topic 4 Flashcards
what are the categories of surgical instruments
-scalpel blade
-scissors
-needle holders
-forcepts: thumb, haemostatic, tissue
what is the most common size of scalpel blade
3, #4
function of scalpel handle
to hold the scalpel blade
function of scalpel blade
best instrument for incising tissues with minimal trauma
what are the different types of scissors and their functions
-straight scissors
-curved scissors
-mayo scissors (curved/ straight) (very strong, cutting connective tissue and fascia)
-metzenbaum scissors (curved/straight) (cutting delicate tissue and blunt tissue disection)
-suture scissors (cut sutures during suture removal)
-bandage scissors (for bandage removal)
what are the different type of needle holder and their function
-mayo-hegar
-olsen0hegar (with cutting blade)
function: used to grasp needle while suturing tissues
types of haemostatic forceps and function
mosquito haemostatic forceps (small: used for crushing small blood vessels with precion, not as effective for large vessels)
crile forceps, kelly forceps (contains transverse teeth onlt on the distal end of the jaw, used for crushing small to medium vessels )
types and function of tissue forceps
-allis tissue forceps (extremely traumatic- used on fscial planes and connective tissues only)
doyen forceps (for gastric and intestinal syrgeries)
what are the different thumb forceps and what is their function
adson forceps (plain/rat tooth): provides gentle grasp of tissue and used to manipulate soft tissue during surgery
/dabakey forceps : provides delicate grasp of soft tiisues while minimising tissue damage
what material is surgical instrement made of and why is that important
made out of stainless steel: rust resistant and maintains a keen edge, can use- last long time
describe instrument care (cleaning)
All instruments should be handled gently and delicate
instruments should be separated from the general
instruments before cleaning.
* Multi-component instruments should be disassembled prior
to cleaning. (eg cautery, edoc
* Power equipment should be cleaned separately to ensure
that water does not get inside the components.
* Immediately after use, instruments should be rinsed with
cold water to prevent blood and organic debris from drying
in the serrations, hinges, box locks, or ratchets.
* Each instrument is scrubbed with a soft brush in warm water
with a neutral pH detergent.
Abrasive cleaning agents should never be used.
* Saline solutions are corrosive to stainless steel, so
instruments should be rinsed with deionised or distilled
water.
* Some hospitals have ultrasonic cleaners which clean the
instruments in places the brush cannot reach
Describe the general principles of surgical asepsis
Dermal integrity is disrupted, microorganisms have access to tissue
beneath the skin
* Bacteria contaminating surgical wounds originate from the patient’s
endogenous flora, operating room personnel, and environment. (where the bac come from)
* Prevention of wound contamination is achieved by following the rules of
surgical asepsis
* Breaking the rules subjects our patients to the risk of infection or disease (slower wound healing)
what are the different methods of steralisation
heat sterilisation: steam under pressure (autoclave) steam under pressure (horizontal f=downward displacement autoclave
dry heat
cold sterlisation (delicate/autoclave not free): ethylene oxide
irradiation
describe how steam under pressure works (autoclave)
most widely used
benefits: most economical (can reuse)
ertical pressure cooker
Operates by boiling water in a closed
container
Air vent at the top
Disadvantage is the danger that some air
will be trapped underneath the steam (May not be able to reach instruments)
Manually operated
Horizontal downward displacement autoclave
Larger and fully automatic
Electrically operated boiler that is
incorporated in the autoclave as a source of
steam
Air is driven out more efficiently by
downward placement
Air outlet at the bottom, steam outlet at the
top
Designed for loose instrument rather than
packs
Vacuum-assisted autoclave (porous load)
High-vacuum pump to evacuate air rapidly from
the chamber at the beginning of the cycle11
Steam penetration after evacuation is almost
instantaneous, sterilization occurs quickly
Second vacuum cycle rapidly withdraws
moisture after sterilization and dries the load
All types of instruments, drapes and equipment 11
Choice of cycles
describe dry heat steralisation
Dry heat (oven)
* Oxidative destruction of bacterial protoplasm
* 150 to 180 degrees C
* Range of equipment sterilized is restricted (may be too hot for some)
* Hot-air oven, high-vacuum oven, convection
oven
describe how cold sterliasation takes place (instruments get submerged in)
Ethylene oxide: for instruments that is more delicate, nto appropriate to place in autoclave/autoclave is being used and need instrument asap)
adnvantage: Highly penetrating and effective method
disadvantage: Toxic, irritant to tissue and very inflammable gas
* Inactivates DNA of the cells, preventing cell reproduction
* Effective against vegetative bacteria, fungi, viruses and spores
Commercially produced solutions
* Gluteraldehyde, alcohol-based solutions, iodine, chlorhexidine, peroxides
* Disinfection
* Surgical equipment which may not be sterilized by other means
* Endoscopic and arthroscopy equipment (eg, more fragile)
* Discarded after use
Irradiation
* Gamma irradiation (cold deralation because it doesnt use heat)
* Pre-packaged items are sterilized by this method
Factors affecting the efficiency of sterilisation
Contact between the sterilizing agent and the object being sterilized
* Presence of organic matter around organisms
* Length of exposure to agent
* Concentration of sterilizing agent
* Temperature and humidity (refering to autoclave, automated)
* State of the micro-organisms
an ideal surgical suite should consist of the following areas
preperation room (dirty area)
Scrub room (mixed area)
* Operating theatre (clean area)
* Sterile supply area
* Recovery area
what happens in the preperation room
Induction of patient, as well as preparation of the patient ( give anisthetic frug, intubation, clipping of fur)
what is/ happening in the scrub room
Preparation of surgeon
* Separate from the operating theatre, as scrubbing generates
water-borne aerosol contaminants
* Scrub sinks
* Bench top
(sink has foot pedal so no need to touch)
what haooens in surgical theater
Surgical procedures only
* Restricted to appropriately
dressed personnel (grown, mask, gloves)
* Preferably only 1 door
* Controlled filtered air supply to
provide fresh air
what is the sterile supply area
Cleaning contaminated equipment and setting up sterile
supplies for surgery
* Cleaning equipment, autoclaves, storage shelves
* Adjacent to operating theatre
what haooens in recovery room
Quiet, warm room (faster recovery)
* Near the centre of activity (Anything happen eg post op conm, can see)
difference between steralisation and disinfection
steralisation: destruction of all microorganisms and spores
disinfections: removal of microorganisms but not necessary spores (cannot use disinfected surgical instruments under skin)
what is Disinfectant
Agent that destroys microorganism
Antisepsis
Destruction or inhibition of microorganisms on animate (living) objects
Asepsis
Freedom from infection
Antiseptic
An agent used to kill microorganisms
Usually in the form of a solution
Definitions
Cleaning
Physical decontamination of objects/surfaces
– Removes soil, particulate matter and large numbers of
microorganisms
– Pre-requisite to disinfection or sterilization
– Suitable for surfaces and non-critical items
Aseptic technique
Methods and practices that prevent cross contamination in surgery
example of disinfectant and antiseptic
disinfectant: alcohol
antiseptic: chlorhexidine
rules of asepric tecnique and their reason
Surgical team members remain within the sterile
area
Movement out of the sterile area may
encourage cross contamination
Talking is kept to a minimum
talking releases moisture droplets laden
with bacteria.
Movement in the operating room (or) by all
personnel is kept to a minimum; only necessary
personnel should enter the operating room
Movement in the OR may encourage
turbulent airflow and result in cross
contamination (think swirl around mix with other shit instead of flowing out of theater)
Non- scrubbed personnel do not reach over
sterile fields.
Dust, lint, or other vehicles of bacterial
contamination may fall on the sterile field.
The rules of aseptic technique
Dust, lint, or other vehicles of bacterial
contamination may fall on the sterile field.
Scrubbed team members face each other and
the sterile field at all times
A team member’s back is not considered
sterile even if wearing a wraparound gown
Scrubbed personnel handle only sterile items;
non- scrubbed personnel handle only non-
sterile items
Non- scrubbed personnel and non- sterile
items may be a source of cross contaminatio
If the sterility of an item is questioned, it is
considered contaminated.
Non- sterile, contaminated equipment may be
a source of cross contamination
Sterile tables are only sterile at table height.
Items hanging over the table edge are
considered non- sterile
Gowns are sterile from midchest to waist and from
gloved hand to 2 inches above the elbo
The back of the gown is not considered
sterile even if it is a wraparound gown.
Drapes covering instrument tables or the patient
should be moisture proof.
Moisture carries bacteria from a non-
sterile surface to a sterile surface
f a sterile object touches the sealing edge of the
pouch that holds it during opening, it is considered
contaminated
Once opened, sealed edges of pouches
are not sterile.
Sterile items within a damage or wet wrapper are
considered contaminated.
Contamination can occur from
perforated wrappers or from strike-
through from moisture transport
Hands may not be folded into axillary region; rather,
they are clasped in front of the body above the
wais
The axillary region of the gown is not
considered sterile
If the surgical team begins the surgery seated, they
should remain seated until the surgery has been
completed
The surgical field is sterile only from
table height to the chest; movement
from sitting to standing during the
surgery may increase cross
contamination.
what happens during pre- opperative phase
sterlaisation of instruments
preperation of surgical facilities
what happens durin peri operative pahse
PPE required (surgical suit, heat covers, shoe covers, face mask)
* Surgical hand scrub
* Patient surgical site preparation
what to take note when performing surgical scrubbing
Methodical
- ensuring all surfaces of the hand and forearm have sufficient contact time
with the antiseptic agent.
2. Scrubbing method should not be too vigorous
- As use of stiff brushes may disturb the resident bacteria in the hair follicle
resulting to increase in the surface bacterial count (bacterial come out from underneath hair follicles)
what are the two main methods of surgical hand scrub
Block or counted brush stroke method *
– Each surface of each finger, hand, wrist and forearm is washed with pre-
determined number of brush strokes
2. Anatomic timed method
– Hand washing proceeds for a pre-determined period of time (5-7 mins) by a
clock
what happens during patient preparation of surgical site
Prepared in the preparation room after induction,
just prior to surgery
* Hair removal and skin disinfection reduces the
number of surface bacteria
* Some patients may require bathing if gross
contamination is eviden
how to perform hair clipping
Clipping should be done as gently as possible
* Clipped area should extend about 15 cm each
side of the proposed skin incision
* For limbs, should extend around the
circumference of the limb
* Hair is initially shaved in same direction as hair
growth
* Final surgical clip - Hair is shaved against the
direction of hair growth to achieve the closest
possible shav
Once complete, a vacuum cleaner is
used to eliminate loose hairs on the
skin
* Areas which are not clipped, e.g. paws,
should be isolated from the surgical
field by impermeable draping material,
or enclosed in a latex glove secured by
adhesive tape
* For orchiectomy of cats, scrotal hair is
plucked rather than clipped
how to scrub surgical site
Personnel performing the skin prep
should wear gloves or use gauze
holding forceps
-scrub (chlorohexidine)
rinse( alcohol)
repeat under gauze is clean
-final paint: final coat of antiseptic sol applied after the last sept 2 and after transfering to teatre (chlorhexadine in spray bottle)
what are used to isolate the surgical site
-fenestrated drap (pre cut)
-plain drape
what happens during intra operative phase
-ppe required
-sterile surgical feild
Rules of the surgical theatre
AIl personnel must know what are the ‘sterile’ items and what
are ‘non-sterile’
* ‘Sterile’ persons to touch only ‘sterile’ items and vice versa
* ‘Sterile’ members to face each other and the ‘sterile’ field.
* ‘Non-sterile’ members should not reach over the ‘sterile’ field
Do not talk unless necessary
* Restrict movements or do not move around the room or enter
and leave the room unless necessary
* Avoid sneezing and coughing
* Do not leave sterile fields unattended
* If the sterility of a surgical equipment is questioned, it is
considered ‘contaminated’
Rules of the surgical theatre
what happens during post opp phase
Clean only around surgical incision with dilute chlorhexidine. Do not use alcohol.
* Adequate clean bedding must be provided at the recovery room.
* Bandages, catheters, and drains must be regularly maintained and changed for
comfort and cleanliness
* If a patient is chewing at the bandage or plaster cast, use an Elizabethan collar to
restrain it
qhat are the four phases in surgery
– Pre- operative (preparing)
– Peri- operative (preparing patient)
– Intra- operative (surgery)
– Post- operativ (after care)
