Aseptic Technique Flashcards
The patient’s normal flora is the most common reservoir for contamination during surgical procedures.
T
Chlorhexidine gluconate should not be allowed to contact the eye or middle ear.
T
Povidone-iodine must remain on the skin to be effective.
T
Hair removal is indicated for all surgical procedures.
F Only if it will obscure field or hinder technique.
The most common resident organisms are coagulase-negative staphylococci, with Staph epidermidis accounting for 60% of resident microbes.
F Over 90%. Rest is true
Anaerobic diphtheroids such as Proprionibacterium acnes are common in lipid-rich locations, such as the pilosebaceous unit.
T
Gram-negative bacteria are mostly limited to the humid intertriginous areas, with Enterobacter, Klebsiella, E.coli and Proteus spp being the predominant organisms.
T
The majority of post-operative wound infections are due to transient micro-organisms that contaminate the wound after surgery.
T Mostly due to endogenous flora from patient’s nose, throat, or skin.
S.aureus is the most frequent cause of surgical site infection, followed by coagulase-negative staph, Enterococcus spp., group A strep, and P.aeruginosa.
T
For surgical procedures, the contact and airborne routes are the most likely means of contamination.
T
Surgical site infection is defined by the CDC as any surgical wound that produces pus within 10 days of the procedure.
F 30 days.
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.
T
Contaminated wounds are those with frank purulent fluid such as an abscess, or perforation of a viscus or faecal contamination.
F This is a dirty wound.
Dirty wounds include those where major breaks in aseptic technique have occurred, or there is inflammation, but no frank purulence encountered.
F This is a contaminated wound.
Biopsies performed in a hospital ward, as opposed to an outpatient setting, have a higher risk for infection.
T
Longer procedures carry a greater risk of contamination than brief procedures.
T
The surgical scrub, if performed correctly, can reduce the microbial load by 80% and maintain this reduction for several hours.
F 90-95%. Everything else is true.
Chlorhexidine gluconate is most active against Gram positive bacteria, but also active against Gram negatives and enveloped viruses.
T Poor activity against M.tuberculosis, fair activity against fungi.
Povidone-iodine is most active against Gram positive bacteria, but also active against Gram negative bacteria, M.tuberculosis, fungi and enveloped viruses.
T
Povidone-iodine must be lest on the skin to have a persistent effect
T
Chronic maternal use of povidone –iodine have been associated with hyperthyroidism in newborns
F Hypothyroidism
Both chlorhexidine and povidone-iodine have relatively slow onset of action.
F Both fast.
Chlorhexidine glucondate has the fastest onset
F 60-95% alcohols do
A caution of 60-95% alcohols is their flammability
T
Repeated use of chlorhexidine gluconate has an additive effect.
T
Repeated use of povidone-iodine has a additive effect.
F
Alcohols (60-90%) may be used as an antiseptic and have the fastest onset of action.
T Need to use liberal amount and allow to dry.
Alcohol is rapidly germicidal but once evaporated it does not have significant residual activity
T
CHG and alcohol containing preparations should be avoided in the periocular area
T
Chlorhexidine gluconate binds to the stratum corneum and maintains residual activity in excess of 6 hours, even when wiped from the field.
T
Povidone-iodine is quickly inactivated in the presence of blood or sputum.
T
PI is safe to use in the periocular area
F Must be half strength (5%)
Chlorhexidine gluconate is quickly inactivated in the presence of blood or sputum.
F
The mixture of alcohol and chlorhexidine gluconate achieves better antiseptic than either agent alone.
T
Studies have shown a clear relationship between bacterial contamination of the surgical field and the volume at which the surgeon speaks.
T
Povidone-iodine has excellent sustained activity, even after wiped from the skin
F Intermediate to minimal if wiped from skin
Chlorhexidine gluconte and PI, but not parachlorometaxylenol cover gram negative organisms
F - all do
In dermatologic surgery, gloves become perforated in approximately 1% of procedures.
F 11%.
Hands should always be washed after removing surgical gloves.
T Surgeon only notices 17% glove perforations.
Fingernails should be kept short to facilitate cleaning
T
On the night before surgery, a preoperative shower with chlorhexidine gluconate or povidone-iodine has been shown to decrease wound infection rates.
T
There is convincing scientific data to show that wearing scrubs rather than street clothes affects the incidence of infection
F There is no data
There is conflicting data regarding the ability of face masks to reduce infection
T
If repeated application of antiseptic preparations is expected (eg. during Mohs), it is not necessary to use the same agent for each consecutive application.
F Should try to use the same, since some antiseptic agents are mutually inactivating.
Autoclaving generates pressures of 2 Pascals and temperatures of 121C that must be maintained for 15-30 mins.
T
A potential limitation to autoclave sterilisation is that repeated exposures to high humidity may dull sharp cutting surfaces.
T
The surgical hand scrub should be at least 2 minutes.
T
For most dermatological surgery a formal surgical scrub is not generally considered necessary
T
Excessive thermal destruction of tissue is not associated with an increased risk for infection.
F
Should it be necessary to cough or sneeze while wearing a face mask, you should step backwards and turn away from the surgical field
F Should face the surgical field
Hair should always be removed before surgical procedures
F Only if it will obscure the surgical field or hinder properly surgical technique
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
F 48 hours
