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Surgery 1 > Lecture 3: Surgical Attire & the Surgical Suite > Flashcards

Lecture 3: Surgical Attire & the Surgical Suite Flashcards

1
Q

Why do we care about asepsis stuff

A

B/c infection leads to an increase in post op treatment/hospitalization which leads to increase in cost, increase mortality, decrease owner satisfaction, & increase in pain

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2
Q

Define clean

A

Free of obvious dirt & debris

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3
Q

Define contaminated

A

Dirty & has debri

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4
Q

Define Asepsis

A

Removal of pathogenic organisms

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5
Q

Define sterile

A

Removal of all microorganisms (+/- spores)

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6
Q

What are the environmental barriers of infection

A
  • surgical suite
  • Equipment
  • Instrument
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7
Q

What are the surgical staff barriers of infection

A
  • Surgeon
  • Ancillary staff
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8
Q

What are the patient barriers of infection

A
  • Draping
  • Skin preparation
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9
Q

T/F: Only the surgeon in the OR contributes to contamination potential

A

False all people in the OR contribute to contamination potential

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10
Q

Addition of 5 people increases the microbial count by what

A

15x

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11
Q

What can increase particles in the OR

A
  • People
  • Talking
  • Skin exposure
  • Activity/Movement (esp in & out of the OR)
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12
Q

What is the primary source of contamination from surgeons

A

Skin debris

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13
Q

Whose body should be covered in the OR

A
  • Surgeon
  • Assistants
  • OR technicians
  • Anesthetists
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14
Q

What are the components of surgical attire

A
  • Scrubs
  • Gowns
  • Head covers
  • Face masks
  • Foot covers
  • Gloves
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15
Q

Explain surgical scrubs

A
  • First barrier against shedding skin debris from humans
  • Changed after each case?
  • top tucked in
  • Cover scrubs when out of the surgery suit
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16
Q
A
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17
Q

Do men or women shed more

A

Men

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18
Q

Open lab coat =

A

No effect

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19
Q

Explain surgical gowns

A
  • Second barrier against sheeding skin debris
  • Sterile
  • Can be disposabe or reusable (depends on cost effectiveness)
  • Reusable have finite amount of washings
  • Water resistant but comfortable & breathable
  • Lint free
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20
Q

How should a surgical gown be put on

A
  • Folded w/ the interior outermost
  • Gloves should cover nonwater-resistant cuffs
  • Assistant will tie you in
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21
Q

What are the borders of the sterile area

A

Above the waist & below the shoulders

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22
Q

What is a major source of bacteria

A

Hair (has more bacteria than non haired skin)

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23
Q

When should reusable head covers be washed

A
  • after everytime
  • Discard after 75x
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24
Q

What is the goal of head covers

A

To cover all the hair

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25
Q

What should bearded surgeons wear

A
  • Hood
  • beard cover
26
Q

Elaborate on face masks

A
  • Redirects airflow away from surgical site
  • Not effective bacterial filters (sides are not seald)
  • The most effective type is soft & pleated
  • Still need to reduce talking
  • Wear at all times in the OR once sterile prep is initiated
  • effective < 2 hours
27
Q

Which face mask are more effective ear loops or ties

A

Ties

28
Q

What happens if a face mask is partially removed

A

Causes contamination of the mask

29
Q

Where does 15% of air contamination come from

A

The floor/walking

30
Q

In what type of suite are foot covers not useful in reducing contamination to the operating floor

A

Equine surgery suite

31
Q

What is the best option of foot covers

A
  • dedicated surgery shoes
  • Clean floors
32
Q

Elaborate on surgical gloves

A
  • Latex
  • Non-late (vinyl or nitrile)
  • Sterile & single use
  • Should fit snug but not cut off circulation
  • Sleeves can be added for a waterproof barrier
33
Q

When are thicker latex gloves used

A
  • special circumstances
  • Orthopedic
34
Q

When is double gloving seen

A
  • LA surgery for draping
  • Ortho sx
  • An option for any procedure
35
Q

What is the industry standard for glove punctures before sx

A

1.5%

36
Q

What increases as surgical duration increases

A

Glove punctures during sx

37
Q

Why are surgeon’s hands considered dirty

A
  • Handle contaminated wounds
  • Handle dirty animals
  • irritation from scrub
  • Dirtiest around fingernails
38
Q

Scrub reduces normal bacterial flora & other skin protective barriers but increases what

A

Increases the chanceof colonization by pathogenic bacteria

39
Q

What is the goals of scrubbing

A
  • Remove dirt & oil
  • Remove &/or kill transient organisms
  • Reduce resident population of bacteria
  • Be done w/ little damage to the skin
40
Q

What can happen if scrubbing leads to damage to the skin

A
  • Lead to rebound bacterial growth
  • Difficult to remove the bacteria for the next procedure
41
Q

Define normal flora

A
  • Located under superficial cells of the stratum corneum
  • Compete w/ pathogenic bacteria
42
Q

Define Transient flora

A
  • Acquired by contact w/ other things in the environment
  • Superficial colonization
43
Q

Define infectious/pathogenic flora

A

More common w/ frequent scrubbing

44
Q

What is the goal of hand disinfection

A

To reduce all bacteria

45
Q

When do pre-scrub counts return & recolonize

A
  • Return: 8H
  • Recolonize: 2 - 3 days
46
Q

List some hand maintenance

A
  • short (< 2 mm finger nails) & clean fingernails
  • No nail polish or artificial nails
  • Moisturizer
  • No jewelry
47
Q

What are the components of an ideal scrub

A
  • Quick
  • Effective
  • Cost-effective
  • Non-irritating
  • Residual action
48
Q

Elaborate on Chlorhexidine gluconate

A
  • Aqueous scrub
  • Immediately bactericidal
  • Residual activity
  • Potentially inactivated by soap & hand cream
49
Q

Elaborate on Povidone-iodine

A
  • Aqueous scrub
  • Possibly better activity vs resistant bacteria
  • Poor residual activity
  • Can cause skin irritation in some people
50
Q

Elaborate on Ethanol, isopropanol, or N-propanol

A
  • Alcohol based rubs
  • 60 - 80% alcohol for effectiveness
  • Rapid & immediate action
  • Often w/ another antiseptic like chlorohexidine to prolong activity
  • Less damage to the skin & non-allergenic
  • Hands need to be clean first
51
Q

Scrub followed by alcohol-based rub …..

A
  • Does not further reduce flora
  • Scrub can decrease rub efficacy
  • Scrub may increase the risk of dermatitis (making it more difficult to decontaminate skin)
52
Q

What is the ideal hand disinfection technique

A
  • Clean under nails
  • Scrub w/ brush
  • Brushless scrub from tips of fingers to elbows
53
Q

How long should contact time be will scrubbing

A
  • 2 - 5 mins
  • 20 to 30 strokes per 25 anatomical parts of the hands
54
Q

What is the alternative surgical attire for field surgery

A
  • Variation of surgical attire
  • Usually no hat or mask
  • Gown over coveralls w/ gloves
  • Coveralls w/ sterile sleeves & gloves
55
Q

What should the surgical facility be like

A
  • Traffic flow is min in & out of the OR
  • Keep the door closed
  • Storage is separate from the OR
  • Have an area for instrument preparation
  • Have “clean” & “dirty” rooms (at least 400 sq ft or larger)
  • Surfaces are easy to clean (even the ceiling)
  • Well-placed drains
  • 68 to 73 degrees w/ 30-60% humidity
  • Air under milk positive pressure
56
Q

Why is laminar air filtering systems through a HEPA filter ideal

A

Reduces bacterial counts significatly but is expensive

57
Q

How should electrical outlets & anesthesia hook ups be placed

A
  • Above waist height
  • Have emergency electricity
  • At least one surgery light & one outlet
58
Q

What is the ideal staffing of the surgery area

A
  • min of 3 people
  • Anesthetists
  • Technician
  • Surgeon
59
Q

What are the jobs of the operating room supervisor

A
  • Order
  • Stock items
  • Surgery log
  • Controlled supstances
60
Q

What are the rules for the DVTC

A
  • Wear scrubs (change @ the DVTC)
  • Lab coat over scrubs w/ button closed
  • Clean closed toed shoes
  • No jewelry, rings, watches, & bracelets
  • Short fingernails w/ no nail polish

Surgery 1 (4 decks)

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