Lecture 2 - Preparation of Surgical Packs and Team Flashcards
How often should instruments be cleaned?
ASAP after each use
What does cleaning instruments remove?
Organic debris and inorganic salt that can affect sterilization
What type of water should be used to clean instruments and why?
Distilled or deionized; avoids excess salt, has neutral pH
What type of scrub brush should be used to clean insturments?
soft
T/F: Instruments should not be soaked
True
What type of cleaner should be used for the instruments?
One specific for instruments
What is a part of regular instrument maintenance?
lubrication
How should instruments be dried?
With a clean cloth in a timely manner
What are the 4 sterilization methods?
- Steam (autoclave)
- Hydrogen peroxide gas plasma
- Ethylene oxide
- Vaporized hydrogen peroxide
What is the most common method of sterilization and why is it used so often?
Steam autoclaving;
Inexpensive, easy to use, non-toxic, penetrates packs
What is a disadvantage of ateam autoclaving?
May damage heat labile items such as endoscopes and anesthesia tubes
What is the temp of autoclaves?
HOT!!!!!!!!!!!
What are the 2 types of steam autoclaving?
Gravity displacement and pre-vacuum
What type of steam autoclaving is most common?
gravity displacement
Under what principle does gravity displacement autoclaving work?
Air is heavier than steam, is passive
Under what principle does pre-vacuum autoclaving work?
Active movement of air out of the chamber
What temp/time does the ISU autoclave use?
121 degrees C for 30 min, 15 min dry time
What are chemical sterilization indicators?
Impregnated paper strips or tape change color when a certain temperature is met
T/F: Chemical sterilization indicators do not reflect duration of exposure and do not indicate sterility
True
What are biological sterilization indicators and how often should they be used?
Highly resistant, non-pathogenic, spore-forming on paper or in glass vial placed in autoclave;
Use once weekly to ensure effective sterilization process
How do biological sterilization indicators work?
After cycle is completed, indicator is cultured;
Any growth indicates failure of sterilization
Who/what is responsible for ensuring efficacy of sterilization in practice?
you
What are the contents of our surgical packs?
Instruments 1 blue huck towel 20 4x4s - sponge count 1 paper patient drape 4 green huck towels 2 gowns 2 teri towels per gown 2 wraps
What is the purpose of pack preparation?
To allow penetration of sterilization agent and sterile handling of equipment prior to use
What are the steps of wrapping an instrument pack?
- Wrap the pack in a clean huck towel
- Place a pack wrap on a large clean surface
- Fold the corner closest to you over the tray, fold in edge
- Fold the right corner over the pack repeat on left
- Turn around the pack and fold in the far corner, tucking it under the previous folds
- Repeat with a second layer, apply chemical indicator tape, date, initial
What are the steps to folding/wrapping a gown?
- Place a clean gown on a clean, flat surface, front facing up
- Fold the sleeves toward the center of the gown
- Fold the sides of the gown to the center midline (seams align)
- Fold the gown in half longitudinally
- Begin fanfolding the bottom of the gown to neck
- Fold hand towel in half, fanfold similarly, dog ear
- Wrap the gown with the towel on top in a double wrap
What is the ideal environment for pack storage?
Cool, dry and temp controlled environment
What is the shelf life of a pack dependent on?
type of materials used; consult autoclave manufacturer recommendations
When should you NOT use a pack?
If the seal is broken or the packaging is damaged
What should you have on your feet each time you enter the OR?
Shoe covers
Masks have a _____ filter to contain _____.
hydrophilic; respiratory secretions
What type of nail polish is associated with increased bacterial load?
Those that are >4 days old
What is the purpose of the surgical scrub?
- Mechanical removal of dirt and oil
- Reduction of the transient bacterial population
- Depression of the skin’s resident bacteria
What are 3 types of surgical scrubs?
- Chlorhexidine gluconate
- Povidone-iodine
- Hexachlorophene
What are some types of alcohol-based (brushless/rinseless) surgical scrubs?
- Triseptin
- Avagard
- Sterillium rub
- Purell waterless surgical scrub
- Endure 450
What is the method to scrubbing?
- Open brush, place package on sink ledge
- Clean under nails with pick if necessary
- Hands above elbows - coat arms with chlorhexidine from fingers to elbows
- Scrub each side of finger, between fingers, back and front of hand 10-20 times for each location
- Scrub arms by washing each side (from wrist to elbow), alternating between arms.
- Rinse both hands and arms by passing thru the water in one direction only (fingertips to elbows)
- Proceed to OR holding hands above elbows (open door with your back)
- Dry hands and arms using the sterile towel in your pack with aseptic technique
What is the contact time for scrubbing and when does it begin?
4 min; begins when you coat your arms with the scrub solution
When should you gown?
After you scrub and before you glove
When should you glove?
After gowning and prior to handling sterile items
Statistically, how often are there glove perforations during surgery and how many holes?
43% of the time, 2.3 holes avg per sx
How can you prevent bacterial contamination from holes in the gloves?
Double glove or change gloves during key times such as handling of implants, closure of an enterotomy or pyometra site
