VNSA10 Flashcards
What is the aim of an operating theatre?
To provide an area that is free from infectious organisms
What are potential sources of infection ?
Equipment
Animal
People
Surgical site
What protocols should be in place to reduce risk of infection in theatre ?
Correct theatre attire
Min num of people and movement
New set of instruments for each op
Surgical list in order clean to dirty
A room for dirty procedures
Sterilisation programme
Ambient temp and good ventilation
Sterilisation programme
Site prep before entering theatre
Rectifying breaks in sterilisation
Discarding contaminated instruments or equip
Record of surgeries and instruments for tracking
Strict cleaning protocols
SOPs
Name operating theatre design principles
Being an end room
Sufficient size allowing ease of movement and sterile trolleys
Easily cleanable (PCV walls, curved floors etc)
One way movement of personnel
Clear separation between clean and contaminated areas
Theatres designated for specific surgery (orthopaedic, general and dirty)
What can the patient prep area be used for?
Induce anaesthesia
Prep of surgical site
Placement of IV catheter
Catheterisation of bladder
What should the average temp of the operating theatre be?
15-20 degrees
Important as anaesthetised patients cant control body temperature
Define sepsis
Combination of infection and systemic inflammation
Define asepsis
Where no living disease causing microorganisms are present
Define antisepsis
Process of preventing the growth of infectious germs like bacteria, virus and fungi
Define endogenous
Produced or synthesised within the organism or system
Define exogenous
Describes substances originating from outside the organism
Define elective surgery
Surgery isn’t emergency and can be scheduled in advance
Define necessary/urgent surgery
Needed soon but can be delayed
Define emergency surgery
Needed ASAP, life threatening
Define clean surgery
Surgical wound made under aseptic conditions
Does not enter any contaminated viscus and there is no break in sterile technique
Eg - neutering, uncomplicated hernias
Define clean-contaminated surgery
Surgical wound made under aseptic conditions that enters the oropharynx, respiratory, alimentary or urogenital tracts, but no other source of contamination.
Eg - lung lobectomy, gastrostomy, tracheotomy
Define contaminated surgery
Major spill of contaminated material at surgery, or break in sterile technique, or entry into a viscus with a high bacterial load.
Eg- abdominal surgery where gut contents are spilled, oral surgery, wound over 4hrs old, lower bowel surgery.
Define infected surgery
Surgical site is known to be already infected
Eg - aural surgery, abscesses, old wounds, removal of necrotic tissue
What are the essentials for an operating theatre?
Adequate lighting (fixed and adjustable)
Theatre trolley
Anaesthetic machine
Scavenging
Seamless
Wall mounted clock
Positive pressure air ventilation
Crash box
Table
What equipment and design should be in the prep area?
Adjustable height table
Anaesthetic machine and selection of ET tubes and circuits
Seamless
Weighing scales
Bins (clinical, sharps, normal)
Clippers and blades
Skin prep solutions
Bandages and dressings
Restraint equip
Dental equipment
What equipment and properties should the scrub room have
Stainless steel sinks
Seamless
Elbow, knee or foot operated taps
Scrub solutions
Sterile gowns, gloves, caps and mask away from splash zone
What equipment and properties should the sterile store have?
Sterile packs of instruments and supplies in date order
Enclosed cabinet for storage
Seamless
Control of humidity/temp/handling
Disposable sterile items
What equipment and properties should the sterilisation room have?
Autoclave or appropriate sterilisation equipment
Seamless
Sterilisation pouches, nylon film, metal drums, boxes or cartons
Sterilisation indicators
Sinks for washing used equipment
What equipment and properties should the recovery area have?
Recovery cages, tanks etc
Viewing window
Seamless
Monitoring equipment
Crash trolley and emergency box
Oxygen
IV fluids and infusion equipment
Bedding
External heat sources (heat pads, water bottles, warm air blankets etc)
How long can a tourniquet be used to limit blood loss in surgery?
15-20 mins
Name the 3 suction tips and their function?
Frazier - used for fine delicate suction which may be controlled by covering the hole at the base of tip
Yankauer - has a bulb at the end which reduces trauma and allows maximum visibility. Open tip allows rapid aspiration.
Poole - specially designed to remove pooled blood, fluids and debris. Allows for pinpoint suctioning - useful in abdominal surgery.
What is cryosurgery and when can it be used?
Liquid nitrogen used to destroy living tissue by controlled application of extreme cold. Aim is to kill cells in a diseased target whilst producing minimal damage to normal surrounding tissue.
Used in - cancer, skin growths, removal of tumours or lesions, lumps/masses
Cryosurgery precautions
Liquid nitrogen = harmful substance - subject to COSHH regulations and SOPs
Only can be transported in an insulated supplied supplier metal container
Insulated gloves and full PPE when handling
Use a metal funnel when filling
Patient prep = skin clipped and basic prep and insulate surrounding skin
Skin will be erythematous and oedematous when finished
Wash and disinfect then autoclave if possible probe when thawed.
Define PAT testing
Portable appliance testing
What is the composition of surgical instruments?
Stainless steel
A ferrous alloy with a minimum of 10.5% chromium content.
Doesn’t stain, corrode or rust as easily as normal steel.
Nickel and chromium added to make it stainless.
What are some parameters of stainless steel
High resistance to corrosion
Great strength
Attractive surface finish
Chromium improves steel quality
The more chromium in the alloy the more resistant it is to corrosion
What variety of stainless steel is also known as “cutlery stainless steel”
Martensitic
May be a touch magnetic
Most commonly used in instruments
Greater hardness through heat treatment
Corrosion resistant
Provides strength and durability
Eg - biomedical cutting instruments, scissors, bone cutters and chisels
What variety of stainless steel is also known as marine grade stainless steel?
Austenitic
Immune system reaction to nickel is a potential complication
Hardened by being worked
High resistance to corrosion
Not as hard as martensitic
Eg - implants and equipment thats put under pressure, bone fixation screws and plates, body piercings, trolleys
Tungsten carbide
One of the hardest materials known (aka ‘man-made diamond’)
Hardness makes it resistant to corrosion and wear
It’s sintered at 1458°c to 3200°c
These inserts are added to instruments to enhance their performance and longevity
Inserts are micro bonded to the working end of the device
Expensive
Avoid them coming into contact with benzyl ammonium chloride
Chromium plated stainless steel
Popular as low price
Rust, pit and blister due to plated surface being susceptible to low pH solutions
Blunt quickly
Easy to maintain
Highly polished surface
Titanium
Light, strong and lustrous white metal
Alloyed with 6% aluminium and 4% vanadium
Corrosion resistant inc oxidising and chloride environments
Can be heated to 440°c
Resistant to fatigue
Often selected for metal plates or femoral stem implants
Ophthalmic instruments as less glare - inc visability
Expensive
Vitallium
More resistant to corrosion than stainless steel
Expensive to manufacture
Screws made of this bond securely to bone - care if removing to not break head off
Mostly used in dentistry
Can you use different materials with implants
NO
Stainless steel plates shouldn’t be held with vitallium screws due to electrolytic and chemical reactions
Corrosion of metal implants resulting in local tissue reaction leading to wound breakdown or non-union of the fracture.
Care with instruments used also
Name the 3 types of finishes on surgical instruments
Mirror - highly polished, doesn’t discolour easily
Satin - dull matt (low glare) has been sandblasted. Easier to stain.
Ebony - black, used for laser surgery
How should instruments be stored
Separate area
Dust free, dry and well ventilated
Ideally in closed cupboards
Handled as little as possible to minimise damage
Packed loosely on shelves
Sharp points covered
Unused packs to be repacked/re-sterilised after 12 weeks, 6mths if double bagged or up to expiration
How to lubricate instruments
Lubricants recommended by manufacturer
Avoid mineral oils and grease as they leave a film on the surface
Antimicrobial water-soluble lubricants (instrument milk)
No need to rinse