Wound care and Aseptic Flashcards
Three zones of the operating theatre?
- outer zone
- main access corridor, transfer area, documentation area and patient holding area
- clean/semi restricted zone
- clean corridor, sterile equipment, storage and anaesthesia/recovery
- restricted zone
- scrub sinks and operating room
aseptic technique
= Utilised by OT personnel to minimise the patients risk of exposure to endogenous and exogenous microorganisms when the patients natural body defences are breached during surgery or other procedures
- Refers to knowledge and application of skills required when developing and maintaining a sterile field using aseptic technique
• Area immediately surrounding the draped patient
• Sterile surgical personnel
• Sterile draped instrument tables and equipment
Surgical handwash
- technique
- duration
- drying
- what needed
Technique
• Remove jewellery
• Keep fingernails short
• Inspect skin for intactness
• Wash hands, nails & forearms thoroughly & apply a TGA approved hand disinfectant &/or antiseptic
• Rinse carefully, keeping hands above elbows
• No touch techniques apply
Durration
- first wash of the day = 5 mins
- subsequent was = 3 mins
Drying - with sterile towels
When needed - before any invasive surgical procedure
Three layers of the skin?
- epidermis
- dermis
- subcutis
Epidermis layer
• Epidermis, is the outer most layer, mainly consisting of keratinocytes, is continuously produced by the basal cell layer - a zone between dermis and epidermis.
- The new epidermal cells (keratinocytes) rising to the surface of the skin, become loaded with keratin and are eliminated by desquamation after 8-10 days.
Dermis layer
- Thickest tissue layer of the skin
- Dermal thickness ranges from 2-4 mm
- Major proteins found in the dermis are collagen and elastin
- Other cells found in the dermis are mast cells, macrophages and lymphocytes
•Beneath the dermis is the hypodermis or subcutaneous fatty tissue
Subcutis layer
• Layer of adipose tissue or fat that in addition to attaching the dermis to the underlying muscles and bone, delivers the blood supply to the dermis, provides insulation and has a cushioning effect
Function of the skin
Skin as a barrier protects against o Chemical and mechanical damage o Bacterial and viral pathogens o Ultraviolet radiation o Also prevents excessive loss of fluids and electrolytes to maintain the homeostatic environment
Factors affecting the bodys ability to maintain intact and healthy skin
o Wounds are disruptions that may occur in the skin’s integrity, leading to a loss of the skins normal functioning
o Factors that lead to the development of wounds and delays in wound healing include vascular disease, diabetes, malnutrition, medications, excessive moisture, external forces and the aging process
what is a wound
= a break in the epidermis of the skin that can lead to infection and sepsis
Types of wounds
- acute
- chronic
Chronic wounds
- Arterial and venous leg ulcers
- Pressure ulcers
- Neuropathic ulcers
- Malignant ulcers
- Chronic wounds are in principle acute wounds where the healing process has stopped or has been interrupted somewhere in the normal sequence
Acute wounds
- Burns
- Donor sites
- Aberrations - Traumatic abrasions are caused by a moving surface rubbing against the skin or by dragging along a rough surface
- Incisional/surgical wounds
- Trauma
- An acute wound occurs when healthy tissue is damaged by traumatic means, such as surgery, heat, electricity, chemical or abrasions
- The continuity of the skin surface loss
Types of wound healing
Primary = Clean, straight line, edges well approximated with sutures, rapid healing
Secondary = Larger wounds with tissue loss, edges not approximated, heals from the inside out, granulation tissue fills in the wound, longer healing time, larger scars
Tertiary = Delay 3-5 days before injury is sutured, greater access from pathogens to invade, greater inflammation, more granulation, larger scars
Phases of wound healing (4)
- immediate = haemostasis
- inflammation phase - increased blood flow
- debridement (phagocytosis
- removal of cellular debris/devitalised tissue and cleaning of wound
- macrophages adn leukocytes are dominating cells
- 2-3 days
- proliferation
- macrophages attract endothelial cells
- new capillaries are formed
- fibroblast amount increase
- collagen produced
- granulation - red appearance
- epithelialisation
- maturation
- transformation of the produced collagen will increase the strength of the connective tissue
- some of the capillaries formed during granulation will disappear thereby normalising the blood supply
- duration - longer than a year