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Principles of Surgery > Principles of Surgical Asepsis > Flashcards

Principles of Surgical Asepsis Flashcards

1
Q

What is the purpose of aseptic technique?

A

Practices that aim to prevent infection in the patient.

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2
Q

What does aseptic technique include?

A

They include but are not limited to…
• Sterilization of equipment, gowns, drapes, etc
• Surgical suite preparation
• Patient preparation
• Surgical team preparation

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3
Q

What is the history of aseptic technique?

A

• British surgeon that found a way to prevent infection in wounds during and after surgery
• He was the first to apply the science of Germ Theory to surgery
• Lister’s Antisepsis System is the basis of modern infection control
• His principles made surgery safe

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4
Q

Antisepsis is defined as the?

A

prevention of sepsis by exclusion, destruction, or inhibition of growth of most microorganisms on animate/living objects.

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5
Q

Antiseptics are used for what purpose?

A

• Antiseptics are used to kill most microorganisms during patient skin prep and surgical scrubbing
• Remember skin is not sterile

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6
Q

Asepsis is defined as ?

A

Absence of pathogenic microbes in living tissue that cause disease
• PREVENT wound contamination by destroying organisms before they enter the wound

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7
Q

Aseptic technique is defined as ?

A

• Aseptic technique- Principles employed to minimize degree of contamination of a surgical wound

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8
Q

Barrier is defined as?

A

A material used to reduce or inhibit the migration or transmission of microorganisms in the environment. Personnel attire and gowns, furniture and patient drapes, equipment and supply packaging, and ventilating filters.

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9
Q

Contaminated is defined as?

A

carrying or infected by microorganisms.

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10
Q

Cross-contamination is defined as?

A

Transmission of microorganisms from patient to patient or from inanimate object to patient.

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11
Q

Decontamination is defined as?

A

Cleaning and disinfecting or sterilizing processes carried out to make contaminated items safe to handle.

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12
Q

Disinfection is defined as ?

A

Chemical or mechanical (friction) destruction of pathogens.

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13
Q

Irreducible minimum is defined as?

A

The microbial burden cannot get any lower. The item is sterile to its highest degree.

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14
Q

Spatial relationships are defined as?

A

Having awareness of sterile unsterile, clean, and contaminated areas, objects, and individuals and their proximity to each other.

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15
Q

Standard precautions are defined as?

A

Procedures followed to protect personnel from contact with the blood and body fluids of patients.

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16
Q

Sterile is defined as ?

A

Free of living organisms.

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17
Q

Sterile field is defined as?

A

Area around the site of incision into tissue or the site of introduction of an instrument into a body orifice that has been prepared using sterile supplies and equipment.

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18
Q

Sterile technique is defined as?

A

The method by which contamination with microorganisms is prevented to maintain sterility through out the surgical procedure.

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19
Q

Terminal sterilization and disinfection is defined as?

A

Procedures carried out for the destruction of pathogens at the end of the surgical procedure in the operating room (OR) after the patient has been removed.

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20
Q

What is the purpose of asepsis?

A

PREVENT wound contamination by destroying organisms before they enter the wound

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21
Q

Antisepsis is defined as?

A

Destruction of most microorganisms on animate/living objects

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22
Q

Sterility is defined as the absence of ?
This can only be applied to?

A

all forms of microbial life
• Only inanimate objects

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23
Q

It is important to remember that complete absence of microorganisms cannot be reached in a hospital environment. How can we help reduce transmission?

A

Using aseptic techniques will help control pathogens and decrease risk of infection

24
Q

What is the purpose of aseptic and sterile technique?

A

• Decrease iatrogenic infection rate
• Minimize sources of contamination
• Block transmission of microorganisms
• Reduce patients’ risk of exposure to microorganisms that cannot be removed.

25
Q

Transmission of Microorganisms
How can microorganisms be transmitted in a hospital setting?

A

Microorganisms can be transmitted from:
Patient
Hospital Staff
Contaminated instruments
Environment

26
Q

List and describe the sources of contamination

A

Animal Sources
• Skin - cells constantly shed;
• Hair - natural bacteria live here; secretions contain bacteria; prep patient well and shave them!
• Nasopharynx; Oral Cavity - natural bacteria; secretions
• Ear Pinnae = yeast, bacteria
• Vulva, Prepuce, Anus = yeast, bacteria

27
Q

Sources of contamination from Inanimate sources include

A

• Fomites & Air
• Hair clipper = especially if you do not clean the clippers in between every patient
• Scrubs = e.g. parvo puppy, you can pass secretions between patients.
• Hospital structures = roof, air vents, HVAC, etc.
• Walls
• Floors
• Furniture
• Equipment
• Lights

28
Q

Sources of contamination
Airborne sources

A

• Particles in air are responsible for about 80-90% of contamination during surgery.
• 1 cubic foot of air contains thousands of particles
• This can increase in longer procedures to more than 1 million
• Decrease foot traffic in sx room (staff, other patients, pet owners)

29
Q

What is the primary aerial bacterial source?

A

YOU THE SURGEON

30
Q

How many microbes are shed from skin/min/person?

A

3,000-50,000 MICROBES SHED FROM SKIN /MIN/PERSON

31
Q

Describe Surgeon Preparation:

A

Surgical Scrubbing
• Drying of hands
• Gowning
• Gloving

32
Q

Describe Patient Preparation:

A

Surgical site preparation
• Hair removal
• Skin preparation
• Draping

33
Q

Describe Surgeon Attire

A

Lab Coat
• Surgical scrubs
• Surgery Cap
• Face Mask
• Shoe covers

34
Q

Scrubbing removes ____ and ____, reduces ______ ________ population, ______ of skin’s resident bacterial
population, bacteria isolated in _____

A

dirt, oil, transient bacterial, depression, skin

35
Q

How has scrubbing changed over time?

A

Scrub brushes are used less, alcohol rubs are much more popular now and has also decreased scrubbing time.

36
Q

Scrubbing Break Down

A

Remove all jewelry and put on surgery cap, surgery
mask, and booties
• Nail polish?? - some studies suggest increase in microbial growth.
• Fake nails??? - harbors more bacteria than we think so remove them.
• Make way to sink and open new scrub brush
• Basic hand wash
• Clean fingernails
• Scrub
• Anatomic timed method OR Counted brush stroke method

37
Q

What do we need to remember when we wash our hands?

A

Make sure you are not going over the same spot
Going from fingernails to finger to palm.

38
Q

What do we need to remember when we are scrubbing?

A

See SOAP

39
Q

Why did things change?

A

Until recently surgical hand asepsis included scrubbing hands and arms with a brush
• Studies have shown scrubbing leads to skin damage and increased bacterial counts
• Scrubbing with a brush removes epidermal layers, increases bacterial cell shedding, increases microbial counts, and changes microbial flora so we are actually introducing more bacteria and increasing risk of transmission and potential infection.
• Vigorous scrubbing is no longer recommended

40
Q

Scrubbing-> Alcohol
Based (Avagard)

A

Remove all jewelry
• Basic hand wash
• Clean fingernails
• Apply hand antiseptic
• 3 pump application (for first surgery of the day, any surgery after that you can just do 1).

41
Q

How do you dry your hands?

A

Pick up sterile towel from pack on table
• Unfold towel and hold lengthwise
• Use one end of towel to dry 1 hand/arm
• Bring dry hand to opposite end of towel and repeat
step 3
• Drop towel into trash or on the ground

42
Q

What are the different types of gown options?

A

Reusable/Cloth Gowns
• Woven material (cotton)
• Loosely woven, all cotton fabric type 140 muslin
• 270 pima cloth (smaller pores than 140 muslin)

43
Q

Pros and cons of reusable/cloth gowns

A
44
Q

Disposable gowns

A

Disposable Gown
• Non-woven material
• Made from fibers
instead of yarn/cotton
• You will glove up before
tying waist

45
Q

What do we need to remember when we are getting gowned up?

A
46
Q

Keep in mind when using disposable gowns

A

Gown ties on the side
• Assistant ties the neck/collar but YOU tie
waist
• “twirl”

47
Q

What to remember about Sterile Surgical Gloves

A

Another barrier between surgical team member and patient
• Gloves should have inner surfaces lubricated with adherent coating of hydrogel
• This is what makes them slide onto hands nicely
• Ideally gloves should not be dropped onto the opened gown pack before scrubbing and shouldn’t be placed onto sterile field until surgeon’s hands have been dried

48
Q

Describe the closed technique for gloving

A

Closed Technique
• Most common for surgery
• Ensures hand never comes in contact with the outside of the gown or glove

49
Q

Describe Open gloving

A
50
Q

Describe Assisted gloving

A

To glove another team member
• Scrub person always gloves the other person’s right hand first

51
Q

Describe how to remove gloves aseptically

A

see SOAP

52
Q

What is not sterile?

A

Body parts:
• Back
• Neck
• Shoulders
• Axillae
• Anything below waist
• Keep hands between wait and axillae
• Anything below table height
• Wet gowns or drapes
• Anything under drapes/patient

53
Q

What are the benefits of draping?

A

Eliminates the passage of microorganisms between
nonsterile and sterile areas
• Minimizes skin exposure
• Decreases risk of contamination
• Maintains sterile field around surgery site
• Types of drapes
• Reusable
• Huck towels
• Fenestrated cloth
• Disposable
• Paper, plastic, or combination

54
Q

What are the benefits of Instrument sterilization

A

Process that removes microorganisms
from medical instruments
• Steam
• Chemical
• Plasma
• Peracetic acid
• Ionizing radiation
• Cold chemical sterilization

55
Q

What is the purpose of sterile technique

A

Designed to prevent transmission of microorganisms
into the body during surgery or other invasive
procedures
• All surgical procedures ideally performed under sterile
conditions with end goal of preventing infection

56
Q

Principles of sterile technique?

A

Only use sterile items in the sterile field
• Sterile scrubbed personnel are gowned and gloved
• Sterile personnel operate within a sterile field
• Sterile drapes are used to create a sterile field
• All items used in a sterile field must be sterile
• All items introduced onto a sterile field should be opened, dispensed, and
transferred by methods that maintain sterility and integrity
• Sterile fields are areas that are set up for procedures and are free from
microorganisms
• Usually, a tray covered with a sterile towel
• A sterile field should be maintained and monitored constantly
• Surgical staff should be trained to recognize when they have broken
technique and should know what to do next

Principles of Surgery (13 decks)

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