Aseptic Technique and Surgical Site Infection Flashcards
Sources of Microbial Contamination
Endogenous
From the patient
Normal flora
skin
GI tract
Lower Urinary tract
Upper respiratory
Infection
Sources of Microbial contamination
Exogenous
From the Environment
Room air
Clippers
Surgical team
Instruments / drapes
Diagnostic / therapeutic devices
Implants
What is Aseptic Technique?
Minimize the risk of infection by reducing or eliminating environmental factors, treatment factors, patient factors and pathogen factors
Draping
Isolates the surgical site / personnel from contaminated areas
provides sterile working area
Asepticd Technique
A combination of practices used to eliminate mircroorganisms within an operative field
Sterillization
process of destroying ALL microorganisms on an object
Antibiotics
Chemical substance that alter microbial activity in the patient
Is surgery inherently sterile?
NO
Why is surgery not inherently sterile?
Because it is impossible to sterilize biological tissues and approximately 20% of bacteria remain on the skin of the patient and surgical personnel
4 risk factors that contribute to an infection
environment
Treatment
Patient
Pathogen
Environmental Factors
Microbial organisms encountered during surgery can come from endogenous or exogenous sources
Endogenous
that the microorganisms are found on the patient
normal flora
Common commensal organisms of the skin
Staphylococcus and Streptocococus
Common Commensal organisms of hte Upper GI tract
Mostly Gram + cocci
Common commensal organisms of the Lower GI (colon)
Anaerobes and gram negative bacilli
Common commensal organisms of the Genitourinary
Gram negative bacilli
Exogenous
Microorgansisms are form sources surrounding the patient
Aseptic technique is used to?
reduce the NUMBERS of microorgansisms (endogenous/exogenous) within the surgical field
Patient Preparation
is performed to reduce exogenous bacteria ont he patient’s skin and or mucus membranes that will be in the surgical field
Order of patient prep
Anesthesia, Clip the hair, Dirty prep, Move to OR, Final prep, quadrant draping, Patient drape
Dirty Prep
Performed after clipping using one or more antiseptic solutions
Remove oils, dirt, and other debris fromt he skin and to begin to decrease microbial numbers
Final Prep
should be done using sterile equipment
Gloves, gauze, Bowls, antiseptic solution
Three alternating scrubs using sterile guaze soaked in chlorhexidine scrub, and sterile gauze soaked in isopropyl alcohol
Clamps used for quadrant drapes
Penetrating (bakhause) towel clamps
Clamps used for patient drape
Non-penetrating (edna) towel clamps
Preparing the equipment
Make sure the instruments are clean - no blood or gross debris
Equipment must be wrapped
Sterilization
Treatment factors
factors related to the surgical procedure being performed
Treatment factor
Drains
MINOR
Treatment factor
Peri-operative hypothermia / hypotension
MINOR
Treatment Factor
Blood Loss
MINOR
Treatment Factor
Placing a permanent implant
MAJOR
Treatment Factor
Duration of anesthesia and Surgery
MINOR
Surgery times >90mins have increased risk of infection
Patient factors
Intrinsic propterties or comorbid conditions that put patients at an increased risk for infection
Patient Factor
Sex
MINOR
males are at a higer risk
Patient Factor
Age
MINOR
very young and very old are at a higher risk for infection
Patient Factor
Endocrinopathies
MINOR - if controlled
MAJOR - if uncontrolled
Patient Factor
Immunosuppression
MAJOR
Patient Factor
Obesity or Malnutition
MINOR
Patient Factor
Recent Surgery
MAJOR
Patient Factor
Prior Irradiation
MAJOR
Patient Factor
Pyoderma or other infections
MAJOR
Pathogen Factors
Factors related ot these bacteria and include the type of bacteria, the number, and the virulence of the bacteria
Wound Classificiation:
Clean
Surgical incision NOT entering the respiratory, GI, genitourinary, or oropharyngeal tracts
Clean wounds have 2 - 4.9% infection rate
Wound Classification
Clean - Contaminated
Surgical incisions entering the respiratory, GI, Gentiourinary, Oropharyngeal tracts OR a clean surgery where a drain is placed
Clean-Contaminated wounds have a 3.5-4.5% infection rate
Wound Classification:
Contaminated
Surgical incisions with major break in asepsis ro spillage of GI content/infected urine or wounds with no necrosis or purulent discharge
Contaminated wounds have 4.6-9.1% infection rate
Wound classification:
Dirty
Surgical insicions with fecal contamination, a previously perforates viscus, or entering into an infected area (abscess) OR wounds with necrosis, purulent discharge, or foreign material
Dirty wounds have a 6.7-17.8% infection rate
