Sepsis Asepsis and Sterilization Flashcards
• Sepsis- state of _________________
• The word Asepsis: Greek “a” to ________, “sepsis”= _____________
infection by microbial organisms
deprive
putrefaction
Asepsis presumes the risk of __________ contamination is minimal.
airborne
Aseptic method can be _________ or ________
medical
surgical
Medical asepsis: objects are classified as ________ or ________
clean or dirty
Sources of infection
• Endogenous: _____,_______,______
Exogenous: _________,________,_________
Skin
Mucous membranes
Viscera
Theatre environment
The Surgeon
other theatre staffs
Some Principles of asepsis
• Surgeon’s preparation for surgery
• Surgeons with an ________ should not operate
• Surgeon with ______,_______,_____ on the hand and forearm should not operate
•________/__________ swabs
URTI
cuts, abrasions, rashes
Nasal/pharyngeal
Asepsis-theatre work ethics
• Always _________ the sterile field; avoid _________ to the sterile.
• Keep sterile instruments _________ level
• Avoid reaching ________________.
• Do not _________,_______,_______ over a sterile field
• Keep sterile field dry.
• Sterilized instruments should have labels showing contents, time and date and
face ; tuning side or back
above waist or table
across the sterile field.
speak, sneeze or cough
Asepsis-theatre work ethics contd
• __________ before a surgical procedure removes as many microorganisms from the hand
• Sterile gowns
• Gloving
• Carry linens away from the body
• Do not raise dust-avoid __________
Scrubbing
shaking linens
Asepsis:Patient-related factors
•______ hospital stay before surgery and after is desirable
• Control patient related _____________ that increases susceptibility to sepsis
• Preoperative showering –no evidence
• Change patients to _____________ before transporting them to theatre. Remove nail polishes, jewelleries
• Remove ___________ before entering the theatre
Short
co-morbid factors
clean theatre gown
ward blankets
Asepsis-theatre related factors
• Air-borne mode of transmission unusual but should be considered in surgeries involving _________.
• Circulating airborne pathogens is related to the ________ in the theatre and their _____________ and __________
• Door leading to the theatre should not be _________ as it affects ventilation system
implants
number of people
movements and theatre clothing worn.
left open
Theatre ventilation systems should be _________ or ___________ mode(Theatre pressure(<or>?) outside rooms)</or>
plenum
positive air pressure
>
Decontamination
Concept applied to __________________ to ensure safety in their further use on patients and handling by the theatre staff
re-usable medical instruments
Decontamination involves:
_________
_________
___________
Cleaning
Disinfection
Sterilization
decontamination
Cleaning removes ________ contamination not necessarily _____________
• Disinfection is a process that reduces the ________________. _____,_______ may be unaffected
• Disinfectants are ________ preparations used on ____________.
visible; destroy microorganisms.
number of viable organism to an acceptable level
Viruses bacterial spores
Chemical; inanimate objects
Cleaning is a prerequisite to __________ and __________
disinfection and sterilization
Disinfectant May be toxic to tissues
T/F
T
Disinfection of surgical instruments •
Disinfection may be via:
•__________ for heat-tolerant instruments. ________,________
• Kills most _______
• Chemical disinfection: good where —————— cannot be used
• eg 2percent _________ and ________
Moist heat
rigid proctoscope, speculum; viruses
moist heat
glutaraldehyde and peracetic acid
Moist heat disinfection may be used for heavily contaminated instruments prior to cleaning
T/F
T
Levels of chemical disinfection
Differentiate
High level disinfection
Intermediate disinfection
Low level disinfection
High:can handle everything, including spores but that’s when it’s not in a high concentration
Intermediate:inactivates mycobacterium, and all the others, except bacterial spores
Low: kills most bacteria , some viruses, some fungi , but can’t be relied on to kill the resistant microorganisms such as bacterial spores or tubercle bacilli
Medical devices Versus risk of infection
Critical
Semi-critical
Non-critical
Critical : enters normal body sterile tissue . Must be sterilized
Semi-critical:contact mucous membranes. High level disinfection, sterilization
Non-critical: contact intact skin. Intermediate or low level disinfection
Selection of chemical disinfectants in clinical practice
• Low Level disinfectants:
__________
____________
Intermediate level disinfectants
________
_______
___________
High level disinfectants
____________
_______________
Phenolics
Quatenary ammonium compounds
Alcohols
Hypochlorites
Iodine/iodophors
Hydrogen peroxide
Glutaraldehyde
Antiseptics
• An antiseptic is a type of _________, which _________ or ______________ micro-organisms on living tissues without ____________ effects when applied to surfaces of the body or to exposed tissues.
disinfectant
destroys or inhibits growth of
causing injurious
Clinical applications of anti-sepsis
• prevent infection of _________ or ______
•applied to _______ and _______ to prevent sepsis by removing or excluding microbes from these
unbroken skin or mucous membranes
Burns and open wounds
Ideal antiseptics
• _______ action
• _______ action
• _______ effect
• _______
• _______ reaction
Rapid
Broad
Persistent
Safe
Minimal
Chlorhexidine plus cetrimide ( ________ )
Povidone-iodine( ___________ )
Savlon
Betadine
___________________ (Savlon)
Chlorhexidine plus cetrimide
_____________________ (Betadine)
Povidone-iodine
Sterilization
• (Partial or Complete?) destruction of all viable microorganisms including _____,______,______
Complete
spores, viruses and mycobacteria.
Modes of sterilization
• __________
• __________
• __________
Physical
• Chemical
• Ionizing radiation
_________ is the Principle behind the autoclave
Steam under pressure
SSIs are infections along ____________ related to the operation within _________ for a non prosthetic /_______ for a prosthetic surgery.
the operative tract
30 days
1 year
IDENTIFYING SSIs
Based on:
•Site & extent
● Incisional infections
-Superficial: ______ only ± _________
-Deep: __________(_____ and _____)
● Organ/ Space infections: ____________
Skin; ; subcutaneous tissue
Deep soft tissue (fascia and muscle)
Organ/space
Minor SSI
-may ___________ or ____________
-not associated with ____________ or _______ signs.
•Major SSI
-discharges ___________
-needs a ___________ to drain it.
-systemic signs of SIRS-tachycardia,
pyrexia, raised white count.
discharge pus; infected serous fluid
excessive discomfort; systemic
significant quantities of pus
secondary procedure
Quantitatively, the risk of SSI is markedly increased if a surgical site is contaminated with >_____ microorganisms per gram of tissue.
•The dose of contaminating microorganisms to produce infection lower in presence of ________. E.g 100 staphylococci per gram of tissue introduced on ________
105
foreign material
silk sutures
Risk Factors for SSI: Patient factors
•_____
•Diabetes
–________
–Glucose >______ mg/dL post period
(<48 hours)
•Nicotine use: delays primary wound healing
•Malnutrition
•Obesity: ____% over ideal body weight
•Prolonged preoperative stay: surrogate of the severity of illness and comorbid conditions
•Coexistent infections at a remote body site
•Altered ____________
Age
HbA1C ; 200
20
immune response
LOCAL INFECTIONS
•Abscess
–Signs of acute inflammation
– _______ organisms implicated
–release of cytokines,O2 free radicals
–Tissue ______ and _______
–Drainage with _______
–Guided _______
–Antibiotics if not ________
–Healing by ______________
Pyogenic
necrosis & suppuration
curettage
aspiration; localised
secondary intention
