1
Q
Asepsis (definition)
A
absence of microbes
2
Q
Sterile (definition)
A
absence of living microorganisms (inanimate objects)
3
Q
Surgically clean (definition)
A
destruction of all accessible microorganisms on the surface (living organisms=our patients)
4
Q
contaminated (definition)
A
a surface or structure where microorganisms are present
5
Q
What is considered a surgical site infection? (SSI)
A
infection from a surgical incision within 30 days of surgery
6
Q
What is considered a surgical site infection if an implant was used?
A
1 year
7
Q
What is the most common hospital acquired infection?
A
surgical infections
8
Q
What are the possible consequences of surgical infections?
A
- cost
- morbidity
- mortality–euthaniasia from cost
9
Q
What can be sources of microbes for surgical site infection?
A
- environment
- patient
- surgeon
- surgical site–traumatic wound
10
Q
What can be sources of microbes for surgical site infection?
A
- environment
- patient
- surgeon
- surgical site–traumatic wound
11
Q
What are three ways to design the operating room to reduce infection risk?
A
- clean, mixed and contaminated areas
- designed OR for contaminated vs clean procedures
- positive airflow–air flows from OR to corridors
12
Q
What is the operating room cleaning protocol?
A
- clean after each procedure and at start and end of the day
- walls and tables easy to clean
13
Q
Why should you limit traffic and personnel in the OR?
A
because +1 person =30% more infections
14
Q
What are 5 methods of sterilization?
A
- steam sterilization
- gas (ethylene oxide)
- plasma (H2O2) sterilization
4.
15
Q
What are 5 methods of sterilization?
A
- steam sterilization
- gas (ethylene oxide)
- plasma (H2O2) sterilization
- ionizing radiation
- cold chemical
16
Q
How does steam sterilization work?
A
- autoclave
- steam under pressure 121 degrees for 15-30 minutes
- coagulates proteins
17
Q
What does steam sterilization (autoclave)
A
- cleans instruments
- correct packing, wrapping
- proper positioning in unit
18
Q
How does gas (ethylene oxide) sterilization work?
A
- kills microbes by alkylation
19
Q
How does gas (ethylene oxide) sterilization work?
A
- kills microbes by alkylation of proteins
20
Q
What is gas sterilization used for?
A
heat and moisture sensitive equipment
21
Q
What are disadvantages of gas sterilization?
A
- flammable, explosive gas
- very toxic to personnel if exposed
- long sterilization cycle
- needs aeration before use
22
Q
How does cold sterilization work?
A
- glutaraldehyde used
2. submerge for 10-12 hours
23
Q
What is cold chemical sterilization used for?
A
equipment sensitive to heat that can be submerged
24
Q
Why must equipment that is cold sterilized be rinsed well?
A
it is irritating
25
What are disadvantages of cold chemical sterilization?
1. takes a long time
2. adverse health effects (resp, dermal)
3. do NOT use for any major procedure. will get infection. avoid if can
26
How do we know sterilization worked?
1. CLEAN instruments
2. chemical indicators BOT autoclave tape AND indicator strips
3. biological indicators: nonpathogenic spores (bacillus)--no growth
27
What are 6 general patient factors that influence surgery site infection
1. disease status (ASA classification)
2. nutritional status
3. age, gender? (male>female)
4. distant infection
5. very dirty-->bath and allow to dry
6. duration of hospitalization
28
What are 6 general patient factors that influence surgery site infection
1. disease status (ASA classification)
2. nutritional status
3. age, gender? (male>female)
4. distant infection
5. very dirty-->bath and allow to dry
6. duration of hospitalization
29
What are anesthesia patient factors that affect surgical site infection?
1. ASA classification
2. hypotension (perfusion)
3. peri-operative hypothermia (pefusion)
4. anesthetic drugs--older; propofol--lipid substrate--contaminated
5. total anesthesia time--immune function compromized
30
How much does risk of infection go up every hour the animal is under anesthesia
30%
31
What is the patient infection rate with clean wounds (surgical incision)?
2.5%
32
What is the patient infection rate with clean contaminated wounds (surgical incision into viscous organ)
4.5%
33
What is the patient infection rate with contaminated wounds?
7.3%
34
What is the patient infection rate with infected wounds?
18.1%
35
What is overall infection rate of wounds
5.1%
36
What is overall infection rate of wounds
5.1%
37
What are the recommendations for clipping hair?
1. use #40, wide clip NOT razor
2. wide clip
3. AFTER anesthesia induced
4. avoid paws if can
38
What is the goal of skin preparation?
1. remove dirt
2. reduce resident microbial count
3. inhibit rapid rebound growth of microbes
39
What antiseptics should be used in skin preparation
1. alcohol + chlorhexidine
| chlorhexidine > povidone iodine
40
What is the minimum contact time for antiseptics?
3 minutes
41
Why does chlorhexidine have residual activity?
1. binds to keratin
42
Why does chlorhexidine have residual activity?
1. binds to keratin
43
What is the technique for skin preparation?
1. sterile prep--sterile gloves
2. use dominant hand to prep, other hand to pick up
3. circular pattern
4. don't go back to middle with same sponge
5. don't scrub too hard (skin abrasions)
44
What is the goal of draping the patient?
create a barrier to prevent spread of microbes from the patient to the surgical site/surgeon
45
What thread count of cloth is an effective barrier?
270 IF DRY (can deteriorate with age)
46
Why is important that drapes be dry?
if water can get though then bacteria can too
47
What is an alternative to cloth drapes
synthetic polymers
48
What is the technique of placing surgical drapes?
1. use four drapes, place on clipped area
3. secure with towel clamps
2. single large drape to cover the entire patient and table
49
What 3 things should you NOT do when placing drapes?
1. do NOT readjust the drapes once placed
2. do NOT reuse the towel clamps
3. do NOT use a penetrating towel clamp on the final drape into the patient--can create a route that bacteria can get in
50
What 3 things should you NOT do when placing drapes?
1. do NOT readjust the drapes once placed
2. do NOT reuse the towel clamps
3. do NOT use a penetrating towel clamp on the final drape into the patient--can create a route that bacteria can get in
51
Why is surgeon preparation important?
to minimize contamination of patient by surgeon
52
What is proper surgical attire?
1. dedicated surgical scrubs
2. surgical caps that cover all hair, NOT cloth
3. mask--new each surgery
4. shoe cover/booties or dedicated OR shoes
53
What do surgical gowns provide in terms of protection?
a WATERPROOF impermeable barrier
54
Why is it a problem if cuffs get wet?
they are contaminated
55
Is there a difference between paper and treated cloth as to which you should use?
no, as long as waterproof
56
What percent of gloves have holes before wearing?
1.5%
57
Up to how many gloves have holes by the end of surgery and which hand is more common?
1. 26%
| 2. nondominant common
58
Why are hydrogel gloves better than powder gloves?
because powders cause inflammation (granulomatous)
59
Why are hydrogel gloves better than powder gloves?
because powders cause inflammation (granulomatous)
60
What are 5 surgical techniques that decrease the likelihood of infection?
1. strict asepsis
2. tissue trauma
3. amount of hemorrhage
4. dead space
5. surgical time
61
How much does infection rate increase for each hour of surgery?
it doubles
62
In which surgeries should you use prophylactic antibiotics?
1. strong risk of infection
2. long surgeries >90 minutes
3. infection is catastrophic (implant)
63
What are the most common microbes that infect surgical sites?
1. staph (on skin)
| 2. e. coli
64
What are the most common group of antimicrobials used in prophylaxis for surgery?
cephalosporins
65
What are the 3 principles of prophylactic antibiotic administration?
1. high tissue levels at time of incision (IV, at time of anesthesia)
2. repeat every 90 minutes
3. stop when skin closed
66
Does it help if you give antibiotics for more than 24 hours?
no it increases infection
Surgical skills
flashcards
Decks in class (23)
# Cards
-
Aseptic technique66
-
Wound classification43
-
Wound healing43
-
Early wound management53
-
Second intention healing55
-
Suture materials82
-
Primary wound closure36
-
Hemostasis57
-
Dead space and drainage33
-
Tension and plasties25
-
Skin flaps and grafts62
-
Intra-abdominal adhesions71
-
Minimally invasive surgery24
-
Fracture biomechanics and classification44
-
External coaptation31
-
Internal fixation: pins, wires and interlocking nails37
-
External skeletal fixation (internal fixation)31
-
Screws and plates32
-
Bone healing and fracture42
-
Malunion, delayed union, nonunion25
-
Fracture healing assessment13
-
The tauma of major surgery11
-
Bandaging28
