Lecture 3: Surgical Attire & the Surgical Suite (Exam 1) Flashcards
Why do we care about asepsis stuff
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
Define clean
Free of obvious dirt & debris
Define contaminated
Dirty & has debri
Define Asepsis
Removal of pathogenic organisms
Define sterile
Removal of all microorganisms (+/- spores)
What are the environmental barriers of infection
- surgical suite
- Equipment
- Instrument
What are the surgical staff barriers of infection
- Surgeon
- Ancillary staff
What are the patient barriers of infection
- Draping
- Skin preparation
T/F: Only the surgeon in the OR contributes to contamination potential
False all people in the OR contribute to contamination potential
Addition of 5 people increases the microbial count by what
15x
What can increase particles in the OR
- People
- Talking
- Skin exposure
- Activity/Movement (esp in & out of the OR)
What is the primary source of contamination from surgeons
Skin debris
Whose body should be covered in the OR
- Surgeon
- Assistants
- OR technicians
- Anesthetists
What are the components of surgical attire
- Scrubs
- Gowns
- Head covers
- Face masks
- Foot covers
- Gloves
Explain surgical scrubs
- First barrier against shedding skin debris from humans
- Changed after each case?
- top tucked in
- Cover scrubs when out of the surgery suit
delete this
Do men or women shed more
Men
Open lab coat =
No effect
Explain surgical gowns
- 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
How should a surgical gown be put on
- Folded w/ the interior outermost
- Gloves should cover nonwater-resistant cuffs
- Assistant will tie you in
What are the borders of the sterile area
Above the waist & below the shoulders
What is a major source of bacteria
Hair (has more bacteria than non haired skin)
When should reusable head covers be washed
- after everytime
- Discard after 75x
What is the goal of head covers
To cover all the hair
What should bearded surgeons wear
- Hood
- beard cover
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
Which face mask are more effective ear loops or ties
Ties
What happens if a face mask is partially removed
Causes contamination of the mask
Where does 15% of air contamination come from
The floor/walking
In what type of suite are foot covers not useful in reducing contamination to the operating floor
Equine surgery suite
What is the best option of foot covers
- dedicated surgery shoes
- Clean floors
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
When are thicker latex gloves used
- special circumstances
- Orthopedic
When is double gloving seen
- LA surgery for draping
- Ortho sx
- An option for any procedure
What is the industry standard for glove punctures before sx
1.5%
What increases as surgical duration increases
Glove punctures during sx
Why are surgeon’s hands considered dirty
- Handle contaminated wounds
- Handle dirty animals
- irritation from scrub
- Dirtiest around fingernails
Scrub reduces normal bacterial flora & other skin protective barriers but increases what
Increases the chance of colonization by pathogenic bacteria
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
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
Define normal flora
- Located under superficial cells of the stratum corneum
- Compete w/ pathogenic bacteria
Define Transient flora
- Acquired by contact w/ other things in the environment
- Superficial colonization
Define infectious/pathogenic flora
More common w/ frequent scrubbing
What is the goal of hand disinfection
To reduce all bacteria
When do pre-scrub counts return & recolonize
- Return: 8H
- Recolonize: 2 - 3 days
List some hand maintenance
- short (< 2 mm finger nails) & clean fingernails
- No nail polish or artificial nails
- Moisturizer
- No jewelry
What are the components of an ideal scrub
- Quick
- Effective
- Cost-effective
- Non-irritating
- Residual action
Elaborate on Chlorhexidine gluconate
- Aqueous scrub
- Immediately bactericidal
- Residual activity
- Potentially inactivated by soap & hand cream
Elaborate on Povidone-iodine
- Aqueous scrub
- Possibly better activity vs resistant bacteria
- Poor residual activity
- Can cause skin irritation in some people
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
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)
What is the ideal hand disinfection technique
- Clean under nails
- Scrub w/ brush
- Brushless scrub from tips of fingers to elbows
How long should contact time be will scrubbing
- 2 - 5 mins
- 20 to 30 strokes per 25 anatomical parts of the hands
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
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
Why is laminar air filtering systems through a HEPA filter ideal
Reduces bacterial counts significatly but is expensive
How should electrical outlets & anesthesia hook ups be placed
- Above waist height
- Have emergency electricity
- At least one surgery light & one outlet
What is the ideal staffing of the surgery area
- min of 3 people
- Anesthetists
- Technician
- Surgeon
What are the jobs of the operating room supervisor
- Order
- Stock items
- Surgery log
- Controlled supstances
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
