instruments / Devices Flashcards
What is the typical power source of an Endoscopic Light Source?
Usually powered by halogen or xenon.
Which type of light source is preferred for Endoscopic Light Sources?
Xenon preferred because it emits a high-intensity light that closely reproduces the color of natural light.
What is the typical wattage range for good picture quality in Endoscopic Light Sources?
Typically between 150 and 300 watts.
What are the four basic interactions that can occur with tissue when energy is in the form of a laser beam?
Absorption, transmission, scatter, and reflection
Which of the four interaction is key to effective laser-to-tissue interaction?
A. absorption
B. transmission
C. scatter
D. reflection
Absorption
What substances are able to absorb light?
- Water
- Pigments
- Lipids
- Hemoglobin
- Oxyhemoglobin
- Carbon
Fill in the blank: Lasers with ____ wavelengths (Nd:YAG, Diode lasers) may be desirable when gross tissue ablation is required.
shorter
But not when precise delicate tissue handling is required.
What are two examples of lasers with shorter wavelengths?
- Nd:YAG 1064 nm
- Diode lasers 810 nm
What effect do short wavelenght lasers have on tissue knowing that they are poorly absorbed by water and react more with pigment in tissues?
Coagulative necrosis, deeper thermal conduction, and spread
Short wavelenght readliy tansmit or pass through water and scatter deeper within the tissues.
Fill in the blank: Lasers with longer wavelengths are characterized by ____ tissue penetration.
shallow
What are three examples of lasers with long wavelengths?
- CO2 laser 10,600 nm
- Holmium:yttrium–aluminum–garnet [Ho:YAG] 2100 nm
- Erbium:YAG [Er:YAG] 2940 nm
Fill in the blank: Lasers with long wavelengths do not pass through ____ and are instead absorbed by it and strongly react to it.
water
Fill in the blank: Lasers with long wavelengths (CO2 laser 10,600 nm, holmium:yttrium–aluminum–garnet [Ho:YAG] 2100 nm, and erbium:YAG [Er:YAG] 2940 nm) have shallow tissue penetration because these particular wavelengths do not pass through water and instead are absorbed by it and strongly react with it, ____ tissue, layer by layer
Vaporizing tissue
Fill in the blank: Lasers with long wavelengths result in high surface temperatures and good cutting with ____ collateral damage.
minimal
Fill in the blank: Lasers with ultrashort wavelengths, such as argon lasers, have a ____ depth of tissue penetration.
medium
What is the range of wavelengths for argon lasers?
488 to 514 nm
Fill in the blank: Lasers with ultrashort wavelengths (argon) are recommended for ____ tissues.
vascular
because their radiation is well absorbed by red pigments such as hemoglobin
Fill in the Blank: The radiation from lasers with ultrashort wavelengths is well absorbed by ____ pigments such as hemoglobin.
red
Tissue effects from a burst of laser energy.
Laser beam —> vapoization, carbonization, coagulation, hyperthermia
Zones of injury after a burn
Zone of coagulation
Zone of stasis
Zone of hyperemia
What is the wavelength of CO2 Laser?
10,600 nm
What happens to intracellular water when CO2 Laser is used?
Instantaneous heating to the boiling point, causing cells to explode in its path
What are the two main uses of CO2 Laser?
- Cutting
- Vaporization
What is the level of injury caused to deep tissue structures by CO2 Laser?
Very little
What size blood vessels can be coagulated and sealed by CO2 Laser?
<0.6 mm in diameter
List some veterinary applications of CO2 Laser.
- Oral surgery
- Onychectomy
- Skin reconstruction
- Upper airway surgery
- Staphylectomy
- Perianal/rectal surgery
True or False: Ho:YAG Laser (2100 nm) is moderately absorped by water.
False - Highly absorbed by water
This property allows for effective treatment in various medical applications.
How can Ho:YAG Laser be used?
vaporize, cut, coagulate, and smooth tissues
These capabilities make it versatile in surgical procedures.
Why is the Ho:YAG Laser preferred for arthroscopic procedures?
Causes minimal tissue necrosis and is able to cut and ablate with ease
This minimizes damage to surrounding tissues during surgery.
What is lithotripsy and how does the Ho:YAG Laser assist in this procedure?
The laser absorbs water from the urolith, resulting in photothermal fragmentation of the stone
This technique is used for breaking down urinary and biliary calculi.
List some applications of the Ho:YAG Laser.
- Arthroscopy
- Lithotripsy
- Surgery of the upper airway
- Oral surgery
- Urogenital surgery
- Intervertebral disc ablation
These applications highlight the laser’s versatility in different surgical fields.
What wavelength does the Er:YAG Laser emit?
2940 nm
What is the primary substance that strongly absorbs the 2940 nm wavelength of the Er:YAG Laser?
Water
Besides water, what other substance is absorbed by the Er:YAG Laser?
Hydroxyapatite
What are the two primary materials that the Er:YAG Laser is effective for cutting?
Bone as well as tissue
What is the wavelength of Nd:YAG Laser?
1064 nm
Which tissue type is slightly absorbed by Nd:YAG Laser?
Water
What is the deepest tissue penetration of Nd:YAG Laser?
Up to approximately 5 mm
What is one of the primary uses of Nd:YAG Laser?
Coagulation of larger blood vessels
True or False: Nd:YAG Laser produces a smaller coagulation zone.
False - They produce a large coagulation zone and damage adjacent tissues.
What is a disadvantage of using Nd:YAG Laser?
Produces a larger coagulation zone and damage to adjacent tissue
In which procedure has Nd:YAG Laser been used?
Laparoscopic ovariectomy in dogs
What is the typical wavelength range of diode lasers?
590 to 5300 nm
Most commonly in the 810- to 980 nm range for soft tissue applications.
What is a significant advantage of diode lasers over CO2 lasers?
Superior hemostatic abilities
This is particularly noted in the context of soft tissue procedures.
Why do diode lasers cause a greater depth of thermal injury?
Not easily absorbed by water
This characteristic allows for deeper tissue penetration.
What are the two modes of operation for diode lasers?
Contact (cutting) and noncontact (vaporization)
These modes are chosen based on the desired clinical effect.
Name at least two clinical applications of diode lasers.
- Feline onychectomy
- Removal of dermal, subdermal, and oral masses
The variety of delivery fiber tips allows for diverse applications.
Diode lasers typically operate in which nm range for effective soft tissue penetration?
810- to 980 nm
This range is optimal for most types of soft tissues.
Fill in the blank: Diode lasers can be delivered through an ____.
[endoscope, otoscope, or bronchoscope]
These tools enable their use in various clinical scenarios.
What wavelength range does the Argon Laser operate within?
488 to 514 nm
What type of light does the Argon Laser emit?
Visible blue-green light
What substance is highly absorbed by the Argon Laser light?
Hemoglobin
What is the primary transformation of energy when the Argon Laser interacts with hemoglobin?
Heat
What are the Argon Laser’s main applications?
- Removal of vascular lesions
- Controlling intraocular hemorrhage
*
Coagulation, Vaporization and Cutting in a bleeding environment
What types of modes can the Argon Laser operate in?
Contact or noncontact modes
What is a feature of the Argon Laser regarding its placement?
Placed through flexible endoscopes
Is the Argon Laser considered expensive?
Yes
What effect does the Argon Laser produce in less vascular tissue?
Charring
What is the wavelength of the Excimer Laser?
193 nm
What type of surgery is the Excimer Laser frequently used for?
Precision delicate ophthalmic surgery (LASIK)
What does the term ‘excimer’ stand for?
Excited dimer
How does the excimer laser interact with tissue?
Disrupts the molecular bonds of the surface tissue without causing water vaporization
What is the tissue depth of ablation that the Excimer Laser can achieve?
1 mm
What is a key advantage of using the Excimer Laser in surgery?
Can remove exceptionally fine layers of surface material with almost no heating and minimal inflammation to surrounding area
Chlorohexadine Properties (7)
- Disrupt cell membrane (Bacteria, enveloped viruses, less so non-enveloped virus)
- Bactericidal at [high] and bacteriostatic at [low]
- NOT SPORICIDAL (Spore killer), (EXCEPT AT 60-70 C), alcohol improves efficacy
- **Surgical scrub 2.0-4.0%
- Wound treatment ≤ 0.05%, oral rinse 0.12% (NOT for cats)
- **Disinfectant solutions 0.5-2.0%
- > 0.5% toxic to fibroblast, cat mouths may get erosions, neurotoxicity, ototoxicity
What are the two modes applying energy to hemostat?
- Cutting mode
- Coaptive coagulation
What is the BEST EFFECT of the cutting mode?
Noncontact form to create spark → Current arcs to the tissue
How does cutting mode compare to coagulation current in terms of tissue damage?
Less char & tissue damage compated to coagulation current
What is coaptive coagulation?
A type of desiccation coagulation
What occurs when the lumen of a vessel is occluded by a metal instrument with coaptive coagulation?
Lumen of a vessel is occluded by a metal instrument → Lumen wall is coagulated → Denatures adventitia → Vessel Dehydration → Collagen Weld (Stops bleeding)
Type of Sterilizaton (7)
- Liquid Chemical Germicides (Cold Sterilzation)
- Steam Sterilization
- Ethylene Oxide Sterilization
- Ozone Sterilization
- Plasma Sterilization
- Vaporized Hydrogen Peroxide
- Sterilization by Radiation
What is the process of soaking in a disinfectant until acceptable reduction of microbial presence called?
Cold Sterilization
This process is also referred to as liquid chemical germicides.
Most liquid chemical germicides have biologic sterility indicators: true or false?
Liquid Chemical Germicides (Cold Sterilzation)
False
Most do not have biologic sterility indicators.
What is a disadvantage of liquid chemical germicides regarding their ability to access instruments?
Liquid Chemical Germicides (Cold Sterilzation)
Decreased ability to access interiors and crevices of instruments
This limitation affects their overall efficacy.
Agents with high efficacy against spores typically have what levels of toxicity?
Liquid Chemical Germicides (Cold Sterilzation)
High levels of user, instrument, and environmental toxicity
This makes them potentially hazardous in various settings.
Are liquid chemical germicides currently advised for surgical instrument sterilization?
Liquid Chemical Germicides (Cold Sterilzation)
No
They are not advised for this purpose.
What is the preferred method for sterilizing heat- and moisture-stable instruments?
Steam Sterilization (Autoclave)
This method is widely accepted in medical and laboratory settings due to its effectiveness.
How does steam sterilization kill microorganisms?
Through coagulation and denaturation of proteins by moist heat
This process is essential for effective sterilization.
What are advantages of steam sterilization?
Inexpensive, efficacious (including spores), nontoxic, and rapid
These features make it a preferred choice in various settings.
What is the temperature and time required for steam sterilization in a gravity-displacement unit?
121C (250F) for 30 minutes then 15-30 minutes of drying time
This ensures effective sterilization while preventing damage to instruments.
What is the temperature and time required for steam sterilization in a prevacuum unit?
132C (270F) for 4 minutes
This method is faster and often used for more delicate instruments.
How long can double layered linen packs or plastic-paper envelopes be safely stored after steam sterilization?
At least 96 weeks
Proper storage is crucial for maintaining sterility.
In steam sterilization, how should bowls be positioned?
Bowls must face down
This prevents trapping of cool air, which can compromise sterilization.
What is the main purpose of flash sterilization?
Rapid sterilization for immediate use
Flash sterilization is used when immediate use of sterilized items is necessary.
What type of sterilizer is commonly used for flash sterilization?
Steam autoclave with higher temperature and shorter cycle time
This method allows for quick sterilization of items.
What is the protocol for unwrapped metallic nonporous items during flash sterilization?
3 minutes at 135C (275F) with 1 minute of drying
This protocol ensures effective sterilization while minimizing exposure time.
What is a more accurate term for flash sterilization?
Immediate-use steam sterilization
This term emphasizes the purpose of the sterilization process.
Is flash sterilization recommended for implantable devices?
Not recommended
Flash sterilization may not provide adequate assurance of sterility for implantable devices.
What is the boiling point of ethylene oxide?
10.5C (51F)
Ethylene oxide gas is colorless and odorless.
How does ethylene oxide sterlize?
Alkylation of proteins and nucleic acids
This process obstructs cell metabolism and reproduction.
What are the hazards associated with ethylene oxide?
Flammable, toxic (carcinogenic, mutagenic, neurologic hazards)
Ethylene oxide poses multiple health risks.
Which materials can ethylene oxide be adsorbed to?
Rubber, plastics
This adsorption necessitates an aeration cycle to remove the gas.
What is the storage life for cloth sterilized with ethylene oxide?
15-30 days
Storage life varies depending on the material.
What is the storage life for paper sterilized with ethylene oxide?
30-60 days
Different materials have different storage life expectations.
What is the storage life for tape-sealed plastic sterilized with ethylene oxide?
90-100 days
This reflects the stability of the sterilized product.
What is the storage life for heat sealed plastic sterilized with ethylene oxide?
1 year
Heat sealed plastic has the longest storage life among the materials listed.
Ozone sterilization is best used for?
Moisture- and heat-sensitive items
Ozone sterilization is specifically designed for items that cannot withstand high temperatures or moisture.
What is the source of ozone in ozone sterilization?
Water and oxygen
Ozone sterilization oxygen water” refers to water that has been treated with ozone, a highly reactive form of oxygen (O3), to kill bacteria and other microorganisms, effectively sterilizing it; essentially, the ozone dissolves into the water, acting as a powerful oxidizer to disinfect the liquid, then quickly breaks down back into regular oxygen, leaving only clean water behind.
How does ozone kill microbes?
By oxidizing molecules
This process disrupts the cellular structure of the microbes. Uses ozone gas to kill microorganisms and sterilize surfaces, air, and object.
What is the typical cycle duration for ozone sterilization?
Approximately 4 hours at 30 to 35C.
The temperature range for this cycle is 30C to 35C.
Is ozone sterilization suitable for wood and paper items?
No
Ozone sterilization is not suitable for these materials or any packaging that may be affected.
What type of energy creates the plasma phase in plasma sterilization?
Electromagnetic energy
This energy is used to convert vapor into a plasma state.
What substances can be vaporized to create plasma in plasma sterilization?
Hydrogen peroxide, oxygen, or peracetic acid/H2O2 mixture
These vapors are essential for generating the plasma phase.
What role do free radicals play in plasma sterilization?
They deactivate cellular processes
Free radicals are reactive species that disrupt cellular integrity.
Is plasma sterilization rapid and effective?
Yes, but it is expensive
The cost can be a limiting factor in its use.
What is a significant advantage of using hydrogen peroxide in plasma sterilization?
No aeration is required because there are no toxic residues
This makes it safer for handling post-sterilization.
What is the cycle time for plasma sterilization?
28-75 minutes
The exact time can vary depending on the specific process used.
What temperature range is used during the plasma sterilization cycle?
45C-50C
This temperature range is crucial for effective sterilization.
What types of items is plasma sterilization useful for?
Heat- and moisture-sensitive items
It is ideal for items that cannot withstand traditional sterilization methods.
What types of items should NOT be sterilized using plasma sterilization?
Linens, liquids, or wood
These materials may not withstand the conditions of plasma sterilization.
What type of packaging is required for plasma sterilization?
Synthetic packaging and special container trays
This is necessary to ensure the integrity of the sterilization process.
Can plasma sterilization penetrate small lumina such as endoscopic equipment?
Yes, but less successfully than ethylene oxide
Ethylene oxide is generally more effective for such applications.
What is the typical temperature range for the low temperature, rapid cycle of Vaporized Hydrogen Peroxide?
30-55 min
Is Vaporized Hydrogen Peroxide toxic?
No
What is NOT required when using Vaporized Hydrogen Peroxide?
Aeration
What types of items is Vaporized Hydrogen Peroxide used for?
Heat- and moisture-sensitive items
Fill in the blank: Vaporized Hydrogen Peroxide is NOT used for _______.
liquids, linens, powders or cellulose
What type of radiation is primarily used for sterilization?
Ionizing radiation from cobalt 60 gamma rays or electron accelerators
Cobalt 60 is a radioactive isotope commonly used in radiation therapy and sterilization processes.
What limit manufactoring companies from using sterilization by radiation?
cost and significant safety regulations
Safety regulations are crucial to ensure the protection of workers and the environment during sterilization processes.
What materials are commonly sterilized using radiation?
Suture and certain implants
Suture materials and implants must be sterilized to prevent infection during surgical procedures.
Fill in the blank: Prolonged storage of polyethylene implants after gamma sterilization may result in ____.
oxidative damage
Oxidative damage can compromise the integrity and performance of polyethylene materials.
What types of materials may be damaged by radiation sterilization?
Certain biologics (eg. Bone graft) and pharmaceuticals
What are the three types of sterilization indicators?
Physical, Chemical and Biologic indicators
Physical indicators are specific to the sterilization unit, while chemical indicators provide information on the sterilization process.
What do physical sterilization indicators verify?
Time and temperature
They may be in the form of printouts or graphs.
How many classes are there for chemical sterilization indicators?
Six classes
Higher class numbers provide more specific information.
What is the purpose of Class 1 chemical indicators?
Demonstrates exposure to sterilization process and are applied on exterior
They are applied to the exterior.
Where are Classes 2-6 chemical indicators placed?
Internally
These indicators are placed inside packs.
What is the specific test used in Class 2 indicators?
Bowie-Dick tests
These tests are designed for air removal.
What does Class 3 chemical indicator test for?
One parameter
What does Class 4 chemical indicator test for?
More than one parameter
What do Class 5 indicators react to?
ALL parameters important to a given type of sterilization
What is the monitoring capability of Class 6 indicators?
ALL parameters + specific guidelines associated with a unique indication
Where should Class 1 indicators be placed?
On the outside
Additional classes (2-6) should be placed in the deepest portion of the pack.
What is considered the BEST METHOD to determine sterilization efficacy?
Biologic indicators
Which spores are used for steam, plasma, and ozone sterilization?
Geobacillus stearothermophilus
Which spores are used for ethylene oxide sterilization?
Bacillus atrophaeus
What are disadvantages of biologic indicators?
Cost and long inbucation time (16 hours to 7 days)
Rapid readout indicators are available for vacuum-assisted steam with a 1-hour readout.
What is the mechanism of action of Povidone-Iodine?
Oxidation/substitution by free iodine -> denatures proteins
This process disrupts the structural integrity of proteins, leading to microbial cell death.
What types of microorganisms is Povidone-Iodine effective against?
Bacteria, viruses, and fungi
Povidone-Iodine is a broad-spectrum antiseptic.
How effective is Povidone-Iodine against spores?
Poor to acceptable
Its effectiveness against spores is not as strong as against other microorganisms.
What are the advantages of using Povidone-Iodine?
- No resistance identified
- Can be used in ears, eyes (5% solution) and mouth
- Decreases oral inflammation
These advantages make it a versatile antiseptic in various medical applications.
What is a significant disadvantage of Povidone-Iodine?
- May cause irritation (skin reactions observed in 50% of cases)
- Inactivated in blood and organic debris
- Toxic to fibroblast greater than 0.5% (caution around wounds)
This irritation can limit its use in sensitive populations.
What type of forceps is most suitable for static tissue holding during dissection around secured tissue?
Crushing
Crushing forceps are designed to hold tissue firmly without causing movement.
What is the primary function of Non-crushing forceps?
May completely (Doyen forceps) or partially (cardiovascular forceps) occlude lumen with minimal trauma
Non-crushing forceps are designed to minimize damage to the tissue while maintaining control.
What are Hemostatic forceps used for?
Used to isolate bleeding points or bluntly dissect tissue
Hemostatic forceps play a crucial role in controlling bleeding during surgical procedures.
What type of serrations do Halsted mosquito, Crile, and Kelly forceps have?
Transversely oriented serrations
These serrations are designed to grasp a small amount of tissue effectively.
What is the design orientation of serrations in Rochester-Carmalt forceps?
Longitudinally oriented serrations
This design allows for grasping larger amounts of tissue while directing the tip away from the vessel.
Fill in the blank: Crushing forceps are most suitable for _______.
static tissue holding
They provide stability during dissection.
True or False: Non-crushing forceps can cause significant trauma to the tissue.
False
Non-crushing forceps are designed to minimize trauma.
True or False: Chlorhex hand scrubs are more effective than povidone-iodine scrubs for a given duration.
True
Chlorhexidine scrub solution is ____% vs disinfectant solution of ____% vs. wound treament solution of ____ %
- 2.0-4.0%
- 0.5-2.0%
- <0.05%
What area of the hand is reported to have the highest bacterial load despite hand scrubbing?
subungual area
The subungual area is the area beneath the nails, which tends to harbor more bacteria compared to other parts of the hand.
How long after scrubbing with antiseptic and ethanol cleanser does a rebound to the prescrub level of bacteria occur?
8 hours
This indicates that the effectiveness of hand scrubbing may diminish relatively quickly.
What effect does the use of antiseptic and ethanol cleanser have on bacterial counts?
Decrease
Antiseptic and ethanol cleansers are effective in reducing the bacterial load on hands.
What is the effect of scrub brushes and nail picks on bacterial load?
does not appear to change the
This suggests that mechanical cleaning methods may not significantly impact the bacterial load.
Loop tension of twist, single loop and double loop?
Twist 70.3 +/- 20.3
Single loop 165 +/- 28.52
Double loop 391.8 +/- 49.6
Load resisted before lossening of twist, single loop and double loop?
Twist 268.5 +/- 26.4
Single loop 259.8 +/- 18.4
Double loop 661.7 +/-33.8
What are three advantages of swaged (eyeless) needles over nonswaged (eyed) needles?
• Sterility - supplied in single-use, sterile packs
• Sharpness - single-use
• Decreased tissue trauma
These advantages contribute to improved surgical outcomes.
Laser-drilled swaged needles have less or greater tissue drag compared to channel-swaged needles?
[less]
How can laser-drilled swaged needles be gripped compared to channel-swaged needles?
Farther back
This feature can enhance control during surgical procedures.
Name Parts
Tips
Jaws
Box lock pin
Box lock
Shank
Ratchet
Ring handle
Name three different blade handles and what blades they fit.
3 scalpel handle - #10 , #11 , #12 , #15
#4 scalpel handle - #20 , #21 , #22 , #23
Beaver surgical knife handle - #64 , #67
Nonsterile Team vs Sterile Team
Nonsterile Team:
- Anesthesiologist and anesthesia vet nurse/ tech
- Circulating vet nurse/ tech
Sterile Team:
- Surgeon
- Surgery Assistant
- Scrub vet nurse/ tech
OR principles of Conduct:
- Sharing goals
- Having clear
- Mutual trust
- Establishing effective communications
- Agreeing with measurable process and outcomes
Name the nonverbal communication.
- Scalpel blade handle
- Thumb forceps
- Needle drivers
Define surgical asepsis:
Surgical Asepsis is the complete absence of contamination by pathogenic organisms.
Define Antiseptics:
I
Define Disinfectants:
Antiseptics prevent or reduce the growth of pathogenic organism on living tissues, resulting in prevent infection.
I
Disinfectant are agents (usually chemicals) that destroy most pathogenic organisms but NOT SPORES on inanimate objects.
Disinfectants Classifications:
High- level
Intermediate- level
Low-level
High-level disinfectant solutions can also be used as sterilants, which are agents used to destroy microorganisms. Contact time of 20 to 30 minutes is generally recommended for disinfection.
Intermediate-level disinfectants cannot kill spores or some viruses, but they are capable of killing all bacteria, fungi, and nonhydrophilic viruses. These disinfectants require a 10- to 15-minute contact time and are often used on operating room surfaces, furniture, floors, and countertops.
Disinfectants can become antiseptics and vice versa, depending on the concentrations in which they are used.
Ventilation:
Laminar airflow system, aka ultraclean airflow, creates an unindirectional, positive pressure flow of air leading to a decrease in environmental bacterial loads.
Horizontal laminar flow is perforable to vertical-flow systems
Humidity should be 30 to 60%
Temperature 68 degrees to 73 degrees
What has been proven to increase operating room infections?
Multiple factors including traffic flow, number of people, and excessive conversation.
Risk increases by 30% per person in the OR
Do gloves decrease infection rates in the operating room?
Gloves have not been proven to decrease infection rates.
What factors are associated with more common perforations in gloves?
Vinyl gloves, non-dominant hand use, and single gloving.
Is there a superior style of caps that reduces infection rates?
No, one style of cap is not superior to another.
What is the effectiveness of masks in protecting against contamination?
Masks have failed to demonstrate protection from contamination.
What effect do shoe covers have in the operating room?
Shoe covers decrease bacterial transfer but there is no proof they lower infection rates.
How do disposable gowns affect bacterial transmission?
Disposable gowns are associated with less bacterial transmission and lower rates of contamination.
What did studies find about woven reusable fabrics in the operating room?
Bacteria can easily penetrate all woven reusable fabrics within 30 minutes.
True or Flase: Disposable nonwoven fabrics remain impermeable to bacteria.
True
What is the single factor that reduces environmental and surface contamination in the OR?
Laminar airflow.
By what percentage does the risk of infection increase per person in the operating room?
30% per person.
Fill in the Blank: Bacteria can easily penetrate all woven reusable fabrics within ____ minutes.
30 minutes
What is the primary mechanism by which steam autoclaving kills microorganisms?
Coagulation and denaturation of proteins by moist heat
This process is effective in destroying various types of microorganisms, including spores.
What are the advantages of steam autoclaving?
Effective against spores, nontoxic, and rapid
This makes it a preferred method for sterilization in many settings.
What is the required temperature and time for steam autoclaving in a gravity-displacement sterilizer?
121°C for 30 minutes, followed by 15-30 minutes to dry
Proper drying time is essential for effective sterilization.
What is the required temperature and time for steam autoclaving in a prevacuum unit?
132°C for 4 minutes, followed by 15-30 minutes to dry
The prevacuum method allows for quicker sterilization times.
In steam autoclaving, how should bowls be positioned?
Facing down
This positioning helps prevent water accumulation inside the bowls.
How long can double wrapped packs last when sterilized by steam autoclaving?
96 weeks
This indicates the efficacy of the packaging in maintaining sterility.
What is the main function of a Flash steam autoclave?
To sterilize equipment using steam at higher temperatures in a shorter cycle
What is the cycle time and temperature for a gravity-dependent steam autoclave?
3 minutes at 135°C (275°F) with 1 minute of drying
This cycle is designed to ensure effective sterilization while minimizing exposure time.
What is the accurate term for flash autoclave?
Immediate-use steam sterilization
This term highlights the rapid sterilization process intended for urgent scenarios.
Is immediate-use steam sterilization recommended for implantable devices?
No
This method is not suitable for items that will be implanted in the body due to potential risks.
What is the boiling point of Ethylene Oxide?
10.5°C (51°F)
How does Ethylene Oxide sterilize?
By alkylation of proteins and nucleic acids, obstructing cell metabolism and reproduction
What are the hazards associated with Ethylene Oxide?
Toxic, carcinogenic, mutagenic, and neurologic hazards
What materials can Ethylene Oxide be adsorbed by?
Many substances including rubber and some plastics
What are the required conditions for effective sterilization with Ethylene Oxide?
- Temperature 29°C to 65°C [84.2°F to 149°F]
- Humidity 45% to 85%
- Time 2 to 5 hours, followed by aeration
How are cycle times and concentration related in Ethylene Oxide sterilization?
Cycle times and concentration are inversely correlated
How long do Ethylene Oxide sterilized items wrapped in plastic heat-seal last?
12 months
How long do Ethylene Oxide sterilized items wrapped in cloth last?
1 month
How long do Ethylene Oxide sterilized items wrapped in paper last?
2 months
How long do Ethylene Oxide sterilized items sealed with plastic tape last?
2-3 months
What is the primary method used in plasma sterilization?
Uses electromagnetic energy to create a plasma phase from vapor of H2O2 and O2 or peracetic acid/H2O2 mixture
Plasma sterilization utilizes reactive species generated from vaporized hydrogen peroxide or a mixture of peracetic acid and hydrogen peroxide.
What is the role of free radicals in plasma sterilization?
Deactivating cellular function
Free radicals disrupt cellular processes, leading to effective sterilization.
Is aeration required when using H2O2 in plasma sterilization?
No aeration needed, because it is non-toxic
This feature makes H2O2 a favorable option for sterilization.
What is the sterilization temperature range for plasma sterilization?
45°C to 50°C
This temperature range is suitable for heat-sensitive instruments.
What is the typical cycle time range for plasma sterilization?
28 to 75 minutes
The duration may vary based on the specific items being sterilized.
What types of items are ideally sterilized using plasma sterilization?
Moisture/heat sensitive items
This method is not suitable for linens, wood, or liquids.
What type of packaging is required for plasma sterilization?
Synthetic packaging and special container trays
These are necessary to ensure effective sterilization and maintain the integrity of the items.
How does plasma sterilization perform in penetrating small lumina and endoscopic equipment?
Effective but less successful compared with EtO
Ethylene oxide (EtO) is often more effective in these applications.
What are the specific classes of chemical indicators for sterilization?
6 classes: the higher the better
Class 1 and 5 are recommended for every pack, while Class 2 indicates air.
Which class of chemical indicator indicates air?
Class 2: Bowie-dick indicates air
Bowie-dick test is used to assess the air removal capability of sterilizers.
What is considered the best method for biological sterilization indicators?
Biologic indicators
Biologic indicators provide a reliable means of verifying sterilization processes.
What organism is used for biological indicators for steam, plasma, and ozone sterilization?
Geobacillus stearothermophilus
This organism is highly resistant to heat and is commonly used for validating steam sterilization.
Which organism is used for biological indicators for Ethylene Oxide sterilization?
Bacillus atrophaeus
This organism is used to ensure the efficacy of Ethylene Oxide sterilization processes.
What is the purpose of the indicator placed on the outside of every package?
To verify the package has been exposed to a sterilization process
This indicator demonstrates that the sterilization process occurred.
What does an internal indicator signify?
That the contents have been exposed to the relevant parameters
This type of indicator is used for a specific purpose.
What does a single parameter indicator react to?
A single parameter of sterilization
This indicator is placed internally to confirm exposure to specific sterilization conditions.
What is the function of an indicator that reacts to multiple parameters of sterilization?
To register that the contents have been exposed to multiple relevant parameters
This indicator is also placed internally.
What is an integrating indicator?
An indicator that reacts to all critical parameters of sterilization
This type is placed internally to ensure complete exposure to sterilization.
What is the role of an emulating indicator?
To react to all critical parameters of a given sterilization cycle
This indicator is also placed internally and ensures thorough exposure to the sterilization process.
What is the recommended contact time for alcohol-based scrubs?
2 minutes or even 1.5 minutes can be effective
Contact times of 1.5 to 2 minutes are suggested for optimal effectiveness.
What advantage do alcohol-based scrubs have?
Superior rapid killing
Alcohol-based scrubs are known for their ability to quickly kill bacteria.
How long does bacterial regrowth take after using an alcohol scrub?
~6 hours
Bacterial regrowth occurs approximately 6 hours after the application of the scrub.
What area has the highest bacterial load despite scrubbing in regards with hand prep?
Subungual area
The subungual area refers to the space under the nail, which is known to harbor a significant amount of bacteria.
What is observed within 8 hours after scrubbing with antiseptic and ethanol cleanser with nail prep?
Rebound to the prescrub level of bacteria
This indicates that the effectiveness of the scrub diminishes over time, leading to a return of bacteria.
What effect does the use of antiseptic and ethanol cleanser have on bacterial counts with hand prep?
↓bacterial counts
This shows that antiseptic and ethanol cleansers are effective in reducing bacterial presence.
Do scrub brushes and nail picks change the bacterial load with hand prep?
No
The use of scrub brushes and nail picks does not impact the bacterial count in the subungual area.
What is the evidence regarding gloves and infection prevention?
Gloves not proven to decrease infection
This indicates that wearing gloves alone may not be sufficient to prevent infections.
Which type of glove is more resistant to puncture?
Latex
Latex gloves are generally considered to have better puncture resistance compared to vinyl gloves.
On which hand is penetration of gloves most common?
Non-dominant hand
This suggests that the non-dominant hand is at higher risk for glove failure during procedures.
What is the association between double gloving and contamination?
Double gloving associated with lower number of holes but similar contamination vs single gloving
This indicates that while double gloving may reduce the number of perforations, it does not significantly reduce contamination.
What is the range of glove perforation rates for single gloves post-operation?
12.7% to 31%
This statistic highlights the variability in glove integrity after surgical procedures.
What is the perforation rate range for double gloves?
11.5% - 44% for outer & 3.8% - 13% for inner
This shows the difference in perforation rates between the outer and inner gloves in a double gloving scenario.
What is the benefit of changing the outer set of gloves after draping?
Associated with lower risk of SSI
SSI refers to surgical site infections, and changing gloves can help mitigate this risk.
How often should gloves be changed during procedures?
Consider changing gloves q60 minutes, after draping, prior handling implant
This recommendation emphasizes maintaining hygiene and reducing infection risk during lengthy procedures.
What is the mechanism of action of Iodophors/Iodine?
Oxidation/substitution by free iodine denatures proteins
What types of microorganisms are Iodophors effective against?
Bacteria, Virus, and fungi
How effective are Iodophors against spores?
Poor to acceptable
What is the onset time for Iodophors/Iodine?
Intermediate
What is the residual activity of Iodophors/Iodine?
Moderate
What potential side effect may Iodophors/Iodine cause?
May cause irritation
What substances can inactivate Iodophors/Iodine?
Blood and organic debris
What is the contact time required with Chlorhexidine hand scrub?
3 minutes
Chlorhexidine 3 min scrub is the same effect as 5 minutes.
Why are alcohol-based scrubs considered superior?
Due to rapid killing and bacterial regrowth takes ~6 hours.
What are common sources of Pseudomonas spp. and other Gram-negative bacteria?
Faucets
Contaminated hands before gloving.
Does the combination of the first scrub with medicated soaps result in increased reduction of microbiota?
No, it has not been shown to result in an increase.
What risk may increase with the use of a combination of the first scrub and medicated soaps?
Risk of dermatitis.
Fill in the blank: Alcohol-based scrubs are considered superior because of their _______.
rapid killing.
What is the mechanism of action of Chlorhexidine gluconate?
Disrupts cell membrane of bacteria and enveloped viruses, less effective on non-enveloped viruses
Chlorhexidine gluconate works primarily by disrupting the cell membrane integrity of microorganisms.
What is the bactericidal property of Chlorhexidine gluconate?
Bactericidal at high concentrations and bacteriostatic at low concentrations
This means it kills bacteria at higher concentrations but inhibits their growth at lower concentrations.
Is Chlorhexidine gluconate sporicidal?
Not sporicidal, except at 60-70°C
Chlorhexidine is generally ineffective against spores unless heated.
How does alcohol affect the efficacy of Chlorhexidine gluconate?
Improves efficacy
The presence of alcohol enhances the antimicrobial activity of Chlorhexidine.
What concentration of Chlorhexidine gluconate is used for surgical scrubs?
2.0-4.0%
This concentration is typically used in surgical settings to ensure effective microbial reduction.
What concentration of Chlorhexidine gluconate is used in disinfectant solutions?
0.5-2.0%
These concentrations are effective for surface disinfection.
What is the concentration of Chlorhexidine gluconate recommended for wound treatment?
≤ 0.05%
Lower concentrations are used for wound care to minimize toxicity and irritation.
What concentration of Chlorhexidine gluconate is used for oral rinses?
0.12%
This concentration is suitable for oral hygiene but is not recommended for cats.
What is the toxicity of Chlorhexidine gluconate at concentrations above 0.5%?
Toxic to fibroblasts, can cause erosions in cat mouths, neurotoxicity, and ototoxicity
Higher concentrations can lead to adverse effects, especially in specific animal populations.
What is the difference in bacterial counts between Iodine, Alcohol, and Chlorhex?
No difference in bacterial counts
This indicates that all three agents are equally effective in reducing bacterial counts.
What is the effect of using Chlorhexidine gluc. 4% followed by 70% isopropyl alcohol?
May result in increased residual antimicrobial activity
This combination can enhance the effectiveness of the antiseptic action.
What skin reaction is associated with Povidone-iodine?
Significantly more skin reaction, including acute contact dermatitis
This highlights a potential drawback of using Povidone-iodine for skin preparation.
What percentage of skin flora remains in deeper layers and follicles?
20%
This indicates that complete sterilization of the skin is not achievable.
At what temperatures does Chlorhex kill MRSA and spores?
High temperatures of 40-70°C
Effectiveness is significantly reduced at lower temperatures.
Hair removal in the perioperative period of ____ hours is associated with a lower incidence of surgical site infection?
Within 4 hours
This practice may reduce the risk of infection compared to earlier hair removal.
What concentration of alcohol is effective as a disinfectant?
60-70% Alcohol
This concentration is crucial for proper disinfection.
What is the mechanism of action of alcohols as disinfectants?
Cause protein denaturation, lysis, and metabolic interruption of cells
This explains how alcohols effectively kill pathogens.
What are the two types of disinfectants mentioned under Iodines?
Iodine and Iodophors
- Iodophors are iodine-containing solutions with a solubilizing agent, like povidone, which provides a sustained release of iodine.
- Iodine itself is the elemental form used as a disinfectant and antiseptic
What is the mechanism by which Iodines act as disinfectants?
Oxidation/substitution by free iodine denatures proteins
This process is crucial for the antimicrobial effect of iodine.
What is the dual role of Chlorhexidine?
Disinfectant AND Antiseptic
This indicates its versatility in both cleaning and antiseptic applications.
What is the limitation of using Chlorhexidine at 2% for wounds?
Do not use 2% for wounds
Higher concentrations are preferred for effective wound care.
What is the effect of Chlorhexidine on cell membranes?
Disrupts cell membrane
This action is key to its effectiveness as a disinfectant.
What are the classifications of disinfectants based on their ability to kill organisms?
High-, intermediate-, and low-level
Each level varies in efficacy against different types of pathogens.
What can high-level disinfectant solutions also be used as?
Sterilants
This means they can completely destroy microorganisms.
What is the required contact time for high-level disinfectants?
20 to 30 minutes
Adequate contact time is essential for effective disinfection.
What is the capability of intermediate-level disinfectants?
Cannot kill spores or some viruses, but capable of killing all bacteria, fungi, and nonhydrophilic viruses
This limits their use in certain situations.
What is the required contact time for intermediate-level disinfectants?
10 to 15 minutes
This shorter contact time is suitable for surfaces like operating rooms.
What is the length of the green linear staple?
90 mm
The green staple is the longest among the options listed.
What is the closure size of the green linear staple?
2.0 mm
This indicates the size to which the green staple closes.
What is the length of the blue linear staple?
60 mm
The blue staple is shorter than the green staple.
What is the closure size of the blue linear staple?
1.5 mm
This indicates the size to which the blue staple closes.
What is the length of the white linear staple?
30 mm
The white staple is the shortest among the options listed.
What is the closure size of the white linear staple?
1.0 mm
This indicates the size to which the white staple closes.
What is the closure size of the GIA staple?
1.5 mm
The GIA staple has the same closure size as the blue linear staple.
Height of an open green, blue and white linear stapling device?
Green 4.8 mm
Blue 3.5 mm
White 2.5 mm
Height of a closed green, blue and white linear stapling device?
- Green 2.0 mm
- Blue 1.5 mm
- White 1.0 mm
What are the dimensions of the Regular LDS?
L = 5.8 mm, H = 5.2 mm
Closes at 5.3 mm
What are the dimensions of the Wider LDS?
L = 8 mm, H = 7.2 mm
Closes at 7.3 mm
What is the maximum vessel diameter that large LDS staples can secure?
Up to 7 mm vessels
What is the diameter range of vessels that can be clipped?
Diameter of vessels < ⅔ and > ⅓ length of clip
How far should the clip be from the cut edge?
Several mm from cut edge
What are the byproducts of cyanoacrylate glue?
Cyanoacetate & formaldehyde
Cyanoacrylate glue polymerizes during use, resulting in these byproducts.
What is the size vessel for Monopolar/Bipolar?
2mm
Monopolar and Bipolar devices use a vessel size of 2mm.
What is the size vessel for Ligasure?
7mm
Ligasure devices have a vessel size of 7mm with 1-3 mm thermal damage.
What is the thermal damage range for Ligasure?
1-3 mm
Ligasure causes thermal damage in the range of 1-3 mm.
What is the size vessel for Enseal?
7mm
Enseal devices also have a vessel size of 7mm.
What is the thermal damage range for Enseal?
2 mm
Enseal causes 2 mm of thermal damage.
What is the size vessel for Harmonic?
3mm
Harmonic devices use a vessel size of 3mm.
What is the thermal damage range for Harmonic?
0-1 mm
Harmonic causes minimal thermal damage, ranging from 0-1 mm.
What is the primary function of harmonic devices?
Hemostasis through coaptive coagulation, smaller vessels
Coaptive coagulation refers to the process where tissue is brought together to promote clotting.
How does ultrasonic technology work in harmonic devices?
It delivers electrical energy in the form of mechanical energy
This unique delivery method allows for precise cutting and coagulation.
Does ultrasonic technology transfer electricity to the patient?
No electricity is transferred to or through the patient
This makes harmonic devices safer for patients during procedures.
What occurs when a blade is used in harmonic devices?
Cutting of tissue at the center of the blade, coagulation of edge tissue occurs via the vibration-induced heat
The blade’s vibration generates heat, facilitating both cutting and coagulation.
What temperature range do harmonic devices operate at for cutting and coagulating?
50° to 100°C
This is lower than the temperatures used by other electrosurgical devices or lasers.
Fill in the blank: Ultrasonic technology in harmonic devices uses ____ to deliver energy.
mechanical energy
True or False: Harmonic devices operate at higher temperatures than traditional electrosurgical devices.
False
Harmonic devices operate at significantly lower temperatures.
What does V represent in the voltage formulation?
ohm’s law v=ir
V = Voltage (Volts): difference in potential btw 2 points
Voltage is a measure of the electric potential difference between two points in a circuit.
What does I represent in the voltage formulation?
ohm’s law v=ir
I = Electrical current (Amperes): flow of these electrical charges
Electrical current is the rate at which electric charges flow through a conductor.
What does R represent in the voltage formulation?
ohm’s law v=ir
R = Impedance (Ohms): Resistance, material property that governs the flow of electrical current through a medium or tissue
Impedance includes both resistance and reactance in a circuit.
According to Ohm’s law, how are current (I), voltage (V), and resistance (R) related?
ohm’s law v=ir
Current (I) is directly proportional to voltage (V) and inversely proportional to resistance (R)
This relationship is expressed mathematically as V = IR.
What is the formula for power (W) in terms of voltage and current?
Power (W) = VI = I²R
Power represents the rate at which work is done or energy is transferred.
What is power (W) expressed as?
Power (W) is the amount of work performed and is expressed as watts
Watts are a measure of electrical power equivalent to one joule per second.
In pure cut mode on an electrosurgical unit, how is current delivered?
Current is delivered uninterrupted 100% of the time
This mode is used for cutting tissue with minimal thermal damage.
If the generator is set to pure cut mode, what can be said about the voltage?
Therefore, according to W = V × I, voltage is low
This indicates that in pure cut mode, power is maintained while voltage is minimized.
Which mode should you use when applying energy to a hemostat to perform coaptive coagulation of a vessel?
Cutting mode
Best effect achieved through noncontact form to create a spark, leading to current arcs to the tissue, resulting in less char and tissue damage compared to coagulation current.
What is coaptive coagulation?
A type of desiccation coagulation
Involves occluding the lumen of a vessel with a metal instrument, coagulating the lumen wall, denaturing the adventitia, causing vessel dehydration, and forming a collagen weld to stop bleeding.
What occurs during coaptive coagulation?
- Lumen of a vessel is occluded by a metal instrument
- Lumen wall is coagulated
- Adventitia is denatured
- Vessel dehydration occurs
- Collagen weld is formed to stop bleeding
What is the best effect of using cutting mode?
Noncontact form to create spark leading to current arcs to the tissue
This results in less char and tissue damage compared to coagulation current.
Fill in the blank: Coaptive coagulation results in the formation of a _______ to stop bleeding.
collagen weld
What is the mode of tissue effect and depth for CO2?
0.1 mm
CO2 lasers are known for their superficial effect on tissue.
What is the mode of tissue effect and depth for Ho:YAG?
0.3 mm
Ho:YAG lasers penetrate slightly deeper than CO2 lasers.
What is the range of tissue effect depth for Nd:YAG?
1.0 - 5.0 mm
Nd:YAG lasers can penetrate significantly deeper than both CO2 and Ho:YAG lasers.
What is the range of tissue effect depth for Diode lasers?
1.0 - 3.0 mm
Diode lasers provide a moderate depth of tissue effect.
What type of laser can be used in the joint?
Ho:YAG Laser (2100 nm)
Holmium:yttrium–aluminum–garnet laser
What is the wavelength of the Ho:YAG Laser?
2100 nm
What is highly absorbed by water in the context of the Ho:YAG Laser?
Long wavelength
List the functions of the Ho:YAG Laser.
- Vaporize
- Cut
- Coagulate
- Smooth tissues
What medical procedures is the Ho:YAG Laser good for?
- Lithotripsy
- Upper airway procedures
- Oral procedures
- Urogenital procedures
- IVDD-LDA
- Arthroscopy
What is the advantage of using the Ho:YAG Laser in arthroscopy?
Minimal tissue necrosis
True or False: CO2 laser can be used for arthroscopy.
False
What type of wavelength does the Argon Laser use?
Ultrashort wavelength
What color of light does the Argon Laser emit?
Visible blue/green light
What substances does the Argon Laser get absorbed by?
Oxyhemoglobin and tissue pigment
Not water
Why is the Argon Laser useful for vascular lesions?
Absorbed by hemoglobin
What happens to the energy absorbed by the Argon Laser?
Transformed into heat
What medical procedures can the Argon Laser assist with?
- Controlling intraocular hemorrhage
- Coagulation
- Vaporization
- Cutting in a bleeding environment
In what modes can the Argon Laser be applied?
Contact or noncontact modes
Can the Argon Laser be used through flexible endoscopes?
Yes
What is the wavelength of Nd:YAG laser?
1064 nm
What does Nd:YAG stand for?
Neodymium:yttrium-aluminum-garnet
What is the significance of the short wavelength in Nd:YAG lasers?
Deepest penetration (up to 5 mm) because it is only slightly absorbed by water
What is a primary use of Nd:YAG lasers?
Coagulation of large vessels
What is a consequence of using Nd:YAG lasers for coagulation?
Produces a larger coagulation zone and damage
Can Nd:YAG lasers be used for endoscopic procedures?
Yes, using flexible quartz fibers
In which veterinary procedure can Nd:YAG lasers be used?
Lap OVE in dogs
Scalpel versus electrocautery, which had a higher wound strength at 10-12 days?
Scalpel
- Incisions with a scalpel blade had approximately twice thewound strengthat 10 to 12 days after surgery as those made with electrocautery
Scope use for Thoracoscopy and Arthroscopy (20 kg)?
Arthro: 2.7mm 30 degree scope.
- 1.9mm 30 degree for carpus and tarsus
Thoraco: 30 degree scope to avoid bending the scope against the ribs
