Asepsis, Antibiotics and infection Flashcards
Asepsis
the maintenance of pathogen free environmenta on or within living tissue
Aseptic technique
methods used to prevent contamination of living tissue with pathogens
sterilization
the process of killing all microorganisms with the use of either physical or chemical agents
antiseptic
chemical agent
kills pathogenic microorganisms or inhibits the growth as long as the agent and microbe remain in contact
agents applied to the body
Disinfectant
a germicidal chemical substance that kill microorganisms on inanimate objects that cannot be exposed to heat
why worry about aseptic technique?
increased risk of a surgical site infection
increased risk of inections secondary to a diagnostic or supportive procedures (IV fluids, ETT, urinary catheter)
increased risk of nosocomial infections
Why worry about surgical site infection?
increased morbidity
increased mortality
increased cost
client dissatisfaction
What determines if a wound will become infected?
host factors: age, systemic disease, poor nutrition, shock, immune suppression
environmental factors: excessive trauma during sx–>necrotic tissue–>increased risk of infection, trauma after sx (licking chewing, mutilation, excessive activity)
pathogen factors: numbers and level of pathogenicity
What can we do to decrease infection?
maintain cleanliness of the OR
sterilization of surgical equipment and materials
prep of surgical personnel
prep of patient
proper operative technique
post op care
operating room
enclosed room, enclosed cabinets, dedicated to surgery, not used for storage, laminar air flow
number of people in OR, excessive conversation, excessive number of entrances/exits increases infection rates
clean with disinfectants-quat
packs
double wrapped in cotton muslin or paper
indicators are enclosed wtihin and/or on the exterior
smaller items can be sealed in pouches
always check indicator to confirm adeqyate penetration
sterilization steam
most common method
kills m/o by coagulation and denaturing proteins
temp, pressure, steam and time are factors in the process
30 min cycles with 15-30 drying
ethylene oxide sterilization
alkylation of proteins and nucleis acids
not as readily available
venting of toxic gas required
can sterilize plastic and other materials that cannot be steam sterilized
Cold sterilization
Glutaraldehyde, ortho phthalaldehyde, peracetic or peroxyacetic acid
must be rinsed prior to use
for endoscopes
not appropriate for sx
Scrub clothing
shirt tucked in, elastic leg opening
bacteria shed most by high movement areas-perineum, thighs
lab coat should be worn when outside OR
personnel should change into scrubs once in hospital
cap/hood
organisms exfoliated from head
haired skin has more bacteria than non-haired skin
shoe covers
no benefit
placement/removal contaminates hands
increased falling accidents
have dedicated foot wear
surgical masks
protective
surgical gowns
disposable=consistently impervious, wastefu,l, expensive
fabric gowns-comfortable, less impervious
objectives of hand scrubbign
mechanical removal of gross dirt and oil from the hands
reduction of the transient m/o count as close to zero as possible
prolonged depressant effect on the resident microflora of the hands and forearms
hand scrub
soft scrub
hands free sink
antiseptic
CONTACT TIME!
clean underneath nails
gloves
closed glove technique
must cover entire cuff of gown
must fit snug on hand
patient prep
clip hair-right before surgery
skin prep-chlorhexidine gluconate, povidone-iodine + isopropyl alcohol, start in center, small to larger ovals, be gentle, 4 mins
antiseptic spray
drape surgical field
chlorhexidine
good residual actvity
variable effectiveness with viruses and fungi
povidone-iodine
effective against fungi and viruses
stains coat, less residual activity
causes skin rxns in 50% of dogs
alcohols
rapidly bactericidial
effectiveness decreases in presence of organic debris
perioperative administration of abx
administration of abx immediately before sx, re-administered q 60-90 m during sx and d/c immediately after sx or up until 24 hr after end of sx
postoperative administration of abx
administration of abx after 24 hours after teh end of the sx if considered
when are prophylatic abx indicated
if procedure is expected to last >90 min
if procedure is orthopedic
if surgeon is inexperienced
use for dirt and contaminated wounds
if infection will result in a catastrophic outcome
compromised patient
clean wound
created using aseptic technique
clean-contaminated wound
Hollow viscus entered
genitourinary tract
GI tract
no gross debris
does it matter what abx if used?
consider system involved and likely pathogens
what does surgiical site infection look like?
pain at surgical site
redness
swelling
+/- discharge
+/- tissue separation
+/- fever
+/- neutrophilia
SSI tx
obtain C&S-aspirate deep tissue
treat empirically while awaiting results, adjust tx according to results
drain fluid-maintain drainage, collect drainage
5-7 dyas beyond resolution of clinical sxs
Abscess tx
establish drainage-surgical approach or lance with blade
maintain drainage-make large incision or place a drain or manage as open wound
collect drainage-bandage, not always practical
How long should superficial incisional infections be treated?
5-7 days beyond resolution of clinical signs
usually ends up being 2-3 weeks
How long should I treat a deep infection/bone?
difficult to easily observe affected tissue
use empirical information
monitor with X-rays/u/s and clinical signs
often 4-8 weeks
remove implrants if possible
