Sx Skills - Principles of Asepsis

drraythe's version from 2016-05-05 10:43


Question Answer
Most common cz of Sx site infxn is...Bacteria from the PTx 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 Infxn (SSI)?Infxn that results directly from surgical procedures
Aseptic technique should try to consider what 4 things?(1) Environment (air)
(2) PTx
(3) Our team
(4) Sx equipment
(Not sure if important) Dr Halsted's amazing surgical principals are...Asepsis
Accurate anatomical dissection
Gentile tissue manipulation
Avoid excess tension on tissue during wound closure
Accurate tissue approximation in wound closure
4 non-surgical ways to reduce the risk of Sx site infxn?(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 infxn?(1) Atraumatic surgical technique (GE GENTLE!)
(2) Debride thoroughly
(3) Minimize dead space
(4) Minimize suture tension
(5) Use good hemostasis
(6) Accurate skin closure
(7) Minimize surgical time
(8) 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 itSurgical site
Draped sterile fields
Air space over sterile fields
Surgeon only sterile from mid-chest to waist & elbow to fingertips
only sterile at table height
10 Commandments → #3: What do surgeons do w/ their hands?Surgeons always keep hands clasped in front & 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 (dis y we have a radio in the sx suite)
10 Commandments → #10: If you are in doubt about something being sterile...WHEN IN DOUBT, CHANGE IT OUT! (It is never wrong to assume something in contaminated & ask for a new one)
Minimum pre-surgical database?CBC
What kinda pre-surgical medications should you consider?Sedation + pre-emptive analgesia & +/- ABx
If there is a Sx 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 2 steps of surgical site preparation?(1) Clip & vacuum area (NEVER SHAVE)
(2) Cleansing of site
Explain how you perform the initial cleansing of the surgical site (what DONT you do?)First, alternating gauze swabs w/ CHG & alcohol (X3) Moving the swap in a spiraling-out fashion & then changing the swab after you get the edge (DONT spiral back in, drags contaminants)
Using of PVI & Alcohol is not recommend since the alcohol ↓ 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 & orthopedic procedures. After timed scrub (MIN 5 minimum), spray surgical site w/ 10% PVI
Aseptic preparation requires timed scrub!!!! → WHAT IS THE MIN. CONTACT TIME? What is the exception?Minimum 5 minute contact time. Exception is alcohol based antiseptics (bc the alcohol+antiseptics are more efficacious)
Which would you rather have for pre-operative antisepsis → CHG (chlorhex) or PVI (povidone iodine)CHG > PVI for pre-operative antisepsis (40% ↓ in SSI (aka surgical site infxn))
Which antiseptic is recommended by CDC for catheter site preparation?CHG-alcohol (50% ↓ in catheter-site infxn vs. PVI)
******If you apply towel clamp & it touches skin, if you have to preposition, what should you know?You need a new towel clamp! (WHEN IN DOUBT, CHANGE IT OUT!!)
Explain Solo-Sx draping vs Assistant-Sx drapingW/ solo draping, the last drape placed is the 1 on the opposite side of the table
W/ assisted draping, the cranial & caudal drapes are are placed last
Steps to preparing the surgeon for Sx… DONE IN THE Scrub room!! (6 steps)(1) Remove all jewellery and ensure long hair is tied up
(2) Put on face mask & surgeon’s cap
(3) Open Sx gown pack & surgical glove package
(4) Timed hand scrub then pat dry hands w/ sterile towel (5 MIN)
(5) Put on surgical gown
(6) Surgical gloving
Explain closed vs open glovingCLOSED GLOVING = Hands remain w/in sleeve of gown

OPEN GLOVING = Hands are exposed
Why do surgeons scrub their hands, even tho they will be wearing gloves?In case there is... punctured/torn glove, exposed gown cuff, sleeve soak through
****Do you scrub elbow to finger or finger to elbow?Should scrub from fingertips & work towards the elbow! NOT the opposite
Hand scrubbing is all about...Contact time (******5 MIN*****)
2 min for left hand, 1 min forearm, 2 min right hand, 1 min forearm
Rinse from fingertip to elbow
If you have a hard brush on the scrub sink, what do & don't you use it for?Use to clean nails (alternatively, use nail pick if hard brush isn't available) but only use to clean nails. Use sponge w/ appropriate antiseptic for all other aspects of cleaning (except fingernails)
What situations call for open gloving & 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

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