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BVetMed3 POS- Principles Of Surgery > Aseptic Technique > Flashcards

Aseptic Technique Flashcards

1
Q

What are the two definitions of a surgical site infection?

A

Infection occurring at the surgical site within 30 to 90 days of surgery

OR

1 year of a surgery involving placement of a permanent implant

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2
Q

What are the three classifications of surgical site infection?

A

Superficial - skin and subcutis

Deep - underlying muscle

Organ/body cavity infections - areas deep in the body entered at the time of surgery

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3
Q

What are potential impacts of superficial/deep surgical site infections?

A

Increased morbidity/illness
Increase hospitalisation time
Increase costs

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4
Q

What are potential impacts of organ/body cavity surgical site infections?

A

Surgery failure

Mortality/death

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5
Q

How can you tell which bacterial species has caused a surgical site infection?

A

Culture

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6
Q

How does surgical site infection occur?

A

Pathogens contaminating the wound at the time of surgery progressing to cause infection

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7
Q

What is meant by the term ‘contamination’ ?

A 
Pathogens:
Present
Not multiplying 
Not affecting healing 
Not causing tissue damage
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8
Q

What is meant by the term: ‘infection’?

A 
Pathogens:
Present
Multiplying
Disrupting healing 
Damaging tissues 
May spread to adjacent tissues 
May cause systemic illness
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9
Q

What is the definition of aseptic technique?

A

Practices and procedures performed under carefully controlled conditions with the goal of minimising CONTAMINATION of surgical sites by pathogens

Reduces risk of surgical site infections

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10
Q

What are the 5 key contributing factors to aseptic technique?

A 
Sterilisation of surgical equipment 
Prepping the patient 
Prepping the surgeon
Correct intra-operative technique
Maintenance and design of the operating theatre
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11
Q

What is the definition of sterilisation?

What is it used on?

A

Complete destruction of microbial viability (bacteria, viruses, fungi, spores)

Inanimate objects ONLY

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12
Q

What is the definition of disinfection?

A

Destruction of PATHOGENIC microbes

May not include all viruses and bacterial spores

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13
Q

What is the definition of cleaning?

When is it used?

A

Physical removal of surface debris

is required prior to sterilisation to prevent inhibition of the sterilisation process

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14
Q

What are the techniques which can be used for sterilisation?

A

Steam sterilisation (autoclave)
Chemical sterilisation
Gamma irradiation
Cold sterilisation

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15
Q

What are the types of chemical sterilisation?

A

Ethylene oxide

Hydrogen peroxide gas plasma

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16
Q

How does steam sterilisation work?

A

Heat kills by desaturation of cellular proteins

Pressure is applied to steam in sealed chamber to increase temperature of steam and make vapour more effective for killing

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17
Q

What type of heat is best for sterilisation?

Why?

A

Moist heat or steam

Lower temperature required
Faster death rate
Less resistance among bacterial spores

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18
Q

What are the pros and cons of steam sterilisation?

A

Economical
Non-toxic

Some delicate items can be damaged by heat or pressure

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19
Q

Why is steam good and air bad?

A

Steam - penetrates porous substances, contacts objects to be sterilised, gives up heat to objects via condensation

Air - inhibits diffusion of steam, decreases temperature of steam

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20
Q

What is the goal of an autoclave?

A

Introduce steam and expel air

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21
Q

How can you arrange instruments and equipment in an autoclave to maximise sterilisation?

A

Arrange to facilitate the movement of steam across instruments

Bowls upside down

Drape folded in a fan

Instrument packs on their side

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22
Q

What are the two types of autoclave?

A

Gravity-displacement autoclave

Pre-vacuum sterilisation

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23
Q

How do gravity-displacement autoclave work?

A

Steam introduced under pressure at top of chamber
Air displaced downwards

Sterilisation - 13mins, 120 degrees

Found in hospitals and bigger practices

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24
Q

How does pre-vacuum sterilisation work?

A

Actively removes air to create a vacuum before introduction of steam

Rapid introduction of steam therefore rapid penetration of instrument packs by steam and FASTER sterilisation (flash sterilisation)

Sterilisation in 3 mins at 131 degrees

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25
Why might a gravity displacement autoclave be used in larger practices even though sterilisation takes longer?
Larger chamber so can fit more instruments
26
Why might you use ethylene oxide to sterilise?
Some instruments may be damaged by heat
27
How does Ethylene oxide sterilise instruments? How does it compare to steam sterilisation?
Destroys all known microorganisms by ALKYLATION Takes much longer than steam sterilisation, also is TOXIC - must be removed from chamber after sterilisation and aerated for 24h to 12 days!
28
What is an alternative to ethylene oxide? How does it work? Compare the two
Hydrogen peroxide gas plasma DNA damage causes microbial killing Rapid - 1 hour Byproducts are non-toxic: oxygen and water MORE EXPENSIVE
29
What is gamma irradiation used for?
Sterilisation of many pre-packaged items (dressings, suture materials, needles)
30
How can sterilisation be monitored?
Print out which shows temperatures achieved and how long for Colour change stickers yellow to purple indicates temperature Stripes from white to black indicates steam Write DATE of sterilisation and when it will EXPIRE on pack
31
How can sterilised equipment be packed and stored? How long will it last ?
Cotton Muslin and Crepe paper together = 8 weeks Heat sealed pouches = 1 year
32
How can you elongate the safe storage times for sterilised instruments?
longer in CLOSED CABINETS vs open shelves
33
Why might heat sealed pouches be better than cotton muslin and crepe paper?
Only need to single wrap Water resistant Can be used for steam, EO, and PLASMA(others only steam and EO) Can see instruments inside
34
What is cold sterilisation?
Soaking instruments in disinfectants
35
What is cold sterilisation effective against?
Bacteria MAY NOT DESTROY spores and viruses
36
What instruments are suitable for cold sterilisation
Dental and endoscopy equipment NOT for instruments introduced below the body surface
37
What can be done to prep the patient to minimise risk of surgical site infection?
Hair removal Skin prep Transfer to theatre, positioning and keeping body warm Draping
38
What class of chemicals can be used to prepare the skin of a patient for surgery? What do they do?
Antiseptics Kill or inhibit the growth of pathogenic microbes
39
How can you judge the effectiveness of an antiseptic/.
Speed of killing Persistence - prevention of recolonisation over 6 hours Residual action - antimicrobial action over 5 days
40
What are the three key antiseptics used in practice?
Chlorhexidine gluconate - 4% Povidone iodine - 10% Alcohol
41
What is chlorhexidine gluconate effective against?
Bacteria (gram -ve more than gram +ve) Enveloped viruses (e.g. influenza, canine distemper, FIV, FeLV, FIP) Yeasts
42
What is chlorhexidine gluconate not effective against?
Mycobacterium Protozoa Fungi (some but not others)
43
Describe the properties of chlorhexidine gluconate.
Rapid initial kill - 3 mins for 98% Good persistent and residual action Ineffective in the presence of soaps and detergents Effective in the presence of organic material MINIMAL SKIN IRRITATION
44
Explain the persistent and residual action of chlorhexidine gluconate.
Binds to stratum corneum
45
Where should chlorhexidine gluconate NOT be used?
Middle and inner ear, meninges, brain, cornea, conjunctiva
46
What is povidone iodine effective against?
Broad spectrum killing - bacteria (+ve and -ve) - bacterial spores: prolonged contact required - enveloped and non enveloped viruses e.g PARVO and CALICIVIRUS - yeast, mycobacterium, Protozoa, fungi
47
Describe the properties of povidone iodine.
Rapid initial kill - 77% in 3 mins Good persistent action NO residual action Decreased activity in the presence of organic material ACUTE DERMATITIS in 50% of dogs Allergic and toxic effects in some people
48
Compare chlorhexidine gluconate and povidone iodine
No significant difference in percentage bacterial reduction Chlorhexidine resulted in fewer positive cultures post scrub Povidone iodine can cause skin reaction
49
When would povidone iodine be favoured over chlorhexidine gluconate? Why?
Eye surgery Ear surgery Contact toxicity of chlorhexidine in these areas
50
What is a 70% alcohol solution effective against?
Bacteria (+ve and -Ve) Mycobacterium Fungi
51
What are the properties of 70% alcohol solution?
Rapid immediate kill | Limited persistent and residual effects
52
What negatives are associated with 70% alcohol solutions?
TISSUE NECROSIS if enters open wounds DEHYDRATION of skin and mucous membranes —> irritation
53
What combinations of antiseptics are used for final prep in theatre? Why?
2% chlorhexidine and 70% isopropyl alcohol 0.7% free iodine + 74% isopropyl alcohol ADDITIVE EFFECT of 2 antiseptics with different modes of action
54
What brand name is given to the combination of chlorhexidine and isopropyl alcohol? What is it used for?
ChloraPrep Final prep in theatre
55
What is the goal of hand disinfection?
Removal of gross dirt Reduction in bacterial counts Continued inhibition of resident/colonising bacteria
56
What is the new alternative to hand scrubbing? What are the benefits of this?
Hand rubbing - alcohol based hand disinfectants As efficacious as scrubbing Reduced abrasions Reduced bacterial colonisation
57
How do you carry out rubbing?
1. Good hand hygiene - short nails, no jewellery 2. Wash hands and arms to elbows with pure soap 3. Apply alcohol based hand rub (STERILIUM) to hands and arms - 1 min 30 routine to ensure all surfaces rubbed - Air dry hands and arms
58
What are important properties of surgical gowns?
Physical barrier Prevent passage of bacteria Resistant to passage of blood and other fluids Should not shed lint Comfortable
59
Why is it important to disinfect hands before surgery?
Incase small holes in gloves
60
What are the aims of peri-operative antibiotics?
To prevent bacterial contamination incurred at time of surgery developing into an infection Need to be effective against bacteria present at the surgical site
61
How and when should perioperative antibiotics be administered?
IV Given 30 minutes prior to first cut Repeated every 90-120 minutes Stopped 12-24 hours after surgery
62
What are the contraindications of peri-operative antibiotics?
Microbial resistance Undesirable side effects Increased costs
63
What should you assess to determine if peri-operative antibiotics are required?
Classification of degree of wound contamination Possible consequences of wound infection Duration of surgery Immune function of patient
64
What is a clean surgical wound?
Non-traumatic elective procedure No entry into GIT, urogenital tract or respiratory tract No break in aseptic technique
65
When would perioperative antibiotics be indicated for a clean surgical wound?
Surgeries more than 90 mins Surgeries where infection would be catastrophic e.g. total hip replacement, pacemaker implantation
66
What is a clean-contaminated surgical wound?
Entry into a hollow organ with: No significant spillage No significant infection Clean procedure with minor break in aseptic technique
67
Would perioperative antibiotics be required for a clean contaminated surgical wound?
In general, have little effect if short surgery E.g. neutering, cystotomy in absence of urine infection
68
What is a contaminated surgical wound ?
Fresh (less than 6-8 hours) traumatic wound Spillage from a contaminated hollow organ during surgery Entry into a hollow organ in the presence of infection Clean surgery with a major break in aseptic technique
69
Would perioperative antibiotics be indicated for a contaminated surgical wound?
Yes Need to predict of spillage of bacteria likely following entry into a hollow organ
70
What is a dirty surgical wound?
Infected surgical site Purulent discharge encountered Wound open and untreated for more than 6-8 hours (E.g. cat bite abscess)
71
Would perioperative antibiotics be indicated for a dirty surgical wound?
YES No longer considered prophylactic Therapeutic antimicrobial use based on culture and sensitivity testing is required
72
What patient factors make the requirement of perioperative antibiotics more likely?
Concurrent active infection at a distant site Advancing age Obesity Endocrinopathies Immunodeficiencies
73
Why should perioperative antibiotics not be continued into the post operative period?
Risk of AMR

BVetMed3 POS- Principles Of Surgery (9 decks)

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