Sx Skills- Principals of asepsis

untimely's version from 2015-05-06 23:49


Question Answer
most common cause of sx site infection is...the bacteria from the patient itself
what is Aseptic technique?encompasses all methods used by the surgical team to minimize/prevent contamination of the surgical field
what is a Surgical site infection (SSI)?infection that results directly from surgical procedures
aseptic technique should try to consider what 4 things?(1) environment (air) (2) patient (3) our team (4) sx equipment
(not sure if important) Dr Halsted's amazing surgical principals he contributed were...asepsis, hemostasis, accurate anatomical dissection, gentile tissue manipulation, Avoid excess tension on tissue during wound closure, Accurate tissue approximationin wound closure
4 non-surgical ways to reduce the risk of sx site infection?(1) tx existing infxn (2) Minimize hospitalization time (pre & post) (3) Clip surgical area ~ don’t shave (4) Minimize number of OR personnel
8 surgical ways to reduce the risk of sx site infection?Atraumatic surgical technique, Debride thoroughly, Minimize dead space, Minimize suture tension, Use good hemostasis, Accurate skin closure, Minimize surgical time, Minimize sutures; use monofilament wherever possible
10 Commandments--> #1: where should the sterile person stay?Sterile persons stay in sterile area –no wandering!
10 Commandments--> #2: There is a STERILE ZONE. Describe itIt is it Surgical site, Draped sterile fields, Air space over sterile fields, Surgeon only sterile from mid-chest to waist & elbow to fingertips, Table only sterile at table height (See pic on slide 7)
10 Commandments--> #3: what do surgeons do with their hands?Surgeons always keep hands clasped in front and above waist when not in use
10 Commandments--> #4: who handles what in regards to items?Sterile items handled ONLY by sterile personnel; non-sterile items handled ONLY by non-sterile personnel
10 Commandments--> #5: how should non-sterile people be acting around the sterile zone?Non-sterile personnel NEVER reach over sterile field; keep a distance of at least 1 foot from sterile zone
10 Commandments--> #6: If you are moving around the sterile zone, how should you do it?Always face sterile field/zone when moving past to minimize accidental contamination; pass others back-to- back
10 Commandments--> #7: what's sterile instrument ettiquette like?Edges of instrument packs considered unsterile –instruments that contact these edges are contaminated
10 Commandments--> #8: what if the sx pack is damaged or wet?Damaged or wet surgical packs considered unsterile
10 Commandments--> #9: how should everybody's behavior be like?Minimize… talking, movement
10 Commandments--> #10: If you are in doubt about something being sterile...When in doubt… consider contaminated
minimum pre-surgical database?CBC, Chem, UA
what kinda pre-surgical medications should you consider?Sedation + pre-emptive analgesia, and +/- abx
if there is a surgery in the area of the bladder, or if you can't get a sample of urine pre-surgically, what can you do?Following induction of anesthesia, attempt to express bladder! (where appropriate)
what are the two steps of surgical site preparation?(1) Clip+vacuum area (2) cleansing of site
explain how you perform the initial cleansing of the surgical site (what DONT you do?)First, alternating gauze swabs with CHG & alcohol (X3), moving the swap in a spiraling-out fashion and then changing the swab after you get the edge (DONT spiral back in, drag contaminants). use of PVI & alcohol is not recommend since the alcohol decreases the efficacy of PVI
if you have an eye sx, which scrub do you wanna use?Povidone-iodine 10%!! not irritating to eye, but chlorhex is
Povidone-iodine 10%--> which procedures is this great to use as an antiseptic solution for? explain what you do?periocular and orthopedic procedures. after timed scrub (MIN 5 MIN), spray surgical site with 10% PVI
Aseptic preparation requires timed scrub!!!!--> WHAT IS THE MIN. CONTACT TIME? what is the exception?min. 5 minute contact time. exception is alcohol based antiseptics (bc the alcohol+antiseptics are more efficaceous)
which would you rather have for pre-operative antisepsis--> CHG (chlorhex) or PVI (povodone iodine)CHG > PVI for pre-operative antisepsis (40% decrease in SSI aka surgical site infection)
which antiseptic is recommended by CDC for catheter site preparation?CHG-alcohol (50% decrease in catheter-site infection vs. PVI)
CQ: if you apply towel clamp and it touches skin, if you have to preposition, what should you know?you need a new towel clamp!
explain solo surgical draping versus sx+assistant sxwith solo draping, the last drape placed is the one on the opposite side of the table. With assisted draping, the cranial and caudal drapes are the ones which are placed last
Steps to preparing the surgeon for surgery… DONE IN THE Scrub room!! (6 steps)(1) Remove all jewelleryand ensure long hair is tied up (2) Put on face mask & surgeon’s cap (3) Open surgery gown pack & surgical glove package (4) Timed hand scrub then pat dry hands with sterile towel (5) Put on surgical gown (6) Surgical gloving
explain closed vs open glovingCLOSED GLOVING= hands remain within sleeve of gown. OPEN GLOVING= hands are exposed
why do surgeons scrub their hands, even though they will be wearing gloves?in case there is... punctured/torn glove, exposed gown cuff, sleeve soak through
****CQ: do you scrub elbow to finger or finger to elbow?should scrub from fingertips and work towards the elbow! NOT the opposite
CQ: hand scrubbing is all time (******5 MIN*****)
if you have a hard brush on the scrub sink, what do and don't you use it for?use to cleab nails (alternatively, use nail pick if hard brush isn't available) but only use to clean nails. Use sponge with appropriate antiseptic for all other aspects of cleaning (except fingernails)
what situations call for open gloving, and which call for closed gloving?Open gloving is just when you might wanna put on a pair of sterile gloves. Closed is when you are going to do sterile sx