Aseptic Technique

Question 1

The patient’s normal flora is the most common reservoir for contamination during surgical procedures.

Answer 1

T

Question 2

Chlorhexidine gluconate should not be allowed to contact the eye or middle ear.

Answer 2

T

Question 3

Povidone-iodine must remain on the skin to be effective.

Answer 3

T

Question 4

Hair removal is indicated for all surgical procedures.

Answer 4

F Only if it will obscure field or hinder technique.

Question 5

The most common resident organisms are coagulase-negative staphylococci, with Staph epidermidis accounting for 60% of resident microbes.

Answer 5

F Over 90%. Rest is true

Question 6

Anaerobic diphtheroids such as Proprionibacterium acnes are common in lipid-rich locations, such as the pilosebaceous unit.

Answer 6

T

Question 7

Gram-negative bacteria are mostly limited to the humid intertriginous areas, with Enterobacter, Klebsiella, E.coli and Proteus spp being the predominant organisms.

Answer 7

T

Question 8

The majority of post-operative wound infections are due to transient micro-organisms that contaminate the wound after surgery.

Answer 8

T Mostly due to endogenous flora from patient’s nose, throat, or skin.

Question 9

S.aureus is the most frequent cause of surgical site infection, followed by coagulase-negative staph, Enterococcus spp., group A strep, and P.aeruginosa.

Answer 9

T

Question 10

For surgical procedures, the contact and airborne routes are the most likely means of contamination.

Answer 10

T

Question 11

Surgical site infection is defined by the CDC as any surgical wound that produces pus within 10 days of the procedure.

Answer 11

F 30 days.

Question 12

Wounds are defined as clean if they are elective incisions carried out on non-inflammed tissues under strict aseptic technique and if there is no entry into the GI, respiratory or GU tracts.

Answer 12

T

Question 13

Contaminated wounds are those with frank purulent fluid such as an abscess, or perforation of a viscus or faecal contamination.

Answer 13

F This is a dirty wound.

Question 14

Dirty wounds include those where major breaks in aseptic technique have occurred, or there is inflammation, but no frank purulence encountered.

Answer 14

F This is a contaminated wound.

Question 15

Biopsies performed in a hospital ward, as opposed to an outpatient setting, have a higher risk for infection.

Answer 15

T

Question 16

Longer procedures carry a greater risk of contamination than brief procedures.

Answer 16

T

Question 17

The surgical scrub, if performed correctly, can reduce the microbial load by 80% and maintain this reduction for several hours.

Answer 17

F 90-95%. Everything else is true.

Question 18

Chlorhexidine gluconate is most active against Gram positive bacteria, but also active against Gram negatives and enveloped viruses.

Answer 18

T Poor activity against M.tuberculosis, fair activity against fungi.

Question 19

Povidone-iodine is most active against Gram positive bacteria, but also active against Gram negative bacteria, M.tuberculosis, fungi and enveloped viruses.

Answer 19

T

Question 20

Povidone-iodine must be lest on the skin to have a persistent effect

Answer 20

T

Question 21

Chronic maternal use of povidone –iodine have been associated with hyperthyroidism in newborns

Answer 21

F Hypothyroidism

Question 22

Both chlorhexidine and povidone-iodine have relatively slow onset of action.

Answer 22

F Both fast.

Question 23

Chlorhexidine glucondate has the fastest onset

Answer 23

F 60-95% alcohols do

Question 24

A caution of 60-95% alcohols is their flammability

Answer 24

T

Question 25

Repeated use of chlorhexidine gluconate has an additive effect.

Answer 25

T

Question 26

Repeated use of povidone-iodine has a additive effect.

Answer 26

F

Question 27

Alcohols (60-90%) may be used as an antiseptic and have the fastest onset of action.

Answer 27

T Need to use liberal amount and allow to dry.

Question 28

Alcohol is rapidly germicidal but once evaporated it does not have significant residual activity

Answer 28

T

Question 29

CHG and alcohol containing preparations should be avoided in the periocular area

Answer 29

T

Question 30

Chlorhexidine gluconate binds to the stratum corneum and maintains residual activity in excess of 6 hours, even when wiped from the field.

Answer 30

T

Question 31

Povidone-iodine is quickly inactivated in the presence of blood or sputum.

Answer 31

T

Question 32

PI is safe to use in the periocular area

Answer 32

F Must be half strength (5%)

Question 33

Chlorhexidine gluconate is quickly inactivated in the presence of blood or sputum.

Answer 33

F

Question 34

The mixture of alcohol and chlorhexidine gluconate achieves better antiseptic than either agent alone.

Answer 34

T

Question 35

Studies have shown a clear relationship between bacterial contamination of the surgical field and the volume at which the surgeon speaks.

Answer 35

T

Question 36

Povidone-iodine has excellent sustained activity, even after wiped from the skin

Answer 36

F Intermediate to minimal if wiped from skin

Question 37

Chlorhexidine gluconte and PI, but not parachlorometaxylenol cover gram negative organisms

Answer 37

F - all do

Question 38

In dermatologic surgery, gloves become perforated in approximately 1% of procedures.

Answer 38

F 11%.

Question 39

Hands should always be washed after removing surgical gloves.

Answer 39

T Surgeon only notices 17% glove perforations.

Question 40

Fingernails should be kept short to facilitate cleaning

Answer 40

T

Question 41

On the night before surgery, a preoperative shower with chlorhexidine gluconate or povidone-iodine has been shown to decrease wound infection rates.

Answer 41

T

Question 42

There is convincing scientific data to show that wearing scrubs rather than street clothes affects the incidence of infection

Answer 42

F There is no data

Question 43

There is conflicting data regarding the ability of face masks to reduce infection

Answer 43

T

Question 44

If repeated application of antiseptic preparations is expected (eg. during Mohs), it is not necessary to use the same agent for each consecutive application.

Answer 44

F Should try to use the same, since some antiseptic agents are mutually inactivating.

Question 45

Autoclaving generates pressures of 2 Pascals and temperatures of 121C that must be maintained for 15-30 mins.

Answer 45

T

Question 46

A potential limitation to autoclave sterilisation is that repeated exposures to high humidity may dull sharp cutting surfaces.

Answer 46

T

Question 47

The surgical hand scrub should be at least 2 minutes.

Answer 47

T

Question 48

For most dermatological surgery a formal surgical scrub is not generally considered necessary

Answer 48

T

Question 49

Excessive thermal destruction of tissue is not associated with an increased risk for infection.

Answer 49

F

Question 50

Should it be necessary to cough or sneeze while wearing a face mask, you should step backwards and turn away from the surgical field

Answer 50

F Should face the surgical field

Question 51

Hair should always be removed before surgical procedures

Answer 51

F Only if it will obscure the surgical field or hinder properly surgical technique

Question 52

A sterild dressing must be left undisturbed for at least 72hours to permit a degree of epithelialization to take place and seal the wound edges from bacterial contamination

Answer 52

F 48 hours