Asepsis, Antibiotics and infection

Question 1

Asepsis

Answer 1

the maintenance of pathogen free environmenta on or within living tissue

Question 2

Aseptic technique

Answer 2

methods used to prevent contamination of living tissue with pathogens

Question 3

sterilization

Answer 3

the process of killing all microorganisms with the use of either physical or chemical agents

Question 4

antiseptic

Answer 4

chemical agent

kills pathogenic microorganisms or inhibits the growth as long as the agent and microbe remain in contact

agents applied to the body

Question 5

Disinfectant

Answer 5

a germicidal chemical substance that kill microorganisms on inanimate objects that cannot be exposed to heat

Question 6

why worry about aseptic technique?

Answer 6

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

Question 7

Why worry about surgical site infection?

Answer 7

increased morbidity

increased mortality

increased cost

client dissatisfaction

Question 8

What determines if a wound will become infected?

Answer 8

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

Question 9

What can we do to decrease infection?

Answer 9

maintain cleanliness of the OR

sterilization of surgical equipment and materials

prep of surgical personnel

prep of patient

proper operative technique

post op care

Question 10

operating room

Answer 10

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

Question 11

packs

Answer 11

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

Question 12

sterilization steam

Answer 12

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

Question 13

ethylene oxide sterilization

Answer 13

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

Question 14

Cold sterilization

Answer 14

Glutaraldehyde, ortho phthalaldehyde, peracetic or peroxyacetic acid

must be rinsed prior to use

for endoscopes

not appropriate for sx

Question 15

Scrub clothing

Answer 15

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

Question 16

cap/hood

Answer 16

organisms exfoliated from head

haired skin has more bacteria than non-haired skin

Question 17

shoe covers

Answer 17

no benefit

placement/removal contaminates hands

increased falling accidents

have dedicated foot wear

Question 18

surgical masks

Answer 18

protective

Question 19

surgical gowns

Answer 19

disposable=consistently impervious, wastefu,l, expensive

fabric gowns-comfortable, less impervious

Question 20

objectives of hand scrubbign

Answer 20

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

Question 21

hand scrub

Answer 21

soft scrub

hands free sink

antiseptic

CONTACT TIME!

clean underneath nails

Question 22

gloves

Answer 22

closed glove technique

must cover entire cuff of gown

must fit snug on hand

Question 23

patient prep

Answer 23

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

Question 24

chlorhexidine

Answer 24

good residual actvity

variable effectiveness with viruses and fungi

Question 25

povidone-iodine

Answer 25

effective against fungi and viruses

stains coat, less residual activity

causes skin rxns in 50% of dogs

Question 26

alcohols

Answer 26

rapidly bactericidial

effectiveness decreases in presence of organic debris

Question 27

perioperative administration of abx

Answer 27

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

Question 28

postoperative administration of abx

Answer 28

administration of abx after 24 hours after teh end of the sx if considered

Question 29

when are prophylatic abx indicated

Answer 29

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

Question 30

clean wound

Answer 30

created using aseptic technique

Question 31

clean-contaminated wound

Answer 31

Hollow viscus entered

genitourinary tract

GI tract

no gross debris

Question 32

does it matter what abx if used?

Answer 32

consider system involved and likely pathogens

Question 33

what does surgiical site infection look like?

Answer 33

pain at surgical site

redness

swelling

+/- discharge

+/- tissue separation

+/- fever

+/- neutrophilia

Question 34

SSI tx

Answer 34

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

Question 35

Abscess tx

Answer 35

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

Question 36

How long should superficial incisional infections be treated?

Answer 36

5-7 days beyond resolution of clinical signs

usually ends up being 2-3 weeks

Question 37

How long should I treat a deep infection/bone?

Answer 37

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