Aseptic technique Flashcards
Asepsis (definition)
absence of microbes
Sterile (definition)
absence of living microorganisms (inanimate objects)
Surgically clean (definition)
destruction of all accessible microorganisms on the surface (living organisms=our patients)
contaminated (definition)
a surface or structure where microorganisms are present
What is considered a surgical site infection? (SSI)
infection from a surgical incision within 30 days of surgery
What is considered a surgical site infection if an implant was used?
1 year
What is the most common hospital acquired infection?
surgical infections
What are the possible consequences of surgical infections?
- cost
- morbidity
- mortality–euthaniasia from cost
What can be sources of microbes for surgical site infection?
- environment
- patient
- surgeon
- surgical site–traumatic wound
What can be sources of microbes for surgical site infection?
- environment
- patient
- surgeon
- surgical site–traumatic wound
What are three ways to design the operating room to reduce infection risk?
- clean, mixed and contaminated areas
- designed OR for contaminated vs clean procedures
- positive airflow–air flows from OR to corridors
What is the operating room cleaning protocol?
- clean after each procedure and at start and end of the day
- walls and tables easy to clean
Why should you limit traffic and personnel in the OR?
because +1 person =30% more infections
What are 5 methods of sterilization?
- steam sterilization
- gas (ethylene oxide)
- plasma (H2O2) sterilization
4.
What are 5 methods of sterilization?
- steam sterilization
- gas (ethylene oxide)
- plasma (H2O2) sterilization
- ionizing radiation
- cold chemical
How does steam sterilization work?
- autoclave
- steam under pressure 121 degrees for 15-30 minutes
- coagulates proteins
What does steam sterilization (autoclave)
- cleans instruments
- correct packing, wrapping
- proper positioning in unit
How does gas (ethylene oxide) sterilization work?
- kills microbes by alkylation
How does gas (ethylene oxide) sterilization work?
- kills microbes by alkylation of proteins
What is gas sterilization used for?
heat and moisture sensitive equipment
What are disadvantages of gas sterilization?
- flammable, explosive gas
- very toxic to personnel if exposed
- long sterilization cycle
- needs aeration before use
How does cold sterilization work?
- glutaraldehyde used
2. submerge for 10-12 hours
What is cold chemical sterilization used for?
equipment sensitive to heat that can be submerged
Why must equipment that is cold sterilized be rinsed well?
it is irritating
What are disadvantages of cold chemical sterilization?
- takes a long time
- adverse health effects (resp, dermal)
- do NOT use for any major procedure. will get infection. avoid if can
How do we know sterilization worked?
- CLEAN instruments
- chemical indicators BOT autoclave tape AND indicator strips
- biological indicators: nonpathogenic spores (bacillus)–no growth
What are 6 general patient factors that influence surgery site infection
- disease status (ASA classification)
- nutritional status
- age, gender? (male>female)
- distant infection
- very dirty–>bath and allow to dry
- duration of hospitalization
What are 6 general patient factors that influence surgery site infection
- disease status (ASA classification)
- nutritional status
- age, gender? (male>female)
- distant infection
- very dirty–>bath and allow to dry
- duration of hospitalization
What are anesthesia patient factors that affect surgical site infection?
- ASA classification
- hypotension (perfusion)
- peri-operative hypothermia (pefusion)
- anesthetic drugs–older; propofol–lipid substrate–contaminated
- total anesthesia time–immune function compromized
How much does risk of infection go up every hour the animal is under anesthesia
30%
What is the patient infection rate with clean wounds (surgical incision)?
2.5%
What is the patient infection rate with clean contaminated wounds (surgical incision into viscous organ)
4.5%
What is the patient infection rate with contaminated wounds?
7.3%
What is the patient infection rate with infected wounds?
18.1%
What is overall infection rate of wounds
5.1%
What is overall infection rate of wounds
5.1%
What are the recommendations for clipping hair?
- use #40, wide clip NOT razor
- wide clip
- AFTER anesthesia induced
- avoid paws if can
What is the goal of skin preparation?
- remove dirt
- reduce resident microbial count
- inhibit rapid rebound growth of microbes
What antiseptics should be used in skin preparation
- alcohol + chlorhexidine
chlorhexidine > povidone iodine
What is the minimum contact time for antiseptics?
3 minutes
Why does chlorhexidine have residual activity?
- binds to keratin
Why does chlorhexidine have residual activity?
- binds to keratin
What is the technique for skin preparation?
- sterile prep–sterile gloves
- use dominant hand to prep, other hand to pick up
- circular pattern
- don’t go back to middle with same sponge
- don’t scrub too hard (skin abrasions)
What is the goal of draping the patient?
create a barrier to prevent spread of microbes from the patient to the surgical site/surgeon
What thread count of cloth is an effective barrier?
270 IF DRY (can deteriorate with age)
Why is important that drapes be dry?
if water can get though then bacteria can too
What is an alternative to cloth drapes
synthetic polymers
What is the technique of placing surgical drapes?
- use four drapes, place on clipped area
- secure with towel clamps
- single large drape to cover the entire patient and table
What 3 things should you NOT do when placing drapes?
- do NOT readjust the drapes once placed
- do NOT reuse the towel clamps
- do NOT use a penetrating towel clamp on the final drape into the patient–can create a route that bacteria can get in
What 3 things should you NOT do when placing drapes?
- do NOT readjust the drapes once placed
- do NOT reuse the towel clamps
- do NOT use a penetrating towel clamp on the final drape into the patient–can create a route that bacteria can get in
Why is surgeon preparation important?
to minimize contamination of patient by surgeon
What is proper surgical attire?
- dedicated surgical scrubs
- surgical caps that cover all hair, NOT cloth
- mask–new each surgery
- shoe cover/booties or dedicated OR shoes
What do surgical gowns provide in terms of protection?
a WATERPROOF impermeable barrier
Why is it a problem if cuffs get wet?
they are contaminated
Is there a difference between paper and treated cloth as to which you should use?
no, as long as waterproof
What percent of gloves have holes before wearing?
1.5%
Up to how many gloves have holes by the end of surgery and which hand is more common?
- 26%
2. nondominant common
Why are hydrogel gloves better than powder gloves?
because powders cause inflammation (granulomatous)
Why are hydrogel gloves better than powder gloves?
because powders cause inflammation (granulomatous)
What are 5 surgical techniques that decrease the likelihood of infection?
- strict asepsis
- tissue trauma
- amount of hemorrhage
- dead space
- surgical time
How much does infection rate increase for each hour of surgery?
it doubles
In which surgeries should you use prophylactic antibiotics?
- strong risk of infection
- long surgeries >90 minutes
- infection is catastrophic (implant)
What are the most common microbes that infect surgical sites?
- staph (on skin)
2. e. coli
What are the most common group of antimicrobials used in prophylaxis for surgery?
cephalosporins
What are the 3 principles of prophylactic antibiotic administration?
- high tissue levels at time of incision (IV, at time of anesthesia)
- repeat every 90 minutes
- stop when skin closed
Does it help if you give antibiotics for more than 24 hours?
no it increases infection
