Theatre practice (SA10) Flashcards
What is a pathogen?
- Microbes capable of causing disease
- Virus, bacteria, fungi, etc.
What makes reproductive spores particularly resistant?
- Thick wall
- Remain viable in unfavourable conditions
What can risks be influenced by in theatre?
- Characteristics of patient
- Operation
- Personnel
- Environment
What reduces the patients ability to withstand infection?
- Disease
- Stress
Sepsis
- Presence of pathogen or toxic products in blood or tissue of patient
Asepsis
- Freedom from infection
Aseptic technique
- Steps taken to prevent sepsis
Antisepsis
- Prevention of sepsis
- Destruction or inhibition of microbes
- Using agent safe for living tissue
Sterilisation
- Destruction of ALL microbes
Exogenous microbes
- Found on outside
- May include environment
Endogenous microbes
- Originate from within the body
Nosocomial
- Originated from the environment
- Hospital acquired infection
- Surgical site infections
- MRSA
What does MRSA stand for?
Methicillin Resistant Staphylococcus Aureus
Do all microbes cause infection?
No
Commensal microbes
- Bacteria of skin and nasal passages in humans
- MRSA
- Commonly caused during hospitalisation
- Causes GI disease, septicaemia, skin infections, post-surgical wound infections
- Less common in animals, interspecies transmission can occur
- Very resistant to antibiotic therapy
- High standards of hygiene important to prevent spread
Commensal bacteria
- Live on animals
- Do not cause harm
Facultative pathogens
- Will cause harm in immunosuppressed
Obligate pathogens
- Will ALWAYS cause disease
Saprophytic bacteria
- Replicate on dead tissue
- Responsible for decay
What organisms are involved in wound infections
- Staphylococcus
- Streptococcus
- Proteus
- Pseudomonas
What factors affect infection?
- Virulence of bacteria
- Resistance of the patient, health, disease, age, nutritional status
- Duration of surgery, infection rates double every hour
- Technique of surgery
- Classification/contamination of wound
Virulence of bacteria
- How harmful bacteria is
- Amount of bacteria entering wound
- Environment for bacterial growth
- Poor blood supply
- Devitalised tissue
- Sources of contamination in theatre
- Equipment
- Environment - dust is reservoir of bacteria and contamination
- Personnel - 62% nasal staph carriers
- Patient
What may cause surgical infections?
- Primary surgical disease
- Post-surgical infection
- Poor theatre list planning
- Complications with diagnostic support - catheters, drains, etc.
- Complications unrelated to surgery - infectious or systemic disease
- Implants - suture material to metal implants/hip replacements
What is the main source of pathogens for surgical site infections?
- Endogenous flora of patients skin, mucous membranes, hollow viscera
- Excised skin risks exposed tissue
What are the classifications of surgery?
- Clean
- Clean contaminated
- Contaminated
- Dirty
What is a ‘clean’ surgery?
- Typically elective surgery
- Non-contaminated
- Non-traumatic
- Non-inflamed
- Neuter, routine laparotomy, elective orthopaedic
What is a ‘clean contaminated’ surgery?
- Potential for contamination
- Involves respiratory, GI or genitourinary system
- Often hollow organ
- Enterotomy, enterectomy, cystotomy
What is a ‘contaminated’ surgery?
- Contamination WILL occur
- Leakage or major break in aseptic technique
- Enterotomy, enterectomy, cholecystectomy, cystotomy
What is a ‘dirty’ surgery?
- Infection already present
- Hollow organ rupture
- Infected surgical site
- Septic peritonitis
- Abscess
- Ruptures GI, gallbladder or pyometra
What order should surgeries be completed in?
- Clean
- Clean contamination
- Contaminated
- Dirty
How are surgical patients classified?
- Elective
- Urgent
- Emergency
What constitutes an elective surgical patient?
- Non-urgent
- Healthy
- Usually young
- Routine neutering
What constitutes an urgent surgical patient?
- Necessary
- Not immediately life-threatening
- Required propmt care
- Fracture repair
What constitutes an emergency surgical patient?
- Life threatening
- Abdominal crisis
Ectomy
- Remove
Otomy
- Temporary incision
Ostomy
- Opening
- Can be temporary or permanent
- Stoma = hole
Desis
- Binding together
- Surgical fixation
Pexy
- Fixation of an organ
- Surgical suspension
Plasty
- Reconstructive/surgical repair
Gastrotomy
What is the prep room used for?
- Induction of anaesthesia
- Preoperative procedures; clipping, catheter placement, surgical prep
- Should lead directly into operating theatre
What is the recovery room used for?
- Allow patient to recover
- Close to operating theatre
- Quiet, warm, essential emergency equipment
- Allow for good observation to recover patient
What is the treatment room used for?
- Located off prep room
- Used for minor procedures
Additional areas/room for theatre suite?
- Washing/sterilising room
- Sterile storage
- Scrubbing area
- Changing room
What different categories of cleaning protocols should be used for theatre suite?
- Daily
- Weekly
- Monthly
What should be included in the daily theatre cleaning protocol?
- Floors
- Waste disposal
- Surfaces
- Equipment
- Tables
- Lights
- Scrub sinks
What should be included in the weekly theatre cleaning protocol?
- Thorough deep clean
- Floor and walls scrubbed
- Disinfectant not washed off
- Deep clean all equipment
What should be included in the monthly theatre cleaning protocol?
- All room fittings
- Vents
What is important to consider when designing a theatre suite layout?
- Movement of people through and between zones
How should instruments and kits be sterilised and stored?
- Autoclave should not be in theatre
- Kits stored in cupboards/drawers to prevent dust and damage
Why is it important to have non-static materials in theatre?
- Oxygen used
- Is flammable
- Oxygen usually colour coded black and yellow
What characteristics should walls have to aid in cleaning in theatre?
- Wall covering should be cleanable and waterproof
- Waterproof paint, plastic cladding
What characteristics should doors have in theatre?
- Doors should remain closed, self closing
What characteristics should walls have to aid in cleaning in theatre?
- Anti-static, non-slip, smooth floors
- Some may be bacterial protected
What temperature should theatre be set at and how should it be heated?
- 15 - 20 degrees C
- Prevent patient hypothermia
- Prevent surgeon hyperthermia
- Fan heaters distribute dust - don’t use
- Radiators collect dirt and dust in crevices
What is the minimum amount of air changes that should occur in theatre per hour?
20
What is the most common ventilation type?
- Plenum ventilation
- Positive pressure - elaborate on!
What are most instruments made of?
- Stainless steel
- Very strong
- Highly resistant to corrosion
Why is tungsten carbide used in some instruments?
- Very hard wearing
- Expensive
- Usually have gold handles
Why may chromium plated carbon be used in instruments?
- Cheaper
- Will rust, pit and blunt quickly
Why is titanium used in some instruments?
- Opthalmic equipment
- Titanium is very light, reduces glare from operating microscopes
- Always clean these separately to avoid damage
- Lubricate joints regularly
What are the 2 tissue forceps?
- Allis tissue
- Babcock
Allis tissue forceps
- Hold or grasp tissue
- 4-5 teeth
- Minimal trauma
Babcock tissue forceps
- Hold or grasp tissue
- Triangular tips
- Minimal trauma
What are haemostatic or artery forceps?
- Clamp blood vessels and stop bleeding
- Many different types
What are the different types of artery forceps?
- Spencer wells
- Mosquito
- Rochester Pean
- Kocher
- Aniotribe
- Crile
Mosquito artery forceps
- Clamp finer blood vessels
- Common type = Halstead Mosquito
- Can be straight or curved
- Fine tipped
Rochester Pean artery forceps
- Longer jaws
Kocher artery forceps
- Used to grasp
- Better traction
- Teeth at tips (rat)
Angiotribe artery forceps
- Opposing gooves
- Used on major arteries during heart surgery
Crile artery forceps
- Half serrated, half flat surface
What are the 3 types of gloving?
- Open; most common, easy to break sterility
- Closed; best method
- Plunge; sterile assistant required for this
What should the ambient temperature of the operating theatre be?
15 - 20 degrees celsius
What are the different types of heating used in theatre?
- Wall mounted radiators; difficult to clean
- Panel wall heating; expensive
- Air-con with ventilation; 20 air changes per hour minimum
- Avoid fan heaters; cause air and dust movement
What are the types of theatre trolley?
- Mayo trolley
- Over the table trolley
- Tiered trolley
What are the uses of tourniquets?
- Improve surgical visibility
- Control traumatic bleeding
How are tourniquets applied?
- Applied at proximal aspect of limb
- Occludes blood flow to distal limb
- In emergency more lives are saved than limbs lost
- Can only be used for 15 minutes
What are the uses of the suction unit?
- Aspirate oro/nasopharynx during and after surgery
- Thoracocentesis after surgery
- Suction of fluids and blood during surgery
What are the different tips available for suction units?
- Allow different levels of suction control
- Disposable plastic and reusable metal ones
FRAIZIER - Fine delicate suctioning
YANKAUER - Reduce trauma to tissues and access tight spaces
POOLE - Evacuate pooled blood and debris in deep abdominal surgery
What are the care and maintenance instructions for suction units?
- All blood and debris removed asap with cold water
- Use stylet to ensure tip thoroughly cleaned
- Flush tubing with water under force (syringe)
- Disinfect tubing and tip
- Drain and dry thoroughly
- Sterilise appropriately
What are the types of endoscope?
- 2 types of fibre optic endoscopes in practice
- Different sizes available
RIGID - Diagnostic evaluation of trachea, bronchi, oesophagus, nasal cavities, joints and abdominal cavity
FLEXIBLE - Diagnostic examination of body tracts; respiratory, GI, rectum and colon
What is arthroscopy?
- Rigid endoscope of joints
What is laparoscopy?
- Rigid endoscopy of abdominal cavity
Why is special care needed for fibre optic endoscopes?
- Fibre optic bundles easily damaged
- More damage; less light transmitted; poorer image
- Individual broken fibres = black spots on image
What are the different metals surgical instruments are made from?
- Stainless steel
- Austentic
- Martensitic
- Chromium-plated carbon steel
- Tungsten carbide
- Titanium
Stainless steel instruments
- Most popular type in veterinary
- High resistance to corrosion
- Great strength
- Attractive surface finish
Austenitic instruments
- Stainless steel
- Can’t be heat-hardened
- Non magnetic
- Resists corrosion better than martensitic
- Also called 300 series stainless steel
Martensitic instruments
- Stainless steel
- Magnetic
- Can be heat-hardened
- Not as corrosion resistant as austenitic
- Also called 400 series stainless steel
- Most common stainless steel
Chromium-plated carbon steel instruments
- Cheap
- Commonly used
- Will rust, pit and blister when contact with chemicals and saline
- Tend to blunt quickly
Tungsten carbide instruments
- Inserts added to tips of stainless steel
- Used for cutting or gripping (scissors, needle holders)
- Hard
- Resistant to wear
- Expensive
- Gold handles
- Avoid contact with benzyl ammonium chloride
Titanium instruments
- Ophthalmic surgery
- Handle delicately
- Lighter in weight
What instruments can and can’t be sharpened?
- Blunt scissors can be sent to manufacturers or instrument sharpening service
- Drill bits can be but replacements more reliable
- Oscillating saw blades need replacing
How to clean compressed air machines?
- Follow manufacturer guidelines
- Never immerse in water
- Never put in ultrasonic
- Clean all detachable parts (drill, saw, blade)
- Detach main hand piece from air hose and clean
- Hand piece and hose attachments should be lubricated
- Machine reassembled and attach to air supply
- Run for 30 seconds for oil to circulate and ensure patency before sterilisation
External skeletal fixators (Kirschner apparatus) for fracture repair - pins
- Pins placed into bone percurtaneously or through surgical wound
- Pins placed at 35-40 degree angles to each other
- At least 2 pins proximal and 2 pins distal
- Bar pin (intra medullary pin) go through bone vertically)
- Ellis pin; screw ended and clamps go into or in and out bone
External skeletal fixators (Kirschner apparatus) for fracture repair - types
TYPE 1
- 1 Bar on outside, pins go into bone
TYPE 2
- 2 bars either side, all pins go through whole bone
MODIFIED 2 (TYPE 3)
- Multiple bars, pins go into and through bone
METHOD DEPENDS ON BONE AND FRACTURE TYPE
External skeletal fixators (Kirschner apparatus) for fracture repair - Advantages
- Clamps and bars reusable
- Easy to remove
- Minimal disruption to tissue
- Easily adjustable to alignment
- Easy to combine with other implants
External skeletal fixators (Kirschner apparatus) for fracture repair - reasons for using
- Comminuted fracture
- Open or infected fracture
- Skull/mandibular fracture
- Long bone fractures in young animals to avoid growth plates
- Immobilisation of a joint
What should be removed from a used kit first?
Blade
Internal fixators - open reduction - uses
- Fracture is unstable
- Bone not plasterable
- Comminuted fracture
- Non reducible (Unstable, can’t move bones without surgery)
What is a comminuted fracture?
Multiple fractures in bone
Internal fixators - open reduction - advantages
- Suitable for any bone
- Can handle full range of fractures
- Encourages fracture healing - faster
What is the aim of sterilisation?
- Control microorganisms/pathogens in environment
- Protecting patients and staff from contamination and disease
- Promoting optimum healing and wellness
What is meant by microbial resistance?
- Not all microorganisms are equal
- Some are more easily destroyed than others
What is meant by mode of action?
Different physical and chemical methods to destroy or inhibit microorganisms
- Damage to cell walls or membranes
- Interfere with cell enzyme activity
- Destroy microbial cell contents via oxidation, hydrolysis, reduction, coagulation, denaturation or formation of salts
What factors affect microbial control method effectiveness?
- Time; minimum effective exposure time
- Temperature; more effective with temp increase
- Concentration + preparation; appropriate chemical concentration, adversely effected by mixing
- Organisms; type, number, stage of growth
- Surface; physical properties of surface can interfere with activity of chemicals
- Organic debris; can interfere with control method
- Application method; appropriate for material being sterilised
Sepsis
Infection present
Sterilisation
Destroys all microorganisms, including spores
Disinfection
Destroys microorganisms but not spores
Antisepsis
Prevents/fights sepsis (infection)
Endogenous
Microbe from within or on the body
Nosocomial
Infection from hospital (MRSA)
Exogenous
Microbe from outside of the body
How is sterilisation divided?
- Heat sterilisation
- Cold sterilisation
What are the different types of heat sterilisation?
- Dry heat
- Moist heat
What is dry heat sterilisation?
- Kills by oxidation of protoplasm
- High temperatures of 150 - 180 degrees celcius
- If lower temps, longer times are required (>4-5 hours)
What different equipment is used for dry heat?
- Hot air ovens; heat penetration, holding time, safety time
- High vacuum assisted ovens; vacuum reduces time
- Convection ovens; Motor circulates hot air for uniform and constant temperature
What indicators are used for dry heat?
- Spores test
- Brownes tube (orange > green)
What is moist heat?
- Sterilises by coagulating bacterial protoplasm
- Steam under pressure gives higher temperature for a more consistent time
What equipment is used for moist heat steilisation?
- Vertical pressure cooker;
- Downwards displacement;
- Vacuum autoclaves;
How do moist heat sterilisation indicators work?
What are the types of indicators for moist heat sterilisaton?
- Chemical strips;
- Brownes tubes;
- Bowie Dick Tape;
- Spores test;
