Theatre practice (SA10) Flashcards
1
Q
What is a pathogen?
A
- Microbes capable of causing disease
- Virus, bacteria, fungi, etc.
2
Q
What makes reproductive spores particularly resistant?
A
- Thick wall
- Remain viable in unfavourable conditions
3
Q
What can risks be influenced by in theatre?
A
- Characteristics of patient
- Operation
- Personnel
- Environment
4
Q
What reduces the patients ability to withstand infection?
A
- Disease
- Stress
5
Q
Sepsis
A
- Presence of pathogen or toxic products in blood or tissue of patient
6
Q
Asepsis
A
- Freedom from infection
7
Q
Aseptic technique
A
- Steps taken to prevent sepsis
8
Q
Antisepsis
A
- Prevention of sepsis
- Destruction or inhibition of microbes
- Using agent safe for living tissue
9
Q
Sterilisation
A
- Destruction of ALL microbes
10
Q
Exogenous microbes
A
- Found on outside
- May include environment
11
Q
Endogenous microbes
A
- Originate from within the body
12
Q
Nosocomial
A
- Originated from the environment
- Hospital acquired infection
- Surgical site infections
- MRSA
13
Q
What does MRSA stand for?
A
Methicillin Resistant Staphylococcus Aureus
14
Q
Do all microbes cause infection?
A
No
15
Q
Commensal microbes
A
- 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
16
Q
Commensal bacteria
A
- Live on animals
- Do not cause harm
17
Q
Facultative pathogens
A
- Will cause harm in immunosuppressed
18
Q
Obligate pathogens
A
- Will ALWAYS cause disease
19
Q
Saprophytic bacteria
A
- Replicate on dead tissue
- Responsible for decay
20
Q
What organisms are involved in wound infections
A
- Staphylococcus
- Streptococcus
- Proteus
- Pseudomonas
21
Q
What factors affect infection?
A
- 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
22
Q
Virulence of bacteria
A
- How harmful bacteria is
- Amount of bacteria entering wound
- Environment for bacterial growth
- Poor blood supply
- Devitalised tissue
23
Q
- Sources of contamination in theatre
A
- Equipment
- Environment - dust is reservoir of bacteria and contamination
- Personnel - 62% nasal staph carriers
- Patient
24
Q
What may cause surgical infections?
A
- 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
25
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
26
What are the classifications of surgery?
- Clean
- Clean contaminated
- Contaminated
- Dirty
27
What is a 'clean' surgery?
- Typically elective surgery
- Non-contaminated
- Non-traumatic
- Non-inflamed
- Neuter, routine laparotomy, elective orthopaedic
28
What is a 'clean contaminated' surgery?
- Potential for contamination
- Involves respiratory, GI or genitourinary system
- Often hollow organ
- Enterotomy, enterectomy, cystotomy
29
What is a 'contaminated' surgery?
- Contamination WILL occur
- Leakage or major break in aseptic technique
- Enterotomy, enterectomy, cholecystectomy, cystotomy
30
What is a 'dirty' surgery?
- Infection already present
- Hollow organ rupture
- Infected surgical site
- Septic peritonitis
- Abscess
- Ruptures GI, gallbladder or pyometra
31
What order should surgeries be completed in?
- Clean
- Clean contamination
- Contaminated
- Dirty
32
How are surgical patients classified?
- Elective
- Urgent
- Emergency
33
What constitutes an elective surgical patient?
- Non-urgent
- Healthy
- Usually young
- Routine neutering
34
What constitutes an urgent surgical patient?
- Necessary
- Not immediately life-threatening
- Required propmt care
- Fracture repair
35
What constitutes an emergency surgical patient?
- Life threatening
- Abdominal crisis
36
Ectomy
- Remove
37
Otomy
- Temporary incision
38
Ostomy
- Opening
- Can be temporary or permanent
- Stoma = hole
39
Desis
- Binding together
- Surgical fixation
40
Pexy
- Fixation of an organ
- Surgical suspension
41
Plasty
- Reconstructive/surgical repair
42
Gastrotomy
43
What is the prep room used for?
- Induction of anaesthesia
- Preoperative procedures; clipping, catheter placement, surgical prep
- Should lead directly into operating theatre
44
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
45
What is the treatment room used for?
- Located off prep room
- Used for minor procedures
46
Additional areas/room for theatre suite?
- Washing/sterilising room
- Sterile storage
- Scrubbing area
- Changing room
47
What different categories of cleaning protocols should be used for theatre suite?
- Daily
- Weekly
- Monthly
48
What should be included in the daily theatre cleaning protocol?
- Floors
- Waste disposal
- Surfaces
- Equipment
- Tables
- Lights
- Scrub sinks
49
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
50
What should be included in the monthly theatre cleaning protocol?
- All room fittings
- Vents
51
What is important to consider when designing a theatre suite layout?
- Movement of people through and between zones
52
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
53
Why is it important to have non-static materials in theatre?
- Oxygen used
- Is flammable
- Oxygen usually colour coded black and yellow
54
What characteristics should walls have to aid in cleaning in theatre?
- Wall covering should be cleanable and waterproof
- Waterproof paint, plastic cladding
55
What characteristics should doors have in theatre?
- Doors should remain closed, self closing
56
What characteristics should walls have to aid in cleaning in theatre?
- Anti-static, non-slip, smooth floors
- Some may be bacterial protected
57
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
58
What is the minimum amount of air changes that should occur in theatre per hour?
20
59
What is the most common ventilation type?
- Plenum ventilation
- Positive pressure - elaborate on!
60
What are most instruments made of?
- Stainless steel
- Very strong
- Highly resistant to corrosion
61
Why is tungsten carbide used in some instruments?
- Very hard wearing
- Expensive
- Usually have gold handles
62
Why may chromium plated carbon be used in instruments?
- Cheaper
- Will rust, pit and blunt quickly
63
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
64
What are the 2 tissue forceps?
- Allis tissue
- Babcock
65
Allis tissue forceps
- Hold or grasp tissue
- 4-5 teeth
- Minimal trauma
66
Babcock tissue forceps
- Hold or grasp tissue
- Triangular tips
- Minimal trauma
67
What are haemostatic or artery forceps?
- Clamp blood vessels and stop bleeding
- Many different types
68
What are the different types of artery forceps?
- Spencer wells
- Mosquito
- Rochester Pean
- Kocher
- Aniotribe
- Crile
69
Mosquito artery forceps
- Clamp finer blood vessels
- Common type = Halstead Mosquito
- Can be straight or curved
- Fine tipped
70
Rochester Pean artery forceps
- Longer jaws
71
Kocher artery forceps
- Used to grasp
- Better traction
- Teeth at tips (rat)
72
Angiotribe artery forceps
- Opposing gooves
- Used on major arteries during heart surgery
73
Crile artery forceps
- Half serrated, half flat surface
74
What are the 3 types of gloving?
- Open; most common, easy to break sterility
- Closed; best method
- Plunge; sterile assistant required for this
75
What should the ambient temperature of the operating theatre be?
15 - 20 degrees celsius
76
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
77
What are the types of theatre trolley?
- Mayo trolley
- Over the table trolley
- Tiered trolley
78
What are the uses of tourniquets?
- Improve surgical visibility
- Control traumatic bleeding
79
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
80
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
81
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
82
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
83
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
84
What is arthroscopy?
- Rigid endoscope of joints
85
What is laparoscopy?
- Rigid endoscopy of abdominal cavity
86
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
87
What are the different metals surgical instruments are made from?
- Stainless steel
- Austentic
- Martensitic
- Chromium-plated carbon steel
- Tungsten carbide
- Titanium
88
Stainless steel instruments
- Most popular type in veterinary
- High resistance to corrosion
- Great strength
- Attractive surface finish
89
Austenitic instruments
- Stainless steel
- Can't be heat-hardened
- Non magnetic
- Resists corrosion better than martensitic
- Also called 300 series stainless steel
90
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
91
Chromium-plated carbon steel instruments
- Cheap
- Commonly used
- Will rust, pit and blister when contact with chemicals and saline
- Tend to blunt quickly
92
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
93
Titanium instruments
- Ophthalmic surgery
- Handle delicately
- Lighter in weight
94
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
95
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
96
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
97
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
98
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
99
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
100
What should be removed from a used kit first?
Blade
101
Internal fixators - open reduction - uses
- Fracture is unstable
- Bone not plasterable
- Comminuted fracture
- Non reducible (Unstable, can't move bones without surgery)
102
What is a comminuted fracture?
Multiple fractures in bone
103
Internal fixators - open reduction - advantages
- Suitable for any bone
- Can handle full range of fractures
- Encourages fracture healing - faster
104
What is the aim of sterilisation?
- Control microorganisms/pathogens in environment
- Protecting patients and staff from contamination and disease
- Promoting optimum healing and wellness
105
What is meant by microbial resistance?
- Not all microorganisms are equal
- Some are more easily destroyed than others
106
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
107
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
108
Sepsis
Infection present
109
Sterilisation
Destroys all microorganisms, including spores
110
Disinfection
Destroys microorganisms but not spores
111
Antisepsis
Prevents/fights sepsis (infection)
112
Endogenous
Microbe from within or on the body
113
Nosocomial
Infection from hospital (MRSA)
114
Exogenous
Microbe from outside of the body
115
How is sterilisation divided?
- Heat sterilisation
- Cold sterilisation
116
What are the different types of heat sterilisation?
- Dry heat
- Moist heat
117
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)
118
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
119
What indicators are used for dry heat?
- Spores test
- Brownes tube (orange > green)
120
What is moist heat?
- Sterilises by coagulating bacterial protoplasm
- Steam under pressure gives higher temperature for a more consistent time
121
What equipment is used for moist heat steilisation?
- Vertical pressure cooker;
- Downwards displacement;
- Vacuum autoclaves;
122
How do moist heat sterilisation indicators work?
123
What are the types of indicators for moist heat sterilisaton?
- Chemical strips;
- Brownes tubes;
- Bowie Dick Tape;
- Spores test;
124
