Flashcards in Aseptic Technique Deck (52):
The patient’s normal flora is the most common reservoir for contamination during surgical procedures.
Chlorhexidine gluconate should not be allowed to contact the eye or middle ear.
Povidone-iodine must remain on the skin to be effective.
Hair removal is indicated for all surgical procedures.
F Only if it will obscure field or hinder technique.
The most common resident organisms are coagulase-negative staphylococci, with Staph epidermidis accounting for 60% of resident microbes.
F Over 90%. Rest is true
Anaerobic diphtheroids such as Proprionibacterium acnes are common in lipid-rich locations, such as the pilosebaceous unit.
Gram-negative bacteria are mostly limited to the humid intertriginous areas, with Enterobacter, Klebsiella, E.coli and Proteus spp being the predominant organisms.
The majority of post-operative wound infections are due to transient micro-organisms that contaminate the wound after surgery.
T Mostly due to endogenous flora from patient’s nose, throat, or skin.
S.aureus is the most frequent cause of surgical site infection, followed by coagulase-negative staph, Enterococcus spp., group A strep, and P.aeruginosa.
For surgical procedures, the contact and airborne routes are the most likely means of contamination.
Surgical site infection is defined by the CDC as any surgical wound that produces pus within 10 days of the procedure.
F 30 days.
Wounds are defined as clean if they are elective incisions carried out on non-inflammed tissues under strict aseptic technique and if there is no entry into the GI, respiratory or GU tracts.
Contaminated wounds are those with frank purulent fluid such as an abscess, or perforation of a viscus or faecal contamination.
F This is a dirty wound.
Dirty wounds include those where major breaks in aseptic technique have occurred, or there is inflammation, but no frank purulence encountered.
F This is a contaminated wound.
Biopsies performed in a hospital ward, as opposed to an outpatient setting, have a higher risk for infection.
Longer procedures carry a greater risk of contamination than brief procedures.
The surgical scrub, if performed correctly, can reduce the microbial load by 80% and maintain this reduction for several hours.
F 90-95%. Everything else is true.
Chlorhexidine gluconate is most active against Gram positive bacteria, but also active against Gram negatives and enveloped viruses.
T Poor activity against M.tuberculosis, fair activity against fungi.
Povidone-iodine is most active against Gram positive bacteria, but also active against Gram negative bacteria, M.tuberculosis, fungi and enveloped viruses.
Povidone-iodine must be lest on the skin to have a persistent effect
Chronic maternal use of povidone –iodine have been associated with hyperthyroidism in newborns
Both chlorhexidine and povidone-iodine have relatively slow onset of action.
F Both fast.
Chlorhexidine glucondate has the fastest onset
F 60-95% alcohols do
A caution of 60-95% alcohols is their flammability
Repeated use of chlorhexidine gluconate has an additive effect.
Repeated use of povidone-iodine has a additive effect.
Alcohols (60-90%) may be used as an antiseptic and have the fastest onset of action.
T Need to use liberal amount and allow to dry.
Alcohol is rapidly germicidal but once evaporated it does not have significant residual activity
CHG and alcohol containing preparations should be avoided in the periocular area
Chlorhexidine gluconate binds to the stratum corneum and maintains residual activity in excess of 6 hours, even when wiped from the field.
Povidone-iodine is quickly inactivated in the presence of blood or sputum.
PI is safe to use in the periocular area
F Must be half strength (5%)
Chlorhexidine gluconate is quickly inactivated in the presence of blood or sputum.
The mixture of alcohol and chlorhexidine gluconate achieves better antiseptic than either agent alone.
Studies have shown a clear relationship between bacterial contamination of the surgical field and the volume at which the surgeon speaks.
Povidone-iodine has excellent sustained activity, even after wiped from the skin
F Intermediate to minimal if wiped from skin
Chlorhexidine gluconte and PI, but not parachlorometaxylenol cover gram negative organisms
F - all do
In dermatologic surgery, gloves become perforated in approximately 1% of procedures.
Hands should always be washed after removing surgical gloves.
T Surgeon only notices 17% glove perforations.
Fingernails should be kept short to facilitate cleaning
On the night before surgery, a preoperative shower with chlorhexidine gluconate or povidone-iodine has been shown to decrease wound infection rates.
There is convincing scientific data to show that wearing scrubs rather than street clothes affects the incidence of infection
F There is no data
There is conflicting data regarding the ability of face masks to reduce infection
If repeated application of antiseptic preparations is expected (eg. during Mohs), it is not necessary to use the same agent for each consecutive application.
F Should try to use the same, since some antiseptic agents are mutually inactivating.
Autoclaving generates pressures of 2 Pascals and temperatures of 121C that must be maintained for 15-30 mins.
A potential limitation to autoclave sterilisation is that repeated exposures to high humidity may dull sharp cutting surfaces.
The surgical hand scrub should be at least 2 minutes.
For most dermatological surgery a formal surgical scrub is not generally considered necessary
Excessive thermal destruction of tissue is not associated with an increased risk for infection.
Should it be necessary to cough or sneeze while wearing a face mask, you should step backwards and turn away from the surgical field
F Should face the surgical field
Hair should always be removed before surgical procedures
F Only if it will obscure the surgical field or hinder properly surgical technique