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63 Cards in this Set

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  • Back
What is the definition of asepsis?
The absence of pathogenic microbes in living tissue
What are 3 things that can happen if asepsis is not maintained?
1) Bacterial contamination
2) Bacterial colonization
3) Infection
What is the definition of aseptic technique?
The methods and practices that prevent cross contamination in surgery
What are the 4 components of an aseptic technique?
1) Facilities and environment
2) Surgical site
3) Surgical team
4) Surgical equipment/instruments
What is the definition of sterilization?
Process of killing all microorganisms with the use of physical or chemical agents
What are 2 agents used for sterilization?
1) Physical agents
-Steam under pressure
-Dry heat
-Gamma radiation
2) Chemical agents
-Gas sterilization
-2% glutaraldehyde
What is the definition of disinfectant?
A disinfectant is a chemical that kill microorganisms on inanimate objects
What is the definition of antiseptic?
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
**What concentration of chlorhexidine do you want to use for surgical preparation? why?
<0.05% because can delay wound healing
What concentration of providone-iodine do we want to use?
<1%, above this get wound healing delay
What are 3 reasons to use dilute antiseptic agents?
1) Skin irritation
2) Wound healing delay
3) Severe irritation of serosal surfaces
-Want greater dilution for serosal surfaces
What is a bacteriostatic antimicrobial?
Inhibits bacterial growth
-Bacteriocidal: kills bacteria
What are 6 ways to maintain surgical facilities?
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
What are 3 methods of steam sterilization of instruments?
1) Gravity displacement autoclaves
2) Prevacuum autoclaves
3) Steam pulsing autoclaves
How do gravity displacement autoclaves work?
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
How do prevacuum autoclaves work?
-Air is pumped out of chamber
-Steam is injected into vacuum in chamber
-Can do "flashing" of instruments
How do steam pulsing autoclaves work?
STeam pulse increases pressure in chamber, valve opens, air escapes, next pulse follows
-Slower than prevacuum systems, but faster than gravity displacement systems
Why is it important to wrap instruments/materials in permeable materials when autoclaving?
Because steam works on contact
-Cotton muslin
-Crepe papers
How do you place bowls in the autoclave? Why?
Face down
-Avoid trapping air in them
How should you position linen packs in the autoclave? Instrument packs?
So layers are vertical
-Steam does not penetrate linen very well
-Instrument packs are position vertically
-Leave small space b/w each
What is the temperature and time necessary for sterilization of instruments/materials?
13 minutes at 120 degrees C
-Account for ramp-up time and cool down time
What are 2 types of indicators used during sterilization?
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
What are 2 chemicals used for sterilization?
1) Ethylene oxide
2) Plasma gas sterilizers
What are the warnings when using ethylene oxide for chemical sterilization?
Toxic, flammable, explosive!
What is the advantage of ethylene oxide chemical sterilization? Disadvantage?
Takes longer depending on temperature
Can be used on temperature sensitive materials
What do you have to do after performing chemical sterilization using ethylene oxide?
NEED to be aerated (up to 15 days for implants!)
What are the side effects of ethylene oxide?
Causes irritation of skin, mucous membranes, nausea, vomiting, mental disorientation
Ethylene oxide is incompatible with items sterilized previously by _______.
Radiation (formation of highly toxic ethylene chlorohydrin)
What is a plasma gas sterilizer (chemical sterilization)? How does it work?
H2O2 excited by electric charge
-Creates free-radicals that are cytotoxic to bacteria
-Plasma gas=a cloud of free radicals
What materials are sterilized using plasma gas sterilizers?
Metallic and rubberized materials
Porous materials
What is an advantage of plasma gas sterilizers compared to ethylene oxide?
75 minute cycle w/ no aeration required
Low toxicity
What is cold sterilization?
Soaking instruments in disinfectant solutions
What is a disinfectant used for cold sterilization?
Glutaraldehyde (Cidex)
What are 3 reasons to use glutaraldehyde for cold sterilization?
1) Broad spectrum of activity
2) Not as toxic as formaldehyde
3) Time depends on formulation (20-45 m)
What is meant by selection of the surgical patient?
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
What are 5 components of patient surgical preparation?
1) Correct physiologic abnormalities
-IV fluids for dehydration
-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)
When is the leg hang used for surgical preparation?
Primarily for orthopedic procedures
-From IV pole or ceiling
-Wrap paw w/ latex glove and tape
What is the primary soruce of pathogens? How can we prevent contamination?
The patient! Groom/bathe the whole patient
-Know skin flora of different species!!
What clipper blade should be used to prep a surgical site?
#40 blade (+/- shaving)
How far around the "true" surgical field should be prepped?
10 cm (~4'')
-Do outside OR
-Do not do prior to induction-increases risk of infections
-Avoid trauma to skin
What should be used for a rough prep?
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
What is the general rule for scrubbing a surgical site?
Wipe only from the cleanest area towards the dirty area
-Prevents you from tracking dirt into the surgical field
What is the pattern for prepping a square, flat surgical field?
Start in the center, where the incision is going to be, move outward in eccentric circles until you touch unclipped area
How do you prep the surgical site on the distal leg that is suspended?
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
What kind of material do surgical drapes need to be?
Water repellent or resistant
-Prevents bacteria from obtaining access to the surface of the drape
Where should drapes be applied when performing surgery?
All visible surfaces of the patient
-Prevents aerosolization of debris from the patient's body
-Do not leave too much skin exposed
When applying a drape where should your hands be located?
On the side of the drape away from the animal's body
-Curl in the drapes outer surface around your hands
How should you position a surgical drape?
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
What surgical drapes should be used for a square surgical field?
4 quarter drapes, secured w/ 4 (+) clamps
-Large fenestrated drape, secured over top of the 4 previous towel clamps
What surgical drapes should be used for a distal limb?
-Cover foot w/ sterile glove/vet wrap
-Use a drape circumferentially around upper limb
-Place 2nd layer on each of the above
When should you double-glove?
When draping
-Take off outer gloves when done
-Keep inner gloves sterile
A naked person sheds _____-_____ microbes/ minute.
When should you cover your scrubs?
When leaving the operating room
-lab coat or coveralls
Why is it so important to use caps/headcovers and cover all hair?
Hair harbors staph aureus, e. coli and streps
When do shoe covers decrease bacterial counts?
If trousers are tucked into booties
Why do we wear masks in surgery?
Do not decrease bacterial counts
-But decrease aerosol contamination of surgical site
-Saliva is aerosolized when speaking
What is "scrubbing in"?
Skin preparation
What are 3 reasons to scrub in?
1) Remove dirt & oil from skin
2) Reduce transient bacterial counts to 0
3) Significantly repress resident mcirobes
How long do you scrub hands and forearms when scrubbing in for surgery? What do you use?
> 5mins
-Use Chlorhexidine or povidone-iodine
What is the proper way to flush (rinse) your hands and arms when scrubbing in?
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
What is the pattern that should be used during the 5-10 minutes of scrubbing in?
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!
How should you dry off your forearms when scrubbing in?
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
What are the 7 Halstead's Principles?
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