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Y3 Surgery > Asepsis & Antisepsis > Flashcards

Asepsis & Antisepsis Flashcards

1
Q

Define Asepsis.

A

Freedom from infection or prevention of contact with microorganisms

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2
Q

Define Aseptic Technique.

A

Instruments, air, drapes, gloves and gowns are free from microorganisms

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3
Q

Define Antisepsis.

A

Prevention of sepsis by inhibition or destruction of agents

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4
Q

What is the Aseptic Technique?

A
  1. Wash hands and instruments with carbolic acid
  2. Wear gloves
  3. Spray OT with carbolic acid
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5
Q

Lister and Lancet 1867 states that amputation mortality is reduced from?

A

46 to 15%

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6
Q

Current Asepsis Technique in the Operating Theatre

A
  1. 20 air changes per hour
  2. Filtered air
  3. Laminar flow
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7
Q

Current Asepsis Technique of the Surgeon

A
  1. Hand scrub iodophors or hexachlorophene solution
  2. Sterile gloves
  3. Sterile gown
  4. Aseptic technique
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8
Q

Current Asepsis Technique of the Patient

A
  1. Pre-operative MRSA swab (If positive, treat with bactroban ointment
  2. Pre-operative body wash with hibiscrub
  3. Shave only on the day of operation
  4. Skin preparation
  5. Sterile drape
  6. Protect wound
  7. Beware long surgery, drains and other illnesses
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9
Q

Current Asepsis Technique on Instruments

A

Autoclave or gas sterilised

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10
Q

What are the common bacteria removed by Antisepsis?

A
  1. Resident bacterial flora: Coag -ve Staphylococcus, Corneybacterium, Acinetobacter, enterobacterium
  2. Transient: Staph aureus, MRSA
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11
Q

Why do we need Asepsis?

A

To prevent surgical site infection

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12
Q

What are the characteristics of surgical site infection?

A
  1. 10-15% of nosocomial infections
  2. 60% at incision site
  3. Significant morbidity and mortality for severe infection
  4. Increased hospital stay and costs
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13
Q

What are the types of Surgical Site Infection?

A
  1. Superficial Incisional SSI
  2. Deep incisional SSI
  3. Organ/Space SSI
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14
Q

What is a Superficial Incisional SSI?

A

Occurs within 30 days and involves skin or subcutaneous tissue and one of the following

  1. Purulent discharge
  2. Positive culture
  3. Clinical signs of infection
  4. Clinical diagnosis
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15
Q

What is a Deep Incisional SSI?

A

Occurs within 30 days if no implant left in situ

Occurs within 1 year if implant left in situ and one of the following

  1. Purulent discharge from deep infection
  2. Dehiscence of deep incision
  3. Discharging abscess
  4. Clinical diagnosis
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16
Q

What is a Organ SSI?

A

Occurs within 30 days if no implant left in situ

Occurs within 1 year if implant left in situ and one of the following

  1. Infection involves organ/space or related anatomy
  2. Purulent discharge from deep space
  3. Positive culture
  4. Deep abscess confirmed clinically or radiologically
  5. Clinical diagnosis
17
Q

Surgical Wound Classification: Clean/Class I

*Popular exam question

A

Uninfected operative wound in which no inflammation is encountered.

Primary closure with closed drainage

Respiratory, alimentary and genito-urinary tracks

1.5% risk of SSI

18
Q

Surgical Wound Classification: Clean-contaminated/ Class II

*Popular exam question

A

Any operative wound in which the respiratory, alimentary or genito-urinary tracks are opened in a controlled manner without contamination

8% risk of SSI

19
Q

Surgical Wound Classification: Contaminated
*Popular exam question

A

Open fresh accidental wounds

Operations with major break in sterile techniques

Gross contamination or major spillage

Non-purulent inflammation

10-15% risk of SSI

20
Q

Surgical Wound Classification: Dirty-infected/ Class IV

*Popular exam question

A

Old traumatic wounds with devitalised tissue and those that involve existing clinical infection or perforated viscera.

Organisms involved were present in the operative field before the operation

25% risk of SSI

21
Q

What are the Patient Risk Factors for SSI?

A
  1. Age, nutrition
  2. DM, obesity, smoking
  3. Colonisation, immunosuppression
  4. Blood transfusion, anaemia
  5. Malignancy, co-existing infection
  6. Length of pre-operative stay
22
Q

What are the Operative Risk Factors for SSI?

A
  1. Category and duration of operation
  2. Skin asepsis, surgical scrub, preoperative shaving, preoperative skin prep
  3. Ab prophylaxis
  4. OT sterilisation
  5. Foreign material
  6. Surgical drains, surgical technique
  7. Poor haemostasis, dead space obliteration
  8. Tissue trauma
23
Q

What is the normal flora at the Head and Neck region?

A

Staphylococcus (Aureus and coag negative)

Streptococcus

Cornybacteria, Neisseria, Haemophilus, Anaerobes

24
Q

What is the normal flora at the Thorax region?

A

Staphylococcus (Aureus and coag negative)

25
Q

What is the normal flora at the Upper GI region?

A

Gram-negative rods such as enterobacter, lactobacilli

26
Q

What is the normal flora at the Lower GI region?

A

Aerobic gram-negative rods including enterobacter, enterococci

Anaerobes such as bacteroides, clostridium yeasts

27
Q

What is the normal flora at the female genital tract?

A

Staph, strep, corneybacteria, lactobacilli

28
Q

When should you clean your hands? (5 situations)

A
  1. Before touching a patient
  2. Before an aseptic procedure
  3. After body fluid exposure risk
  4. After touching a patient

5.After touching patient surroundings

29
Q

Equation for risk of SSI

A

Dose of bacterial contamination X virulence/resistance of patient

30
Q

Characteristics of Hygienic Hand Rub

A
  1. Bactericidal agent which is alcohol based without addition of water
  2. Contains emollient
  3. Fast acting and easy to use
  4. Can be used repeatedly
31
Q

How to clean fingernails?

A

Sub-ungal regions harbour bacteria

  1. Trimmed nails
  2. No varnish or artificial nails
  3. Use a scrub
32
Q

What is the purpose of a Surgical Scrub?

A

To remove debris and transient micro-organisms from fingernails, fingers and forearms

Reduce resident flora to a minimum

Inhibit rapid rebound growth on bacterial flora

The anti-microbial agent should reduce micoroganisms on intact skin, be non-irritant, broad spectrum, fast acting and have a residual effect

33
Q

Notes on Surgical Drapes

A
  1. Aseptic barrier
  2. Cotton vs disposable
  3. Wet drapes provide ideal culture medium
34
Q

Characteristics of Antiseptic agents

A

1.Fast acting

  1. Persistent effect
  2. Broad spectrum
  3. Non-irritant and acceptable
  4. Reduce microorganisms on intact skin
  5. Binds to stratum corneum
35
Q

Not done

A

Y3 Surgery (1 decks)

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