Ch 13 OR

Question 1

5 principles of conduct in an OR

Answer 1

Sharing goals
Having clear roles
Mutual trust
Effective communication
Agreeing with measurable processes and outcomes

Question 2

surgical briefing and debriefing?

Answer 2

Sign-In - Confirm patient, consent, procedues and site
Briefing - Safety checks, steps of procedure, specific measures (ABx)
Sign-Out - Name of procedure, swab count, sharps count, confirm samples to be submitted
Debriefing - Review the procedure, any near-misses, if any different steps should have been taken, disclose the patient plan

Question 3

What benefits are provided by a surgical checklist?

5

Answer 3

Decrease intra-op surgeon delay >80%

Improve patient surgical outcomes

Decrease intra-op adverse effects

Decrease post-op mortality

Overall reduction in hospital mortality

Question 4

What is the recommended way for sterile team members to change position?

Answer 4

Back-to-back or face-to-face with adequate space between them

Question 5

What is the recommended ventilation within an OR?

Answer 5

Horizontal, laminar air flow
Minimum of 15 air exchanges per hour with a minimun 20% outdoor air
30-60% humidity
Temperature 20-23C
Laminar airflow has been associated with a 61% decrease in room bacteria and 92% decrease at the wound site compared to conventional ventilation

Question 6

Define surgical asepsis

Answer 6

Complete absense of contamination by pathogenic organisms

Question 7

Define antiseptic and disinfectant

Answer 7

Antiseptic - prevents or reduces the growth or action of pathogenic organisms on living tissue Alcohols, Iodine

Disinfectant - Agents, usually chemical, that destroy most pathogenic organisms but not spores on inanimate objects. (Quaternarium ammonium compounts, phenols, chlorine and compounds)

Question 8

What are the properties of an ideal drape?

Answer 8

Blood and fluid resistant
Lint free
Anti-static
Able to maintain an isothermic environment

Question 9

What is the recommended gold-standard hand prep?

Answer 9

Well-formulated waterless hydroalcohol solutions

Question 10

List the benefits of disposable gowns

Answer 10

less permeable to bacteria
More economical
Decrease surgical infection rate

Bacteria have been found to easily penetrate reusuable woven gowns within 30min

Question 11

What are the three options for gloving?

Answer 11

Closed
Open
Assisted

Assited gloving it the most sterile way. Closed and open gloving have been shown to cause contamination of the gown, particularly of the cuff, in 100% of cases compared to 0% with assisted

Question 12

Influence of closed glove exchange on bacterial
contamination of the hands of the surgical team
Biehl 2022

Answer 12

Prospective experimental study.
Sample population: Surgical teams participating in 65 individual surgical
procedures were included, resulting in 200 individual enrollments.

Conclusion: Closed glove exchange did not increase bacterial hand contamination over baseline levels.

Question 13

Comparative antimicrobial efficacy of 4 surgical hand-preparation procedures prior to application of an
alcohol-based hand rub in veterinary students
Viljoen 2021

Answer 13

To determine the influence of skin preparations before application
of an alcohol-based hand rub
Clinical prospective study.
Sample population: Veterinary students

the participants of groups that performed a hand preparation had lower total CFUs than those that did not perform a hand preparation (P = .001)

Surgeons should wash their hands prior to ABHR

Question 14

Comparison of hydroalcoholic rubbing and conventional
chlorhexidine scrubbing for aseptic skin preparation in dogs
Asimus 2019

Answer 14

Study design: Experimental study.
Animals: Healthy dogs (n = 6) with no clinical signs of skin disease.

(1) 5 scrubbings with chlorhexidine gluconate and rinsing (CHXG),
(2) washing with mild soap prior to 3 rubbings with hydroalcoholic solution (soap-
HAR), or (3) 3 rubbings with hydroalcoholic solution (HAR

Rubbing with hydroalcoholic (HA) solution was as effective as CHXG

currently no known resistance to HA

Question 15

Preoperative skin asepsis protocols using chlorhexidine
versus povidone-iodine in veterinary surgery:
A systematic review and meta-analysis
Marchionatti 2022

Answer 15

This study showed that asepsis protocols using chlorhexidine
were comparable to povidone-iodine in preventing postoperative SSI and
reducing skin bacterial colonization.

Insufficient information and detail were frequent among studies and precluded a clear assessment of bias.

Question 16

Knowledge and attitudes towards surgical safety checklists: a survey of veterinary professionals
. Davidow

Answer 16

(66%) believed the checklist had prevented an error or complication.

Implementation of an SSC in an academic teaching hospital decreased
the odds of perioperative and postoperative surgical complications

Question 17

Conclusion: Trainee surgeons did not have greater intraoperative delays.
Delays were created when surgeons prepared their own instrumentation.
Workflow differed between experts and trainees.
Clinical significance: Advancing a trainee surgeon into the primary role is
unlikely to increase intraoperative delays, which can be reduced by the
inclusion of trained scrub technicians. A focus on efficient hemostasis and
fluidity when suturing may improve operative efficiency for surgical
trainees.

Question 18

Surgical site infection-inflammation in dogs draped with a single-layer Kraton elastic seal extremity drape for stifle surgery
Morgera 2022

Answer 18

elective orthopedic surgery of the stifle after draping with a single-layer Kraton elastic seal patient drape or conventional double-layer drapes.
Study design: Prospective clinical trial.
Sample population: A total of 789 dogs.

No difference in postoperative infection-inflammation was
detected

Question 19

Evaluation of Surgical Gown Cuff Contamination During Orthopaedic Surgery in a Veterinary Teaching Hospital
Brand 2023

Answer 19

determine the frequency of positive
cultures of the surgical gown cuffs among scrubbed personnel prior to

41.6%) cultures were positive Staphylococcus, Corynebacterium and
Streptococcus.
Using multivariable logistic regression models, humidity and the number of
individuals scrubbed had a significant effect on the likelihood of positive culture after surgery.

Question 20

Pre-surgical hand preparation in veterinary
practice

KR Crosse

3 x vet studies: incidence
of glove perforation by end 23.3% (Character et al. 2003), 26.2%
(Hayes et al. 2014) and 17.9% (Biermann et al. 2018).

Answer 20

Staphylococcus pseudintermedius is now identified in recent studies as the most common isolate from canine SSI (Nazarali) can be isolated from veterinarians themselves

A deep sink that reduces splashing, hands-free tap systems and generous space outside a thoroughfare

o Initial scrub times of 10 minutes or longer were reduced to 5 minutes when equal efficacy was demonstrated.
o alcohol-based scrub solutions has shown that scrub times of 2 minutes, or even 1.5 minutes, can be as effective as traditional 3 or 5 minute scrubs, depending on the agent used.

Question 21

goal of surgical hand srub

Answer 21

1. eliminate transient flora
2. reduce the resident flora at the start of each procedure
3. prevent bacterial growth on the hands for the timespan of the procedure.

World Health Organisation > hands
should be washed in soap and the subungual area cleaned with a nail pick

ABR
ethanol-based rubs have a good
chance of equivalence to 60% propanol (European standard solution) if the concentration is >75% but <95%
CHG component may be
inactivated by emollients or thickeners

Question 22

alcohol based rubs

Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, cost etc.
Most from human medical facilities, extrapolation of the data to veterinary surgery is appropriate

Answer 22

Learnt from the published data > commercial ABR are well tolerated and as effective as a CHG scrub regarding
1. immediate reduction of bacterial numbers
2. persistent effects.

Across a wide range of products, there are conflicting results in the literature
An ABR (61% ethyl alcohol with
1% CHG) showed an immediate reduction in cfu that
was not different compared to that of a CHG scrub,
but after 2 hours significantly less cfu were present in
the ABR group (Edwards et al. 2017).

VET study: comparing CHG, PI and ABR, > PI significantly less effective at reducing cfu on hands than CHG (Verwilghen et al. 2011b). All these studies used bacterial culture to quantify cfu on participants’ hands as a
proxy for the actual outcome measure of effectiveness, namely SSI.

Question 23

• Alcohols

Answer 23

o bactericidal activity but have variable efficacy against viruses and are generally ineffective against spores

o denaturing proteins

 most effective concentration is reported to be 60% to 70%

Question 24

o iodine-containing compounds

Answer 24

o Iodine, in its active forms, has rapid efficacy in killing bacteria, spores, viruses, and fungi
o activity is decreased in the presence of organic debris and blood

Question 25

• Chlorhexidine

scrub formulations are recommended to be 2.0% to 4.0%,

Answer 25

o not considered to be sporicidal at normal temperatures, although sporicidal activity has been reported at higher temperatures (60° to 70° C)
o variable efficacy against viruses and fungi

at higher concentrations, it has a bactericidal effect caused by coagulation of cellular contents

Question 26

PREPARATION OF THE PATIENT

studies have shown differing levels of microbe reduction with various protocols, very few have documented any associated effect on infection rate

Answer 26

o Approximately 20% of the skin flora remains protected in deeper layers and follicles, no matter which protocol is chosen

o Contact times can vary from as little as 30 seconds with some chlorhexidine-alcohol preparations to 2 minutes with povidone-iodine