topic 4

Question 1

what are the categories of surgical instruments

Answer 1

-scalpel blade
-scissors
-needle holders
-forcepts: thumb, haemostatic, tissue

Question 2

what is the most common size of scalpel blade

Answer 2

3, #4

Question 3

function of scalpel handle

Answer 3

to hold the scalpel blade

Question 4

function of scalpel blade

Answer 4

best instrument for incising tissues with minimal trauma

Question 5

what are the different types of scissors and their functions

Answer 5

-straight scissors
-curved scissors
-mayo scissors (curved/ straight) (very strong, cutting connective tissue and fascia)
-metzenbaum scissors (curved/straight) (cutting delicate tissue and blunt tissue disection)
-suture scissors (cut sutures during suture removal)
-bandage scissors (for bandage removal)

Question 6

what are the different type of needle holder and their function

Answer 6

-mayo-hegar
-olsen0hegar (with cutting blade)
function: used to grasp needle while suturing tissues

Question 7

types of haemostatic forceps and function

Answer 7

mosquito haemostatic forceps (small: used for crushing small blood vessels with precion, not as effective for large vessels)
crile forceps, kelly forceps (contains transverse teeth onlt on the distal end of the jaw, used for crushing small to medium vessels )

Question 8

types and function of tissue forceps

Answer 8

-allis tissue forceps (extremely traumatic- used on fscial planes and connective tissues only)
doyen forceps (for gastric and intestinal syrgeries)

Question 9

what are the different thumb forceps and what is their function

Answer 9

adson forceps (plain/rat tooth): provides gentle grasp of tissue and used to manipulate soft tissue during surgery
/dabakey forceps : provides delicate grasp of soft tiisues while minimising tissue damage

Question 10

what material is surgical instrement made of and why is that important

Answer 10

made out of stainless steel: rust resistant and maintains a keen edge, can use- last long time

Question 11

describe instrument care (cleaning)

Answer 11

All instruments should be handled gently and delicate
instruments should be separated from the general
instruments before cleaning.
* Multi-component instruments should be disassembled prior
to cleaning. (eg cautery, edoc
* Power equipment should be cleaned separately to ensure
that water does not get inside the components.
* Immediately after use, instruments should be rinsed with
cold water to prevent blood and organic debris from drying
in the serrations, hinges, box locks, or ratchets.
* Each instrument is scrubbed with a soft brush in warm water
with a neutral pH detergent.
Abrasive cleaning agents should never be used.
* Saline solutions are corrosive to stainless steel, so
instruments should be rinsed with deionised or distilled
water.
* Some hospitals have ultrasonic cleaners which clean the
instruments in places the brush cannot reach

Question 12

Describe the general principles of surgical asepsis

Answer 12

Dermal integrity is disrupted, microorganisms have access to tissue
beneath the skin
* Bacteria contaminating surgical wounds originate from the patient’s
endogenous flora, operating room personnel, and environment. (where the bac come from)
* Prevention of wound contamination is achieved by following the rules of
surgical asepsis
* Breaking the rules subjects our patients to the risk of infection or disease (slower wound healing)

Question 13

what are the different methods of steralisation

Answer 13

heat sterilisation: steam under pressure (autoclave) steam under pressure (horizontal f=downward displacement autoclave
dry heat
cold sterlisation (delicate/autoclave not free): ethylene oxide
irradiation

Question 14

describe how steam under pressure works (autoclave)

Answer 14

most widely used
benefits: most economical (can reuse)
ertical pressure cooker
 Operates by boiling water in a closed
container
 Air vent at the top
 Disadvantage is the danger that some air
will be trapped underneath the steam (May not be able to reach instruments)
 Manually operated

Horizontal downward displacement autoclave
 Larger and fully automatic
 Electrically operated boiler that is
incorporated in the autoclave as a source of
steam
 Air is driven out more efficiently by
downward placement
 Air outlet at the bottom, steam outlet at the
top
 Designed for loose instrument rather than
packs

Vacuum-assisted autoclave (porous load)
 High-vacuum pump to evacuate air rapidly from
the chamber at the beginning of the cycle11
 Steam penetration after evacuation is almost
instantaneous, sterilization occurs quickly
 Second vacuum cycle rapidly withdraws
moisture after sterilization and dries the load
 All types of instruments, drapes and equipment 11
 Choice of cycles

Question 15

describe dry heat steralisation

Answer 15

Dry heat (oven)
* Oxidative destruction of bacterial protoplasm
* 150 to 180 degrees C
* Range of equipment sterilized is restricted (may be too hot for some)
* Hot-air oven, high-vacuum oven, convection
oven

Question 16

describe how cold sterliasation takes place (instruments get submerged in)

Answer 16

Ethylene oxide: for instruments that is more delicate, nto appropriate to place in autoclave/autoclave is being used and need instrument asap)
adnvantage: Highly penetrating and effective method
disadvantage: Toxic, irritant to tissue and very inflammable gas
* Inactivates DNA of the cells, preventing cell reproduction
* Effective against vegetative bacteria, fungi, viruses and spores

Commercially produced solutions
* Gluteraldehyde, alcohol-based solutions, iodine, chlorhexidine, peroxides
* Disinfection
* Surgical equipment which may not be sterilized by other means
* Endoscopic and arthroscopy equipment (eg, more fragile)
* Discarded after use

Irradiation
* Gamma irradiation (cold deralation because it doesnt use heat)
* Pre-packaged items are sterilized by this method

Question 17

Factors affecting the efficiency of sterilisation

Answer 17

Contact between the sterilizing agent and the object being sterilized
* Presence of organic matter around organisms
* Length of exposure to agent
* Concentration of sterilizing agent
* Temperature and humidity (refering to autoclave, automated)
* State of the micro-organisms

Question 18

an ideal surgical suite should consist of the following areas

Answer 18

preperation room (dirty area)
Scrub room (mixed area)
* Operating theatre (clean area)
* Sterile supply area
* Recovery area

Question 19

what happens in the preperation room

Answer 19

Induction of patient, as well as preparation of the patient ( give anisthetic frug, intubation, clipping of fur)

Question 20

what is/ happening in the scrub room

Answer 20

Preparation of surgeon
* Separate from the operating theatre, as scrubbing generates
water-borne aerosol contaminants
* Scrub sinks
* Bench top
(sink has foot pedal so no need to touch)

Question 21

what haooens in surgical theater

Answer 21

Surgical procedures only
* Restricted to appropriately
dressed personnel (grown, mask, gloves)
* Preferably only 1 door
* Controlled filtered air supply to
provide fresh air

Question 22

what is the sterile supply area

Answer 22

Cleaning contaminated equipment and setting up sterile
supplies for surgery
* Cleaning equipment, autoclaves, storage shelves
* Adjacent to operating theatre

Question 23

what haooens in recovery room

Answer 23

Quiet, warm room (faster recovery)
* Near the centre of activity (Anything happen eg post op conm, can see)

Question 24

difference between steralisation and disinfection

Answer 24

steralisation: destruction of all microorganisms and spores
disinfections: removal of microorganisms but not necessary spores (cannot use disinfected surgical instruments under skin)

Question 25

what is Disinfectant

Answer 25

Agent that destroys microorganism

Question 26

Antisepsis

Answer 26

Destruction or inhibition of microorganisms on animate (living) objects

Question 27

Asepsis

Answer 27

Freedom from infection

Question 28

Antiseptic

Answer 28

An agent used to kill microorganisms  Usually in the form of a solution Definitions

Question 29

Cleaning

Answer 29

Physical decontamination of objects/surfaces – Removes soil, particulate matter and large numbers of microorganisms – Pre-requisite to disinfection or sterilization – Suitable for surfaces and non-critical items

Question 30

Aseptic technique

Answer 30

Methods and practices that prevent cross contamination in surgery

Question 31

example of disinfectant and antiseptic

Answer 31

disinfectant: alcohol antiseptic: chlorhexidine

Question 32

rules of asepric tecnique and their reason Surgical team members remain within the sterile area

Answer 32

Movement out of the sterile area may encourage cross contamination

Question 33

Talking is kept to a minimum

Answer 33

talking releases moisture droplets laden with bacteria.

Question 34

Movement in the operating room (or) by all personnel is kept to a minimum; only necessary personnel should enter the operating room

Answer 34

Movement in the OR may encourage turbulent airflow and result in cross contamination (think swirl around mix with other shit instead of flowing out of theater)

Question 35

Non- scrubbed personnel do not reach over sterile fields. Dust, lint, or other vehicles of bacterial contamination may fall on the sterile field. The rules of aseptic technique

Answer 35

Dust, lint, or other vehicles of bacterial contamination may fall on the sterile field.

Question 36

Scrubbed team members face each other and the sterile field at all times

Answer 36

A team member’s back is not considered sterile even if wearing a wraparound gown

Question 37

Scrubbed personnel handle only sterile items; non- scrubbed personnel handle only non- sterile items

Answer 37

Non- scrubbed personnel and non- sterile items may be a source of cross contaminatio

Question 38

If the sterility of an item is questioned, it is considered contaminated.

Answer 38

Non- sterile, contaminated equipment may be a source of cross contamination

Question 39

Sterile tables are only sterile at table height.

Answer 39

Items hanging over the table edge are considered non- sterile

Question 40

Gowns are sterile from midchest to waist and from gloved hand to 2 inches above the elbo

Answer 40

The back of the gown is not considered sterile even if it is a wraparound gown.

Question 41

Drapes covering instrument tables or the patient should be moisture proof.

Answer 41

Moisture carries bacteria from a non- sterile surface to a sterile surface

Question 42

f a sterile object touches the sealing edge of the pouch that holds it during opening, it is considered contaminated

Answer 42

Once opened, sealed edges of pouches are not sterile.

Question 43

Sterile items within a damage or wet wrapper are considered contaminated.

Answer 43

Contamination can occur from perforated wrappers or from strike- through from moisture transport

Question 44

Hands may not be folded into axillary region; rather, they are clasped in front of the body above the wais

Answer 44

The axillary region of the gown is not considered sterile

Question 45

If the surgical team begins the surgery seated, they should remain seated until the surgery has been completed

Answer 45

The surgical field is sterile only from table height to the chest; movement from sitting to standing during the surgery may increase cross contamination.

Question 46

what happens during pre- opperative phase

Answer 46

sterlaisation of instruments preperation of surgical facilities

Question 47

what happens durin peri operative pahse

Answer 47

PPE required (surgical suit, heat covers, shoe covers, face mask) * Surgical hand scrub * Patient surgical site preparation

Question 48

what to take note when performing surgical scrubbing

Answer 48

Methodical - ensuring all surfaces of the hand and forearm have sufficient contact time with the antiseptic agent. 2. Scrubbing method should not be too vigorous - As use of stiff brushes may disturb the resident bacteria in the hair follicle resulting to increase in the surface bacterial count (bacterial come out from underneath hair follicles)

Question 49

what are the two main methods of surgical hand scrub

Answer 49

Block or counted brush stroke method * – Each surface of each finger, hand, wrist and forearm is washed with pre- determined number of brush strokes 2. Anatomic timed method – Hand washing proceeds for a pre-determined period of time (5-7 mins) by a clock

Question 50

what happens during patient preparation of surgical site

Answer 50

Prepared in the preparation room after induction, just prior to surgery * Hair removal and skin disinfection reduces the number of surface bacteria * Some patients may require bathing if gross contamination is eviden

Question 51

how to perform hair clipping

Answer 51

Clipping should be done as gently as possible * Clipped area should extend about 15 cm each side of the proposed skin incision * For limbs, should extend around the circumference of the limb * Hair is initially shaved in same direction as hair growth * Final surgical clip - Hair is shaved against the direction of hair growth to achieve the closest possible shav Once complete, a vacuum cleaner is used to eliminate loose hairs on the skin * Areas which are not clipped, e.g. paws, should be isolated from the surgical field by impermeable draping material, or enclosed in a latex glove secured by adhesive tape * For orchiectomy of cats, scrotal hair is plucked rather than clipped

Question 52

how to scrub surgical site

Answer 52

Personnel performing the skin prep should wear gloves or use gauze holding forceps -scrub (chlorohexidine) rinse( alcohol) repeat under gauze is clean -final paint: final coat of antiseptic sol applied after the last sept 2 and after transfering to teatre (chlorhexadine in spray bottle)

Question 53

what are used to isolate the surgical site

Answer 53

-fenestrated drap (pre cut) -plain drape

Question 54

what happens during intra operative phase

Answer 54

-ppe required -sterile surgical feild

Question 55

Rules of the surgical theatre

Answer 55

AIl personnel must know what are the ‘sterile’ items and what are ‘non-sterile’ * ‘Sterile’ persons to touch only ‘sterile’ items and vice versa * ‘Sterile’ members to face each other and the ‘sterile’ field. * ‘Non-sterile’ members should not reach over the ‘sterile’ field Do not talk unless necessary * Restrict movements or do not move around the room or enter and leave the room unless necessary * Avoid sneezing and coughing * Do not leave sterile fields unattended * If the sterility of a surgical equipment is questioned, it is considered ‘contaminated’ Rules of the surgical theatre

Question 56

what happens during post opp phase

Answer 56

Clean only around surgical incision with dilute chlorhexidine. Do not use alcohol. * Adequate clean bedding must be provided at the recovery room. * Bandages, catheters, and drains must be regularly maintained and changed for comfort and cleanliness * If a patient is chewing at the bandage or plaster cast, use an Elizabethan collar to restrain it

Question 57

qhat are the four phases in surgery

Answer 57

– Pre- operative (preparing) – Peri- operative (preparing patient) – Intra- operative (surgery) – Post- operativ (after care)