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Infection Control Yr1 > Theatre prep + etiquette > Flashcards

Theatre prep + etiquette Flashcards

1
Q

What’s the advantage of using a waterproof drape?

A

It prevents the patient from becoming cold + wet - thus maintaining thermoregulation

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2
Q

When should you only wear scrubs?

A

In theatre

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3
Q

Why should scrubs be coloured co-ordinated?

A

To differentiate between the levels of surgical personnel, within the theatre suite

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4
Q

What should be considered when washing scrubs, after a surgical procedure?

A

They are washed seperately, in a seperate washing area

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5
Q

What should be considered, in regards to footwear, when in theatre?

A

They are used only within theatre, no where-else - at any time

Consider foot covers also, as good practice

Foot-covers can be used in an emergency too

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6
Q

In an emergency, what is the minimal amount of PPE that should be worn, when rushing into theatre?

A

Disposable + sterile:
1. Gowns
2. Sterile gloves
(Prep-scrubs under gown only)
1. Hair-nets
1. Foot-covers

Bare socks - if desperate, says Lucy!

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7
Q

State the difference between prep-scrubs and theatre-only scrubs

A

Prep-scrubs = only to be worn in prep, when preparing patients for surgery
+
Theatre-only scrubs = Only worn in theatre - NOT within prep!

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8
Q

If you need something in an emergency, and you are already in theatre, who can you ask?

A

The circulating surgical nurse!

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9
Q

How can scrubs contribute towards contamination in theatre?

A

They can harbour micro-organisms, and therefore act as a fomite

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10
Q

What is, arguably, the 2 most important sterile items to wear in the OR?
+
Who wears them?

A

Sterile:
1. Gloves
1. Gown
+
All sterile personnel

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11
Q

Why should you (as gold standard) wear seperate, disposable gowns in the surgical prep area?

A

To prevent the transmission of fomites to vulnerable, sedated patients from risk of SSI etc

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12
Q

What are the 2 main reasons why masks be worn in the OR?

A
  1. To prevent the spread of HAIs
    +
  2. Act as eye protection

From patients that are infectious, harbour any HAIs or zoonotic disease

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13
Q

What should you always be aware of, in regards to the sterile field?

A

Where you are, in relation to it

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14
Q

Where does the Sterile Field begin and end?

A

Beings = At the surgical site
+
Ends = At the instrument trolley

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15
Q

If you absloutely must move the drapes, during surgery, as directed by the vet - where can you touch it?

A

Underneath

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16
Q

Define what is meant by the term ‘Sterile Field’

A

The Sterile Field = the area within the window (SS) , created by the drapes
+
The drapes themselves

SS = Surgical Site

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17
Q

What are the 5 main aspects, that are included within the Sterile Field?

A
  1. Surgical site
  2. Drapes (All areas)
  3. Surgical tabletop
  4. Surgical instruments
  5. Instrument tray
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18
Q

The exception to the rule..

What is the only non-sterile aspect within the surgical field?

A

The edges of the drapes!

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19
Q

If anything falls off the surgical field, what should be done?

A

It must be disposed of
+
NOT re-used

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20
Q

If you need to dispose of something, such as blood-soaked swabs, from the surgical area, where must it be disposed of?

(In theatre)

A

In the Kick bucket

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21
Q

What must you do if you break sterility, and touch something that is not sterile, what 2 minimal steps must you take before re-entering the theatre?

A

You MUST - as a minimum:
2. Re-scrub
+
1. Re-glove

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22
Q

Is the back or front of the gown considered sterile?

A

The Front

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23
Q

Explain why the back of the surgical gown is not considered sterile?

A

Because when it is sterilised, the sterile part of the gown (the front) is folded inside when packed and sterilised
+
The back of the gown has to be touched by the surgical assistant, to tie it - breaking sterility

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24
Q

What area of the sterile gown, is actually considered ‘sterile’?

A

The chest portion of the front of the gown, where the sterile gloved-hands are held and NO other area

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25
Q

Where should your hands be placed when you have been donned and gloved?

A

With your hands clasped, in-front of your chest
+
Must not move from this position, unless instructed otherwise

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26
Q

Why should your hands not touch any part of the gown or put your hands by your side when donned?

A

Because the portion outside of the chest area and gloves are not considered sterile

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27
Q

State the 3 things you must do when moving in the OR?

A
  1. Move slowly
  2. Walk back-to-back
  3. Vocalise when you move, to inform everyone of your presence
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28
Q

What way should you face when you are moving around the SS?

SS = Surgical site

A

With your front facing the SS

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29
Q

What should you never block, for the VS, in the OR?

A

Their light source/the lamp

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30
Q

Where should you always stand, in relation to the VS, during a surgical procedure?

A

Opposite them, on the other side of the SS

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31
Q

What should Non-sterile assistants not touch?

A

Any sterile personnel or everything that is considered sterile!

Sterile Personnel = Sterile assistant, VS etc

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32
Q

How should you act within the theatre?

(4 things)

A
  1. Act calmly
  2. Act slowly
  3. Thinking before you act
  4. Not leaning over the SS
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33
Q

How do you avoid unintentional contamination as non-sterile assistant?

A

By keeping your hands clasped
or
behind your back!

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34
Q

What should you do if you accidentally contaminate the surgical field?

A

Speak up!
It is better to address it immediately, than risk a patient’s life or increase the risk of post-op surgical infections

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35
Q

Where should you stand, as a non-sterile assistant?

A

In the corner of the room
+
Away from all sterile personnel + equipment

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36
Q

Where should you stand when there is a teaching moment, in the OR?

A

Behind the VS
+
At the head of the surgical table with the anaesthetist
+
Remember to not lean forwards!

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37
Q

Why apart from the obvious, should you not sneeze and cough in theatre?

4 reasons..

Think about a particular pathogen that likes to live in the mms + nose!

A

To protect the patient from:
Cross-contamination
+
Surgical Site Infections
+
Prevent post-op infections
+
Limit spread of HAIs.. in particular MRSA!

MRSA = Methicillin Resistant Staphylococcus Aureus

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38
Q

What 5 things should you be aware of when talking in theatre?

A

All discussions are kept professional
+
Subjects should be patient + case related
+
Keep talking to a minimum - to reduce the chance of mistakes, or disrupt the VS’s concentration
+
Save any relative questions to the end
+
Don’t interupt or disrupt the VS during emergencies

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39
Q

Should the VS touch the mayo trolley?

A

No, as it increases the risk of contamination

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40
Q

In some refferal practices, are scrub nurses able to pass sterile items to the VS?

A

Yes

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41
Q

How should you open seal and peel pouches?

A

In an aseptic manner:

Holding the edges of the openings and peel them up + away from each other, folding them outwards - without touching the sterile person

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42
Q

What should you check with the VS before breaking sterility, after seeming to have completed the surgical procedure?

A

Ask/confirm with the VS if they have finished + you are allowed to break sterility

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43
Q

What should you not do before confirming if it is okay to break sterility?

A

Do not remove equipment from the sterile field or move the patient unless asked to do so

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44
Q

What is considered the 6 main basic components of the surgical suite?

A

1.The surgical suite (itself)
2.Recovery kennels
3.Surgical changing rooms
4.Instrument washing + packing
5.Imaging suite
6.Preparation area

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45
Q

Name the 4 classifications of surgical procedures

A
  1. Clean
  2. Clean contaminated
  3. Contaminated
  4. Dirty
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46
Q

What is meant by a ‘Clean’ surgical procedure
+
Give an example of one

A

A surgical procedure which is not contaminated.

Example = Ovariohysterectomy or Orchidectomy

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47
Q

What is meant by a ‘Clean contaminated’ surgical procedure
+
Give an example of one

A

A surgery where a body cavity is entered under controlled conditions + with limited contamination.

Example = Median-sternotomy

Median-sternotomy, also known as a ‘Sternal split’ = allows the VS to access both halves of the chest cavity

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48
Q

What is meant by a ‘Contaminated’ surgical procedure
+
Give an example of one

A

A gross spillage or break into a body cavity, using a sterile technique.

Examples = oral surgery or abdominal surgery - with spillage

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49
Q

What is meant by a ‘Dirty’ surgical procedure
+
Give an example of one

A

A surgery including infected or necrotic tissues or bodily fluids.

Examples = Dentals + Abscesses

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50
Q

What is the ideal design of the theatre suite set to achieve?

A

Preventing cross-contamination by seperating areas

Dirty theatres, dental suites

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51
Q

Why should non-surgical personnel not go beyond prep area?

A

Preventing personnel from leaving + re-entering clean rooms
+
To limit unnecessary traffic + cross contamination

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52
Q

How should surgical personnel, rooms, equipment and instruments be coded?

A

Colour coded

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53
Q

What 5 procedures can you carry out in the prep room?

A
  1. Induction of anaesthesia
  2. Surgical prep (Clip + scrub)
  3. Placing Intravenous catheters
  4. Taking blood samples
  5. Triage, minor or emergency care (general practice)

Some general practices may have a dental area in prep also

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54
Q

State some equipment that should be kept in the prep area

A
  1. Endotracheal tubes
  2. Pre-medication + induction pharmceuticals
  3. Anaesthetic circuits + monitoring equipment
  4. Crash box + cash area
  5. Surgical prep equipment: Clippers, hoover, lint rollers
  6. PPE
  7. Sharps + clinical waste bins
  8. Positioning aids: troughs + sand bags
  9. Tables: fixed, on wheels or access to moveable trolleys
  10. Fixed sinks for dirty procedures
  11. Good lighting or moveable spotlight
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55
Q

Where should skin prep be found?

A

Just outside of theatre, NEVER inside the OR

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56
Q

How should theatre doors be designed?

A

They should be:
* Without handles
+
* They should be automatic or have a push mechanisms

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57
Q

Where should PPE, sterilised surgical instruments and consumebles be stored and why?

A

In Sterile stores
+
To avoid contamination + water droplets

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58
Q

How should equipment be stored within the Sterile storage area?

A

Should be near cleaan area/prep or corridor and has:

  • Adequate shelving
  • Easily accessible
  • Logical order
  • Glass doors
  • Items can be clearly identified
  • In-date (order)
  • Well stocked
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59
Q

Where should the changing area be?

A

Near the clean area of theatre

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60
Q

What should be kept within the changing area?

A

Clean:
* Scrubs
* Shoes
* Masks
* Hats

  • Seperate laundry bins - to limit cross contamination

Allows staff to change into surgical scrubs before entering the clean area

61
Q

How should the changing area be cleaned?

A

In accordance to the surgical suite cleaning protocols

62
Q

How should sinks be designed in the prep area?

A

They should be:
* No touch taps
* Operated by foot, knee, elbow or infrared (motion sensor)
+
* Mixer taps

63
Q

What should be mounted to the wall, around the sink, in prep?

A

A skin cleansing solution
+
disposable paper towels
+
Preferably sterile single use, impregnated Hibiscrub or Iodine nail brushes/picks

Below the sink: rubber mats, to reduce trip hazard

Be aware that rubber mats increase the likelihood of miro-organisms

64
Q

What should a sink be free from, in prep area?
+
What material should a sink be made out of?

A

Clutter
+
Stainless steel or any other form of antimicrobial surface

65
Q

What type of flooring should be used in skin prep?

A

Non-slip flooring

66
Q

Where should you donn and put gloves on?

A

In a clear area, just outside of theatre

67
Q

Where should the recovery area, ideally be located?

A

Adjacent to theatre, but seperate from normal wards
+
Often found in prep areas, in the general practice

68
Q

Ideally, where should critical patients be housed, to recover?

A

In High dependency units
or
Intensive care units

69
Q

For how long should patients be monitored for, post-operatively?

A

Until the patient is:
* Fully recovered
* All parameters are within their normal limits
* They are conscious
* Apparent gag-reflex

70
Q

What room temperature should the recovery area be, for patients?

A

22-24 degrees celcius

71
Q

What important ‘cart’ should be avaliable and easily accessible in the recovery area?

A

Crash cart

72
Q

Give an example of 2 types of equipment that should be kept in the recovery area

A
  1. Head supports
  2. Heating aids
73
Q

What ‘ratio’ of RVN to patient, should there be?

According to the pp…

A

1:1

74
Q

What large pieces of equipment can be portable in large hospitals and refferal centres?

A

Portable x-ray machines

75
Q

Where should the ‘Imaging’ room be located?

A
  • Close to theatre, with easy access
  • Preferably = beside or in-between several theatres
76
Q

Why is it important to have the imaging room so close to theatre?

A

For the VS to take pre-op + post-op imaging/x-rays of the patient

Especially in orthopeadics

77
Q

What 3 potential types of facilities can an imaging room hold?

A
  1. Radiography
  2. Ultrasonography
  3. Endoscopy
78
Q

Why were/are wall-mounted x-ray viewers seen as an increased risk for infection?

A

Because of the dust + other particles that can harbour on the machine

79
Q

What 2 things should be considered in regards to the layout of the operating room?

A

It is:
1. Spacious
1. Room to manoeuvre without compromising sterility

80
Q

What should be considered in regards to the construction materials used in the operating room?

A

All surfaces are antimicrobial

81
Q

What 3 things should be considered in regards to the equipment in the operating room?

A
  1. Each piece of equipment is individual to that theatre - i.e; one per theatre
  2. They are easy to clean
  3. They are made of antimicrobal materials, where possible
82
Q

What 4 things should be considered in regards to the environment of the operating room?

A
  1. Air conditioning or use of a suitable air-flow system is in place
  2. It is clean
  3. It is dust-free
  4. At the appropriate temperature

Remember - increased temperature = increased bacterial colonization

83
Q

Why is it important to have an operating table which is electrically or manually able to adjust it’s height?

A
  1. To reduce back injuries of staff
  2. Necessary for CPR
  3. Adjust to patient size
  4. Allow for more efficent treatment of care

CPR = CardioPulmonary Resuscitation

84
Q

What is a Tilt table useful for?

A

Treating Diaphramatic hernias
+
For patients at risk of Aspiration - due to V+ or regurgitation

85
Q

What 2 types of modifications can some operating tables have?

A
  1. Self-heated
  2. Drainage troughs = for dental + post mortem tables
86
Q

What 2 types of surface materials should operating tables have?

A

Stainless steel or rubber

87
Q

State 1 disadvantage of using a stainless steel top for an operating table

A

It requires another layer, such as rubber on top, to prevent hypothermia + increase patient comfort

Patient comfort = less stress = decreased sedation pre-op time

Adding another layer = more expense

88
Q

State 2 benefits of using a rubber top for an operating table

A
  1. It’s removable
  2. Easy to disinfect + clean
89
Q

Name the 4 types of positioning aids

A
  1. Sandbags
  2. Foam pads
  3. Ties
  4. Troughs
90
Q

State 2 benefits (each) of using sandbags + foam pads for patient positioning aids

A
  1. Usually have a plastic covering, which is easy to clean
  2. They come in various shapes + sizes
91
Q

Why are ties considered dangerous positioning aids?

A

Because they must only be tied on the table, when they are anaesthetised

They cannot be tied to the table as if they are sedated and they wake up, disoriented + scared, they will injure themselves

92
Q

State 3 benefits of using Troughs for patient positioning aids

A
  1. They are usually covered with plastic + easy to clean
  2. They can be filled with foam, so they are comfortable for the patient
  3. They can come in various shapes + sizes
93
Q

True or False

Anaesthetised or recovering patients should be monitored at all times, when using patient transport systems.

A

True

94
Q

What is the vital thing you MUST remember when using patient transport systems?

A

To maintain the patient’s airway at ALL time

95
Q

What are the 2 things you can do, to help maintain the patient’s airway when using patient transport systems?

A
  1. Pull the neck forward
    +
  2. Extend the tongue
96
Q

Where should you place the patient’s tongue, when extending the tongue, to maintain the airway?

A

Place the tongue under the lower jaw

97
Q

What is the purpose of extending + placing the tongue under the lower jaw - specifically?

A

It helps prevent the tongue from falling back into the mouth + blocking the airwary

98
Q

What can you use to help position patient’s in sternal recumbency - especially brachycephalic breeds?

A

A foam wedge, to help maintain the airway

99
Q

True or False

You shouldn’t lift dogs that over 15kg by yourself

A

Truee

100
Q

What posture should you maintain when you lift patients?

A

Bend your knees
+
Keep your back straight

101
Q

State 8 materials/pieces of equipment can be used for transporting patients in the VP

A
  1. Blankets
  2. Towels
  3. Stretchers
  4. Hoists
  5. Carriers
  6. Cat trollies
  7. Slings
  8. Y-harnesses
102
Q

State the 2 common types of stretchers

A
  1. Nylon
  2. Framed
103
Q

Name an advantage and an disadvantage for using a blankets + towels for transporting patients

A

Advantages:
1. Removes some strain from staff
1. Keeps animal comfortable
2. Inexpensive
3. Easily accessible
4. Multi-use

Disadvantages:
1. Not secure

104
Q

Name a benefit for using stretchers for transporting patients

A

Benefits:
1. Easy to clean
1. Machine washable

Nylon:
1. Have padded handles, for less strain for staff

Framed
1. Aids patient positioning

105
Q

Name a benefit for using hoists for transporting patients

A
  1. Great for moving recumbent patients
  2. Provides rehabilitative support
106
Q

What patient transport system should be used for cats, when they are conscious?

A

Carriers

107
Q

Name an advantage + disadvantage for using a carriers for transporting patients

A
  • Advantage: They are secure
  • Disadvantage: Doesn’t provide great visability to monitor the patient
108
Q

Name a benefit for using a cat trollies for transporting patients

A
  1. You’re can attach it to cat baskets/carriers
  2. Allows for easy transportation
109
Q

Name a benefit for using a slings + y-harnesses for transporting patients

A
  1. Easy to access
  2. Great for supporting larger animals, such as large dogs
110
Q

What is Diathermy equipment?
And what is it used for?

A

Equipment used for cutting + coagulating tissues
by the use of heat application

111
Q

Briefly explain how diathermy equipment works

A

Tissues are cut using a high-frequency electrical current, which produces heat within the tissue - at the point of application.
As waveforms change, so will the corresponding tissue effects.

112
Q

State the function of the continous waveforms

A

Cutting tissue

113
Q

State the function of the interrupted waveforms

A

Coagulation

114
Q

What is the most important thing that diathermy equipment can do?

A

It’s rapid control for controlling blood haemorrhaging

115
Q

What 2 things does diathermy equipment reduce?

A

It reduces:
1. Surgical time
1. Need for surgical materials

116
Q

True or false.

Diathermy equipment can either Monopolar, Bipolar or Tripolar.

A

False.

There is only monopolar + bipolar.

117
Q

When using monopolar diathermy equipment, does the patient need to be ‘earthed’?

A

Yes

118
Q

When using bipolar diathermy equipment, does the patient need to be ‘earthed’?

A

No

119
Q

How does monopolar diathermy equipment achieve coagulation?

A

By using a finger switch pencil
+
The cutting action of monopolar is achieved by a continuous low voltage electric current waveform action which vaporises the tissues on contact

120
Q

Where does the earth wire sit in relation to the patient, when using Monopolar D-Eq?

A

The earthwire sits within the plate
+
Sits underneath the patient
+
connected to the diathermy unit

121
Q

How does the earth-wire transfer the current?

A

Through a harmless plate, often through the floor of theatre

122
Q

Why do you need good contact between the earthing plate and the patient?

A

To prevent the current from passing along the patient and to the VS

123
Q

Where does the current pass through in Bipolar D-Eq?

A

Through the tips of the forceps + across the tissue

124
Q

How is the current in bipolar D-Eq stimulated?

A

By the use of a foot pedal

125
Q

How is coagulation achieved, when using bipolar D-Eq?

A

Applying the forceps directly to the site of haemorrhaging

126
Q

What should be applied to the pads, when using D-Eq?

A

Contact gel

127
Q

What is the benefit of using stainless steel pads, when using Bipolar D-Eq?

A

It’s easy to clean

128
Q

What do you not need if you have sticky pads, when using Bipolar D-Eq?

A

No contact gel

129
Q

What 2 things should you MUST NOT do when cleaning any Diathermy equipment?

A
  1. Do not use surgical spirit
  2. Do not submerse the cables throughly
130
Q

What is suction apparatus used for?

A

Suctioning fluids + bloods

131
Q

Why are portable suction apparatuses great for dentals?

A

To help prevent aspiration during procedures

(If aspiration occurs, less bacteria will be in the mouth and aspirated contents reducing the chances of pneumonia)

132
Q

Are suction tips classed as sterile or un-sterile?
+
Can they be reused?

A

They are sterile
+
They must not be reused

133
Q

Can you get single and double bottled suction apparatuses?

A

Yes

134
Q

Name a benefit of suction apparatuses

A

They’re easy to clean

135
Q

What is scavenging?

A

The collection + removal of anaesthetic gases in the OR

136
Q

What is a key factor for any surgical suite?

Think air flow…

A

Good ventilation or scavenging set

137
Q

Give an example of active air flow?

A

The use of a suction apparatus

137
Q

What are the 2 types of airflow called, in the theatre?

A
  1. Active
  2. Passive
138
Q

Explain how to clip a patient in preparation for a surgical procedure

A

Patient should be clipped in the prep room

Select appropriate clipper blades (Usually size 40)

Check for any damage, rust or visable soiling

Consider the possibility that the blades have been used before for previous patients - if in doubt = use clean ones or clean the current ones

Remove any loose hair

Use a smaller set of clippers, if necessary, to gain access to the smaller hairs, around the clipped area - using adhesive tape or an adhesive roller

Clean the clipper blades using a

Remember = never clip a patient in theatre!

139
Q

Give an example of passive air flow?

A

‘Feed down’ tubes
(No suction)

140
Q

What is the minimal number of air changes, there must take place in the theatre, over 12+ hours?

A

6 changes, every 12+ hours

141
Q

When cleaning the OR, what type of dusting should you do every day?

A

Damp-dusting

142
Q

When should you turn on the active ventiliation, for surgery?

A

Prior to each surgery

143
Q

How often should anaesthetic circuits be cleaned?

A

Every day

144
Q

How should you clean anaesthetic circuit?

A

Submerge it in disinfectant

  • Sterilise regulary
  • Includes the anaesthetic bag
145
Q

What are the 3 biggest contamination factors in the surgical suite?

A
  1. Foot traffic
  2. Incorrect cleaning
  3. Innapropriate lay out/storage
146
Q

How often should spray bottles, filled with disinfectant solutions, be changed?

A

Spray bottles should be replenished weekly

147
Q

How often should theatre specfic heads be changed?

A

Weekly

148
Q
A

Infection Control Yr1 (21 decks)

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