Aseptic technique

Question 1

Define antisepsis

Answer 1

prevention of sepsis by the destruction or inhibition of microorganisms using an agent that may be applied safely to living tissue

Question 2

Define asepsis

Answer 2

absence fo pathogenic microbes in living tissue

Question 3

Define sepsis

Answer 3

presence of pathogens or their toxic products in the tissues of a patient

Question 4

Define antiseptic

Answer 4

chemical agent that either kills or inhibits pathogenic microorganisms. applied to the body

Question 5

Define disinfectant

Answer 5

Germicidal chemical substance that kills microorganisms of inanimate objects

Question 6

Define disinfection

Answer 6

removal of microorganisms but not necessarily their spores

Question 7

Define sterilisation

Answer 7

complete elimination of microbial viability, including spores, by chemical / physical means

Question 8

What are the personnel non - sterile barriers

Answer 8

scrubs suit
head cover
shoe cover
face amsk

Question 9

What disinfectants can be used to prepare the surgeons skin?

Answer 9

clorhexidine
iodine
alcohol
sterillium

Question 10

Sterile barriers

Answer 10

gloves

surgical gown

Question 11

6 physical ways of sterilisation of surgical equipment

Answer 11

heat
steam
moist heat
dry heat
irradiation
filtration

Question 12

How is steam sterilisation used and what for?

Answer 12

saturated steam under pressure

instruments, drapes, gowns, swabs, rubber, glass, plastic

Question 13

How is dry heat sterilisation used?

Answer 13

oxidative destruction of bacteria

glass, cutting instruments, ophthalmic instruments, drill bits, powders, oils

Question 14

3 main chemical ways of sterilisation

Answer 14

Ethylene oxide
hydrogen peroxide gas plasma
cold sterilisation with disinfectant

Question 15

How does ethylene oxide sterilisation work?

Answer 15

kills bacteria, spores, fungi and large viruses.
toxic, irritant and flammable
used for fibre - optics, plastic, anaesthetic tubing, optical instruments, high speed drills and burs

Question 16

How does hydrogen peroxide gas plasma sterilisation work?

Answer 16

uses an electrical field

Question 17

2 types of sterilisation indicators

Answer 17

chemical - colour change

biological - try to culture spores

Question 18

How is the patient prepared?

Answer 18

1) hair removal
2) skin preparation
3) draping the patient

Question 19

How should an operating theatre be designed?

Answer 19

• away from normal traffic
• big enough for surgical team but small enough to clean easily
• air at mild positive pressure
• stainless steel and glass furniture
• windows cant open
• restricted access
• clean surgeries before dirty
• clean between patients, start and end of day and weekly

Question 20

3 mains determinants of wound infection

Answer 20

1) bacterial factors - number, types, virulence, duration of exposure, growth needs
2) wound factors - want healthy, viable tissue with a good blood supply
3) patient factors - systemic disease, trauma, drug therapy

Question 21

factors that increase risk of wound infection

Answer 21

• duration of surgery and anaesthesia
• more people in operating theatre
• dirty surgical site
• duration of post - op stay
• wound drainage
• fat patient
• abx prophylaxis
• removing hair a while before surgery
• poor metabolic / nutritional status
• emergency surgery

Question 22

if abx used incorrectly:

Answer 22

drug resistance
increase cost
adverse patient effects
alters normal flora
superinfection
hospital acquired infection risk increase

Question 23

Exceptions for clean surgery abx use

Answer 23

over 90 min
implant used
infection would be catastrophic
immunocompromised patient

Question 24

ABX prophylaxis recommendations

Answer 24

• give IV
• 30-60 mins before incision
• give every 1- 2 half lives
• 3-6 hours post surgery has no effect
• dont give for more than 12 - 24 hour post op
• dont use oil based of subQ as wont reach incision site

Question 25

What are the 4 NRC classifications?

Answer 25

clean
clean- contaminated
contaminated
dirty

Question 26

What is a clean surgery

Answer 26

non - traumatic wound
elective surgery with primary healing
no infl
no break in asepsis
resp / GIT / uro tract not entered

Question 27

what is clean - contaminated surgery

Answer 27

GI / resp tract entered
urogenital entered without inf
biliary tract entered without inf
minor break in aseptic technique

Question 28

what is contaminated surgery?

Answer 28

gross spillage from GIT
entrance to biliary / uro with inf present
fresh traumatic wound
major break in asepsis

Question 29

what is dirty surgery?

Answer 29

perforated viscus
acute bacterial inf / pus
traumatic wound
transection of clean tissue to reach pus

Question 30

when should abx be given as therapy?

Answer 30

dirty surgeries

Question 31

when should abx be given prophylactic?

Answer 31

contaminated surgery

sometimes in clean - contaminated

Question 32

what abx are used for wound infection of skin / contamination from body tract?

Answer 32

Cefazolin

amoxy - clav

Question 33

what abx are used for a body tract inf?

Answer 33

metronidazole

cefuroxime