PREPARATION OF THE SURGERY TEAM AND STERILISATION/ASEPSIS

Question 1

What is sepsis?

Answer 1

– Invasion of the body by pathogenic microorganisms or their toxins

Question 2

What is Asepsis?

Answer 2

Absence of the microorganisms that cause infections

Question 3

What is antiseptics?

Answer 3

Chemical that inhibits/prevents the growth of microbes on living tissue

Question 4

What is disinfectant?

Answer 4

Chemical that inhibits/prevents the growth of microbes on inanimate objects

Question 5

What is Aseptic techniques? and how is it implemented?

Answer 5

Activities performed before, during and after surgery designed to
minimise the introduction of microbes into living tissue

• Set up sterile field in which surgery can be safely performed
• Isolate operating site from surrounding unsterile area
• Prevent contamination of surgical site and sterile field

Question 6

What is sterilisation?

Answer 6

Techniques used to eradicate allmicro-organisms

Question 7

What are the most important techniques to preventing infection to the patient?

Answer 7

Aseptic and sterile techniques are the most important
practices to prevent infection in the patient

Question 8

Who is involved in aseptic techniques?

Answer 8

Un-scrubbed personnel
* Non sterile
* Circulator
* Scout
* Theatre tech/nurse
* Anaesthetist

Scrubbed personnel
* Sterile
* Veterinarian
* Scrub assistant

Question 9

If you are an unsterile personnel, what are important techniques you have to be aware of when performing aseptic techniques?

Answer 9

• DO NOT lean over sterile field
• DO NOT walk between sterile trolleys and operating
  tables
• DO NOT touch inner
  surface of sterile packs
• DO NOT turn your back
  on sterile field
• DO avoid contact with scrubbed personnel
• DO handle sterile packs with care
• Excessive handling/dropping/humidity can force bacteria
  into packs
• DO keep sterile field dry
• If moisture is allowed, bacteria can migrate
• DO open sterile drape/gown carefully
• When opening, do not flip it out, it may stir up dust or touch a
  non-sterile object
• If in doubt about the sterility of an item, always discard it

Question 10

If you are an sterile personnel, what are four important techniques you have to be aware of when performing aseptic techniques?

Answer 10

 Always drape patient from near to far
 Drape surface of the animal and table
 Drape the surgicalsite
 Drape the top of the instrument trolley / table
* Proper attire in the surgical theatre
* Surgical hand scrub
* Gowning and gloving
* Aseptic techniques
* Theatre cleaning

Question 11

What scrub solutions are used?

Answer 11

1. chlorhexidine 4%
2. iodine 7.5%

Question 12

What is the aim of the surgical scrub?

Answer 12

Removes as many micro-organisms as possible from
hands, nails, arms by mechanical washing and antiseptic
contact time

Question 13

What is brushless scrub?

Answer 13

can be used instead of washing, highly concentrated alcohols mixed with antiseptics, iodine or chlorhexidine

no water needed

Removes bacteria from hands by killing it rather than
scrubbing it off
* The rub should start with the fingers and proceed to the
hands and continue up the arms to 5cm above the elbow

Question 14

Is the back of a gown sterile?

Answer 14

no, never sterile

Question 15

what is the purpose of gloving?

Answer 15

The purpose is to create barrier between sterile and
non-sterile areas
* Cover the surgical teams’ skin to prevent it from
contaminating patient
* Open on surface away from other sterile supplies so
that surgeon doesn’t contaminate them with any drips of
water

Question 16

where are nonsterile areas?

Answer 16

Neckline, shoulders, sleeve cuff, gown back

Question 17

If contamination has occured, what steps are taken to fix it?

Answer 17

take immediate action

change glovers, gowns, instruments

may need to consider prophylactic antibiotics

Question 18

how do you ensure theatre cleanliness?

Answer 18

1. cleaning - removal of soil and organic materials with detergent

remove all instruments and take to instrument cleaning area
clean and disinfect tables, positioning aids, monitoring leads

2. disinfection - Destruction of micro-organisms by use of disinfection
   (virucidal, bactericidal)

PLAN YOUR DAY
* Do the clean surgeries first, then
clean-contaminated, then dirty
procedures last

Question 19

HOW DO YOU PREVENT MICROBIAL INVASION

Answer 19

Surgeon/Veterinary Staff
* Surgical attire, personal hygiene, aseptic techniques

Housekeeping
* All surfaces in theatre to be wiped down with alcohol/disinfectant
* Decrease traffic flow through theatre and prep area

Surgical Equipment
* Surgical instruments should be scrubbed thoroughly and cleaned
* Use correct sterilisation cycles for instruments/kits

Patient
* Clip appropriate margins for surgical site
* Surgical Scrub for patient

Question 20

How do you clean surgical equipment?

Answer 20

scrubbed thoroughly

ultrasonic cleaner

wrapped properly with autoclavable paper - indicator strips/tape

correct sterilisation cycle for instruments

handle autoclaved equipment carefully

Question 21

Tissues entering the body cavity, vascular systems and non intact MM, require CRITICAL cleaning - using appropriate processing methods, what is the aim of cleaning and what are the methods?

Answer 21

• High heat sterilisation
• Steam sterilisation

Objects will be sterile (free of all micro organisms
including bacterial spores)

Question 22

Tissues entering that contact (indirectly or directly) with intact MM or non intact skin require require SEMI - CRITICAL cleaning - using appropriate processing methods, what is the aim of cleaning and what are the methods?

Answer 22

• High level disinfection
• Thermal disinfection
• Chemical disinfection
• Objects will be free of all micro organisms, with the
  exception of high numbers of bacterial spores

Question 23

Tissues entering that contact intact skin require but not MM require non critical cleaning - using appropriate processing methods, what is the aim of cleaning and what are the methods?

Answer 23

• Low level disinfection
• Cleaning (manual or mechanical)

objects will be clean

Question 24

What is the instrument and equipment processing order?

Answer 24

1. Pre-soak in distilled water and instrument cleaning
   solution
2. Manual clean & rinse in distilled water
3. Ultrasonic cleaning & rinse in distilled water
4. Inspect
5. Lubricate to prolong life
6. Dry
7. Wrap
8. Sterilise
9. Store

Question 25

What is involved in manual cleaning?

Answer 25

• Use enzymatic cleaner and distilled water
• All items must be thoroughly cleaned
• Use a fine brush to clean each surface of the instrument
• Brushing action same direction as instrument teeth
• Any grease, oil, organic matter etc must be removed

Question 26

Why is distilled water rinse prefered over tap water?

Answer 26

High in minerals - Leaves residue
on instruments
* Can cause permanent damage and
shorten instrument life
* Can interfere with cleaning agents

Question 27

What is in surgicial packs?

Answer 27

 General Instruments
 Swabs
 Hand towels
 Bowls
 Sterile indicators

Question 28

what are considerations to be made when preparing a surgical pack?

Answer 28

 Ensure hinged/jointed instruments are unlocked
 Keep packs as small as practical to ensure thorough steam
penetration
 Don’t pack too tightly or steam can’t penetrate
 Don’t pack too loosely as pack may fall apart
 Sterile indicators
 Label kits