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BVetMed3 POS- Principles Of Surgery > Aseptic Technique > Flashcards

Aseptic Technique Flashcards

1
Q

What are the two definitions of a surgical site infection?

A

Infection occurring at the surgical site within 30 to 90 days of surgery

OR

1 year of a surgery involving placement of a permanent implant

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2
Q

What are the three classifications of surgical site infection?

A

Superficial - skin and subcutis

Deep - underlying muscle

Organ/body cavity infections - areas deep in the body entered at the time of surgery

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3
Q

What are potential impacts of superficial/deep surgical site infections?

A

Increased morbidity/illness
Increase hospitalisation time
Increase costs

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4
Q

What are potential impacts of organ/body cavity surgical site infections?

A

Surgery failure

Mortality/death

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5
Q

How can you tell which bacterial species has caused a surgical site infection?

A

Culture

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6
Q

How does surgical site infection occur?

A

Pathogens contaminating the wound at the time of surgery progressing to cause infection

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7
Q

What is meant by the term ‘contamination’ ?

A 
Pathogens:
Present
Not multiplying 
Not affecting healing 
Not causing tissue damage
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8
Q

What is meant by the term: ‘infection’?

A 
Pathogens:
Present
Multiplying
Disrupting healing 
Damaging tissues 
May spread to adjacent tissues 
May cause systemic illness
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9
Q

What is the definition of aseptic technique?

A

Practices and procedures performed under carefully controlled conditions with the goal of minimising CONTAMINATION of surgical sites by pathogens

Reduces risk of surgical site infections

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10
Q

What are the 5 key contributing factors to aseptic technique?

A 
Sterilisation of surgical equipment 
Prepping the patient 
Prepping the surgeon
Correct intra-operative technique
Maintenance and design of the operating theatre
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11
Q

What is the definition of sterilisation?

What is it used on?

A

Complete destruction of microbial viability (bacteria, viruses, fungi, spores)

Inanimate objects ONLY

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12
Q

What is the definition of disinfection?

A

Destruction of PATHOGENIC microbes

May not include all viruses and bacterial spores

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13
Q

What is the definition of cleaning?

When is it used?

A

Physical removal of surface debris

is required prior to sterilisation to prevent inhibition of the sterilisation process

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14
Q

What are the techniques which can be used for sterilisation?

A

Steam sterilisation (autoclave)
Chemical sterilisation
Gamma irradiation
Cold sterilisation

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15
Q

What are the types of chemical sterilisation?

A

Ethylene oxide

Hydrogen peroxide gas plasma

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16
Q

How does steam sterilisation work?

A

Heat kills by desaturation of cellular proteins

Pressure is applied to steam in sealed chamber to increase temperature of steam and make vapour more effective for killing

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17
Q

What type of heat is best for sterilisation?

Why?

A

Moist heat or steam

Lower temperature required
Faster death rate
Less resistance among bacterial spores

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18
Q

What are the pros and cons of steam sterilisation?

A

Economical
Non-toxic

Some delicate items can be damaged by heat or pressure

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19
Q

Why is steam good and air bad?

A

Steam - penetrates porous substances, contacts objects to be sterilised, gives up heat to objects via condensation

Air - inhibits diffusion of steam, decreases temperature of steam

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20
Q

What is the goal of an autoclave?

A

Introduce steam and expel air

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21
Q

How can you arrange instruments and equipment in an autoclave to maximise sterilisation?

A

Arrange to facilitate the movement of steam across instruments

Bowls upside down

Drape folded in a fan

Instrument packs on their side

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22
Q

What are the two types of autoclave?

A

Gravity-displacement autoclave

Pre-vacuum sterilisation

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23
Q

How do gravity-displacement autoclave work?

A

Steam introduced under pressure at top of chamber
Air displaced downwards

Sterilisation - 13mins, 120 degrees

Found in hospitals and bigger practices

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24
Q

How does pre-vacuum sterilisation work?

A

Actively removes air to create a vacuum before introduction of steam

Rapid introduction of steam therefore rapid penetration of instrument packs by steam and FASTER sterilisation (flash sterilisation)

Sterilisation in 3 mins at 131 degrees

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25
Q

Why might a gravity displacement autoclave be used in larger practices even though sterilisation takes longer?

A

Larger chamber so can fit more instruments

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26
Q

Why might you use ethylene oxide to sterilise?

A

Some instruments may be damaged by heat

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27
Q

How does Ethylene oxide sterilise instruments?

How does it compare to steam sterilisation?

A

Destroys all known microorganisms by ALKYLATION

Takes much longer than steam sterilisation, also is TOXIC - must be removed from chamber after sterilisation and aerated for 24h to 12 days!

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28
Q

What is an alternative to ethylene oxide?

How does it work?

Compare the two

A

Hydrogen peroxide gas plasma

DNA damage causes microbial killing

Rapid - 1 hour
Byproducts are non-toxic: oxygen and water
MORE EXPENSIVE

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29
Q

What is gamma irradiation used for?

A

Sterilisation of many pre-packaged items (dressings, suture materials, needles)

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30
Q

How can sterilisation be monitored?

A

Print out which shows temperatures achieved and how long for

Colour change stickers yellow to purple indicates temperature
Stripes from white to black indicates steam

Write DATE of sterilisation and when it will EXPIRE on pack

31
Q

How can sterilised equipment be packed and stored?

How long will it last ?

A

Cotton Muslin and Crepe paper together = 8 weeks

Heat sealed pouches = 1 year

32
Q

How can you elongate the safe storage times for sterilised instruments?

A

longer in CLOSED CABINETS vs open shelves

33
Q

Why might heat sealed pouches be better than cotton muslin and crepe paper?

A

Only need to single wrap
Water resistant
Can be used for steam, EO, and PLASMA(others only steam and EO)
Can see instruments inside

34
Q

What is cold sterilisation?

A

Soaking instruments in disinfectants

35
Q

What is cold sterilisation effective against?

A

Bacteria

MAY NOT DESTROY spores and viruses

36
Q

What instruments are suitable for cold sterilisation

A

Dental and endoscopy equipment

NOT for instruments introduced below the body surface

37
Q

What can be done to prep the patient to minimise risk of surgical site infection?

A

Hair removal

Skin prep

Transfer to theatre, positioning and keeping body warm

Draping

38
Q

What class of chemicals can be used to prepare the skin of a patient for surgery?

What do they do?

A

Antiseptics

Kill or inhibit the growth of pathogenic microbes

39
Q

How can you judge the effectiveness of an antiseptic/.

A

Speed of killing
Persistence - prevention of recolonisation over 6 hours
Residual action - antimicrobial action over 5 days

40
Q

What are the three key antiseptics used in practice?

A

Chlorhexidine gluconate - 4%
Povidone iodine - 10%
Alcohol

41
Q

What is chlorhexidine gluconate effective against?

A

Bacteria (gram -ve more than gram +ve)
Enveloped viruses (e.g. influenza, canine distemper, FIV, FeLV, FIP)
Yeasts

42
Q

What is chlorhexidine gluconate not effective against?

A

Mycobacterium
Protozoa
Fungi (some but not others)

43
Q

Describe the properties of chlorhexidine gluconate.

A

Rapid initial kill - 3 mins for 98%

Good persistent and residual action

Ineffective in the presence of soaps and detergents

Effective in the presence of organic material
MINIMAL SKIN IRRITATION

44
Q

Explain the persistent and residual action of chlorhexidine gluconate.

A

Binds to stratum corneum

45
Q

Where should chlorhexidine gluconate NOT be used?

A

Middle and inner ear, meninges, brain, cornea, conjunctiva

46
Q

What is povidone iodine effective against?

A

Broad spectrum killing

  • bacteria (+ve and -ve)
  • bacterial spores: prolonged contact required
  • enveloped and non enveloped viruses e.g PARVO and CALICIVIRUS
  • yeast, mycobacterium, Protozoa, fungi
47
Q

Describe the properties of povidone iodine.

A

Rapid initial kill - 77% in 3 mins
Good persistent action
NO residual action

Decreased activity in the presence of organic material

ACUTE DERMATITIS in 50% of dogs
Allergic and toxic effects in some people

48
Q

Compare chlorhexidine gluconate and povidone iodine

A

No significant difference in percentage bacterial reduction

Chlorhexidine resulted in fewer positive cultures post scrub

Povidone iodine can cause skin reaction

49
Q

When would povidone iodine be favoured over chlorhexidine gluconate?

Why?

A

Eye surgery
Ear surgery

Contact toxicity of chlorhexidine in these areas

50
Q

What is a 70% alcohol solution effective against?

A

Bacteria (+ve and -Ve)
Mycobacterium
Fungi

51
Q

What are the properties of 70% alcohol solution?

A

Rapid immediate kill

Limited persistent and residual effects

52
Q

What negatives are associated with 70% alcohol solutions?

A

TISSUE NECROSIS if enters open wounds

DEHYDRATION of skin and mucous membranes —> irritation

53
Q

What combinations of antiseptics are used for final prep in theatre?

Why?

A

2% chlorhexidine and 70% isopropyl alcohol

0.7% free iodine + 74% isopropyl alcohol

ADDITIVE EFFECT of 2 antiseptics with different modes of action

54
Q

What brand name is given to the combination of chlorhexidine and isopropyl alcohol?

What is it used for?

A

ChloraPrep

Final prep in theatre

55
Q

What is the goal of hand disinfection?

A

Removal of gross dirt

Reduction in bacterial counts

Continued inhibition of resident/colonising bacteria

56
Q

What is the new alternative to hand scrubbing?

What are the benefits of this?

A

Hand rubbing
- alcohol based hand disinfectants

As efficacious as scrubbing
Reduced abrasions
Reduced bacterial colonisation

57
Q

How do you carry out rubbing?

A
  1. Good hand hygiene - short nails, no jewellery
  2. Wash hands and arms to elbows with pure soap
  3. Apply alcohol based hand rub (STERILIUM) to hands and arms
    - 1 min 30 routine to ensure all surfaces rubbed
    - Air dry hands and arms
58
Q

What are important properties of surgical gowns?

A

Physical barrier
Prevent passage of bacteria
Resistant to passage of blood and other fluids
Should not shed lint

Comfortable

59
Q

Why is it important to disinfect hands before surgery?

A

Incase small holes in gloves

60
Q

What are the aims of peri-operative antibiotics?

A

To prevent bacterial contamination incurred at time of surgery developing into an infection

Need to be effective against bacteria present at the surgical site

61
Q

How and when should perioperative antibiotics be administered?

A

IV
Given 30 minutes prior to first cut
Repeated every 90-120 minutes
Stopped 12-24 hours after surgery

62
Q

What are the contraindications of peri-operative antibiotics?

A

Microbial resistance

Undesirable side effects

Increased costs

63
Q

What should you assess to determine if peri-operative antibiotics are required?

A

Classification of degree of wound contamination

Possible consequences of wound infection

Duration of surgery

Immune function of patient

64
Q

What is a clean surgical wound?

A

Non-traumatic elective procedure

No entry into GIT, urogenital tract or respiratory tract

No break in aseptic technique

65
Q

When would perioperative antibiotics be indicated for a clean surgical wound?

A

Surgeries more than 90 mins

Surgeries where infection would be catastrophic e.g. total hip replacement, pacemaker implantation

66
Q

What is a clean-contaminated surgical wound?

A

Entry into a hollow organ with:
No significant spillage
No significant infection

Clean procedure with minor break in aseptic technique

67
Q

Would perioperative antibiotics be required for a clean contaminated surgical wound?

A

In general, have little effect if short surgery

E.g. neutering, cystotomy in absence of urine infection

68
Q

What is a contaminated surgical wound ?

A

Fresh (less than 6-8 hours) traumatic wound

Spillage from a contaminated hollow organ during surgery

Entry into a hollow organ in the presence of infection
Clean surgery with a major break in aseptic technique

69
Q

Would perioperative antibiotics be indicated for a contaminated surgical wound?

A

Yes

Need to predict of spillage of bacteria likely following entry into a hollow organ

70
Q

What is a dirty surgical wound?

A

Infected surgical site

Purulent discharge encountered

Wound open and untreated for more than 6-8 hours

(E.g. cat bite abscess)

71
Q

Would perioperative antibiotics be indicated for a dirty surgical wound?

A

YES
No longer considered prophylactic

Therapeutic antimicrobial use based on culture and sensitivity testing is required

72
Q

What patient factors make the requirement of perioperative antibiotics more likely?

A

Concurrent active infection at a distant site

Advancing age

Obesity

Endocrinopathies

Immunodeficiencies

73
Q

Why should perioperative antibiotics not be continued into the post operative period?

A

Risk of AMR

BVetMed3 POS- Principles Of Surgery (9 decks)

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