Lecture 3: Surgical Attire & the Surgical Suite (Exam 1) 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
2
Q
Define clean
A
Free of obvious dirt & debris
3
Q
Define contaminated
A
Dirty & has debri
4
Q
Define Asepsis
A
Removal of pathogenic organisms
5
Q
Define sterile
A
Removal of all microorganisms (+/- spores)
6
Q
What are the environmental barriers of infection
A
- surgical suite
- Equipment
- Instrument
7
Q
What are the surgical staff barriers of infection
A
- Surgeon
- Ancillary staff
8
Q
What are the patient barriers of infection
A
- Draping
- Skin preparation
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
10
Q
Addition of 5 people increases the microbial count by what
A
15x
11
Q
What can increase particles in the OR
A
- People
- Talking
- Skin exposure
- Activity/Movement (esp in & out of the OR)
12
Q
What is the primary source of contamination from surgeons
A
Skin debris
13
Q
Whose body should be covered in the OR
A
- Surgeon
- Assistants
- OR technicians
- Anesthetists
14
Q
What are the components of surgical attire
A
- Scrubs
- Gowns
- Head covers
- Face masks
- Foot covers
- Gloves
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
16
Q
delete this
A
17
Q
Do men or women shed more
A
Men
18
Q
Open lab coat =
A
No effect
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
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
21
Q
What are the borders of the sterile area
A
Above the waist & below the shoulders
22
Q
What is a major source of bacteria
A
Hair (has more bacteria than non haired skin)
23
Q
When should reusable head covers be washed
A
- after everytime
- Discard after 75x
24
Q
What is the goal of head covers
A
To cover all the hair
25
What should bearded surgeons wear
* Hood
* beard cover
26
Elaborate on face masks
* 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
Which face mask are more effective ear loops or ties
Ties
28
What happens if a face mask is partially removed
Causes contamination of the mask
29
Where does 15% of air contamination come from
The floor/walking
30
In what type of suite are foot covers not useful in reducing contamination to the operating floor
Equine surgery suite
31
What is the best option of foot covers
* dedicated surgery shoes
* Clean floors
32
Elaborate on surgical gloves
* 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
When are thicker latex gloves used
* special circumstances
* Orthopedic
34
When is double gloving seen
* LA surgery for draping
* Ortho sx
* An option for any procedure
35
What is the industry standard for glove punctures before sx
1.5%
36
What increases as surgical duration increases
Glove punctures during sx
37
Why are surgeon's hands considered dirty
* Handle contaminated wounds
* Handle dirty animals
* irritation from scrub
* Dirtiest around fingernails
38
Scrub reduces normal bacterial flora & other skin protective barriers but increases what
Increases the chance of colonization by pathogenic bacteria
39
What is the goals of scrubbing
* Remove dirt & oil
* Remove &/or kill transient organisms
* Reduce resident population of bacteria
* Be done w/ little damage to the skin
40
What can happen if scrubbing leads to damage to the skin
* Lead to rebound bacterial growth
* Difficult to remove the bacteria for the next procedure
41
Define normal flora
* Located under superficial cells of the stratum corneum
* Compete w/ pathogenic bacteria
42
Define Transient flora
* Acquired by contact w/ other things in the environment
* Superficial colonization
43
Define infectious/pathogenic flora
More common w/ frequent scrubbing
44
What is the goal of hand disinfection
To reduce all bacteria
45
When do pre-scrub counts return & recolonize
* Return: 8H
* Recolonize: 2 - 3 days
46
List some hand maintenance
* short (< 2 mm finger nails) & clean fingernails
* No nail polish or artificial nails
* Moisturizer
* No jewelry
47
What are the components of an ideal scrub
* Quick
* Effective
* Cost-effective
* Non-irritating
* Residual action
48
Elaborate on Chlorhexidine gluconate
* Aqueous scrub
* Immediately bactericidal
* Residual activity
* Potentially inactivated by soap & hand cream
49
Elaborate on Povidone-iodine
* Aqueous scrub
* Possibly better activity vs resistant bacteria
* Poor residual activity
* Can cause skin irritation in some people
50
Elaborate on Ethanol, isopropanol, or N-propanol
* 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
Scrub followed by alcohol-based rub .....
* 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
What is the ideal hand disinfection technique
* Clean under nails
* Scrub w/ brush
* Brushless scrub from tips of fingers to elbows
53
How long should contact time be will scrubbing
* 2 - 5 mins
* 20 to 30 strokes per 25 anatomical parts of the hands
54
What is the alternative surgical attire for field surgery
* Variation of surgical attire
* Usually no hat or mask
* Gown over coveralls w/ gloves
* Coveralls w/ sterile sleeves & gloves
55
What should the surgical facility be like
* 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 mild positive pressure
56
Why is laminar air filtering systems through a HEPA filter ideal
Reduces bacterial counts significatly but is expensive
57
How should electrical outlets & anesthesia hook ups be placed
* Above waist height
* Have emergency electricity
* At least one surgery light & one outlet
58
What is the ideal staffing of the surgery area
* min of 3 people
* Anesthetists
* Technician
* Surgeon
59
What are the jobs of the operating room supervisor
* Order
* Stock items
* Surgery log
* Controlled supstances
60
What are the rules for the DVTC
* 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
