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VSC410 EOS Exam > Preparing for Surgery > Flashcards

Preparing for Surgery Flashcards

1
Q

Define aseptic technique

A

A set of techniques and practices designed to prevent or minimise microbiological contamination of the surgical wound.

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2
Q

Why is there no such thing as “sterile”

A

Sterile implies an inanimate object- there will always be air and a patient to contaminate the surgical site

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3
Q

what does infection involve?

A

The hosts immune system

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4
Q

5 factors associated with infection

A

Bacterial numbers >105

Bacterial type

Host Resistance

Presence of Foreign Bodies

Interaction between host and bacteria

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5
Q

Define sepsis

A

the presence of pathogens, or their toxic products in the tissues of a patient

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6
Q

Define asepsis

A

absence of pathogenic microbes in living tissue

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7
Q

Define sterilization

A

destruction of all microbes and organisms, including spores (inanimate objects only) by physical or chemical means

Sterilization is the complete removal of all viable microbial forms including the vegetative forms of bacteria and spores

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8
Q

Define antisepsis

A

use of antimicrobial chemicals on living tissues

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9
Q

Define disinfectant

A

A germicidal chemical agent that kills microorganisms on inanimate objects

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10
Q

When do surgical infections usually occur?

A

30 days general
12 months orthopedic

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11
Q

What is the goal of successful surgery?

A

Prevention of surgical infection and to encourage wound healing

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12
Q

4 Golden rules of preparing for surgery

A
  1. STRICT ASEPTIC TECHNIQUE-
    NO PATHOGEN HAS YET DEVELOPED RESISTANCE TO ASEPTIC TECHNIQUE!
  2. Disruption of dermal integrity = access to inner tissues- everytime there is a cut, it allows stuff access
  3. Laws of the Operating Room
  4. Aseptic technique prevents cross contamination in surgery
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13
Q

4 sources if bacterial contamination

A
  1. The surgical personnel
  2. the patient (urogenital, respiratory, gastrointestinal)
  3. Operating theatre environment (need to work clean to dirty )
  4. Surgical instruments and implanted materials (biomaterials) inc. suture
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14
Q

4 aspects involved in aseptic techniques

A
  1. surgical site
  2. facilities and environment
  3. surgical team
  4. surgical equipment
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15
Q

Golden rule of antibiotics

A

Antibiotic coverage is NEVER a good substitute for appropriate precautions and good operative technique

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16
Q

5 signalments of patient selection and preparation when preventing surgical infections

A

History (age, food, cycle stage, previous surgery, medications, sensitivities, other disease processes)

Physical exam

CBC and Biochem

Urine SG

Treatment of underlying disease or remote infection

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17
Q

ASA 1

A

Minimal risk of normal healthy patient with no underlying disease

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18
Q

ASA 2

A

SLight risk of a slight to milk systemic disease. Neonate, geriatrics, obesity

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19
Q

ASA 3

A

Moderate risk, obvious systemic disease
Anemia, moderate dehydration, fever, low grade heart murmur or cardiac disease

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20
Q

ASA 4

A

High risk with severe, systemic, life threatening disease
severe dehydration, shock, uremia, toxemia, high fever, uncompensated heart disease, uncompensated diabetes, pulmonary disease, emaciation

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21
Q

ASA 5

A

Extreme risk, moribund (point of death), patient will probs die with or without surgery
Advanced cases of kidney, heart, liver or endocrine disease
Profound shock
severe trauma
pulmonary embolus
terminal malignancy

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22
Q

ASA E

A

Emergency
can be attached to each class in case of emergency surgery

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23
Q

6 characteristics of an ideal antiseptic agent

A

Non irritant to skin

Bactericidal

Broad spectrum

Long residual activity

Not inactivated in the face of organic material

Economical

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24
Q

3 chemical groups of antiseptic agents

A

Iodophors (povidone- iodine)

Bisbiguanide (chlorhexidine)

Alcohols

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25
Q

Iodine MOA

A

penetrates cell wall and displaces molecules with free iodine

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26
Q

Iodine persistent action

A

4-6 hours

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27
Q

Iodine toxicity

A

Thyroid dysfunction
Acute contact dermatitis
Activity decreases by organic material

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28
Q

Chlorhexidine MOA

A

Increase cell wall permeability
Precipitates cellular components

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29
Q

Chlorhexidine persistent action

A

> 6 hrs

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30
Q

Chlorhexidine residual action

A

upto 1-2 days

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31
Q

Chlorhexidine toxicity

A

Ototoxic
corneal toxic
neurotoxic

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32
Q

Alcohol MOA

A

Cell lysis, protein denaturation, metabolic interruption

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33
Q

Alcohol toxicity

A

Corneal toxicity
neurotoxic

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34
Q

Why are abraded areas problematic ?

A

Need to be minimised as they will lead to direct contact with surgery site regardless of how well you close the sight

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35
Q

What are skin and hair?

A

Bacterial reservoirs

Staphylococcus, streptococcus, micrococcus, clostridium and bacillus

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36
Q

What is the recommended technique for hair removal?

A

Clipping - appropriate area each side of proposed incision should be clipped

BUT NOT THE DAY BEFORE - increases risk of infection by 3 fold

Water soluble gel should be placed on open wounds prior to clipping- nicks and grazes act as a focus for bacterial contamination

37
Q

is clipping or shaving better ?

A

Clipping - shaving increases infection rate

38
Q

3 scrub method

A

LATHER and SCRUBBING IS IMPORTANT

Initial scrub –Antiseptic/Detergent mixture

Second scrub –Alcohol antiseptic scrub/wipe

Tertiary scrub –Antiseptic agent

Avoid overzealous force - increases irritation and bacterial liberation

Wear gloves

Initial prep should be done outside the operating room

39
Q

4 sources of contamination from the surgeon to the patient ?

A

Hands (nails)
Mouth (breath)
Head (skin)
Hair

40
Q

4 Barrier method components

A

Scrub suit
Surgical head covers
Shoes or shoe covers
Face masks

41
Q

Purpose of scrub suit

A

Not impermeable barrier to micro-organisms
aim is to reduce particulate shedding in the operating theatre (should not be worn outside theatre or cover)

42
Q

Purpose of surgical head covers

A

Hair is a source of bacterial contamination from the surgical team

43
Q

purpose of shoes or shoe covers

A

Prevent external bacteria and hair being tracked into theatre

Also avoids tracking material from theatre around hospital

44
Q

purpose of face masks

A

Aerosol droplets and direct to the sides (so forget ur manners if you need to cough)

Contains expelled microorganisms

45
Q

3 aims of surgeon skin prep

A

Mechanical removal of gross dirt from hands and forearms

Reduction in the transient microbial count to as close to zero as possible

Prolonged depressant effect on the resident microflora of the hands ANDarms

46
Q

Important points of gown (3)

A

Act as a barrier between patient and surgical team

-Gowns should be resistant to blood and aqueous fluids- Cloth gowns are cheaper but lose all barrier properties when wet

-Disposable single use gowns have superior barrier properties and decrease wound infection rates

47
Q

important points of gloves (2)

A

Sterile gloves are mandatory to reduce contamination

25-30% of surgical gloves have tears at end of surgery

48
Q

Operating team breaks in asepsis

A

Exposed hair

Active respiratory infection

Dermatitis

Loose fitting mask

Soiled scrub suit

49
Q

Scrub procedure breaks in asepsis

A

Rings and bracelets left on

Long or dirty fingernails

Improper scrub technique

Gowning or gloving with wet hands

50
Q

Advantages of disposable barrier materials

A

Excellent water repellent

Always in good condition

Labour saving - less laundry

Presterilised

51
Q

Disadvantages of disposables

A

Expensive

May be less conforming

Large stock required

52
Q

Advantages of reusable

A

Cheaper
Less waste

53
Q

Disadvantages of reusable

A

Poor barrier to properties which lead to strike through

Labour intensive

Threads may detach and lint into wound

Reduced quality with repeat washing

54
Q

4 quadrant method of draping

A
  1. side closest to surgeon (between patient and surgeon)
  2. Adjacent quadrant (left side)
  3. Quadrant opposite 2 (right side)
  4. Opposite surgeon

Secure with towel clamp

55
Q

How many organisms fall into surgical wound in 1hr

A

75 000

Bacteria can be endogenous or exogenous

56
Q

What is a nosocomial infection?

A

also called health-care-associated or hospital-acquired infections, are a subset of infectious diseases acquired in a health-care facility

More AB resistance with nosocomial infections

Animals acquire hospital organisms soon after admission and reservoirs established in the lower gitract, lower utand nasopharynx

57
Q

7 requirements of an operating theatre

A

Located out of high traffic area

Only necessary personnel enter

All personnel correctly attired

Room not used to examine or treat animals

(Mild positive pressure laminar air flow so air flows out when door opened)

(Airflow should move from area of least to greatest contamination)

PRINCIPLES OF OPERATION AND CONDUCT

58
Q

3 steps of routine cleaning procedure

A

Damp dust all surfaces at start of day

End of day vacuum and disinfect all surfaces and equipment

Once weekly thorough scrub of walls and floors

59
Q

2 forms of sterilization

A

First, instruments must be cleaned (mechanically or chemically) then:

1: Physical- heat, filtration, radiation

2: Chemical- ethylene oxide, alcohols

60
Q

What is the role of sterilisation indicators ?

A

Monitor the efficacy of sterilisation method

61
Q

What is a sterilisation indicator ?

A

Chemical indicators undergo a colour change when exposed to a certain temperature

NOTE: do not indicate time of exposure or if items or sterile

62
Q

2 classes of chemical indicators

A

1: Tape
2: Bowie-dick indicator strips

63
Q

4 consequences of post surgical wound infection

A

There should be less than 5% chance of getting a wound infection from a clean surgical site

  1. wound breakdown or delayed healing
  2. septicaemia/ endotoxemia
  3. pain, morbidity
  4. Increased hospitalization
64
Q

Why occurs during wound breakdown or delayed healing

A

Breakdown of viscera repair
Sepsis associated with implants
Haemorrhage associated with lysis around infected ligatures
Evisceration
hernia repair failure

65
Q

True or false: al surgical wounds become contaminated even when strict asepsis is maintained

A

TRUE

66
Q

When are peri-operative AB delivered ?

A

Prophylactic usage
After induction, before you start surgery

Want circulating therapeutic levels circulating in the tissues

Ideally be present at surgical site at time of potential contamination- ideally intravenously at least 20-30 mins before first cut, repeated at 60-90 minute intervals depending on selected antibiotic

67
Q

When are post operative antibiotics delivered?

A

Therapeutic usage
Send patient home with them if there has been an identified:
-breech in sterility
- systemic disease/ comorbidities

Dependent on:
- owner compliance
- classification of surgery (risk to patient, risk of complication)

68
Q

When are host tissues most susceptible to bacterial lodgement ?

A

Within first 3 hours of contamination

69
Q

When are ABs more efficacious

A

when given pre-operative +/- repeat

Duration of therapy should be determined by the wound classification and individual patient assessment

70
Q

4 classifications of surgical wounds

A
  1. Clean
  2. Clean Contaminated
  3. Contaminated
  4. Dirty
71
Q

Class 1: Clean

A

An uninfected operative wound in which no inflammation is encountered
respiratory, alimentary, genital, or uninfected urinary tract is not entered.
primarily closed
if necessary, drained with closed drainage.
Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria.

72
Q

Class 2: Clean contaminated

A

An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Specifically, operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.

73
Q

Class 3: Contaminated

A

Open, fresh, accidental wounds.
Operations with major breaks in sterile technique (eg, open cardiac massage)
Or gross spillage from the gastrointestinal tract,
incisions in which acute, non-purulent inflammation is encountered

74
Q

Class 4: Dirty- infected

A

Old traumatic wounds with retained devitalized tissue Wound that involve existing clinical infection or perforated viscera.
This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.

75
Q

4 usages of the surgical wound classification

A
  1. Predicts level of bacterial contamination
  2. Predicts likelihood of infection
  3. Informs use of peri-operative antibiosis
  4. applies to non-surgical wound and helps to inform antibiotic usage and wound management
76
Q

How much can wound ischemia (blocked blood flow/ arterial insufficiency) potentiate infection?

A

10 000 fold

77
Q

What can some bacterial species do in a local wound environment?

A

secrete a bioslime or glycocalyx

78
Q

What can surgical implants do in a local wound environment?

A

Act as nidus (focus of infection - a place where bacteria may multiply)

79
Q

What does tissue trauma do?

A

Significantly affects the number of bacteria required to produce infection

80
Q

6 Halsted Principles of Surgery

A
  1. Aseptic technique
  2. Sharp anatomic dissection
  3. Gentle tissue handling
  4. Careful haemostasis (preservation of blood supply)
  5. Avoid tension
  6. Obliteration of dead space (accurate tissue apposition)
81
Q

Why bother with Halsted’s principles of surgery?

A

Reduced dehiscence

Rapid wound healing

Prevention infection

82
Q

Number one way to reduce peri-operative errors?

A

Medical checklists

They act as a memory aid and guide users through accurate task completion

They specify each step, in order aiming to limit errors

83
Q

4 stages on a surgical safety checklist

A

1: pre operative (prep room) inc anaesthesia choices, allergies, airway/ aspiration risk, blood loss risk, equipment test, surgical site

2: before incision (operating room) inc prophylactic AB’s, sponge count in, team members and role, anticipated critical events

3: Before leaving operating room inc spong count out, specimens labelled and accounted for, equipment issues, review of patient

4: after leaving operating room inc rectal sponges and purse string sutures out

84
Q

3 ways to limit surgical complications

A

Consider checklist for atomisation of regular procedures

Maintain team communication

Be aware of environment and self

85
Q

errors of omission are

A

under stimulated

86
Q

errors of commission (doing something wrong)

A

overstimulated

87
Q

Why are procedural skills perishable?

A

You still need adequate initial preparation and ongoing practice to maintain proficiency

88
Q

5 ways to optimise zone of optimal personal function

A

Practice under pressure
Mental rehearsal
Team review
limit distractions
pause and review

89
Q

5 components of the clinical audit

A
  1. Identify the audit topic
  2. Set the standard and design the method
  3. Collect the data
  4. Analyse the data
  5. Implement change

VSC410 EOS Exam (7 decks)

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