Aseptic Technique Flashcards
Halsted’s Principles of Surgery Tenets
õ Strict aseptic technique
õ Gentle tissue handling
õ Meticulous hemostasis
õ Preservation of blood supply
õ Accurate anatomic dissection and tissue apposition
õ Obliteration of dead space
õ Minimization of tension
why is asepsis important?
to prevent preoperative infection, aka surgical site infection (SSI)
SSI leads to increased morbidity, mortality and cost
infection risk =
(contamination x virulence) / host resistance
14 y/o vs 1 y/o very different cases!
aseptic surgery
- prevent infection of the surgical wound
- limit exposure to microorganisms: IMPOSSIBLE TO ELIMINATE ALL
- proper preparation of the environment, surgical site, equipment and personnel
- consider source of microorganisms!
what is the wound classification system?
- clean
- clean-contaminated
- contaminated: hasn’t set in infection yet
- dirty: infected!
when are abx indicated in a CLEAN surgery?
- environment: time! 90 mins anesthesia = abx
- patient: species, breed, age, weight
- disease process: cancer, endocrinopathies- diabetes is a large risk for sx site infex!
- surgical procedure: tissue trauma, dead space, implants
clean wound/site
- sx where respiratory, GI, UG and oropharyngeal tracts are not entered
- no break in sterile technique
- inx rate 0-4.4%
- mass removals, elective orthopedics
- abx?
antimicrobial prophylaxis
- giving abx agent BEFORE the contamination or infection of sx site
- empirical selection
- source of potential contamination
- goal: achieve and maintain inhibitory abx concentrations at the incision site for the duration of the procedure (usually need to give 15-30 min before)
how do you give prophylactic abx?
- 15-30. min before skin incision
- IV administration
- repeated every 90-150 mins
what abx are commonly give prophylactically?
- cefazolin: 1st generation cephalosporin, G+ spectrum (SKIN)
- cefoxitin: 2nd generation cephalosporin, increased G- and anaerobic spectrum
^ open GI tract = need 2nd gen!
what is a clean-contaminated site?
- respiratory, GI or UG tracts entered under controlled conditions
- minor break in sterile technique
- inx rate 4.5-9.3%
- ex: simple enterotomy, cystotomy (without UTI)
- abx?
when do you use abx w GI sx?
clean contaminated, contaminated, dirty
risk factors, level of system, prophylactic vs therapeutic use
if you have a clean and clean-contaminated procedure with no signficant risk factors, what is your abx protocol?
indv based- but stop immediately after surgery. if dogs was diabetic, then would send home with abx
consequences of unnecessary postoperative abx?
- mask early signs of visceral dehiscence!
- unnecessary cost
- adverse effects: altered microbiome
contaminated wounds
- freshly traumatized wounds
- spillage of GI or UG contents into abdominal cavity
- major break in sterile technique
- infection rate: 5.8-28.6%
- ex: open long bone fracture, oral cavity or perianal/perineal procedures
USE ANTIMICROBIALS
what is infection?
greater than 10^5 bacteria per gram of tissue
what is the golden period of infection?
6-8 hours!!!
what are factors that accelerate infection?
- poor host defenses
- foreign material
when can a surgical site infection (SSI) occur?
within 30 days of surgery (or up to 1 year with a permanent implant placed)
what is a dirty wound?
- established infection
- traumatized wounds with devitalized tissue
- fecal contamination
- ex: abscess, septic peritonitis
USE ANTIMICROBIALS
culture and sensitivity useful to target abx therapy
how can you prevent SSI?
- ID of high risk animals
- adherence to aseptic principles
- judicious use of abx drugs
- surveillance: want to watch a high-risk animal for longer
aseptic surgery
- prevent infx of surgical wound
- limit exposure to microorganisms, cannot eliminate all!
- proper prep of equipment, people, site
- what is the source!
what is aseptic technique?
methods and practices used to prevent contamination in surgery
aspesis
the ABSENCE of bacteria, viruses and other microorganisms in living tissue
only able to achieve this thru sterilization of inanimate objects
what is antisepsis?
destruction of MOST pathogenic microorganisms on living objects
what is disinfection?
destruction of MOST pathogenic microorganisms on inanimate objects
what is sterilization?
destruction of ALL microorganisms on inanimate objects
antiseptics
- iodophors: povidone-iodine, betadine
- chlorhexadine gluconate: nolvasan, hibiclens, betasept
3 isopropyl alcohol
what are the different methods of sterilization?
- steam: time, heat pressure
- chemical: ethylene oxide: toxic
- gas plasma
- ionizing radiation
- cold chemical
