Aseptic Technique Flashcards
1
Q
Definition of Surgical Site Infection
A
- within a year of a surgery involving an implant
2
Q
How often do Surgical Site Infections occur?
A
- they are a significant impact on what we do
3
Q
Superficial/Deep Infections Impact
A
- puppy has ventral abdominal wound
- lots of swelling on abdomen and prepuce especially
- profuse growth of E.Coli
- morbidity was markedly increased
4
Q
Organ/body cavity Infections Impact
A
- can result in surgery failure
- not jsut morbidity –> could lead to death
example:
- this involved making a cut in the tibia
- failure to heal on medial tibia
- don’t see a clean fractured bone –> there is a display of failure for bone to heal
5
Q
MRSA and Surgical SIte Infections
A
- had a skin graft to repair
- 3 days after placement - culture revealed MRSa and partial loss of skin graft
- need to be careful how we are using AB’s!!
6
Q
How do SSI’s occur?
(contamination –> Infection)
A
- need to know difference between contamination and infection
- what we want to do is prevent contamination going to infection
7
Q
Aseptic Technique Definition
A
8
Q
Steps of Aspetic Technique
(5 things)
A
- need to focus on ourselves, patient and environment sterilization
9
Q
3 types of Surgical Site Infections
A
10
Q
Sterilisation of surgical equipment
A
- when talking about sterilization - this is in terms of inanimate objects only!
- =
11
Q
Sterilisation techniques
A
- 2 main methods to chemical sterilisation
12
Q
Steam Sterilisation
A
- damage possibilities means we may need alternative methods
13
Q
Steam Sterilisation in Autoclaves
A
- if air gets into this process, it is BAD
- various pieces of kit that are put in are put in where that the steam can cover the surface of all instruments
- cloth folded in fan shape to allow penetration of steam
- avoid stacking things on top of eachother
- bowl flipped over to allow penetration of steam - WHOLE POINT
14
Q
Gravity-Displacement autoclave vs. Pre-vacuum sterilisation
A
- GSA: steam pushes the air downwards
- PVS: the autoclave that is most common in pracitces
- rapid penetration of steam on instrument packs
- due to shortness of time –> Flash Sterilisation
- this chamber is smaller and that is why it can be so rapid, but you cannot fit as much!
15
Q
Ethylene Oxide (EO) gas
A
- good for some things that may be damaged by steam sterilisation
- sutures materials, catheters, plastics
- this is a colorless gas
- 450-1500 mg per litre
- must be removed from chamber after sterilisation process - and this is a long process
- need to be careful how we use this method! - only use for what cant be sterilised another way
- due to t being rather toxic
16
Q
Hydrogen Peroxide Gas Plasma
(4th state of matter)
A
- good particularly for plastics
- in the chamber there is this process
- Hydorgen Peroxide plasma causes the ultimate DNA dmage that leads to DNA damage
- echo
- It is a good alternative to EO but is more $$
17
Q
Gamma Irridiation
A
- can tell when things are sterilised by radiation as it will tell you
18
Q
Monitoring the Sterilisation process
A
- we need to make sure it is working
- every autoclave will have a printout (echo)
- strips can be placed inside packs with the instruments
- color change says if it was exposed at right temp and the black strips show steam, but still need to know exactly how long
- need to say date of sterilisation on packs and when they will expire - SO IMP!
19
Q
Storage of Sterilized Equipment
A
- need to maintain sterility for as long as possible
- also need to know when there is a risk of microbes in the packs
- if you use muslin: make sure to wrap the instruments twice, if water gets on it then it is no longer sterile!
- can use crepe paper on top of that: also not waterproof!
- heat sealed pounches: only need a single wrap, water resistant
- storage times depends on where you place the packs after
20
Q
Cold “Sterilisation”
A
- this will primarily destroy bacteria but may not get spores or viruses
- companies just assure the cold sterilisation but we don’t know what is in it
- there is a specific program for that sterilisation process
21
Q
Preparation of the Patient
(4 steps)
A
- read this paper
- “bear hugger”- warm air is being pumped into the bag
- sandbag is placed to help open up the chest
22
Q
Prep of the Patient- Antiseptics
A
- how long after you have applied them to the skin will they continue to kill?
23
Q
Antiseptics
(3)
A
- will see these being used in practice
24
Q
Chlorhexidine gluconate - 4% solution
A
- we are talking at specific concentrations
- when talking about chlorohexidine we are talking about a 4% sol’n
- advantage is that it has a rapid initial kill
- will still be effective in blood and pus (imp.) but also has contact toxicities!
25
Q
Povidone iodine - 10% solution contains 1% free iodine
(active component)
A
- will see this and chlorohexidine often
- but this will kill yeast, myco, protozoa (etc.) - unlike CH
- rapid initial kill is a bit less than CH
- doesnt last over 3-6 hours to 3 or 5 days
- acute dermatitis result is not a great side effect
26
Q
Chlorhexidine v. povidone iodine in dogs
A
- put them head to head
- remember concentration differences!
- echo
27
Q
Alcohol - 70% solution
A
- very poor spectrum killing
- very rapid immediate kill
- can cause necrosis in open wounds
28
Q
Alcohols frequently used with other antiseptics
A
- you will see the combo use of both
- achieve better overall reduction in microbes
- use chloraprep as a final prep
- orange because surgeons like to visualize the field and see they are ready for surgery
29
Q
Preparation of the Surgeon
A
- gowns, masks, hats, etc.
30
Q
Hand Disinfection
A
31
Q
Traditional Scrubbing Techniques
A
- using same antiseptics used to prep the patient
- bc of the time it takes to kill bacteria, the scrubbing is based upon timing of contact with antiseptics
- scrubbing technique with a brush may not be right: may cause abrasions on the hand a colonisation of bacteria that makes it difficult to remove that material
32
Q
Modern Scrubbing Techniques
A
- reduces abrasions and bacterial colonisation
- alcohol is less likely to cause a skin reaction on people which will increase compliance
- need to cover entire SA with alcohol
33
Q
What is really required in Scrubbing?
A
- no jewelry
- need to use pure soap
- AB soap will result to a sensitivity in your hands, pure soap allows people to be much more compliant
- make sure you get under the surfaces of your nails
34
Q
Gloving and Gowning
A
- need a comfortable surgeon or you may compromise the surgery!
- plastic would lead to an overheated surgeon
- If water is on gown for long periods, there will be compromise of the gown integrity and permeability (blood)
- these gowns need to be effective at all times! dispose of them once they are compromised
35
Q
Glove Punctures and Glove Powder
A
- so important to disinfect hands before gloving
- each step is vital to preventing SSI’s because there are errors in each step, need to reduce the risk
36
Q
Peri -Operative AB’s
A
- cannot compensate for poor aseptic technique
- need to use an IV antibiotic
- need to give them 30 min prior to the first cut
37
Q
When are Peri-Operative AB’s indicated?
A
38
Q
Surgical Wound Classification
(4)
A
39
Q
- Clean Wound Classification
A
- this is an example of a skin mass being removed
- no need to use AB’s as they do not decrease the infection rate when used in these cases (unless the surgeries are 90 min or if the infection would be catastrophic–> want implants to last a lifetime)
40
Q
- Clean-Contaminated Wound Classification
A
ex: bladder with cystotomy and regular spay
41
Q
- Contaminated Wound Classification
A
- contaminated but not infected
- these surgeries are increasing in SSI rates
- chance of spillage is quite high - AB use is indicated
42
Q
- Dirty Wound Classification
A
- jaw bone will be encountered
- we are talking about PREVENTATITVE AB’s
- can’t consider it to be prophylactic as the infection is already there
43
Q
Peri Operative AB’s - Immune Function of the Patient
A
44
Q
Peri-Operative AB’s - Ongoing Risk of Infection
A
