Aseptic Technique and Surgical Site Infection

Question 1

Sources of Microbial Contamination

Endogenous

Answer 1

From the patient

Normal flora

skin

GI tract

Lower Urinary tract

Upper respiratory

Infection

Question 2

Sources of Microbial contamination

Exogenous

Answer 2

From the Environment

Room air

Clippers

Surgical team

Instruments / drapes

Diagnostic / therapeutic devices

Implants

Question 3

What is Aseptic Technique?

Answer 3

Minimize the risk of infection by reducing or eliminating environmental factors, treatment factors, patient factors and pathogen factors

Question 4

Draping

Answer 4

Isolates the surgical site / personnel from contaminated areas

provides sterile working area

Question 5

Asepticd Technique

Answer 5

A combination of practices used to eliminate mircroorganisms within an operative field

Question 6

Sterillization

Answer 6

process of destroying ALL microorganisms on an object

Question 7

Antibiotics

Answer 7

Chemical substance that alter microbial activity in the patient

Question 8

Is surgery inherently sterile?

Answer 8

NO

Question 9

Why is surgery not inherently sterile?

Answer 9

Because it is impossible to sterilize biological tissues and approximately 20% of bacteria remain on the skin of the patient and surgical personnel

Question 10

4 risk factors that contribute to an infection

Answer 10

environment

Treatment

Patient

Pathogen

Question 11

Environmental Factors

Answer 11

Microbial organisms encountered during surgery can come from endogenous or exogenous sources

Question 12

Endogenous

Answer 12

that the microorganisms are found on the patient

normal flora

Question 13

Common commensal organisms of the skin

Answer 13

Staphylococcus and Streptocococus

Question 14

Common Commensal organisms of hte Upper GI tract

Answer 14

Mostly Gram + cocci

Question 15

Common commensal organisms of the Lower GI (colon)

Answer 15

Anaerobes and gram negative bacilli

Question 16

Common commensal organisms of the Genitourinary

Answer 16

Gram negative bacilli

Question 17

Exogenous

Answer 17

Microorgansisms are form sources surrounding the patient

Question 18

Aseptic technique is used to?

Answer 18

reduce the NUMBERS of microorgansisms (endogenous/exogenous) within the surgical field

Question 19

Patient Preparation

Answer 19

is performed to reduce exogenous bacteria ont he patient’s skin and or mucus membranes that will be in the surgical field

Question 20

Order of patient prep

Answer 20

Anesthesia, Clip the hair, Dirty prep, Move to OR, Final prep, quadrant draping, Patient drape

Question 21

Dirty Prep

Answer 21

Performed after clipping using one or more antiseptic solutions

Remove oils, dirt, and other debris fromt he skin and to begin to decrease microbial numbers

Question 22

Final Prep

Answer 22

should be done using sterile equipment

Gloves, gauze, Bowls, antiseptic solution

Three alternating scrubs using sterile guaze soaked in chlorhexidine scrub, and sterile gauze soaked in isopropyl alcohol

Question 23

Clamps used for quadrant drapes

Answer 23

Penetrating (bakhause) towel clamps

Question 24

Clamps used for patient drape

Answer 24

Non-penetrating (edna) towel clamps

Question 25

Preparing the equipment

Answer 25

Make sure the instruments are clean - no blood or gross debris Equipment must be wrapped Sterilization

Question 26

Treatment factors

Answer 26

factors related to the surgical procedure being performed

Question 27

Treatment factor Drains

Answer 27

MINOR

Question 28

Treatment factor Peri-operative hypothermia / hypotension

Answer 28

MINOR

Question 29

Treatment Factor Blood Loss

Answer 29

MINOR

Question 30

Treatment Factor Placing a permanent implant

Answer 30

MAJOR

Question 31

Treatment Factor Duration of anesthesia and Surgery

Answer 31

MINOR Surgery times \>90mins have increased risk of infection

Question 32

Patient factors

Answer 32

Intrinsic propterties or comorbid conditions that put patients at an increased risk for infection

Question 33

Patient Factor Sex

Answer 33

MINOR males are at a higer risk

Question 34

Patient Factor Age

Answer 34

MINOR very young and very old are at a higher risk for infection

Question 35

Patient Factor Endocrinopathies

Answer 35

MINOR - if controlled MAJOR - if uncontrolled

Question 36

Patient Factor Immunosuppression

Answer 36

MAJOR

Question 37

Patient Factor Obesity or Malnutition

Answer 37

MINOR

Question 38

Patient Factor Recent Surgery

Answer 38

MAJOR

Question 39

Patient Factor Prior Irradiation

Answer 39

MAJOR

Question 40

Patient Factor Pyoderma or other infections

Answer 40

MAJOR

Question 41

Pathogen Factors

Answer 41

Factors related ot these bacteria and include the type of bacteria, the number, and the virulence of the bacteria

Question 42

Wound Classificiation: Clean

Answer 42

Surgical incision NOT entering the respiratory, GI, genitourinary, or oropharyngeal tracts Clean wounds have 2 - 4.9% infection rate

Question 43

Wound Classification Clean - Contaminated

Answer 43

Surgical incisions entering the respiratory, GI, Gentiourinary, Oropharyngeal tracts OR a clean surgery where a drain is placed Clean-Contaminated wounds have a 3.5-4.5% infection rate

Question 44

Wound Classification: Contaminated

Answer 44

Surgical incisions with major break in asepsis ro spillage of GI content/infected urine or wounds with no necrosis or purulent discharge Contaminated wounds have 4.6-9.1% infection rate

Question 45

Wound classification: Dirty

Answer 45

Surgical insicions with fecal contamination, a previously perforates viscus, or entering into an infected area (abscess) OR wounds with necrosis, purulent discharge, or foreign material Dirty wounds have a 6.7-17.8% infection rate