Surgical Asepsis Flashcards
how long do you fast animals prior to surgery in the following examples:
- healthy patient
- very young patient
- colonoscopy
- emergency
healthy: 12h
very young: 4-6h
colonoscopy: 48h
emergency: no fasting
what type of grip should you use for the clipper
pencil
how far do you want to clip on either side of the proposed incision
typically 10cm
if long hair, large mass removal or reconstruction involved, 15cm
T/F extra clipping is recommended to extend an incision if required
T
when do you want to express the patients bladder
after clipping but before skin prep (soap scrub)
at what point should you don a hat and mask
after clipping and vaccuming the patient and expressing the bladder and before skin prep
what is the order of skin prep
1) soap scrub (chlorhexidine) (2 scrubs, total of 5 minutes)
2) alcohol (3 passes)
3) chlorhexidine/alcohol solution (3 passes)
T/F while performing the soap scrub, as long as the soap is in contact with the skin you do not need to physically scrub the skin for the entire 5 minutes
T
how should you perform patient prep
start at the center of the surgical field along proposed incision line and continue towards the periphery using concentric circles
what is the purpose of the alcohol prep
disinfects and dissolves oils
what is the minimum contact time for the chlorhexidine/alcohol prep
30 seconds
T/F surgically prepped skin is considered sterile
F; it is very clean but is never steril
T/F you do not need to be wearing gloves when you apply the sterile drape to the patient’s surgical field
T
what is the purpose of surgical masks? what are they good for? what do they not stop?
good for preventing droplets of moisture while talking, coughing or sneezing
do not protect against bacterial contamination caused by breathing
what do you open onto the gowning table? what do you open onto the instrument table?
gowning table: gown pack (with drapes) and glove pack
instrument table: instrument pack and laparotomy sheet, suture, blades, any other extras
how long should you scrub for the first procedure of the day and then for subsequent procedures
5 min for first; 3-5 for subsequent
what is the order for the gross hand clean
1) open pack
2) water
3) soap
4) suds
5) clean nails
6) rinse
how much time should you spend scrubbing you fingers, palms and tops of hands and how much time should you spend scrubbing your wrists and arms
fingers, palms and back of hands: 2 minutes each
wrists and arms: 1 minute each
how long are surgical gowns sterile for
1 procedure only
T/F after you gown you should bring your drapes to your instrument table to avoid back and forth travel
T
what parts of the gown are considered unsterile
- the back
- the neckline, shoulders and underarm
- anything above 2 inches above the elbow
- the cuff
what parts of the gown are considered sterile
- 2 inches above the elbow to the level of the wrist cuff
- chest to the level of the surgical field
when would it make sense to double glove or wear thicker gloves
orthopedic surgery (increased risk of puncture)
if gloves are compromised, they should be immediately replaced using an ________________ technique
open-gloving
a punctured glove _________ the risk of surgical site infection
doubles
over what percentage of gloves have a puncture in the thumb or index finger at the end of any surgery
12.7-31%
how is the final prep performed
by a gowned and gloved surgeon using sterile gauze, disinfectant and sponge forceps
T/F you do final patient prep after applying drapes
F; done after gowning and gloving and before draping
T/F you should discard the sterile gauze used for final patient prep in the large metal bowl
F: it will throw off your gauze count if you do this
how much should you fold over your sterile drape
10-15cm
how does around the world draping work
head -> side -> tail -> side
T/F towel clamps are considered unsterile once applied
T
T/F you add towel clamps over the lap sheet
F
what is strike through
when bacteria can pass through pores in fabric if wet or too thin
do cloth or paper lap sheets allow more strikethrough
cloth, especially with more washes as the pores increase
T/F blood and debris inhibit sterilization
T
T/F you should use a lubricant bath to protect your instruments from corrosion
F; has been shown to increase contamination with repeated use, use lubricant sprays instead
what time and temperature should you use on an autoclave in general
30 min at 121 C
what instruments do you NOT sterilize with the box-locks open
towel clamps
what does steam sterilization kill in theory
bacteria, fungi, spores, viruses
what is a drawback of autoclaves
need the perfect combination of water, high temperature and pressure to work; some instruments will melt so you cannot use
what is the minimum temp and time for flash sterilization and what type of autoclave is needed
132 C for 4 min; prevacuum autoclave
what is an important consideration regarding cloth packs placed in plastic sleeves
the outer cloth is not sterile so you cannot plop the pack out of the plastic onto your surgical field
are chemical or biological indicators more reliable? which are more useful?
biological more reliable; chemical more useful (no time delay as you do not have to wait for culture results)
most chemical sterilization uses what gas
ethylene oxide
what does plasma sterilization use
vapour phase hydrogen peroxide
what is a benefit of plasma sterilization vs chemical sterilization
plasma sterilization requires no aeration period
what is most commonly used for cold sterilization
glutaraldehyde
what are some examples of uses of cold sterilization
“dirty” surgeries or endoscopic equipment
how are sterile medical supplies usually sterilized
gamma irradiation
T/F packs must not be exposed to humidity or water droplets, dust or the floor
T
