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CPS > Surgery, preparation, protocols and good theatre practice > Flashcards

Surgery, preparation, protocols and good theatre practice Flashcards

1
Q

Asepsis?

A

The absence of pathogenic microbes or infection in living tissue.

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2
Q

Antisepsis?

A

The use of antimicrobial chemicals on living tissue

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3
Q

Disinfection?

A

Destruction of pathogenic microbes e.g. use of germicidal products on inanimate objects.

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4
Q

Sterilization?

A

Destruction of all microorganisms.

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5
Q

Are surgical wounds sterile?

A

No - all become contaminated with bacteria, but not all contamination becomes infection.

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6
Q

What 3 areas of preparation can increase successful outcome?

A
  1. Patient prep
  2. Surgeon prep
  3. Theatre behaviour
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7
Q

Where should patient prep be performed?

A

In a separate room to the theatre.

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8
Q

What is the issue with hair removal?

A

Hair is a gross contaminant and significant reservoir for microbes and organic debris.

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9
Q

By how much does hair removal increase the chance of contamination prior to anaesthesia?

A

3x higher chance.

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10
Q

Why should razors not be used?

A

Grazes and associated with a 10x increase in contamination risk.

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11
Q

How should you treat open wounds?

A

First flush them and then cover with sterile gel.

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12
Q

What are the pros and cons of depilatories?

A

Pros: Atruamatic, good for rabbits

Cons: Expensive, cause a lot of mess, not good on coarse hair and cause frequent skin reactions in cats.

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13
Q

What is the best method of hair removal?

A

Clipping - lower rate of surgical infection

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14
Q

When should you NOT clip the wound and why not?

A

The day before, increases the bacterial load.

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15
Q

How far should you clip around the proposed surgical site?

A

10-15cm

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16
Q

How do you then remove the hair?

A

vacuum the table and the patient.

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17
Q

How much of the limb would you clip for orthropaedic surgeries?

A

The entire limb.

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18
Q

What should you do with the paw during orthopaedic surgery and why?

A

The paw harbours a lot of bacteria and is difficult to deal with nail beds and pads therefore should be covered with impermeable material e.g. surgical glove.

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19
Q

What are the three aims of skin preparation?

A
  1. reduce the level of gross dirt and transient microbes.
  2. Rapidly reduce resident microbe levels to sub-pathogenic levels with minimal tissue irritation.
  3. prevent rapid re-bound growth of microbes.
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20
Q

is skin sterile and it not, why not?

A

Skin is not made sterile because antiseptic does not reach the lower levels of the skin - 20% bacteria there.

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21
Q

What are the three stages to skin preparation?

A
  1. initial removal of gross dirt and transient microbes
  2. surgical scrub with detergent-based solutions
  3. alcohol aqueous solution rinse.
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22
Q

What should be worn during surgical site preparation?

A

Gloves

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23
Q

What should and should not be used to clear the area?

A

Should use good quality swabs. should not use cotton wool (leaves fluff) and should not use scrub brushes.

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24
Q

How do we avoid hypothermia in our patients?

A

use warm water and avoid wetting excessively.

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25
Q

Why should we not be rough when preparing the patient?

A

trauma and increased bacterial release from the hair follicles.

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26
Q

What is very important when prepping the patient?

A

Start in the middle, work out and discard swab. CONTACT TIME is very important!

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27
Q

What should the final stage of prep be when in the theatre?

A

No touch with alcohol tincture.

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28
Q

What happens if there is any contamination?

A

need to start the protocol again - do not clip in theatre!

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29
Q

How should we prepare the foot?

A

Secure in a glove and swill the foot in there.

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30
Q

Name 7 features which make for an ideal antiseptic?

A
  1. rapid action
  2. persistent effect
  3. residual action
  4. active in organic matter
  5. non-toxic and non-irritant
  6. easy to use, cost effective and economic
  7. Bactericidal - broad spectrum activity
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31
Q

How does povoidone Iodine work?

A

It damages the cell wall and inhibits protein synthesis

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32
Q

What is iodophor?

A

It is iodine complexed with high MW carrier to reduce toxicity and staining.

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33
Q

What happens as you increase the dilution of iodophor?

A

It increases in bactericidal activity (10% povidone-iodine diluted to 0.1% solution has the most bactericidal activity).

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34
Q

Name 4 benefits of using 10% povoidone-iodine?

A
  1. rapid action
  2. bactericidal - broad spectrum
  3. kills fungi, most viruses, protozoa, yeasts and micobacteria
  4. sporicidal if kept in contact for long enough (15 mins-2hrs)
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35
Q

How long is povoidone iodine effective for?

A

1 hour (some can last 4-6 hours)

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36
Q

What decreases the activity of povoidone iodine?

A

The presence of organic material

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37
Q

What is a contraindication of using povoidone iodine?

A

50% chance of skin reaction e.g. acute contact dermatitis, sensitivity in people.

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38
Q

What is the toxicity of povoidone iodine?

A

Toxic if used on open wounds, mucus membranes and peritoneal surfaces.

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39
Q

What is hibiscrub?

A

Chlorhexidine gluconate

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40
Q

What chemically is hibiscrub?

A

Bisbiguanide compound

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41
Q

How does chlorhexidine gluconate work?

A

It alters the cell wall permeability and causes protein precipitation

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42
Q

What spectrum is hibiscrub?

A

Broad spectrum (better for against gram +ves than gram -ves)

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43
Q

Which resistant bacteria is hibiscrub resistant against?

A

MRSA

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44
Q

What else is hibiscrub effective agaiinst?

A

Effective against most yeasts, fungi and some viruses

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45
Q

What is hibiscrub ineffective against?

A

Spores and mycobacteria.

46
Q

Is hibiscrub active in the presence of organic matter?

A

YES

47
Q

What is the residual and persistent activity of hibiscrub?

A

Excellent - binds to stratum corneum therefore repeated application has a cummulative effect.

48
Q

Are skin reactions common? If there are any, what are they?

A

Skin reactions uncommon.

With prolonged use, might get photosensitivity, contact dermatitis and hypersensitivity.

49
Q

Why is hibiscrub okay for neonates?

A

Because there is minimal skin absorption.

50
Q

What needs to be avoided when using hibiscrub?

A
  1. ototoxic - middle ear and inner ear –>deafness
  2. Neurotoxic –> avoid brain and meninges
  3. concentrations above 0.05%, toxic to conjunctiva and cornea
51
Q

What would you therefore use during eye or eye surgery?

A

Dilute iodine.

52
Q

What are alcoholic tinctures used for?

A

The second step after povoidone and chlorhexidine use

53
Q

What is the activity of alcoholic tinctures?

A

Broad spectrum - bactericidal

54
Q

What does alcohol kill?

A

Good against bacteria and fungi, some viruses, poor against spores.

55
Q

When is max kill achieved using alcoholic tinctures?

A

At least 2 minute contact: 60-70%

56
Q

When is the efficacy of alcoholic tinctures depressed?

A

In the presence of organic matter.

57
Q

Name the 5 contra-indications of using alcohol tinctures?

A
  1. relatively non-toxic, unless used in newborns
  2. Can cause hypothermia if evaporated greatly
  3. avoid open wounds
  4. skin drying
  5. flammable and explosive
58
Q

What has the highest and most rapid kill rate?

A

Alcohol

59
Q

Name 4 reasons chlorhexidine is superior to povoidone iodine?

A
  1. broader spectrum of antimicrobial activity
  2. longer persistent and residual activity
  3. minimal loss of activity in organic matter
  4. fewer skin reactions and toxicity.
60
Q

What is the most important thing to remember when using ANY preparation agent?

A

Allow sufficient contact time.

61
Q

What should you use for eyes and ears and at what concentration?

A

Povoidone iodine

1: 10 dilution for eyelids
1: 50 dilution for occular surfaces and conjunctival sac

62
Q

How do you remove the residual solution from the eyes?

A

With saline or hartmanns.

63
Q

What should you never use near the eyes?

A

NEVER use products containing detergents of soaps

64
Q

What dilution should you use in the ear canal?

A

1:10

65
Q

Should alcohol be used in the ear canal?

A

No - only use alcohol on the pinna

66
Q

Why should we not use chlorhexidine gluconate in the ears?

A

Ototoxic - neurosensory deafness.

67
Q

Which preparation is okay to use on open wounds?

A

Hibiscrub (0.05%) - 2-4% for scrub

68
Q

How should you treat the wound following preparation?

A

pack wound with sterile KY jelly.

69
Q

How should you lavage open wounds?

A

With warm, sterile Hartmann’s or saline

70
Q

What should you do with the wound whilst the rest of the area is prepared?

A

pack with moist swabs

71
Q

What are the non-sterile barriers of surgeons?

A

Mask, shoes, hats, scrubs

72
Q

What are the surgical barriers?

A

Gloves, gowns.

73
Q

What is a primary source of operating room contamination?

A

Shedding

74
Q

How do scrubs help with this?

A

Scrubs reduce the amount of shedding of skin debris.

75
Q

When should you NOT wear scrubs?

A

When outside of theatre, examining cases, changing bandages, visiting wards etc.

76
Q

Why are hats worn?

A

To stop hair shedding which is a major source of bacterial contamination.

77
Q

What do masks protect from?

A

Saliva and microorganisms

78
Q

What is the small particle filtration of masks?

A

90%

79
Q

How long are masks effective for?

A

8 hours.

80
Q

Why should mask not be worn untied and dangling?

A

increased scrub suit contamination

81
Q

Why don’t we want to be too rough when scrubbing?

A

We do not want to damage skin as this would lead to increased bacteria.

82
Q

How long should all surfaces be exposed to scrub in the scrub protocol?

A

At least 2 minutes.

83
Q

Where should your hands be during the scrub protocol?

A

Above the elbows.

84
Q

What is sterilium?

A

85% ethyl alcohol

85
Q

how effective is sterilium?

A

kills 99.9% bacteria within 15 seconds

86
Q

What does sterilium kill?

A

Yeasts, bacteria, viruses, TB and mycobacteria (includes HIV)

87
Q

Which has a more lasting effect? Surgical hand rub or surgical hand scrubbing?

A

Surgical hand rub (sterilium)

88
Q

Name 4 advantages to using sterilium?

A

cost and time saving

non-irritating/ moisturising

89
Q

What must not be present so that sterilium works?

A

must have no organic debris present e.g. wash hands and nails.

90
Q

How long do you need to apply sterilium for?

A

1.5 minutes (as effective as 3 mins)

91
Q

Which is more effective generally? Surgical hand rub or surgical hand scrub?

A

Surgical hand rub - lasts longer and faster action

92
Q

How do you towel dry?

A

Consider the towel in quarters. Use the top two quadrants for the hands and the bottom two quadrants for the arms.

93
Q

Name two of the most common mistakes of contamination?

A

Going back to dry hands with towel.

Towel touches the front of the scrubs.

94
Q

What are the two types of gowns and drapes?

A

Re-usable woven fabric and disposable non-woven fabric.

95
Q

name 4 downfalls of using woven, reusable fabric?

A
  1. ineffective when wet
  2. 30-50% culture +ve after surgery
  3. Bacterial penetration at seams - need inspection after laundry
  4. Lint production (textile fibres)
96
Q

Name an advantage of woven, reusable fabrics?

A

They have a very tight weave - more effective barrier

97
Q

What can disposable fabrics be made out of?

A

polyester, wood pulp and synthetic polymers.

98
Q

What are 3 advantages of non-woven materials?

A

Random orientation of fibres means inpenetrable to fluids and bacteria.

They have lower particle counts

they have lower +ve results following surgery

99
Q

What is a downfall of using non-woven fabrics?

A

They are more expensive.

100
Q

Are gloves an absolute barrier?

A

No - 1.5% might have holes and by end of surgery, 12-31% might have holes.

101
Q

What should you do as soon as you notice a hole in the gloves?

A

ALWAYS change gloves as soon as noticed.

102
Q

What does closed gloving mean?

A

Keep hands and fingers within the cuff of the gown sleeves. No contact with the external surfaces.

103
Q

Which gloving technique is better to use?

A

Closed - open is best avoided.

104
Q

What are the three types of drapes?

A

Cotton muslin +/- skin towels
Disposable
Adhesive incise drapes

105
Q

What are the pros and cons of adhesive incise drapes?

A

They are expensive.
They do not stick well and no strong evidence of reduced infection rates.

They are however waterproof.

106
Q

What draping technique is standard?

A

quarter draping

107
Q

What should you NEVER use to attach drapes?

A

Tissue forceps.

108
Q

What are the three things in the surgical sterile field?

A

The surgical site + surgeon + instrument trolley

109
Q

What are the parameters of sterility of the surgeon?

A

Chest to level of sterile field

Cuffs to 5cm above elbow.

110
Q

What is not sterile in terms of the table and the surgical trolley?

A

Nothing below the table and nothing below the instrumental trolley.

111
Q

Can the patient be made sterile?

A

No, but everything is aimed at reducing the contaminants.

112
Q

What should you NOT do if you are not sterile?

A

You should not lean over the sterile field.

CPS (21 decks)

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