Theatre practice (SA10) Flashcards

1
Q

What is a pathogen?

A
  • Microbes capable of causing disease
  • Virus, bacteria, fungi, etc.
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2
Q

What makes reproductive spores particularly resistant?

A
  • Thick wall
  • Remain viable in unfavourable conditions
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3
Q

What can risks be influenced by in theatre?

A
  • Characteristics of patient
  • Operation
  • Personnel
  • Environment
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4
Q

What reduced the patients ability to withstand infection?

A
  • Disease
  • Stress
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5
Q

Sepsis

A
  • Presence of pathogen or toxic products in blood or tissue of patient
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6
Q

Asepsis

A
  • Freedom from infection
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7
Q

Aseptic technique

A
  • Steps taken to prevent sepsis
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8
Q

Antisepsis

A
  • Prevention of sepsis
  • Destruction or inhibition of microbes
  • Using agent safe for living tissue
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9
Q

Sterilisation

A
  • Destruction of ALL microbes
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10
Q

Exogenous microbes

A
  • Found on outside
  • May include environment
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11
Q

Endogenous microbes

A
  • Originate from within the body
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12
Q

Nosocomial

A
  • Originated from the environment
  • Hospital acquired infection
  • Surgical site infections
  • MRSA
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13
Q

What does MRSA stand for?

A

Methicillin Resistant Staphylococcus Aureus

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14
Q

Do all microbes cause infection?

A

No

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15
Q

Commensal microbes

A
  • Bacteria of skin and nasal passages in humans
  • MRSA
  • Commonly caused during hospitalisation
  • Causes GI disease, septicaemia, skin infections, post-surgical wound infections
  • Less common in animals, interspecies transmission can occur
  • Very resistant to antibiotic therapy
  • High standards of hygiene important to prevent spread
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16
Q

Commensal bacteria

A
  • Live on animals
  • Do not cause harm
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17
Q

Facultative pathogens

A
  • Will cause harm in immunosuppressed
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18
Q

Obligate pathogens

A
  • Will ALWAYS cause disease
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19
Q

Saprophytic bacteria

A
  • Replicate on dead tissue
  • Responsible for decay
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20
Q

What organisms are involved in wound infections

A
  • Staphylococcus
  • Streptococcus
  • Proteus
  • Pseudomonas
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21
Q

What factors affect infection?

A
  • Virulence of bacteria
  • Resistance of the patient, health, disease, age, nutritional status
  • Duration of surgery, infection rates double every hour
  • Technique of surgery
  • Classification/contamination of wound
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22
Q

Virulence of bacteria

A
  • How harmful bacteria is
  • Amount of bacteria entering wound
  • Environment for bacterial growth
  • Poor blood supply
  • Devitalised tissue
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23
Q
  • Sources of contamination in theatre
A
  • Equipment
  • Environment - dust is reservoir of bacteria and contamination
  • Personnel - 62% nasal staph carriers
  • Patient
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24
Q

What may cause surgical infections?

A
  • Primary surgical disease
  • Post-surgical infection
  • Poor theatre list planning
  • Complications with diagnostic support - catheters, drains, etc.
  • Complications unrelated to surgery - infectious or systemic disease
  • Implants - suture material to metal implants/hip replacements
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25
Q

What is the main source of pathogens for surgical site infections?

A
  • Endogenous flora of patients skin, mucous membranes, hollow viscera
  • Excised skin risks exposed tissue
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26
Q

What are the classifications of surgery?

A
  • Clean
  • Clean contaminated
  • Contaminated
  • Dirty
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27
Q

What is a ‘clean’ surgery?

A
  • Typically elective surgery
  • Non-contaminated
  • Non-traumatic
  • Non-inflamed
  • Neuter, routine laparotomy, elective orthopaedic
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28
Q

What is a ‘clean contaminated’ surgery?

A
  • Potential for contamination
  • Involves respiratory, GI or genitourinary system
  • Often hollow organ
  • Enterotomy, enterectomy, cystotomy
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29
Q

What is a ‘contaminated’ surgery?

A
  • Contamination WILL occur
  • Leakage or major break in aseptic technique
  • Enterotomy, enterectomy, cholecystectomy, cystotomy
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30
Q

What is a ‘dirty’ surgery?

A
  • Infection already present
  • Hollow organ rupture
  • Infected surgical site
  • Septic peritonitis
  • Abscess
  • Ruptures GI, gallbladder or pyometra
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31
Q

What order should surgeries be completed in?

A
  • Clean
  • Clean contamination
  • Contaminated
  • Dirty
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32
Q

How are surgical patients classified?

A
  • Elective
  • Urgent
  • Emergency
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33
Q

What constitutes an elective surgical patient?

A
  • Non-urgent
  • Healthy
  • Usually young
  • Routine neutering
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34
Q

What constitutes an urgent surgical patient?

A
  • Necessary
  • Not immediately life-threatening
  • Required propmt care
  • Fracture repair
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35
Q

What constitutes an emergency surgical patient?

A
  • Life threatening
  • Abdominal crisis
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36
Q

Ectomy

A
  • Remove
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37
Q

Otomy

A
  • Temporary incision
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38
Q

Ostomy

A
  • Opening
  • Can be temporary or permanent
  • Stoma = hole
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39
Q

Desis

A
  • Binding together
  • Surgical fixation
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40
Q

Pexy

A
  • Fixation of an organ
  • Surgical suspension
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41
Q

Plasty

A
  • Reconstructive/surgical repair
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42
Q

Gastrotomy

A
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43
Q

What is the prep room used for?

A
  • Induction of anaesthesia
  • Preoperative procedures; clipping, catheter placement, surgical prep
  • Should lead directly into operating theatre
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44
Q

What is the recovery room used for?

A
  • Allow patient to recover
  • Close to operating theatre
  • Quiet, warm, essential emergency equipment
  • Allow for good observation to recover patient
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45
Q

What is the treatment room used for?

A
  • Located off prep room
  • Used for minor procedures
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46
Q

Additional areas/room for theatre suite?

A
  • Washing/sterilising room
  • Sterile storage
  • Scrubbing area
  • Changing room
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47
Q

What different categories of cleaning protocols should be used for theatre suite?

A
  • Daily
  • Weekly
  • Monthly
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48
Q

What should be included in the daily theatre cleaning protocol?

A
  • Floors
  • Waste disposal
  • Surfaces
  • Equipment
  • Tables
  • Lights
  • Scrub sinks
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49
Q

What should be included in the weekly theatre cleaning protocol?

A
  • Thorough deep clean
  • Floor and walls scrubbed
  • Disinfectant not washed off
  • Deep clean all equipment
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50
Q

What should be included in the monthly theatre cleaning protocol?

A
  • All room fittings
  • Vents
51
Q

What is important to consider when designing a theatre suite layout?

A
  • Movement of people through and between zones
52
Q

How should instruments and kits be sterilised and stored?

A
  • Autoclave should not be in theatre
  • Kits stored in cupboards/drawers to prevent dust and damage
53
Q

Why is it important to have non-static materials in theatre?

A
  • Oxygen used
  • Is flammable
  • Oxygen usually colour coded black and yellow
54
Q

What characteristics should walls have to aid in cleaning in theatre?

A
  • Wall covering should be cleanable and waterproof
  • Waterproof paint, plastic cladding
55
Q

What characteristics should doors have in theatre?

A
  • Doors should remain closed, self closing
56
Q

What characteristics should walls have to aid in cleaning in theatre?

A
  • Anti-static, non-slip, smooth floors
  • Some may be bacterial protected
57
Q

What temperature should theatre be set at and how should it be heated?

A
  • 15 - 20 degrees C
  • Prevent patient hypothermia
  • Prevent surgeon hyperthermia
  • Fan heaters distribute dust - don’t use
  • Radiators collect dirt and dust in crevices
58
Q

What is the minimum amount of air changes that should occur in theatre per hour?

A

20

59
Q

What is the most common ventilation type?

A
  • Plenum ventilation
  • Positive pressure - elaborate on!
60
Q

What are most instruments made of?

A
  • Stainless steel
  • Very strong
  • Highly resistant to corrosion
61
Q

Why is tungsten carbide used in some instruments?

A
  • Very hard wearing
  • Expensive
  • Usually have gold handles
62
Q

Why may chromium plated carbon be used in instruments?

A
  • Cheaper
  • Will rust, pit and blunt quickly
63
Q

Why is titanium used in some instruments?

A
  • Opthalmic equipment
  • Titanium is very light, reduces glare from operating microscopes
  • Always clean these separately to avoid damage
  • Lubricate joints regularly
64
Q

What are the 2 tissue forceps?

A
  • Allis tissue
  • Babcock
65
Q

Allis tissue forceps

A
  • Hold or grasp tissue
  • 4-5 teeth
  • Minimal trauma
66
Q

Babcock tissue forceps

A
  • Hold or grasp tissue
  • Triangular tips
  • Minimal trauma
67
Q

What are haemostatic or artery forceps?

A
  • Clamp blood vessels and stop bleeding
  • Many different types
68
Q

What are the different types of artery forceps?

A
  • Spencer wells
  • Mosquito
  • Rochester Pean
  • Kocher
  • Aniotribe
  • Crile
69
Q

Mosquito artery forceps

A
  • Clamp finer blood vessels
  • Common type = Halstead Mosquito
  • Can be straight or curved
  • Fine tipped
70
Q

Rochester Pean artery forceps

A
  • Longer jaws
71
Q

Kocher artery forceps

A
  • Used to grasp
  • Better traction
  • Teeth at tips (rat)
72
Q

Angiotribe artery forceps

A
  • Opposing gooves
  • Used on major arteries during heart surgery
73
Q

Crile artery forceps

A
  • Half serrated, half flat surface
74
Q

What are the 3 types of gloving?

A
  • Open; most common, easy to break sterility
  • Closed; best method
  • Plunge; sterile assistant required for this
75
Q

What should the ambient temperature of the operating theatre be?

A

15 - 20 degrees celsius

76
Q

What are the different types of heating used in theatre?

A
  • Wall mounted radiators; difficult to clean
  • Panel wall heating; expensive
  • Air-con with ventilation; 20 air changes per hour minimum
  • Avoid fan heaters; cause air and dust movement
77
Q

What are the types of theatre trolley?

A
  • Mayo trolley
  • Over the table trolley
  • Tiered trolley
78
Q

What are the uses of tourniquets?

A
  • Improve surgical visibility
  • Control traumatic bleeding
79
Q

How are tourniquets applied?

A
  • Applied at proximal aspect of limb
  • Occludes blood flow to distal limb
  • In emergency more lives are saved than limbs lost
  • Can only be used for 15 minutes
80
Q

What are the uses of the suction unit?

A
  • Aspirate oro/nasopharynx during and after surgery
  • Thoracocentesis after surgery
  • Suction of fluids and blood during surgery
81
Q

What are the different tips available for suction units?

A
  • Allow different levels of suction control
  • Disposable plastic and reusable metal ones
    FRAIZIER
  • Fine delicate suctioning
    YANKAUER
  • Reduce trauma to tissues and access tight spaces
    POOLE
  • Evacuate pooled blood and debris in deep abdominal surgery
82
Q

What are the care and maintenance instructions for suction units?

A
  • All blood and debris removed asap with cold water
  • Use stylet to ensure tip thoroughly cleaned
  • Flush tubing with water under force (syringe)
  • Disinfect tubing and tip
  • Drain and dry thoroughly
  • Sterilise appropriately
83
Q

What are the types of endoscope?

A
  • 2 types of fibre optic endoscopes in practice
  • Different sizes available
    RIGID
  • Diagnostic evaluation of trachea, bronchi, oesophagus, nasal cavities, joints and abdominal cavity
    FLEXIBLE
  • Diagnostic examination of body tracts; respiratory, GI, rectum and colon
84
Q

What is arthroscopy?

A
  • Rigid endoscope of joints
85
Q

What is laparoscopy?

A
  • Rigid endoscopy of abdominal cavity
86
Q

Why is special care needed for fibre optic endoscopes?

A
  • Fibre optic bundles easily damaged
  • More damage; less light transmitted; poorer image
  • Individual broken fibres = black spots on image
87
Q

What are the different metals surgical instruments are made from?

A
  • Stainless steel
  • Austentic
  • Martensitic
  • Chromium-plated carbon steel
  • Tungsten carbide
  • Titanium
88
Q

Stainless steel instruments

A
  • Most popular type in veterinary
  • High resistance to corrosion
  • Great strength
  • Attractive surface finish
89
Q

Austenitic instruments

A
  • Stainless steel
  • Can’t be heat-hardened
  • Non magnetic
  • Resists corrosion better than martensitic
  • Also called 300 series stainless steel
90
Q

Martensitic instruments

A
  • Stainless steel
  • Magnetic
  • Can be heat-hardened
  • Not as corrosion resistant as austenitic
  • Also called 400 series stainless steel
  • Most common stainless steel
91
Q

Chromium-plated carbon steel instruments

A
  • Cheap
  • Commonly used
  • Will rust, pit and blister when contact with chemicals and saline
  • Tend to blunt quickly
92
Q

Tungsten carbide instruments

A
  • Inserts added to tips of stainless steel
  • Used for cutting or gripping (scissors, needle holders)
  • Hard
  • Resistant to wear
  • Expensive
  • Gold handles
  • Avoid contact with benzyl ammonium chloride
93
Q

Titanium instruments

A
  • Ophthalmic surgery
  • Handle delicately
  • Lighter in weight
94
Q

What instruments can and can’t be sharpened?

A
  • Blunt scissors can be sent to manufacturers or instrument sharpening service
  • Drill bits can be but replacements more reliable
  • Oscillating saw blades need replacing
95
Q

How to clean compressed air machines?

A
  • Follow manufacturer guidelines
  • Never immerse in water
  • Never put in ultrasonic
  • Clean all detachable parts (drill, saw, blade)
  • Detach main hand piece from air hose and clean
  • Hand piece and hose attachments should be lubricated
  • Machine reassembled and attach to air supply
  • Run for 30 seconds for oil to circulate and ensure patency before sterilisation
96
Q

External skeletal fixators (Kirschner apparatus) for fracture repair - pins

A
  • Pins placed into bone percurtaneously or through surgical wound
  • Pins placed at 35-40 degree angles to each other
  • At least 2 pins proximal and 2 pins distal
  • Bar pin (intra medullary pin) go through bone vertically)
  • Ellis pin; screw ended and clamps go into or in and out bone
97
Q

External skeletal fixators (Kirschner apparatus) for fracture repair - types

A

TYPE 1
- 1 Bar on outside, pins go into bone
TYPE 2
- 2 bars either side, all pins go through whole bone
MODIFIED 2 (TYPE 3)
- Multiple bars, pins go into and through bone
METHOD DEPENDS ON BONE AND FRACTURE TYPE

98
Q

External skeletal fixators (Kirschner apparatus) for fracture repair - Advantages

A
  • Clamps and bars reusable
  • Easy to remove
  • Minimal disruption to tissue
  • Easily adjustable to alignment
  • Easy to combine with other implants
99
Q

External skeletal fixators (Kirschner apparatus) for fracture repair - reasons for using

A
  • Comminuted fracture
  • Open or infected fracture
  • Skull/mandibular fracture
  • Long bone fractures in young animals to avoid growth plates
  • Immobilisation of a joint
100
Q

What should be removed from a used kit first?

A

Blade

101
Q

Internal fixators - open reduction - uses

A
  • Fracture is unstable
  • Bone not plasterable
  • Comminuted fracture
  • Non reducible (Unstable, can’t move bones without surgery)
102
Q

What is a comminuted fracture?

A

Multiple fractures in bone

103
Q

Internal fixators - open reduction - advantages

A
  • Suitable for any bone
  • Can handle full range of fractures
  • Encourages fracture healing - faster
104
Q

What is the aim of sterilisation?

A
  • Control microorganisms/pathogens in environment
  • Protecting patients and staff from contamination and disease
  • Promoting optimum healing and wellness
105
Q

What is meant by microbial resistance?

A
  • Not all microorganisms are equal
  • Some are more easily destroyed than others
106
Q

What is meant by mode of action?

A

Different physical and chemical methods to destroy or inhibit microorganisms
- Damage to cell walls or membranes
- Interfere with cell enzyme activity
- Destroy microbial cell contents via oxidation, hydrolysis, reduction, coagulation, denaturation or formation of salts

107
Q

What factors affect microbial control method effectiveness?

A
  • Time; minimum effective exposure time
  • Temperature; more effective with temp increase
  • Concentration + preparation; appropriate chemical concentration, adversely effected by mixing
  • Organisms; type, number, stage of growth
  • Surface; physical properties of surface can interfere with activity of chemicals
  • Organic debris; can interfere with control method
  • Application method; appropriate for material being sterilised
108
Q

Sepsis

A

Infection present

109
Q

Sterilisation

A

Destroys all microorganisms, including spores

110
Q

Disinfection

A

Destroys microorganisms but not spores

111
Q

Antisepsis

A

Prevents/fights sepsis (infection)

112
Q

Endogenous

A

Microbe from within or on the body

113
Q

Nosocomial

A

Infection from hospital (MRSA)

114
Q

Exogenous

A

Microbe from outside of the body

115
Q

How is sterilisation divided?

A
  • Heat sterilisation
  • Cold sterilisation
116
Q

What are the different types of heat sterilisation?

A
  • Dry heat
  • Moist heat
117
Q

What is dry heat sterilisation?

A
  • Kills by oxidation of protoplasm
  • High temperatures of 150 - 180 degrees celcius
  • If lower temps, longer times are required (>4-5 hours)
118
Q

What different equipment is used for dry heat?

A
  • Hot air ovens; heat penetration, holding time, safety time
  • High vacuum assisted ovens; vacuum reduces time
  • Convection ovens; Motor circulates hot air for uniform and constant temperature
119
Q

What indicators are used for dry heat?

A
  • Spores test
  • Brownes tube (orange > green)
120
Q

What is moist heat?

A
  • Sterilises by coagulating bacterial protoplasm
  • Steam under pressure gives higher temperature for a more consistent time
121
Q

What equipment is used for moist heat steilisation?

A
  • Vertical pressure cooker;
  • Downwards displacement;
  • Vacuum autoclaves;
122
Q

How do moist heat sterilisation indicators work?

A
123
Q

What are the types of indicators for moist heat sterilisaton?

A
  • Chemical strips;
  • Brownes tubes;
  • Bowie Dick Tape;
  • Spores test;
124
Q
A