Sart Exam 3 - Intro To Surgical Principles

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Title: Little Girl in a Blue Armchair
Artist: Mary Cassat

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History of Aseptic Technique

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1840's - Semmelweis (Austria) & Holmes (US)
- indep. demonstrated that simple act of
washing hands in between patients reduced
mortality rates in obstetrical wards
1860's - Pasteur
- developed germ theory of dz
1860's - Lister
- first to apply concept of aseptic tech. to
surgery -> Listerism
- carboxylic acid as an antiseptic
- surgery to repair fractured patella healed w/
out infection

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Asepsis

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-goal of eliminating infection - causing organisms
from surgical environment
-'sterile technique' = aseptic technique
-contamination = intro. of pathogenic organisms

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4 Basic Sources of Bacteria in Surgical Situation

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1. air
2. patient
3. surgeon
4. instruments used by surgeon

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Asepsis: Disinfected/Sterile Area

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-disinfecting field w/chemical solution + manipulating
sterile instruments to avoid touching contaminated
surfaces
-field = surgery site & adjacent area, surgery table,
area where instruments will be places, inside of
laminar flow hood
-requires specialized knowledge & careful attention
to detail
-to prevent contamination, so healing -> w/out
infection

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Asepsis During Procedures

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-contact of sterile surface w/other surfaces avoided
-required for all vertebrate animals to recover
-survival surgery on smaller lab animals performed in
a sanitized lab area, w/appropriate aseptic technique
-dedicated surgery required for non-rodent mammal
-major surgery = entering body cavity or causing
permanent post-surgical disability

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Asepsis: Contamination prevention procedures

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-cleansing & disinfection of operating room
-prep of incision site & draping of animal
-aseptic prep of surgical team
-sterilization of surgical instruments & materials
-prevention also includes responsibility of surgeon
-gentle handling of tissue & proper suturing tech
-'every operation in surgery is an exp. in bacteriology'

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Asepsis: Air

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-operating room or design: low traffic
-ventilation should be controlled
-ideal is filtered laminar flow system
-

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Asepsis: Surfaces

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-easily cleaned
-floors & walls should be non-absorbent

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Asepsis: Surgeon/Personnel

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-numbers should be minimized & behavior controlled
-minimize unnecessary talking & motion
-proper attire:
-clean, but not sterile
-clean scrubs, cap, mask, shoe covers
-sterile
-gloves, gown

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Scrub Technique

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1. 5 min. minimum contact time
2. put on cap, mask, shoe cover - then cover hands &
forearms w/antiseptic soap
3. clean nails carefully
4. scrub w/bristle from fingertips to elbow; fingers =
10 strokes, nails & hands = 20 strokes; arm = 10
5. rinse - hands stay above elbows
6. dry hands & arms w/sterile towel
7. pick up sterile glove on one end w/one hand
8. dry fingers & hand of opp. arm, then elbow
9. unscrubbed assistant opens gown
10. surgeon holds gown at shoulders
11. assistant ties gown
12. put gloves on sterile

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Pre-surgical Care of Patient: Special Care

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Special care aids the well-being of animals &
contributes to success of operation
-food may be w/held before surgery to reduce
chance of vomit during anesthesia
-an enema or laxative will be given, w/food w/holding
to empty the contents of lower intestinal tract to
intestinal surgery
-perform physical exam before surgery
-specimens of bl. & urine may be taken to help
determine animal's state of health

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Pre-surgical Care of Patient: Patient

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-patient should be cleaned/groomed prior
-hair removal concern in vet. surgery
-hair more diff. to clean then skin
-hair in wound delays healing
-hair removed by shaving w/ #40 blade
-patient prep
-clip broad are around site
-scrub w/surgical soap ~5 minutes
-start in center, circle outward
-wipe w/sterile gauze sponges
-can follow scrub w/ 70% ethyl alcohol
-sterile surgical drapes around incision site

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Pre-surgical Care of Patient: Antiseptics

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Chlorohexidine (Nolvansan)
-excellent spectrum of antimicrobial activity
-kills quickly, good residual activity in skin
Iodophore (Betadine) - 'tamed iodine'
-iodine complexed to an organic compound to
minimize toxicity & irritation (povidone iodine)
-excellent spectrum
-kills quickly

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Pre-surgical Care of Patient: Surgical Drapes

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-sterile drapes places around site of incision
-provides sterile field
-diff. materials used: paper, cloth, plastic
-diff. techniques to cover animal

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Maintaining Sterility

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other precautions for maintaining a sterile field are:
-never urn backs on sterile surface
-unsterile area not touched/leaned over
-sterile instruments never below edge of table
-arms & hands stay above waist & below shoulders
-keep sterile surfaces dry
-avoid excessive movement during surgery
-avoid shaking of gowns, towels, drapes
-keep conversation to minimum during surgery
-contamination occurs, step & correct situation

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Sterility

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state in which there are no living microorganisms present

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Asepsis

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state in which the number of disease-producing microorganisms (pathogens) have been greatly reduced

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Antiseptics

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substances that destroy or inhibit growth of microorganisms, but do not sterilize the area, and can be used on living tissue

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Disinfectants

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destroy or inhibit the growth of microorganisms, but do not sterilize, usually damaging to living tissue

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Contamination

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the process by which something is rendered unclean or non-sterile

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Forceps

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-for compressing or grasping tissue
-thumb forceps & hemostats are typical forceps
-hemostats aid in compressing tissue, especially bl.
vessels, to stop bleeding (hemostasis)

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Needle holders

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hemostat-like devices that hold needles used to suture wounds closed

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Needles

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-permanently attached suture material - swaged-on
-tip may be blunt, tapered, sharp, cutting, or some
other configuration

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Scalpel Handle & Blades

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-size 10 blade most popular, 11 has a straight edge &
a sharp point
-size 15 has very small cutting edge, used for fine,
delicate surgery
-size 20 similar to 10, but larger

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Scissors

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-blunt-blunt, blunt-sharp, sharp-sharp
-may also be straight or curved
-some scissors are serrated for cutting thick
bandages or cartilage

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Refractors

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-pull overlying tissue away from surgical site
-hand-held retractors and self-retaining

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Suture Materials

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-thickest suture given number 6
-< 6 = smaller diameter
-sutures having smaller diameter indicated by 0
('aught') smallest suture is designated 12-0
-synthetic = nylon, or natural = silk or gut
-some absorbed by body during healing process;
nylon removed after wound heals, usually 7-10 days

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Gauze Pads

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sponges used for soaking up blood and other fluids from the surgical site

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Cleaning Surgical Instruments

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-manual cleaning
-ultrasonic cleaning
-lubrication
-sterilization of surgical equipment

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Manual Cleaning

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-rinse instruments in cold water
-open all locks & disassemble instruments
-inspect each instrument
-scrub each instrument
-rinse instruments w/hot, clear water
-dry thoroughly before re-packing

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Ultrasonic Cleaning

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-converts high frequency sound waves into
mechanical vibrations
-removes ~90% of dirt & debris but does not sterilize
or eliminate the need for initial removal of blood &
dirt

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Lubrication

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after cleaning, but before autoclaving, use only antimicrobial, water-soluble lubricants

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Sterilization of Surgical Equipment

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-Steam sterilizations under pressure = autoclaving
-chemical sterilization, 'cold' sterilization
-dry heat sterilization in oven or glass bead sterilizer

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Steam Sterilization/Autoclaving

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-standard method
-steam under pressure - reaches high temps &
pressure assures saturation of wrapped surgical
packs
-moist heat more effective mean of killing bacteria,
viruses, fungi & spores than dry heat
-surgical equipment double-wrapped in paper/cloth
& packaged in specially made plastic/paper prior to
autoclaving
-sterility indicators packaged inside
-strips of paper w/chemicals change color
when app. sterilization conditions have been met

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Chemical Sterilization/Cold Sterilization

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-reserved for surgical instruments & other items that
are heat-sensitive & can be immersed in liquid
-glutaraldehyde requires 10 hrs to sterilize
-irritating to tissues, rinse w/sterile saline
-ethylene oxide requires chamber w/vent to outside
-very toxic gas; items must 'air out' for a min. of 24
hours after procedure to prevent exposure
-plasma vapor autoclave utilizes non-toxic hydrogen
peroxide to sterilize heat-sensitive items

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Dry Heat Sterilization

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-in an oven or glass bead sterilizer
-small glass beads are super-heated in a stainless-steel chamber
-instruments sterilized w/in 10 seconds