1%

36

What is overall infection rate of wounds

5.1%

37

What are the recommendations for clipping hair?

1. use #40, wide clip NOT razor
2. wide clip
3. AFTER anesthesia induced
4. avoid paws if can

38

What is the goal of skin preparation?

1. remove dirt
2. reduce resident microbial count
3. inhibit rapid rebound growth of microbes

39

What antiseptics should be used in skin preparation

1. alcohol + chlorhexidine
(chlorhexidine > povidone iodine)

40

What is the minimum contact time for antiseptics?

3 minutes

41

Why does chlorhexidine have residual activity?

1. binds to keratin

42

Why does chlorhexidine have residual activity?

1. binds to keratin

43

What is the technique for skin preparation?

1. sterile prep--sterile gloves
2. use dominant hand to prep, other hand to pick up
3. circular pattern
4. don't go back to middle with same sponge
5. don't scrub too hard (skin abrasions)

44

What is the goal of draping the patient?

create a barrier to prevent spread of microbes from the patient to the surgical site/surgeon

45

What thread count of cloth is an effective barrier?

270 IF DRY (can deteriorate with age)

46

Why is important that drapes be dry?

if water can get though then bacteria can too

47

What is an alternative to cloth drapes

synthetic polymers

48

What is the technique of placing surgical drapes?

1. use four drapes, place on clipped area
3. secure with towel clamps
2. single large drape to cover the entire patient and table

49

What 3 things should you NOT do when placing drapes?

1. do NOT readjust the drapes once placed
2. do NOT reuse the towel clamps
3. do NOT use a penetrating towel clamp on the final drape into the patient--can create a route that bacteria can get in

50

What 3 things should you NOT do when placing drapes?

1. do NOT readjust the drapes once placed
2. do NOT reuse the towel clamps
3. do NOT use a penetrating towel clamp on the final drape into the patient--can create a route that bacteria can get in

51

Why is surgeon preparation important?

to minimize contamination of patient by surgeon

52

What is proper surgical attire?

1. dedicated surgical scrubs
2. surgical caps that cover all hair, NOT cloth
3. mask--new each surgery
4. shoe cover/booties or dedicated OR shoes

53

What do surgical gowns provide in terms of protection?

a WATERPROOF impermeable barrier

54

Why is it a problem if cuffs get wet?

they are contaminated

55

Is there a difference between paper and treated cloth as to which you should use?

no, as long as waterproof

56

What percent of gloves have holes before wearing?

1.5%

57

Up to how many gloves have holes by the end of surgery and which hand is more common?

1. 26%
2. nondominant common

58

Why are hydrogel gloves better than powder gloves?

because powders cause inflammation (granulomatous)

59

Why are hydrogel gloves better than powder gloves?

because powders cause inflammation (granulomatous)

60

What are 5 surgical techniques that decrease the likelihood of infection?

1. strict asepsis
2. tissue trauma
3. amount of hemorrhage
4. dead space
5. surgical time

61

How much does infection rate increase for each hour of surgery?

it doubles

62

In which surgeries should you use prophylactic antibiotics?

1. strong risk of infection
2. long surgeries >90 minutes
3. infection is catastrophic (implant)

63

What are the most common microbes that infect surgical sites?

1. staph (on skin)
2. e. coli

64

What are the most common group of antimicrobials used in prophylaxis for surgery?

cephalosporins

65

What are the 3 principles of prophylactic antibiotic administration?

1. high tissue levels at time of incision (IV, at time of anesthesia)
2. repeat every 90 minutes
3. stop when skin closed

66

Does it help if you give antibiotics for more than 24 hours?

no it increases infection