General (ABs, suture, sterilization) Flashcards Preview

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Flashcards in General (ABs, suture, sterilization) Deck (94):
1

MOA Triclosan

diphenyl ether; MOA microbial cell wall disruption

2

MOA Iodophors

 Per Tob ch 14, MOA involves disordering protein structure, blocking protein synthesis and altering the cell membrane; Per Fossum 4th ed, MOA iodination and oxidation of essential molecules; Penetration of the cell wall and oxidation and replacement of intracellular molecules with free iodine.  Iodophores are solutions of iodine with a surfactant or stabilizing agent that liberates free iodine.

3

Spectrum of Povidone Iodine; and at what concentrations are they lethal to fibroblasts?

One of the most common iodophors. Rapid efficacy in killing bacteria, spores, viruses and fungi -  broad spectrum - lethal to canine fibroblasts at concentrations a 0.5% or greater, but concentrations of 1% or greater are necessary for bactericidal activity. Concentrations of 0.001% maintained bacterial toxicity while sparing human fibroblasts

4

MOA Chlorhexidine

       Cationic bisbiguanide chlorhexidine commonly used in chlorhexidine gluconate (scrub) or chlorhexidine diacetate (solution). Bacteriostatic at lower concentrations by interfering with the cell membrane and causing leakage of intracellular contents.   At higher concentraions- a bactericidal effect. Surgical scrub formulations are recommended 2% to 4%, whereas wound treatment formulations are normally .05% or less -       

5

MOA Alcohols

Bactericidal effects; denaturation, metabolic interruption, and cell lysis 
 - most effective concentration reported to be 60% to 70% - Isopropyl alcohol (50-70%) is an alternative to ethyl alcohol (70%) with greater bactericidal efficacy but is less virucidal activity

6

MOA Hexachlorophene

disruption of microbial cell walls and leakage of cell proteins; less effective than iodophors and chlorhexidines and their use is not recommened per Tob ch 14.

7

MOA Phenols

disruption of cell wall and leakage of proteins;                 not discussed in Tob Ch 14

8

MOA Aldehydes (Glutaraldehyde)

protein and nucleic acid alkylation;  less effective than iodophors and chlorhexidines and their use is not recommened per Tob ch 14. 

9

MOA PCMX

acts by microbial cell wall disruption and exzyme inactivation;  less effective than iodophors and chlorhexidines and their use is not recommened per Tob ch 14. 

10

The current literature strongly suggests that CHG is superior to PVI for preoperative antisepsis for patients. One study found a greater than ___% reduction in total surgical site infection among patients undergoing clean-contaminated surgery who had received a single chlorhexidine-alcohol scrub (Darouiche et al, 2010)

 

40%

11

How much skin contact time do Iodophors require to allow release of free iodine?

2 minutes

12

What condition has been reported after contact of chlorhexidine wth the eye?

corneal edema

13

What 4 factors affect ethylene oxide activity?

1 - gas concentration   2 - temperature    3 - exposure time   4 - humidity

14

What affect does ethylene oxide gas concentration have on exposure time?

double concentraion, decrease time by half

15

What affect does temperature have on ethylene oxide activity?

activity doubles with every 10 degree Celcius increase

16

What affect does ethylene oxide activity have on exposure time?

48 minutes to several hours

17

Optimum humidity for ethylene oxide sterilization?

optimum 40% (to 80%, minimum is 35%)

18

EtO gas concentration

450 - 1200 mg/L

19

EtO temperature

84 - 149 degrees F

20

EtO humidity

45% to 85%

21

EtO time

2 - 5 hours followed by aeration

22

What does increasing the temperature do to the sterilization time?

Increasing the temperature to 55C reduces the exposure time to 4 hours or less

23

What is another technique to address sterilization of heat-sensitive items?

Ozone sterilization

24

MOA Ozone sterilization

ozone molocule O3 readily oxidizes other molecules to cause destruction of microorganisms - advantage : lack of toxic residues

25

MOA Plasma Sterilization

uses electromagnetic energy to create a plasma phase from a vapor of hydrogen peroxide, oxygen, or peracetic acid/hydrogen peroxide mixture - contain free radicals that deactivate cellular process

26

What are plasma sterilizers useful for?

moisture or heat sensitive items

27

Advantage of plasma sterilizers

short cycle time, ability to sterilize a wide range of heat or moisture sensitive items.  lack of environmentally toxic residues

28

What is the most commonly used cold sterilization chemical?

Glutaraldehyde

29

What does Gluteraldehyde do?

efficacy against bacterial spores with prolonged exposure

30

What liquid chemical germicide is superior to Gluteraldehyde?

ortho-phthaladehyde (OPA)

31

What makes OPA (Cidex) superior as a liquid chemical germicide?

less irritating and more efficacios without requiring pH adjustment

32

What is the advantage/disadvantage of peracetic acid as a liquid chemical germicide?

good antimocrobial efficacy and breaks down into environmentally inert products, however it has a short shelf life of 6 days and expensive

33

MOA Steam Sterilization

kills micro-organisms through cooagulation and denaturazation of proteins by moist heat

34

What's the most common type of Autoclave in verterinary practice?

gravity-displacement sterilizer, where steam is introduced under pressure

35

What are the general guidlines for flash sterilization of metallic nonporous items in a gravity-displacement autoclave?

include 3 minutes of exposure time at 135C with 1 minute of drying time

36

What is the composition of surgical gut (plain)?

intestinal serosa/submucosa

37

What is the composition of surgical gut (chromic)?

intestinal serosa/submucosa

38

What is the composition of Vicryl?

Ployglactin 910

39

What is the composition of Vicryl Rapide?

Polyglactin 910

40

What is the composition of Polysorb?

Lactomer (glycolide/lactide co-polymer)

41

What is the composition of Dexon "S"?

Polyglycolic acid

42

What is the composition of Caprosyn?

Polyglytone (glycolide, caprolactone, trimethylene, carbonate and lactide)

43

What is the composition of Monocryl?

Poliglecaprone 25

44

What is the composition of Biosyn?
 

Glycomer 631

45

What is the composition of PDS II?

Polydioanone

46

What is the composition of Maxon?

Polyglyconate

47

Which common absorbable sutures have a twisted configuration?

Surgical gut (plain), surgical gut (chromic)

48

Which common absorbable sutures have a braided configuration?
 

Vicryl, Vicryl Rapide, Polysorb, Dexon "S", Dexon Plus

49

Which common absorbable sutures have a monofilament configuration?
 

Caprosyn, Monocryl, Biosyn, PDS II, Maxon

50

What is the tensile strength of Surgical Gut (plain)?

+(0% at 2-3 wk)

51

What is the tensile strength of Surgical Gut (chomic)?

+(0% at 2-3 wk)

52

What is the tensile strength of Vicryl?

+++(50% at 2-3 wk)

53

What is the tensile strength of Vicry Rapide?

+(0% at 2-3 wk)

54

What is the tensile strength of Polysorb?

+++(80% at 2wk, 30% at 3wk)

55

What is the tensile strength of Dexon "S"?

+++(50% at 2-3wk)

56

What is the tensile strength of Dexon Plus?

+++(50% at 2-3 wk)

57

What is the tensile strength of Caprosyn?

+(0% at 2-3 wk)

58

What is the tensile strength of Monocryl?

+++(50% at 1-2wk)

59

What is the tensile strength of PDS II?

++++(50% at 5-6 wk)

60

What is the tensile strength of Biosyn?

+++(50% at 2-3 wk)

61

What is the tensile strength of Maxon?

++++(50% at 4-5 wk)

62

What is the approximate absorption rate of surgical gut (plain) sutures?

unpredicatble 70 days

63

What is the approximate absorption rate of surgical gut (chromic) sutures?
 

unpredictable - 14-80 days

64

What is the approximate absorption rate of Vicryl sutures?
 

predictable - 56-70 days

65

What is the approximate absorption rate of Vicryl Rapide sutures?
 

predictable - 42 days

66

What is the approximate absorption rate of Polysorb sutures?
 

predictable - 56-70 days

67

What is the approximate absorption rate of Dexon "S" sutures?
 

predictable 90 days

68

What is the approximate absorption rate of Dexon Plus sutures?
 

predictable 90 days

69

What is the approximate absorption rate of Caprosyn sutures?
 

predictable 56 days

70

What is the approximate absorption rate of Monocryl sutures?
 

predictable 119 days

71

What is the approximate absorption rate of Biosyn sutures?
 

predictable 90-110 days

72

What is the approximate absorption rate of PDS II sutures?
 

predictable 180 days

73

What is the approximate absorption rate of Maxon sutures?
 

predictable 180 days

74

A few studies indicate that chlorhexidine preparations with _______ have improved efficacy compared with saline or aqueous solutions

alcohol
 

75

MOA chlorine compounds (hypochlorite)

release of free chlorine and oxygen; disinfectant used to clean floors & countertops

76

No Q&A here. Newer alcohol -based solutions, which typically combine alcohol with PVI, CHG, or zinc pyrithione, appear to have better antimicrobial activity than PVI, CHG, or alcohol alone and provide a more persistent reduction in the baseline number of bacteria. In human clinical studies, 2% CHG plus alcohol (ChloraPrep; Table 5-1) has frequently shown significantly better residual antimicrobial activity compared with 70% alcohol alone or 2% CHG alone, or a combination of PVI and alcohol.In the aforementioned study, the overall rate of surgical site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P = .004). Chlorhexidine-alcohol was significantly more protective than PVI against superficial incisional infection (4.2% vs. 8.6%; P = .008) and deep incisional infection (1% vs. 3%; P = .05), but not against organ/space infection (4.4% vs. 4.5%). Chlorhexidine-alcohol is recommended by the CDC as the antiseptic of choice to reduce vascular catheter–associated bloodstream infection. As compared with PVI, the chlorhexidine-alcohol solution has been found to reduce catheter-associated infection by approximately 50% (O'Grady et al, 2002).

 

 

Newer alcohol -based solutions, which typically combine alcohol with PVI, CHG, or zinc pyrithione, appear to have better antimicrobial activity than PVI, CHG, or alcohol alone and provide a more persistent reduction in the baseline number of bacteria. In human clinical studies, 2% CHG plus alcohol (ChloraPrep; Table 5-1) has frequently shown significantly better residual antimicrobial activity compared with 70% alcohol alone or 2% CHG alone, or a combination of PVI and alcohol.In the aforementioned study, the overall rate of surgical site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P = .004). Chlorhexidine-alcohol was significantly more protective than PVI against superficial incisional infection (4.2% vs. 8.6%; P = .008) and deep incisional infection (1% vs. 3%; P = .05), but not against organ/space infection (4.4% vs. 4.5%). Chlorhexidine-alcohol is recommended by the CDC as the antiseptic of choice to reduce vascular catheter–associated bloodstream infection. As compared with PVI, the chlorhexidine-alcohol solution has been found to reduce catheter-associated infection by approximately 50% (O'Grady et al, 2002).

 

77

What role does pressure play in steam sterilization?

allows higher temp than othewise would be able to be obtained

(according to Tobias pg 149)

havig - allows steam to reach a higher temp, no direct effect on sterilization 

78

Typical temp and time combo for a gravity-displacement steam sterilzer

121 C(250 F) for 30 minutes (should have 15-30 mins drying time too)

79

Typical temp and time combo for a prevacuum sterilizer

132 C (270 F) for 4 minutes

 

80

Dry heat sterilization time and temps

160 C (320 F) for 120 minutes

81

How does steam sterilization work

Causes death by denaturation and coagulation of critical cellular proteins:  Death has a time-temperature relationship

82

How does dry heat sterilization work?

Kills by oxidation

83

How does EtO sterilize

Alkylation of proteins and nucleic acids = obstruction of metabolism and reproduction

84

How does an ultrasounic cleaner work?

Cavitation: ultrasonics generate minute gas bubbles which expand until they are unstable and collapse creating a small vacuum cleaning the instruments

85

Describe the ideal storage of sterile packs

  • Air flow, temp and humidity are controlled
  • Closed cabinets low traffic area
  • Temp not exceed 24 C (75 F)
  • Humidity not exceed 70%
  • Four air exchanges per hour with positive-pressure airflow

86

How must a sterilized pack be labeled

  • Contents
  • sterilization date
  • expected expiration date (depends on material used and storage)
  • staff member that sterilized

87

Safe storage times for sterilized packs using various wrap materials

See table 12-1 pg 151 to memorize

88

Safe storage times for EtO sterilized items in different wraps

cloth, paper, plastic sealed with tape, heat-sealed plastic

 

  • cloth - 15-30 days
  • paper - 30-60 days
  • plastic tape sealed - 90-100 days
  • plastic heat selaed - 1 year

89

Best indicator for sterilization

Biologic indicators

90

Types of sterilization indicators

Physical, chemical and biologic

91

Describe physical indicator

92

Chemical indicators

React to specific parameters critical to sterilization process, typically a color change.  6 classes, higher class = more specific info

  • 1 = sterilization tape.  Only indicates it was processed, limited proof all parameters met
  • 2 = test for air removal.  Called bowie-dick tests
  • 3 = React to temp or time, not both
  • 4 = Reacts to more than one parameter
  • 5 = React to all parametes important to the specific type of sterilization
  • 6 = Newest class.  Monitors guidelines for a specific condition - prion or particular equipment

1 study found 12% falsely indicated sterilization

93

Recommendation for use of chemical indicator

94

Biologic indicators

Consists of culture of microorganisms that is evaluated post processing to determine viability

  • geobacillus stearothermophilus spores - used for steam, plasma and ozone
  • Bacillus atropheus - used for EtO

Ideally run once a week.  Typically need 16 hours to 7 days of incubation. Rapid action ones can be read in 1 hour