Medical And Surgical Aspesis

Question 1

Medical Asepsis and microbial dilution

Answer 1

Deals with reducing the probability of infectious organisms being transmitted to a susceptible individual
-> reducing the total number of organisms is called microbial dilution

Question 2

3 Levels of Microbial Dilution

Answer 2

Simple cleanliness - proper cleaning, dusting, linen handling, and hand hygiene
Disinfection - the destruction of pathogens by using chemical materials
Sterilization - involves treating items with heat, gas, or chemicals to make them germ free

Question 3

Antiseptic vs. Disinfectant

Answer 3

Antiseptic - a substance that tends to inhibit the growth and reproduction of microorganisms
Disinfectant - liquid chemical applied to objects to eliminate many or all pathogenic microorganisms

Question 4

Disinfection is used to clean

Answer 4

Surfaces that cannot be sterilized; tables, floors, walls, and any equipment

Question 5

Surgical Asepsis

Answer 5

The complete destruction of all organisms and spores from equipment used to perform patient care procedures

Question 6

Sterile Conscience

Answer 6

Refers to the awareness of sterile techniques and the responsibility for telling the person in charge whenever you contaminate a field or observe the contamination by someone else

Question 7

Sterile corridor

Answer 7

The area b/w the patient drape and instrument table is maintained as a sterile corridor
Access to this area is limited and permitted to only those wearing sterile attire (radiographer is excluded from here)
Head of the table is not included in the sterile field

Question 8

Operating Room Rules

Answer 8

• doors must be kept closed during surgical procedures
• only persons directly involved in the procedure may be present
• most not work in OR with open wound or acute infection as that increases the potential for infecting the patient
• must constantly be aware of sterile and non sterile items
• if a sterile items is contaminated it must be replace by a sterile one

Question 9

3 Zones of the OR Environment

Answer 9

Unrestricted zone - person may enter in street clothing (change room)
Semi-restricted zone - only persons dressed in scrub clothing with hair and shoe coverings on may enter (outer corridor)
Restricted zone - only persons wearing scrub suits, hair coverings, shoe coverings, and masks are allowed

Question 10

what is a Sterile Field and how do we prepare it

Answer 10

A microorganism free area prepared for the use of sterile supplies and equipment
Can be established using a sterile drape
First step in preparing a sterile field is to confirm the sterility of package supplies and equipment
Packages must be clean and dry to be considered sterile
Inspect the sterile packages for any rips and check the expiration dates

Question 11

Moving Supples within a sterile field

Answer 11

Never reach across the sterile field
When a radiographer must manipulate the sterile field sterile transfer forceps must be used
Keep the forceps above your waist in sight at all times
After use put them with handles facing out so you don’t disrupt the sterile field

Question 12

In the event a procedure is postponed what do you do the sterile field

Answer 12

Cover it immediately with a sterile drape

Airborne contamination is just as serious as a break in sterile techniques

Question 13

Sterile package criteria

Answer 13

They are clean, dry, and unopened
Their expiration date has not been exceeded
Their sterility indicators have changed to a predetermined colour confirming sterilization

Question 14

Sterile indicators

Answer 14

Are placed inside and outside of each package to be sterilized
When the indicator changes colour it is proof that the contents of the pack have been exposed to the sterilization method sufficiently to change the colour to the indicator
Chemical indicators or biologic indicators

Question 15

Chemical Sterilization

Answer 15

Involves the Emerson and soaking of objects in a bath of germicidal solution followed by a sterile water rinse
Disadvantage - difficult to control accurately not often used
Advantages - used if objects can’t go into autoclave or gas, effective at destroying microorganisms but will not kill spores

Question 16

Dry Heat

Answer 16

Such as that in an oven
Advantage - required to sterilize some sharp instruments, certain powders and greasy substances
Disadvantage - time varies from 1-6 hours, temp range of 329-338 degrees Fahrenheit, not commonly used

Question 17

Conventional Gas

Answer 17

Used for items that would be damaged by high temperatures are usually sterilized with a mixture of gases
Advantage - used primarily for electrical, plastic, rubber items,and optical water
Disadvantages - gases are poisonous and must be dissipated by means of

Question 18

Packing and Storing Sterile Supplies

Answer 18

• items must be covered completely by the wrapper and security fastened with tape or heat seal that can’t be reused
• contents must be identifiable and evidence of exposure to the sterilization agents must be present
• sterile items are to be stored in the same place, separate from non sterile items
• are must be clean, dust free, vermin free and draft free
• items that have been sterilized in the hospital and stored in a closed cupboard are considered sterile for 30 days
• on an open shelf they are considered sterile for 21 days
• items sealed in plastic bags immediately after sterilization are considered sterile for 6-12 months

Question 19

Sterile Packing Criteria

Answer 19

Packages must be:

• clean, dry and unexposed
• the expiration date has not been exceeded
• their sterility indicators have changed to a predetermined colour, confirming sterilization

Question 20

Purpose of a surgical scrub

Answer 20

Remove as many microorganisms as possible from the skin of the hands and lower arms by mechanical and chemical means

Question 21

How to do a surgical scrub

Answer 21

Change into scrub suit, put on shoe covers, and put on a mask
Make sure your arms are bare to at least 2 inches above the elbow
Put on surgical hat or hood to cover beard
Remove all jewelry
Inspect finger nails and areas around hands to ensure good condition
If necessary don gown before beginning scrub
Wash hands thoroughly and then wash from a clean area to unclean (hands - elbows)

Question 22

Gas Plasma Technology

Answer 22

Safer method of sterilizing heat and moisture safe items
No toxic fumes, residues, byproducts or residues, and no handling of chemicals
Uses very low heat and moisture
Effectively kills both microorganisms and spores
Cannot sterilize instruments that have long, narrow, lumina
Is can not be used for powders, liquids, or any cellulose materials such as paper, cotton, linen or muslin
Used for: endoscopes, fibre optic devices, microsurgical instruments, and powered instruments

Question 23

Autoclaving

Answer 23

A device that provides steam sterilization under pressure
Most commonly used sterilization method
Cheap, quick, and most convenient for items that can withstand heat and moisture
Uses very high temperatures 250-275
Indication of sterilization by tape indicator

Question 24

Skin preparation

2 methods

Answer 24

Mechanical - may include removal of hair and always a friction scrub with antiseptic soap and water, the scrub is sterile and the person performing it must also be
Chemical - performed after the mechanical skin prep, skin around the the area to be penetrated is often pained with antiseptic solution to destroy remaining microbes and acts as a deterrent for further microbial growth, start in small circle and work outwards when wiping

Question 25

Technologist in the OR

Answer 25

Must wear scrub attire
Must be skilled at setting up the equipment along with obtaining the required images with accuracy
Before bringing equipment into the OR it must be wiped down with germicidal solution

Question 26

Vertical PA C-Arm orientation

Answer 26

Least exposure to the operator

X-Ray tube below and the I.I above the patient

Question 27

30 degree C-arm tilt

Answer 27

Increased exposure to the head and neck by a factor of four

Question 28

Horizontal C-arm Orientation

Answer 28

Increased exposure at the X-Ray tube end

Question 29

Vertical AP C-arm Orientation

Answer 29

Must be avoided

Increased exposure to the head and neck

Question 30

Surgical accessories and clothing

Answer 30

Scrub clothes
Gown to cover scrub clothes
Hat or hood to cover all hair
Shoe covers
Mask 
Protective eyewear
Non-sterile gloves

Question 31

2 c-arm positions to minimize dose

Answer 31

Vertical projection and PA position (X-Ray tube under the patient/table)
Tech stands 6 ft away from tube when possible
Use intermittent (LIH) fluoroscopy when possible

Question 32

Surgical Asepsis

Answer 32

Non-sterile personnel must not come into contact with sterile personnel
Any contaminated sterile drape or cover must be reported and replaced

Question 33

Sterile gown is considered sterile:

Answer 33

From shoulder to level of sterile field
At the sleeve from cuff to just above elbow
OR tables are considered sterile only at level of tabletop

Question 34

ORIF

Answer 34

Open reduction internal fiction

Can be done on any bone or joint

Question 35

Alcohol based handrub method

Answer 35

Perform a pre wash by wetting hands and forearms and lathering with a nonantimicrobial agent from the fingertips to 2” above the elbows
Rinse and hands and arms with running water then dry
Apply alcohol based surgical handrub product that provides a very high level of disinfection that lasts for a long time

Question 36

Standard Precautions

Answer 36

Designed to reduce the risk of transmission of infections from unrecognized sources of blood borne diseases and from other pathogens in health care institutions
Also includes precautions for 3 modes of transmission - airborne, droplet and contact

Question 37

What does standard Precautions apply to

Answer 37

Blood
All body fluids 
Secretions and excretions (expect sweat), regardless of whether they contain visible blood
Nonintact skin 
Mucous membranes

Question 38

OSHA blood borne pathogens standard

Answer 38

To protect workers exposed to blood and other potentially infectious materials by using work protocols, engineering, and ensuring the use of PPE and clothing, and the appropriate signs and labelling

Question 39

Diseases for which quarantine is authorized

Answer 39

Cholera                   SARS
Diphtheria.              Ebola 
Infectious TB
Smallpox
Plague
Yellow fever

Question 40

Universal Precautions

Answer 40

All patients are treated as potential reservoirs of infection
Based on the use of barriers for all contacts with blood and certain body fluids know to carry blood borne pathogens, rather than focusing on isolation of the patient
Barriers = gloves and masks

Question 41

Body substance precautions

Answer 41

The use of barriers for all most and potentially infectious body substances from all patients (feces, nasal secretions, sputum, sweat, tears, urine, vomit)
Developed to help prevent workers from acquiring and transmitting infectious diseases

Question 42

Are the cuffs of sterile gown considered sterile

Answer 42

No because they collect moisture and must always be covered by sterile gloves

Question 43

How to sterile people pass each other

Answer 43

Must pass each other back to back

Question 44

If a sterile material or pack becomes damp or wet is it considered sterile

Answer 44

No

Question 45

How to sterilize a sterile field that has become wet or damp

Answer 45

Must be covered with several thickness of sterile toweling or an impervious drape

Question 46

Are the edges of a sterile wrapper considered sterile

Answer 46

No and they must not touch a sterile object

Question 47

Methods of microbe transmission

Answer 47

Direct
Indirect
Vehicle (food and water)
Airborne

Question 48

Importance of masks

Answer 48

Protects the patient from droplets expelled from personnel and protects the health care worker from pathogenic organisms in the surgical environment
Must cover mouth and nose and have no gap
Masks are regarded as highly contaminated and a new one must be used for each surgical procedure