ISCE Station 2: Surgical Scrub

Question 1

What is surgical prep?

Answer 1

• Solution that is used to clean and disinfect the patients surgical site before a procedure, containing either Chlorhexadine Gluconate or Povidone Iodine, which are fast acting.
• Alcohol based prep is usually used for most surgeries but water based prep or saline is used when working around neonates, mucous membranes, near eyes and internal use due to its absorption and irritability properties

Question 2

Why is surgical prep used?

Answer 2

• They have antimicrobial and antibacterial properties helping to kill transient and resident microbes and bacteria sitting on the surface and below the dermis of the skin to prevent surgical site infections.
• Maintains a sterile environment to help prevent contaminants from reaching open tissues during surgery
• Ensures better wound healing after a surgery so the body can focus on healing rather than fighting off potential infections.

Question 3

What are surgical drapes?

Answer 3

• Disposable or reusable sterile sheets or fabrics used to cover the patient and surrounding areas to create and maintain a sterile field during a surgical procedure.

Question 4

Why are surgical drapes used?

Answer 4

• Create and maintain a sterile environment around the incision to prevent surgical site infections.
• They form a physical barrier between the sterile surgical area and non- sterile surfaces eg. skin, operating table and equipment.
• designed to absorb or repel fluids to keep the surgical site clean and dry to prevent microbes growing.
• provide the patient with privacy and modesty by covering the rest of the body which is not involved in the surgery.

Question 5

What would you do if a surgical instrument was missing during the first count?

Answer 5

• Perform a recount to ensure that the instrument hasn’t been miscounted or overlooked.
• Check the surrounding areas to make sure it hasn’t fallen on the floor.
• Notify the whole surgical team and team leader.
• Update the tray list to show that there is an instrument missing.
• Find a new tray or the extra equipment needed.
• Explain the situation to the theatre coordinator so they can report and escalate it to HSSU or other relevant people.

Question 6

Why is it important for theatre ventilation, temperature and humidity to be set within range for surgery to take place?

Answer 6

• Ventilation - Laminar and plenum flow. Air changes and circulation provide fresh air and prevent the accumulation of anesthetic gases and microbiological particles in the room.
• its a method of pushing away normal flora from the surgical site to prevent surgical site infections.
• Humidity - Range should be set between 20%-60%. Moisture provides a conductive medium and allows a static charge to flow to the ground as fast as a spark is generated.
• Above 70% can cause condensation inside sterile packaging.
• High humidity can cause mould to grow.
• Temperature - Range should be set between 20°C-24°C. It can be increased to prevent hypothermia in pediatric, geriatric and burn patients.
• Hypothermia can impair physiological processes as main organs don’t work well in low temperature and contributes to infections and post- operative complications.
• Some surgical patients lose the ability to naturally gain and lose heat rapidly from anesthetic drugs, exposure and surgical incision (especially larger areas eg. abdomen).

Question 7

What is a diathermy?

Answer 7

• High frequency alternating electrical current to produce localised heating effects which causes local tissue destruction.
• Two types monopolar and bipolar.
• Monopolar - Electrical current flows from the diathermy machine through the active electrodes, passes through the patients body and exits via the return electrode (diathermy plate) placed on the patient. More useful for larger areas.
• Bipolar - Electrical current passes between two electrodes (usually the tips of a pair of forceps) directly in the area being treated, with no need for a diathermy plate. Only the tissue grasped between the forceps is included in the electrical circuit. More useful for smaller areas.

Question 8

Why is a diathermy used?

Answer 8

• Used to cut, using a continuous current, to cauterise, using an interrupted current, and fulgurate/ destroy tissue.
• Minimises blood loss by sealing blood vessels making surgeries safer.
• Removes/destroys abnormal tissue eg. tumors and warts.
• Reduces risk of infection by cauterising tissue it helps to minimise exposure to bacteria and other pathogens.

Question 9

What is a pneumatic tourniquet?

Answer 9

• Compression device designed to temporarily occlude artieral blood flow to limbs. It works by applying controlled pressure through an inflatable cuff around the limb.
• Commonly used in orthopedic surgery and plastic and reconstructive surgery.

Question 10

Why is a pneumatic tourniquet used?

Answer 10

• To create a bloodless surgical field, control major bleeds and perform regional anaesthesia for lower arm fractures
• Allows more precise surgical maneuvers to enhance outcomes in complex surgeries.
• Speeds up surgeries by reducing the frequent need for frequent cauterisation or suctioning of blood.