Pote - Basic Surgical Techniques - Chapter 3

Front 1

What is an operation?

Back 1

All such diagnostic or therapeutic interventions, in which we disrupt the body integrity or reconstruct the continuity of the tissues are called operations.

Front 2

Types of operations

Back 2

- bloodless operations

- bloody operations

Front 3

Types of operating theatres

Back 3

Septic and aseptic

Front 4

In septic operating theatre...

Back 4

..the infected parts of the body are operated.

eg. infected purulent wounds

Front 5

In aseptic operating theatre...

Back 5

..the danger of bacterial infection does not usually exist.

eg. varicectomy

Front 6

Can septic and aseptic operating rooms have a common corridor?

Back 6

Yes, its the preparing of the surgical area which is important.

Front 7

What should you do before you enter the operating room?

Back 7

Before entering into the operating room, you should change your dresses in the dressing (or locker) room (of the operating complex) and wear the surgical cap and the facemask.

Front 8

Characteristics of the operating theatre

(size, walls, ventilation, doors, equipments)

Back 8

- size: 50-70 m2

- no windows (usually)

- walls covered with tiles up to the ceiling

- easily cleaned

- architecturally separate from wards and intensive care unit

- doors should work automatically

- equipped with central and portable vacuum system and pipes for gases

Front 9

The operating complex consists of:

Back 9

- locker rooms (dressing rooms)

- scrub-up area

- preparing rooms

- opearting theatres.

Front 10

Main layout of operating theatre (figure)

Back 10

Front 11

Rules in the operating theatre (6)

Back 11

1. Only those people whose presence is absolutely neccessary should stay in the operating room.

2. Activity causing superfluous air flow (talking, laughing, and walking around) should beavoided.

3. Entry into the operating theatre is allowed only in operating room attire and shoes wornexclusively in the operating room. This complete change to the garments used in the operatingtheatre should also apply for the patient placed in the holding area (i.e. dressing room).

4. Leaving the operating area in surgical attire is forbidden.

5. The doors of the operating room must be closed.

6. Movement into the operating room out of the holding area is allowed only in a cap and maskcovering the hair, mouth and nose.

Front 12

Taking part in operation is permittted only after...

Back 12

..surgical hand washing and scrubbing

Front 13

Is it allowed to wear jewel, watches or rings in the operation theatre?

Back 13

No, of course not!

Front 14

Can the scrubbed team member ever show their backs to each other?

Back 14

No! Never. They should always face each other. They should always face the the sterile field.

Front 15

How should non-scrubbed personnel act in the operating theatre?

Back 15

Non-scrubbedpersonnel should not come close to the sterile field or the scrubbed sterile person, they should not reach over sterile surfaces, and they should handle only non-sterile instruments.

Front 16

Rules about behaviour and movements in the operating room.

Back 16

- face each other and the sterile territory while turning

- Hands kept within sterile boundary, not touching cap, mask, or nonsterileparts.

- do not stretch out hand to catch falling instruments or picking them up.

- do not take intruments from instrument stand - ask the scrub nurse!!

Front 17

Rules for aseptic operating room

Back 17

- Only sterile personel can touch sterile instruments.

- Instruments located below waist is not considered sterile.

- If you're in doubt, it is NOT sterile.

- A surgical area can never be considered sterile.

- Use your brain :)

Front 18

Asepsis term

Back 18

Includes all those procedures, activities and behaviours designed to keep away the micro-organisms (bacteria, fungi, viruses) from patient’s body and the surgical wound.

Front 19

Purpose of asepsis

Back 19

Prevent the contamination.

Front 20

Ideal state of asepsis

Back 20

When the instruments, the skin, and the surgical territory do not contain microorganisms.

Front 21

Antisepsis term

Back 21

-Includes all those procedures and techniques designed to eliminate contamination (bacterial,viral, fungal) present on objects and skin by means of sterilization and disinfection.

- Wider sense: includes allthose prophylactic procedures designed to ensure surgical asepsis.

Front 22

True or false?
The operating field and the surgeon's hands can be consiered sterile.

Back 22

False

Front 23

What do you have to take into consideration before the operation to prevent wound contamination? (3 things)

Back 23

1. A careful scrub and preparation of the operative site.

2. Knowledge and control of risk factors (e.g. normalization of the serum glucose level in casesof diabetes mellitus, etc.).

3. In septic and high-risk patients, there is a need for perioperative antibiotic prophylaxis.

Front 24

What do you have to take into consideration during the operation to prevent wound contamination? (4 things)

Back 24

1. Appropriate surgical techniques.

2. Change of gloves and rescrub if necessary.

3. Normal body temperature must be maintained. Narcosis may worsen the thermoregulation.Hypothermia and general anesthesia both induce vasodilatation, and thus the core temperaturewill decrease.

4. Proper oxygen tension.

Front 25

What do you have to take into consideration after the operation to prevent wound contamination? (2 things)

Back 25

1. Wound infection generally evolves shortly (within 2 hours) after contamination.

2. Hand washing is mandatory and the use of sterile gloves is compulsory while handling wounddressings and changing bandages during the postoperative period.

Front 26

Whats the difference between sterilization and disinfection?

Back 26

Sterilization: the removal of viable microorganisms (including latent and resting forms such as spores)

Disinfection: reduction of the number of viable microorganisms by destroying or inactivating them.

Front 27

Frequent used methods for sterilization

Back 27

- autoclaves

- gas sterilization by ethylene oxide

- coldsterilization

- irradiation.

Front 28

Frequent used methods for disinfection

Back 28

- low-temperature steam

- chemical disinfectants: (e.g., phenolics,chloride derivatives, alcohols, and quaternary ammonium compounds).

Front 29

What do you sterilize and what do you disinfect?

Back 29

Sterilization: instruments and materials used during operations

Disinfection: Surgical hand scrub and surgical area disinfectioning

Front 30

Whats the aim of scrubbing?

Back 30

Reuce the number of transient and resident bacteria.

Front 31

What is Ahlfeld-Furbinger 2-phase scrub?

Back 31

The one we do in lab. First soap, then disinfectant rubbing 5 * 1 minutes.

Front 32

Which glove do you take on first? And are you allowed to hold inside with the other hand to help?

Back 32

Start with the left hand. You should help with right hand on the inside of glove. NOT the outside.

Then the right hand. Now it's only allowed to help on the outside.

Front 33

Is it proved that bathing lowers germ count of skin?

Back 33

No

Front 34

It's compulsory for the patient taking a bath with what type of soap before the operation? And when should it be done?

Back 34

- antiseptic soap (chlorhexidine or quaternol)

- the evening before

Front 35

When should the shaving of the patient be done?

Back 35

Immediately prior to the operation.

Front 36

Most commonly used disinfectants

Back 36

- 70% isopropanol,

- 0,5% chlorhexidine (a quaternaryammonium compound),

- 70% povidone-iodine.

Front 37

When do you do the disinfectioning and scrubbing of the surgical area?

After ______ and before ______.

Back 37

1. surgical hand scrub, 2. dressing

Front 38

From where do you start the disinfection of the patients skin?

Back 38

Tricky question! it depends :)

Aseptic surgical intervention: you start from planned incision line and moving outwards in a circular motion.

Septic/infected operations: starts from periphery towards planned area of operation

Front 39

Can you return to the area you washed with the same sponge?

Back 39

No!

Front 40

Whats the aim of isolation?

Back 40

To prevent contamination from the patient's skin.

Front 41

How many pieces of isolation sheets are there and what are they made of?

Back 41

4 pieces

- disposable sterile sheet

- nondisposable permeable linen textile

- or paper drape

Front 42

What do you use the 4 isolation sheet for in a general operation?

Back 42

1. Isolate patients legs.

2. Isolate patient's head (fixed to the guard)

3./4. Side-sheets

Front 43

What do you use to fix the isolation sheets?

Back 43

Backhaus towel clips