Aseptic Techniques in Surgery

Question 1

Why is aseptic technique important?

Answer 1

• surgical disruption of dermal integrity
• introduction of bacteria into wound
• -> endogenous: within/on patient
• -> exogenous: airbone, surgical team

Question 2

Sterilization

Answer 2

Complete elimination of microbial viability

- bacteria, viruses, spores

Question 3

Disinfection

Answer 3

Destruction of MOST pathogenic organisms on inanimate objects

Question 4

Antisepsis

Answer 4

Prevent growth of microorganisms on living tissue by inhibiting activity or killing them (not sterilized)

Question 5

Living organism too small to be seen with the naked eye

Answer 5

Microbe/microorganism

Question 6

Microbe capable of causing disease

Answer 6

Pathogen

Question 7

Detrimental result of invasion by pathogens

Answer 7

Infection

Question 8

Infection acquired during hospitalization or during attendance at any vet facility

Answer 8

Nosocomial

Question 9

Methods of sterilization

Answer 9

• steam
• chemical
• plasma
• ionizing
• cold chemical

Question 10

Steam and pressure

Answer 10

Most common

• destroys bacteria by coagulation and cellular protein denaturation
• load on edge –> no stacking (increased thickness decreases steam penetration
• small amount of air between packs
• gravity displacement: air is heavier than steam

Question 11

Chemical (gas)

Answer 11

Ethylene Oxide

• flammable, explosive liquid if not mixed with CO2 or freon
• kills via alkylation
• lower temp (120-140 F) for cameras, plastics, cables
• environmental/safety hazards

Question 12

Plasma

Answer 12

Uses reactive ion, electrons, and other atomic particles to sterilize

• lower temp
• used with vapor phase H2O2
• takes only 75 min, immediate use
• irritant: housed in sealed cassette

Question 13

Radiation

Answer 13

Ionizing radiation (Cobalt 60)

• used in commercial manufacturing due to expense
• suture material, gowns, drapes, etc

Question 14

Cold chemical

Answer 14

Glutaraldehyde (2%)

• noncorrosive
• good for delicate lensed instruments
• other: alcohols, chlorhexadine, iodines, phenols, quart, ammonium compounds

Question 15

Rules for sterilization

Answer 15

• know activity of agent
• know potential toxicities
• properly wrap equipment
• check technique/instruments
• use indicators
• know shelf lives

Question 16

Indicators

Answer 16

Monitor effectiveness of sterilization

• chemical: temp induced change, does not indicate sterility, only optimal conditions
• biologic: cultured, weekly use recommended

Question 17

Sterile packs should be stored in _______

Answer 17

Closed containers

Question 18

Inside of wrappers is considered to be sterile to within _______

Answer 18

1 inch of the edges

Question 19

Infection in surgery is indicated in tissue ______

Answer 19

With >10^5 cfu/gram of tissue

- antibiotics NOT designed to make up for poor sterile technique

Question 20

Indications of perioperative antibiotics

Answer 20

• OP times 90 min or greater (infection rate doubles)
• implants
• severely infected/traumatized
• respiratory
• GI
• urogenital

Question 21

Surgeon’s responsibility

Answer 21

• evaluate overall health of patient
• preserve vascularity
• minimize trauma
• maintain tissue oxygenation
  = enhanced healing and reduced potential for infection

Question 22

Control of enviornment

Answer 22

• disinfection of equipment
• frequent repetition of cleaning procedure
• traffic control

Question 23

Patient preparation

Answer 23

• clip/clean area

- scrub: center out, iodine, chlorhexadine (less reaction)

Question 24

Final result of draping

Answer 24

• minimal skin exposure
• multiple layers
• waterproof barrier to prevent strike through

Question 25

Personal prep includes:

Answer 25

- pre surgery - surgery prep - post surgery

Question 26

Pre-surgery

Answer 26

- wash hands - keep fingernails short - remove jewelry - hair coverage: major bacterial contaminant

Question 27

Surgical attire

Answer 27

- clean scrubs - booties - mask: designed to filter and contain microorganisms from droplets - cap/bonnet: hair within cap

Question 28

Surgical gloves

Answer 28

Percentage of defects: - overall: 23.3% defects - more in non-soft tissue procedures - 84% of defects in procedures >60 min

Question 29

Scrubbing

Answer 29

Contact time is key! - 3-5 min with chlorhexidine - fingertips to 2 inches above elbow - binds to keratin for residual effect - check fingernails - prewash

Question 30

Brushless/waterless scrub

Answer 30

- alcohol based - more effective - quicker - method of choice by WHO - Avagard/Steriliium

Question 31

In the OR

Answer 31

From chest to waist is sterile area for body | - from elbow to hand is sterile area for arms

Question 32

Surgery suite etiquette

Answer 32

- inform assistants of position - back to back/front to front - step up to table - maintain sterile field - # of people and degree of movement has been correlated to amount of airbone bacteria (same with amount of talking)

Question 33

Instruments/trays

Answer 33

- anything off the table level is contaminated! - instruments that fall off to the side are contaminated - hands that touch instruments below the table line are contaminated

Question 34

Wet/stained instrument wrappers

Answer 34

Strike through - when liquids soak through a barrier from sterile to unsterile and vice versa - provides a passage for microorganisms - contents of pack are contaminated

Question 35

Sterile supplies that fall or the floor, or are stored on the floor should be considered _________

Answer 35

Contaminated

Question 36

When opening a sterile pack do not _____

Answer 36

Reach across the sterile field | - items opened enveloped style may be handed off to a sterile person

Question 37

After surgery

Answer 37

- keep basic attire on - place waste in proper cans - wash hands again before next patient - lab coat outside of OR

Question 38

Everything done in the operating room is for the purpose of ________

Answer 38

Minimizing microbial contamination, to minimize post operative infection and achieve maximal therapeutic benefit