Theatre Practice Flashcards
Define sepsis
Presence of pathogens or their toxic products in blood/tissues of patient
Define asepsis
Freedom from infection
Define surgical site infection
Infection in wound post surgical intervention
Define antisepsis
Prevention of sepsis by destruction or inhibition
Define disinfection
Removal of microorganisms but not spores
Define disinfectant
Agent that destroys microorganisms
Define virulence
Severity of disease
What are roles of nurses in theatre pre-op?
Infection control Cleaning Preparing personnel Preparing equipment Preparing patient, consent, anaesthesia, monitoring, surgical site
What are roles of nurses intraoperatively?
Infection control Communication to other staff Scrub nurse Circulating surgical nurse Medications Monitoring
What is the role of a scrub nurse in theatre?
Hold instruments
Hold patient
Suturing
Counting needles and swabs
What is a circulating nurses role?
Manages nursing care in theatre
What are roles of nurses post-operatively?
Recover patient Nursing care Medication Cleaning and maintaining equipment Deep cleaning theatre Discharging
What are sources of surgical site infections?
Animal- endogenous or exogenous
Personnel
Theatre space and environment
Equipment, instruments and consumables
Define sterilisation
Complete removal of microorganisms
How can theatres be made more suitable which may help to reduce risk of infection?
Layout- isolated (one entry/exit) so no through traffic, easy to clean
Materials used easy to clean
Operating light easily accessible
Power points accessible
Reduced aircon, doors, windows etc- blow air increasing infection risk
Minimal storage
Health and safety followed
Cleaning protocols- daily damp dust, monthly deep clean
Well maintained
State the different methods of heat sterilisation
Autoclaving- vertical, horizontal, vacuum assisted
Dry heat- hot air oven, high vacuum oven, convection oven
Describe how vacuum assisted autoclave sterilises
Steam penetration and pressure sterilises and the load is then dried
What are the conditions for vacuum assisted autoclave at 121 degrees C? (pressure/PSI, pressure/kg/cm2, time/min)
Pressure/PSI- 15
Pressure/kg/cm2- 1.2
Time/min- 15
What are the conditions for vacuum assisted autoclave at 126 degrees C? (pressure/PSI, pressure/kg/cm2, time/min)
Pressure/PSI- 20
Pressure/kg/cm2- 1.4
Time/min- 10
What are the conditions for vacuum assisted autoclave at 134 degrees C? (pressure/PSI, pressure/kg/cm2, time/min)
Pressure/PSI- 30
Pressure/kg/cm2- 2
Time/min- 3.5
What needs considering to ensure autoclaving is effective at sterilising?
Correct loading and packing
Machine well maintained
Monitored efficacy
List methods of monitoring efficacy of autoclaving and state how they work
TST strips- colour change when inside of packing reaches correct temperature and pressure for correct time
Bowie dick indicator tape- dark brown stripes at 121 degrees but can only show outside temperature
Brownes tubes- colour change from orange to green
Spore tests- spore impregnated paper autoclaved in packing then incubated to see if were killed
List methods of cold sterilisation
Ethylene oxide
Chemical solutions
Gamma radiation (industrial)
When is cold sterilisation used?
When materials would melt
What are some advantages and disadvantages of ethylene oxide sterilisation?
Advantages- highly penetrative and effective, good for equipment that would be easily damaged
Disadvantages- toxic gas produced, takes long time
How does ethylene oxide sterilisation work?
Gas reacts and undergoes alkylation which alters cell membrane proteins shapes causing the membrane to be destroyed and the organism to die
What are the characteristics of ethylene oxide?
Colourless, flammable gas
Boils at 10.5 degrees
Sterilises at 20 degrees
What can’t be sterilised by ethylene oxide and why can so many things be sterilised by it?
Food, drugs, liquid, gels, powders
Non corrosive
What are the regulations surrounding use of ethylene oxide?
Exposure limits
Annual monitoring
Operator training
What are dangers associated with ethylene oxide and exposure to it?
General- toxic, explosive
Acute exposure- eye, skin and respiratory tract irritation, headache, nausea
Chronic exposure- cancer, reproductive effects
What are the routes of exposure to ethylene oxide and what should you do if you are exposed?
Inhalation, skin contact, eye contact
Wash area for 15 minutes, leave room if inhalational
What makes the process of ethylene oxide safe despite its risks?
Small amount of gas used
Sterilised inside liner bag
Users are always trained
How is equipment prepared for ethylene oxide streilisation?
Disassembled
Washed
Dried without heat
Wrapped in paper, cloth or permeable plastic
Describe how you use an ethylene oxide steriliser
Wrap in bag with dosimeter and ampoule
Secure around purge bobbin with velcro strap
Remove air
Break ampoule
Close door, select cycle and leave to run
Open and remove contents
Why should equipment sterilised with ethylene oxide by aerated for 24 hours after stserilisation?
Can penetrate into the items which can cause chemical burns if come into contact with it
How can you determine sterilisation effectiveness for ethylene oxide?
Exposure indicators
Integrating indicator
Biological indicator
What factors affect sterilisation when using ethylene oxide?
Load Drying Temperature Humidity Bag integrity
How should you pack for sterilisation?
Double bag in case of tears Label- contents, date and initials Care with sharp instruments Place TST strip Store correctly
What are general considerations for personnel involved in surgery?
Minimal personnel that reduces risk of infection but doesnt compromise patient
Movement around theatre limited, unscrubbed staff avoiding sterile field, scrubbed staff keep front to surgical field
Describe appropriate theatre attire
Scrubs- well fitted, tidy, clean, short sleeved, easily washed, hard wearing
Footwear- cover shoes, theatre shoes, easily cleaned, non-slip, comfy
Scrub cap
Masks
What are hygiene measures in place for staff in theatre?
General- ideally shower first, not possible mostly, minimal makeup
Hands- good washing, no jewellery, short clean nails
What is the purpose of scrubbing in?
Remove debris and microorganisms and minimise resident flora
Provide residual action to reduce growth of microorganisms
What are the general principles for scrubbing in?
Thoroughly done by timed or numbered strokes systematically from most clean to least clean area
Good lather maintained throughout
Avoid splashing water onto clothing
What are features of the ideal surgical scrub?
Antimicrobial- broad spectrum, rapid action Persistent activity Non-irritating Non-sensitising Non-toxic Not damaging to skin or environment Acceptance of staff to use correctly
State some common types of surgical scrubs
Liquid of foam soaps used with water and scrub brush, CHG/chlorhexidine gluconate, PCMX/parachlorometaxylenol
Impregnated brushes/sponges
What is meant by closed gloving?
Hand stay inside gown to minimise chance of contaminating gloves to maintain asepsis
What is meant by open gloving?
Gloves are put on with hands touching inside of gloves
What are some considerations for pre-op patient prep?
Food and water- withhold where suitable Bathing- remove excess dirt before prepping surgical site Clipping surgical site- provide view, reduce microorganisms, allow aseptic skin prep Enema (GI surgery) IV placement Eye lube Bandages when needed Throat packs (oral/nasal surgery) Pre-op meds- antibiotics, analgesia
Describe the most appropriate clipping technique
Clip correct area and size neatly Remove most in direction of hair then clip against for close shave Hold in pencil grip for most control Keep flat against skin for close shave Care around wounds and sensitive areas Vacuum area to remove hairs Disinfect blades after use Aware of hot clippers
What is the purpose of patient skin prep?
Reduce risk of surgical site infections as removes dirt and microorganisms
What is the most common source of surgical site infections?
Patients endogenous flora (first 5 layers of epidermis)
What are ideal features of patient scrubs?
Wide spectrum antimicrobial action Fast acting Residual action Effective in presence of organic matter Safe
What factors affect the effectiveness of final skin prep?
Type of antiseptic used
Method of antiseptic application
State the methods of antiseptic application for patient skin prep and how effective they are?
Concentric/circles- only cleans one side of skin creases
Alcohol spray- only sits in creases
Friction in crosses- most of creases cleaned
Describe how skin prep is carried out using chlorhexidine
Applied with sterile supplies and gloves or no touch method
Correctly dilute (hibiscrub 50:50 with water)
Remove dirt and organic matter
Scrub in hashtag formation from incision to periphery with pressure to increase friction and effectiveness
Why is resident flora on skin an issue for pateints?
Cause infection if gets into surgical site
Infections caused to immunocompromised patients
How can resident flora be removed from the skin?
Cleaning and disinfection
List some active ingredients for disinfection
Alcohols Mecetronium ethylsulfate Chlorhedixine gulconate PVP Triclosan
What measures can be put in place to allow longer availability of antibiotics?
Global awareness of resistance
Improved sanitation
Not unnecessarily using antibiotics
Developing vaccines
What is the difference between MRSA and MRGN?
MRSA- gram positive, one species, one main resistance mechanism
MRGN- gram negative, over 10 species, over 200 resistance mechanisms
Why are liquid scrubs preferred over gels or foams?
Liquids are most efficient, fast drying, easy to use and reduce need for handwashing
Gels build up on skin so need to wash hands more which is irritating and foams are low alcohol so less effective, have long drying time and can build up on skin
What are the disadvantages of using medicated soap and water as a scrub technique?
Water not sterile Hot water removes protective fatty acids Brushed destroy lipid film and damage epidermis so produces more resident flora Alkaline soaps irritate Water dilutes reducing efficacy
Why are hand rubs with waterless alcohol a good option for scrubbing?
Destroys microorganisms in 30 seconds and resident flora in 90 seconds
Evaporates with no residue
What are the advantages of sterilium as a scrub?
Good immediate and residual action
Effective against bacteria, yeast, enveloped viruses
Evaporates so no need for water
What are the ideal properties of suture materials?
Non-irritant
Good tensile strength- how tight can be pulled before snapping
Dissolvable
Good knot security- knots ability to hold
Low tissue reaction
Low tissue drag- ability to move through tissues
Low capillarity- ability for fluid to wick up suture
Good chatter- friction of material
Low stiffness
Low elongation
Withstand sterilisation
How can suture materials be classified?
Absorbable or non-absorbable
Natural or synthetic
Multifilament or monofilament (natural can only be multi)
What can be seen on suture material packaging?
Length
Size
Expiry dates
Type of material
What are alternatives to suture material and what are their advantages and disadvantages?
Staples- faster but harder to take out
Tissue glue- no removal needed, gets hot and stings
Adhesive strips- cheaper, only for certain wounds
What are the features of needles?
Eye- suture material attaches
Body
Point
Define swaged needle
Suture material attached already
List different shapes of needles available
1/4 circle 1/2 circle 3/8 circle 5/8 circle 1/2 curve Straight Compound curve
Define gossypiboma
Inflammatory reaction to retained gauze swab
Why is gossypiboma more common in veterinary patients than human?
Less likely to use radiopaque swabs
First opinion practice less likely to have scrub and surgical nurses
Reduced risk though as probably shorter surgery and smaller body cavities
What are the effects on the body caused by gossipiboma?
Inflammatory response Aseptic granulomatous encapsulation, cause similar effects to tumour Abscesses Fistula formation Septicaemia Tumour formation Obstructions and perforations
What is the acute presentation for gossypiboma?
Vomiting
Pain
Lethargy
Abdominal distension
What protocols are in place to reduce risk of gossypiboma?
Swabs in counted bundles when packed
Swabs counted at start and when closing organs, body cavities and body walls
X-ray detectable swabs used
Laparotomy swabs used for abdominal or thoracic surgery
Nurses track swabs and equipment
Define surgical safety checklist
Stages of checks taken at various stages of procedure to improve safety and communication
What is the purpose of surgical safety checklists?
Framework for all procedures to minimise human error, reduces peri-operative complications and death
What are materials used for surgical instruments and what are their properties?
Stainless steel- strong, high corrosion resistance, good appearance
Tungsten carbide- insert material in tips for grip, hard wearing, expensive, shown by gold handles
Chromium plated carbon steel- cheaper, poorer quality, sharper, blunt quickly
Titanium- light weight, good for opthalmics, expensive
What does ASIF/AO stand for?
Association for study of internal fixation/association for osteosynthesis
What is the role of ASID/AO?
Studies, practices and teaches AO principles for advancement of treating trauma and musculoskeletal injury
Research, develop, educate and quality assure fracture treatments for patient benefit
Define non-self-tapping screws
Cant cut through material themselves when screwed in
Describe how screws are placed in ortho surgery
Hole drilled into bone
Depth measured with depth gauge
Tap creates screw thread if not self tapping
Screwdriver screws in screw
What is the difference between cortical and cancellous screws?
Cortical- used in hard bone so finer thread
Cancellous- used in spongy bone so chunkier thread, wider gaps between thread to grip bone
What do towel clamps do?
Hold drapes in place
What can artery forceps do?
Ligate tissue
