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Surgery 1 (SAB) > Lecture 5: Antiseptics, Sterilization Methods, & Care of Surgical Equipment > Flashcards

Lecture 5: Antiseptics, Sterilization Methods, & Care of Surgical Equipment Flashcards

1
Q

What are common antiseptics used in vet med

A
  • 70% isopropyl alcohol
  • 2 - 4% chlorhexidine gluconate
  • 10% povidone-iodine
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2
Q

Describe alcohol used in vet med

A
  • Only effective against vegetative bacteria
  • Poor efficacy against spores, fungi, & viruses
  • Higher & more rapid kill rate than chlorhexidine & betadine
  • MOA: Denatures proteins
  • Mild de-fatting/greasing effect (used to improve contact in ultrasound)
  • Inactivated by most organic debris
  • No residual effect after evaporation
  • Toxic to the cornea
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3
Q

Describe alcohol when talking about scrubbing

A
  • The optimal concentration is 60 - 90%
  • Looses efficacy if diluted < 50%
  • Most common rinse but lowers body temp in small animals
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4
Q

Describe isopropyl alcohol

A
  • Higher more rapid kill than chlorhexidine
  • Third best povidone-iodine
  • Can potentiate antimicrobial efficacy of providone - iodine (releases iodine)
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5
Q

Elaborate on chlorhexidine gluconate

A
  • Rapid onset
  • Persistent effect
  • Binds to protein of stratum corneum
  • Residue kills bacteria exiting sebaceous glands, sweat glands, & hair follicles
  • Variable activity against viruses & fungi (not sporicidal)
  • Not affected by organic debris
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6
Q

What is the MOA of chlorhexidine gluconate

A
  • Low concentration = bacteriostatic (cell membrane disruption)
  • High concentration = bactericidal (coagulation/precipitation of cell contents)
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7
Q

Elaborate on Povidone-iodine

A
  • Elemental iodine + Polyvinylpyrrolidine
  • Iodine is released for antiseptic effects
  • Available as 10% solution (Dilution liberates iodine = bactericidal; must scrub @ least 2 mins to release iodine)
  • Bactericidal, viricidal, & fungicidal
  • Sporicidal w/ increased contact time
  • Organisms do not develop resistance
  • Short kill time @ low concentrations
  • Some inactivation by organic debris
  • Debatable residual activity
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8
Q

What is the MOA of Povidone-iodine

A

Interferes w/ microorganism metabolism, protein synthesis, & alters cell membranes

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9
Q

What is the one-step product

A
  • Chloraprep - 2% chlorhexidine plus 70% isopropyl alcohol
  • Duraprep - povidone-iodine + 70% isopropyl alcohol
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10
Q

Describe Ioban

A
  • Iodine impregnated adhesive drape
  • Apply after scrub & rinse w/ isopropyl alcohol
  • Decreases bacterial contamination @ time of surgery but does not seem to affect wound infection rates
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11
Q

What are the main points of chlorhexidine

A
  • Residual activity
  • Rapid removal of bacteria
  • Less inactivation by organic debris
  • Less irritating to skin (some people have significant intolerance to chlorhexidine)
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12
Q

What are the main points of povidone-iodine

A
  • Performs comparably in surgical testing
  • Less expensive
  • Dependent on iodine release
  • Needs to be rinsed w/ alcohol
  • Stains skin
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13
Q

Fill out the chart

A
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14
Q

Describe hydrogen peroxide

A
  • Broad spectrum, including bacterial spores
  • < 3% concentration damage tissues
  • Good for removing blood stains
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15
Q

How should instruments be cared for

A
  • Tools of the trade (significant investment)
  • All instruments in opened back must be cleaned
  • Clean instruments as soon as possible after surgery
  • Inspect instruments for damage during cleaning process
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16
Q

What is considered damaged instruments

A
  • Jaws do not align
  • Ratchet does not click when engages first tooth
  • Ratchet springs open when tapped on palm of hand
  • dull scissors
  • Needle drivers do not secure needle when locked on the 2nd ratchet
  • Obvious damage to metal surface
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17
Q

What can steam not penetrate

A

Organic materials like grease & dried blood

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18
Q

What does blood do to the surface

A
  • Corrodes the surface after 10 min contact time
  • Clean instruments during surgical procedure
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19
Q

What type of area should there be for instruments

A

An ideally dedicated “clean” area to care for instruments in the clinic

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20
Q

What are the steps of cleaning before sterilization

A
  • Pre-cleaning
  • Cleaning
  • +/- lubricating
  • Packing
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21
Q

Label the parts

A
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22
Q

Explain pre-cleaning

A
  • Necessary before any type of cleaning
  • Rinse w/ cold water
  • +/- pre rine w/ enzymatic detergent solution (can be used in place of manual cleaning; consult w/ the product for contact time usually 2 - 10 mins or 30 - 45 mins)
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23
Q

Describe cleaning

A
  • Hydrogen peroxide based detergents (cleaning + microbial killing to reduce bioburden prior to sterilization)
  • Detergent cleaning (water & moderately alkaline, low suds detergent)
  • Ultrasonic cleaning
  • Final rinse w/ de-ionized water
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24
Q

How should instruments be cleaning by hand

A
  • Open all boxes
  • Scrub w/ a brush
  • Oil prior to air drying
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25
Q

Describe ultrasonic cleaning

A
  • Open all instruments and/or take apart (need liquid to contact all surfaces)
  • Non-foaming enzymatic detergen solution
  • Clean through cavitation
  • Rinse after to remove debris
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26
Q

What is cavitation

A
  • Process where high frequency vibratory waves form gas bubbles
  • Gas bubbles form & implode due to pressure waves which releases a shock of energy
  • Energy creates a mini vacuum that assists w/ cleaning
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27
Q

What is the proper labeling of packing instruments

A
  • Content
  • Date of sterilization
  • Person packing
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28
Q

how should packs be packed w/ muslin wraps

A

Double layer w/ two wraps

29
Q

What is important about pima cotton

A
  • Smaller pore size
  • Re use up to 75 times
30
Q

What are the main points of crepe paper

A
  • Superior durability, handling & storage times
31
Q

How should cellophane (plastic)/paper be used for packs

A
  • single instruments
  • Should double wrap (esp. large or odd shapes)
  • Ends are heat sealed
  • Sharp points should be protected by plastic covers
  • Paper allows penetration of sterilizing medium
32
Q

How should aluminum composite containers be used for packing

A
  • Stackable
  • storage for up to 1 year
  • Thermal conductivity ensures dry contents
  • Steam, ethylene oxide, & gas plasma sterilization
33
Q

What is the open shelf life of single wrapped muslin

A

2 days

34
Q

What is the open shelf of double wrapped muslin

A

3 weeks

35
Q

What is the open shelf life of crepe paper

A

3 weeks

36
Q

What is the open shelf life of heat-sealed paper & transparent plastic pouches

A

At least a year

37
Q

What are the physical methods of sterilization

A
  • Thermal energy
  • Filtration
  • Radiation
38
Q

What are the chemical methods of sterilization

A
  • Glutaraldehyde
  • Ethylene oxide
  • Gas plasma
  • Peracetic acid
39
Q

Describe dry heat thermal energy

A
  • Kills by oxidation & desiccation
  • High temperature applied for time
40
Q

Describe of moist heat sterilization

A
  • Kills by protein coagulation & denaturation
  • Lower temperature applied for shorter time
41
Q

what is the difference in different microbes

A

Different sensitivities to heat

42
Q

Explain the physics behind thermal energy

A
  • Bacterial death is logarithmic (time is as important as temperature)
  • pressurized steam increases temperature & water saturation which decreases sterilization time
  • Steam produces heat by condensation which increases the ability to penetrate porous objects
43
Q

What is the most common method of sterilization in vet med & how does it work

A
  • Autoclave
  • Steam pressure drives air out of pressure vessels (gravity displacement)
  • Newer autoclaves have vacuum system which decreases sterilization time and increase the coust of the autoclave ( pre vacumm is goof for flashing instruments)
  • Is critical to achieve condensation on all surfaces & prevent air from lowering the temperature of the steam
44
Q

How should instruments be placed in the autoclave

A
  • Bowls should face down or sideways
  • Valves left open
  • Loosely pack
  • Glass tubes seal w/ cotton plugs
45
Q

What are the min guideline for sterilization

A
  • Exposure = 15 mins
  • Temp = 121 degrees C
  • Pressure = 15 psi or 2 atm
  • Steam autoclave
46
Q

What are the guidelines of emergency sterilization (“flashing”)

A
  • Exposure = 3 mins
  • Temp = 132 degrees C
  • Pre vacuum autoclave
  • Should not be used for implants (plates/screws; is a risk of infection)
47
Q

What are chemical autoclave indicators

A
  • Undergo color change upon exposure to sterilizing temperatures
  • Usually sensitive to time & temperature
48
Q

What are biologic autoclave indicators

A

Culture heat resistant bacterial spores after sterilization

49
Q

T/F: Indicator tape does not inform on sterility

A

True

50
Q

What is the use of filtration for physical sterilization

A
  • Air supply to surgery suite (laminal flow ventilation)
  • Preparation of medications
  • Small volumes of solution
51
Q

Describe laminar air filtering system

A
  • Air flows (.5 m/sec) over “clean” area through HEPA filter
  • Exhausted out peripherally & air is re-circulated
  • Decreases airborne bacterial count
  • Uncommon in vet surgery suits
52
Q

What do depth filters do

A
  • Trap by a combo of random absorption & mechanical entrapment
53
Q

How to screen filters filter

A

By pore size

54
Q

Explain using radiation as a physical sterilization

A
  • Surgical materials that are sensitive to heat or chemical sterilization
  • Damages DNA & RNA
  • Can change composition of plastics & pharmaceuticals
  • Industrial use
55
Q

Explain ethylene oxide for chemical sterilization

A
  • Flammable & explosive liquid - effective @ sterilization (mixed w/ CO2 or freon)
  • Good for equipment that can not withstand high heat or pressure (endoscopes, cameras, plastics, & power cables)
56
Q

What are the recommendations of ethylene oxide

A
  • Temp = 120 to 140 degrees F
  • Humidity = 20 to 40 %
  • Airation in a ventilated room for 7 days or 12 to 18 H in an airator
57
Q

Is ethylene oxide toxic to people

A

Yes

58
Q

Explain using gas plasma for chemical sterilization

A
  • Liquid hydrogen peroxide is changed to vapor
  • Wrap in plastic pouches or nonwoven polypropylene fabric
59
Q

What are the advantages of gas plasma

A
  • Sterilize @ low temps & short time intervals
  • no aeration
  • Available right away
  • Safe
60
Q

What is gas plasma used for

A
  • Stainless steel
  • Aluminum
  • Brass
  • Silicone
  • Teflon
  • Latex
  • Polyethylene
  • Polypropylene
  • PVC
  • Polymethymethacrylate
61
Q

What is gas plasma not used for

A
  • Anything that will absorb H2O2
  • Linen
  • Gauze
  • Wood
  • Paper
  • Endoscopes
  • Some plastics
  • Items that can’t be disassembled
  • catheters > 12 in
  • Anything < 3 mm diameter
62
Q

Explain the use of peracetic acid for chemical sterilization

A
  • Kills bacteria, viruses, fungi, & spores
  • 10 to 15 min contact
  • 0.09% concentration
  • Does not create biofilm
  • Not affect by organic material
  • Can remove glutaraldehyde-hardened material from biopsy chamber
63
Q

What are STERIS system 1 E

A
  • 25 min sterilization cycle
  • Flexible endoscopes
64
Q

What is the MOA of Glutaraldehyde

A
  • Protein & nucleic acid denaturation
  • bactericidal, fungicidal, & viricidal ( > 10 H for sporidical; effectiveness pH, temp, & is concentration dep
  • Antimicrobial activity increases w/ temp & decreases w/ organic material
65
Q

Explain how glutaraldehyde is a tissue irritant

A
  • Sensitivity/allergic reactions
  • Rinse w/ sterile water prior to use
  • Vapors cause mucous membrane irritation
66
Q

Explain Glutaraldehyde

A
  • Most effective @ alkaline pH but this reduces shelf-life
  • added activator (colored)
  • Quality control w/ test strips (dilution over time from water off instruments & activator solution)
  • Prolonged use may corrode metal & some plastics & can create biofilms
67
Q

What are the used glutaraldehyde

A
  • Equipment that cannot be exposed to heat (not as effective as ethylene oxide)
  • Quick sterilization of dropped instrument (10 to 15 min soak time)
  • General cleaning
68
Q

How should instruments be cared for in the field

A
  • Clean after procedures w/ water from the truck
  • Instruments kept in chlorhexidine or providone iodine (during surgery, not recommended to store like this, & not sterile)

Surgery 1 (SAB) (16 decks)

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