Aseptic Technique Flashcards
Obj: in a clinical scenario determine factors influencing infection risk and how to address them
Ob: Discuss the steps and strategies used in surgeon and patient aseptic preparation
Obj: Compare/Contrast different antiseptics for patient preparation
Obj: given a clinical case scenario, determine appropriate antimicrobial usage
obj: Define the four wound classifications and be able to classify procedures into each one
What are Halstead’s Principles
- Strict aseptic technique
- Meticulous hemostasis
- Using fine, non-irritating suture material in minimal amounts
- Gentle handling of tissue
- Sharp anatomic dissection of tissues
- Preservation of vascularity
- Removal of necrotic tissue
- Minimum tension of tissues
- Obliteration of dead space
- Importance of rest
What are endogenous sources of microbial contamination?
- From the patient
- Normal flora
- skin
- GI tract
- Lower Urinary tract
- Upper respiratory
- Infection
What are exogenous sources of microbial contamination?
- From the environment
- Room air
- clippers
- Sx teams
- Instrument/drapes
- Dx/therapeutic devices
- Implants
What is aseptic tecnique?
- A combination of practices used to eliminate microorganisms within an operative field
- Goal is to minimize risk of infection by reducing or eliminating environmental factors, treatment factors, patient factors and pathogen factors
What is the purpose of Draping
- Isolates the Sx site/personnel from contaminated areas
- Provides sterile working area
What factors contribute to Surgical Site Infections?
- Pathogen Factors
- Patent Factors
- Environmental Factors
- Treatment Factors
What are the treatment factors that contribute to SSI?
- Use of drains
- Perioperative hypothermia/hypotension
- Blood loss
- Implants placed
- Duration of surgery (>90min)
- ASA Status
- Duration of anesthesia (>120min)
- Surgeon experience
- Prolonged hospitalization
What are the Patent factors that contribute to SSI?
- Sex (males > females minor)
- Age (old > young minor)
- Endocrinopathies (could be mayor or minor)
- Immunosuppression (major)
- Obesity or malnutrition (minor)
- Recent surgery (major)
- Prior site irradiation (major)
- Pyoderma (major)
What are the Pathogen factors that contribute to SSI?
- Type of bacteria
- # of microbes
- reduce through antiseptics or antimicrobials
- Virulence
What are the common bacteria encountered on the skin?
- Staphylococcus*
- Streptococcus*
What are the common bacteria encountered on the upper GI?
Mostly gram + cocci
What are the common bacteria encountered on the lower GI?
anaerobes and gram negative bacilli
What are the common bacteria encountered on the genitourinary tract?
Gram negative bacilli
When and what type of antimicrobials should be used?
- Dirty wound /procedures
- therapeutic antimicrobials
- Clean-contaminated or Contaminated wounds/procedures
- Prophylactic antimicrobials
- Maybe therapeutic use
- Clean procedures
- No antimicrobials unless:
- high risk surgeries
- patient has major risk factor or multiple minor risk factors
- No antimicrobials unless:
Which antimicrobials should be used?
- Skin/Upper GI - Penicillins or 1st gen cephalosporin
- Lower genitourinary - broad spectrum
- Lower Gi - cephalosporin + fluoroquinolone OR broad spectrum
- Infections - start broad spectrum then change based on culture results