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63 Cards in this Set
- Front
- Back
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What is the definition of asepsis?
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The absence of pathogenic microbes in living tissue
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What are 3 things that can happen if asepsis is not maintained?
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1) Bacterial contamination
2) Bacterial colonization 3) Infection |
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What is the definition of aseptic technique?
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The methods and practices that prevent cross contamination in surgery
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What are the 4 components of an aseptic technique?
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1) Facilities and environment
2) Surgical site 3) Surgical team 4) Surgical equipment/instruments |
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What is the definition of sterilization?
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Process of killing all microorganisms with the use of physical or chemical agents
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What are 2 agents used for sterilization?
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1) Physical agents
-Steam under pressure -Dry heat -Gamma radiation 2) Chemical agents -Gas sterilization -2% glutaraldehyde |
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What is the definition of disinfectant?
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A disinfectant is a chemical that kill microorganisms on inanimate objects
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What is the definition of antiseptic?
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A chemical that kills or inhibits the growth of pathogenic microorganisms when in contact w/ them
-Typically applied to body -Can be a diluted disinfectant |
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**What concentration of chlorhexidine do you want to use for surgical preparation? why?
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<0.05% because can delay wound healing
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What concentration of providone-iodine do we want to use?
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<1%, above this get wound healing delay
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What are 3 reasons to use dilute antiseptic agents?
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1) Skin irritation
2) Wound healing delay 3) Severe irritation of serosal surfaces -Want greater dilution for serosal surfaces |
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What is a bacteriostatic antimicrobial?
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Inhibits bacterial growth
-Bacteriocidal: kills bacteria |
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What are 6 ways to maintain surgical facilities?
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1) Clean or superficially after each procedure
-Clean more thoroughly and disinfect after each contaminated procedure 2) Clean and disinfect or thoroughly daily 3) Keep cleaning supplies very clean 4) Check +/- change air filters weekly 5) Only admit personnel dressed in surgical attire 6) Quality control of proper maintenance -Environmental cultures |
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What are 3 methods of steam sterilization of instruments?
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1) Gravity displacement autoclaves
2) Prevacuum autoclaves 3) Steam pulsing autoclaves |
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How do gravity displacement autoclaves work?
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Steam is introduced under pressure into the top of chamber
-Steam "floats" on denser air, compressing it to the bottom until it has replaced all of the air |
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How do prevacuum autoclaves work?
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-Air is pumped out of chamber
-Steam is injected into vacuum in chamber -faster -Can do "flashing" of instruments |
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How do steam pulsing autoclaves work?
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STeam pulse increases pressure in chamber, valve opens, air escapes, next pulse follows
-Slower than prevacuum systems, but faster than gravity displacement systems |
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Why is it important to wrap instruments/materials in permeable materials when autoclaving?
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Because steam works on contact
-Cotton muslin -Crepe papers |
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How do you place bowls in the autoclave? Why?
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Face down
-Avoid trapping air in them |
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How should you position linen packs in the autoclave? Instrument packs?
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So layers are vertical
-Steam does not penetrate linen very well -Instrument packs are position vertically -Leave small space b/w each |
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What is the temperature and time necessary for sterilization of instruments/materials?
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13 minutes at 120 degrees C
-Account for ramp-up time and cool down time |
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What are 2 types of indicators used during sterilization?
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1) Chemical indicators
-Autoclave tape -Indicates conditions for sterilization have been met -Most common method 2) Biological indicators -Cumbersome but more precise -spores subjected to sterilization then cultured -Growth=failure of sterilization |
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What are 2 chemicals used for sterilization?
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1) Ethylene oxide
2) Plasma gas sterilizers |
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What are the warnings when using ethylene oxide for chemical sterilization?
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Toxic, flammable, explosive!
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What is the advantage of ethylene oxide chemical sterilization? Disadvantage?
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Takes longer depending on temperature
Can be used on temperature sensitive materials |
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What do you have to do after performing chemical sterilization using ethylene oxide?
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NEED to be aerated (up to 15 days for implants!)
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What are the side effects of ethylene oxide?
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Causes irritation of skin, mucous membranes, nausea, vomiting, mental disorientation
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Ethylene oxide is incompatible with items sterilized previously by _______.
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Radiation (formation of highly toxic ethylene chlorohydrin)
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What is a plasma gas sterilizer (chemical sterilization)? How does it work?
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H2O2 excited by electric charge
-Creates free-radicals that are cytotoxic to bacteria -Plasma gas=a cloud of free radicals |
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What materials are sterilized using plasma gas sterilizers?
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Metallic and rubberized materials
Porous materials |
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What is an advantage of plasma gas sterilizers compared to ethylene oxide?
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75 minute cycle w/ no aeration required
Low toxicity |
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What is cold sterilization?
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Soaking instruments in disinfectant solutions
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What is a disinfectant used for cold sterilization?
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Glutaraldehyde (Cidex)
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What are 3 reasons to use glutaraldehyde for cold sterilization?
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1) Broad spectrum of activity
2) Not as toxic as formaldehyde 3) Time depends on formulation (20-45 m) |
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What is meant by selection of the surgical patient?
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Identify risk factors for infection of the surgical site
-Only possible through complete signalment, history, PE, minimum lab data -Recent steroid use? antimicrobial use? remote infection? chronic health problems |
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What are 5 components of patient surgical preparation?
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1) Correct physiologic abnormalities
-IV fluids for dehydration -Electrolytes -Nutritional support 2) Antibiotic prophylaxis 3) Pre-emptive pain medication 4) Vaccinations (tetanus) 5) Withholding feed for 12 hours (for 24 h + 12 h water in ruminants) |
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When is the leg hang used for surgical preparation?
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Primarily for orthopedic procedures
-From IV pole or ceiling -Wrap paw w/ latex glove and tape |
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What is the primary soruce of pathogens? How can we prevent contamination?
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The patient! Groom/bathe the whole patient
-Know skin flora of different species!! |
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What clipper blade should be used to prep a surgical site?
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#40 blade (+/- shaving)
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How far around the "true" surgical field should be prepped?
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10 cm (~4'')
-Do outside OR -Do not do prior to induction-increases risk of infections -Avoid trauma to skin |
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What should be used for a rough prep?
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Betadine or chlorheixdine and alcohol (70%)
-Do outside OR -Remove dirt, oil, non-resident skin flora -Alternate detergents and alcohol -Rough prep is done when alcohol sponges come off clean -Scrub ~ 5-10 min |
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What is the general rule for scrubbing a surgical site?
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Wipe only from the cleanest area towards the dirty area
-Prevents you from tracking dirt into the surgical field |
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What is the pattern for prepping a square, flat surgical field?
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Start in the center, where the incision is going to be, move outward in eccentric circles until you touch unclipped area
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How do you prep the surgical site on the distal leg that is suspended?
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Start at location of incision, prep whole circumference of leg, then move up or down in a zigzag pattern
-Make sure not to let anything run down the leg into the area of the incision |
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What kind of material do surgical drapes need to be?
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Water repellent or resistant
-Prevents bacteria from obtaining access to the surface of the drape |
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Where should drapes be applied when performing surgery?
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All visible surfaces of the patient
-Prevents aerosolization of debris from the patient's body -Do not leave too much skin exposed |
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When applying a drape where should your hands be located?
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On the side of the drape away from the animal's body
-Curl in the drapes outer surface around your hands |
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How should you position a surgical drape?
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Position the edge close to the incision first, then move it away from the incision to desired position. NEVER MOVE THE DRAPE TOWARDS THE INCISION
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What surgical drapes should be used for a square surgical field?
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4 quarter drapes, secured w/ 4 (+) clamps
-Large fenestrated drape, secured over top of the 4 previous towel clamps |
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What surgical drapes should be used for a distal limb?
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-Cover foot w/ sterile glove/vet wrap
-Use a drape circumferentially around upper limb -Place 2nd layer on each of the above |
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When should you double-glove?
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When draping
-Take off outer gloves when done -Keep inner gloves sterile |
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A naked person sheds _____-_____ microbes/ minute.
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1,000-10,000
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When should you cover your scrubs?
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When leaving the operating room
-lab coat or coveralls |
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Why is it so important to use caps/headcovers and cover all hair?
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Hair harbors staph aureus, e. coli and streps
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When do shoe covers decrease bacterial counts?
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If trousers are tucked into booties
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Why do we wear masks in surgery?
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Do not decrease bacterial counts
-But decrease aerosol contamination of surgical site -Saliva is aerosolized when speaking |
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What is "scrubbing in"?
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Skin preparation
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What are 3 reasons to scrub in?
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1) Remove dirt & oil from skin
2) Reduce transient bacterial counts to 0 3) Significantly repress resident mcirobes |
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How long do you scrub hands and forearms when scrubbing in for surgery? What do you use?
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> 5mins
-Use Chlorhexidine or povidone-iodine |
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What is the proper way to flush (rinse) your hands and arms when scrubbing in?
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Always have water flow from fingertips to elbow, never from elbow to fingertips
-Hold your hands up in front of you as if you want to catch a basketball that is about to hit your chest |
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What is the pattern that should be used during the 5-10 minutes of scrubbing in?
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Left thumb, left index, left middle finger, left ring finger, left pinky, left palm, left lateral side of hand, left dorsum of hand
-Right thumb, right index, right middle finger, right ring finger, right pinky, right palm, right lateral side of hand, right dorsum of hand -Left forearm (excluding elbow!) -Right forearm (excluding elbow!) And repeat! |
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How should you dry off your forearms when scrubbing in?
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Go from wrist towards elbow in little zigzag motions, but never from elbow towards wrist
-DO NOT touch your own skin with your hand- always have the towel b/w hand and skin of forearm |
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What are the 7 Halstead's Principles?
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1) Gentle tissue handling
2) Preservation of vascular supply 3) Removal of necrotic tissue 4) Accurate hemostasis -Precise limited use of electrosurgery & ligatures 5) Anatomic tissue approximation w/o tension 6) Obliteration of dead space 7) Strict aseptic technique |
