Surgical Preparation Flashcards
what are the classifications of surgeries?
why do we have them?
necessary to order based on classifications to minimise the risk of cross-contamination
clean
- sterile with no breaks in aseptic technique
- resp, gastro and urinary tracts not entered
- eg orthopaedics, bitch spay
clean contaminated
- sterile with potential for contamination
- contaminated area entered but no spillage or spread of contamination
- eg. ex-lap, cystectomy
contaminated
- sterile but contamination will occur
- contaminated area entered and will be spillage or an area of inflammation
- eg open wounds (0-6hrs), gastro anastomoses
ditry
- in a non-sterile or dirty area
- including oral or rectal surgery
- eg. open wounds (>6hours), tooth removals
why do we perform surgical hand prep?
what are the basic principles?
Reduce the release of skin bacteria from hands
To inhibit the growth of skin bacteria under gloves for the duration of the procedure
principles
- thoroughly clean all surfaces of the hands
- avoid causing irritation or damage (increases shredding)
what products can be used for hand prep?
aqueous scrubs - 5 mins
eg. chlorohexidine gluconate
- a significant residual effect
- can cause irritation
eg. iodine
- little or no residual effect
- reduces chance of skin irritation
- causes decolouration of skin
alcohol scrubs - 90 seconds
eg. sterillium
- quick and effective
- requires pre-scrub with a detergent to remove gross contamination
- significant residual effect
what is the technique for scrubbing with an aqueous scrub?
- remove all jewellery
- regulate hot and cold taps
- wash hands with soap and water
- pick nails
- wash arms up to elbows, keeping hands higher than elbows
- rinse hands and arms to remove all soap and lather
- ask assistant to pass scrubbing brush
- srub in the following order:
- palms
- wrists
- 4 surfaces of each finger
- under nails and knuckles
- arms
- rinse back of hands and arms, keeping hands above elbows
- turn tap off with elbow
how do you dry hands using a terile towel?
- stand clear of all surfaces and pick up corner of the towel with left hand - allow to unfold gently
- let towel fall over palm of right hand
- use top quarter to dry fingers separately, the palm and back of the hand
- use quarter below to dry right forearm and elbow
- repeat for left hand on other side of the towel
keeping hands on different sides of the towel avoids cross contamination
what is the technique for scrubbing with an alcoholic srub?
- remove all jewelry
- regulate hot and cold taps
- wash hands with soap and water, and pick nails
-> for first surgery of the day or if visibly dirty - rinse soap and turn off tap with elbow
- thoroughly dry hands and arms
- use right elbow to dispense hand rub into left hand
- rub fingertips of right had in hand rub
- use left palm to rub remaining hand rub over right hand and arm - up to elbow
- repeat for other hand
- dispense more hand rub then perform WHO handwash
- leave for appropriate contact time then air dry
how do you correctly put on a gown?
- take sterile gown from the pack and hold the shoulders
- let gown fall open - don’t shake
- open gown to locate sleeves
- slip arms into the sleeves
- hold arms out and up
- have assistant adjust and tie the gown touching only inside of the gown
what are the types of gloving methods?
open gloving
- may or may not be wearing a gown
- suitable for minor surgical procedures
- often used spay settings
closed gloving
- must be wearing a gown
- hands remain inside gown
- fingers of gloves should only be adjusted once both hands have been gloved
- used in major procedures
plunge gloving
- used when wearing a gown
- sterile assistant holds each glove open for the surgeon
- rarely used
what considerations need to be made when clipping a patient in preparation for surgery?
can be done prior to induction
- reduces GA time
- needed for lump identification
- less risk of stray hairs
- may stress patient further
- uneven/bad quality clip - may hurt
- need more staff to steady - also more risk
- if done >6hrs prior bacteria infection likely
take care around delicate areas
- especially eyes
avoid razors
aim for 10cm margin
- not possible in smallies/small breeds
keep blades flat against skin and clip against direction of growth
remove lose hair thoroughly using a vacuum or lint roller
what are the methods of surgical site preperation?
concentric circles
- circular motions starting at the incision site and moving outwards
- dirt is moved away from incision site
- tried and tested but no scientific evidence
crosshatching
- horizontal and vertical lines
- ensures all areas of site are equally prepped
- pressure is applied to exfoliate skin
- is evidence based
what are the different types of surgical site prep products?
what are their pros and cons?
aqueous scrubs - 5 mins
eg. chlorohexidine gluconate
- a significant residual effect
- can cause irritation
eg. iodine
- little or no residual effect
- reduces chance of skin irritation
- causes discoloration of skin
alcohol scrub - use in rodents/rabbits should be avoided - thermoregulation harder
eg. isopropyl alcohol and surgical spirit
- final stage of skin prep
- removes oil and detergent residue from skin
- no residual activity
- should be left to completely evaporate
chloraprep
- combination of chlorhexidine gluconate and isopropyl alcohol
- for final stage of skin prep
chlorhexidine clear spray
- significant residual activity
- final stage of skin prep instead of alcohol based product
what is the difference between endogenous and exogenous contamination?
endogenous
- caused by microorganisms which originate from within the patients body
- eg. contamination from dirty surgery (eg anal glands)
- eg. contamination during dental - mouth bacteria
- eg. infection on dermis contaminated in cavity
exogenous contamination
- caused by microorganisms which originate from the environment outside the body
- likely from staff contact or contact with surfaces
- or self traumatizing wounds on recovery
how would you prepare a laceration wound for surgery?
flush with saline - remove debris
lube site - prevent debris falling into wound
clip site - 10cm margins ideal
scrub
- iodine ideal as hibi is harmful to skin membranes and would slow down healing
- use concentric circles - crosshatching painful!
what is the correct method for draping a patient?
order:
1. horizontally below surgical site at surgeons side - allows you to lean over patient and keep sterility
2. horizontally above surgical site at assistance side
3. vertically left of surgical site - with slight overlap of drapes
4. vertically right of surgical site - with slight overlap of drapes
fold edges closest to surgical site to give about 10cm of double thickness
attention to not contaminating sterile drapes when placing
once placed do not move towards surgical site
secure with towel clips
