Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
61 Cards in this Set
- Front
- Back
|
Asepsis
-define |
-process of minimizing the number of microbes present and decreasing their transport in order to decrease infection
|
|
|
Asepsis
-main concept |
-mental state
-can't depend on considering impact of each action on asepsis -have to do every action in an aseptic manner |
|
|
Sterilize
-define |
-kill all microorganisms through chemical or physical means
|
|
|
Disinfect
-define |
-destruction of pathogenic microbes or the inhibition of their growth
|
|
|
Antispetic
-define |
-germicidal chemical applied to the body
|
|
|
Is everything sterilized during antiseptic surgery?
|
-NO
Some things: -disinfected -cleaned -covered |
|
|
Goal of aseptic technique
|
-to create and maintain a situation that make infection unlikely to occur
|
|
|
Surgical infection
-definition |
-10^5 bacteria/gram of tissue
|
|
|
Surgical infection
-critical inoculating dose depends on: |
-local environment
-patient -bacteria |
|
|
Surgical infection
-most common cause |
-endogenous bacteria
|
|
|
Surgical infection
-patient factors |
-extremes of age
-poor health (immunocompromise) -poor nutrition -shock/poor circulation |
|
|
Why is poor circulation a factor of surgical infections?
|
-poor perfusion to transport defense mechanisms
|
|
|
Surgical infection
-environmental factors |
-traumatized/necrotic tissue
-exudate (hematoma) -foreign material -antibiotics |
|
|
Surgical infection
-bacterial factors |
-virulence
-number (inoculating dose) -most common source is patient (endogenous) -air is the most common vehicle |
|
|
Bacterial concentration in the air is proportional to:
|
-activity in the room
|
|
|
Most common bacterial infections
|
-Staph.
-Strep. -Fecal Gram (-) |
|
|
Surgical infection
-most common vehicle |
-air
|
|
|
Surgical infection
-how to prevent |
-select patients appropriately
-prepare patients appropriately -prepare personnel appropriately -sterilize equipment appropriately -use appropriate technique -maintain post-op care -be aware of factors that increase risk of infection |
|
|
Factors that increase risk of infection
|
-length of surgery
-clipping hair prior to induction |
|
|
Sterilization equipment
|
-steam autoclave
-ethylene oxide -cold sterilization -plasma sterilizers -ionizing radiation |
|
|
Steam autoclave
-function of steam and pressure |
Steam:
-wet heat kills at lower temperature Pressure: -used to increase the temperature above boiling point |
|
|
Steam autoclave
-necessity for sterilization |
-needs contact with every surface
-make sure equipment is kept loose -arrange things so that air is not trapped |
|
|
Steam autoclave
-time |
minimum = 13 min @ 120C/250F
-longer for linens -plus drying time |
|
|
Ethylene oxide
-function |
-cyclic ether that kills by alkylation
|
|
|
Ethylene oxide
-efficacy |
-influenced by concentration, temp, time, humidity
|
|
|
Ethylene oxide
-time |
-need aeration time
|
|
|
Ethylene oxide
-how to get toxic results |
-gas items that have been irradiated
|
|
|
Cold sterilization
-use |
-not a good choice for most applications due to a lack of efficacy
can be used for otoscope cones, small growth removals, etc. |
|
|
Plasma sterilizer
-function |
-use vapor form of H2O2 to create reactive ions
|
|
|
Plasma sterilizer
-use |
-not for paper, fabrics, or instruments with wooden handles
|
|
|
Ionizing radiation
-use |
-used for prepackaged items (suture)
|
|
|
Instruments
-proper care |
-manual scrubbing with special detergents (debris removal for better sterilization)
-ultrasonic cleaners -instrument milk -packaging |
|
|
Instruments
-proper packaging |
-paper better than fabric (shelf life depends on wrap and storage)
-indicators -box locks should be open and instruments disassembled |
|
|
Indicators for sterilization
-types |
-chemical
-biological |
|
|
Chemical indicators
-function |
-color change indicates that the conditions for sterility have been reached
-sterility is not guaranteed, because you don't know how long the conditions were reached for |
|
|
Chemical indicators
-use |
-should be on center and outside of pack
|
|
|
Biologic indicators
-function |
-true indicators of sterility through the use of bacterial culture
|
|
|
Biological indicators
-use |
-good for periodic monitoring of sterilizer function
|
|
|
3 components to maintaining asepsis by surgical personnel
|
-attire
-behavior -scrubbing |
|
|
Scrubs
-proper use |
-should have elastic cuffs (most/all don't)
-shirts tucked in -undershirts don't protrude past sleeves -covered with lab coat outside OR and not brought outside building -don't use for dirty procedures -launder daily |
|
|
Caps
-proper use |
-cover all hair
-disposable or laundered daily |
|
|
Shoe covers
-proper use |
-new every time you enter the OR
-not used in JSL |
|
|
Masks
-function |
-no effect on environmental bacteria counts
-decrease droplets falling into wound |
|
|
Gowns
-sterile zone |
-neck to waist in the front only
|
|
|
Aseptic behavior
-what should be assumed by the doctor |
-bacteria jump from any dirty surface to any clean surface
-entire surface is contaminated -bacteria fall from any dirty surface to whatever is below -bacteria can float through air |
|
|
Aspetic behavior
-proper behavior |
-minimize motion in the OR (minimize # of people and amount of traffic)
-gowned personnel should pass back to back -nongowned personnel should never go between sterile objects/people -edges of drape are considered contaminated -a nonsterile hand should never reach over a sterile field -below the waist/table is not sterile -drapes can't be moved toward the incision once placed |
|
|
Aseptic behavior
-common pitfalls |
-moving
-reaching -opening packs -sterile zone -be aware of your whole body and your clothes |
|
|
Scrubbing
-objective |
-remove dirt and oil
-decrease transient microbes to near zero -depress resident microbes |
|
|
Scrub solutions
-main solutions |
-Iodophors
-Chlorhexidine gluconate -Alcohols (ethyl & isopropyl) Others too |
|
|
Iodophores
-what are they |
-iodine + carrier (povidone)
|
|
|
Iodophores
-function |
-penetrate cell and increase oxidation, forming reactive ions and protein complexes
-less irritating than straight iodine |
|
|
Iodophores
-efficacy |
-good spectrum except spores
-fair efficacy in the presence of organic material -some residual activity |
|
|
Chlorhexidine gluconate
-function |
-cationic bisdiguanide
-disrupts cell membranes and precipitates cell contents |
|
|
Chlorhexidine gluconate
-efficacy |
-fair spectrum except fair against fungi and spores
-not effective with organic material -some residual activity -less irritating than iodophores |
|
|
Alcohols
-function |
-coagulate proteins
|
|
|
Alcohols
-function |
-poor with organic material
-poor against viruses and spores -good for defatting and drying ----> rapid kill -lose potency with time -irritating |
|
|
Patient prep
-goal |
-to reduce the surface bacteria
(20%below surface and inaccessible) |
|
|
Patient prep
-general rule of hair removal |
-15 cm to each side of incision
|
|
|
Hair removal
-wound treatment |
-use sterile, water-based gel
|
|
|
Scrub
-antispetic generally used with alcohol |
-chlorhexidine
|
|
|
Surgical asepsis
-facility characteristics |
-clean daily
-separate OR (not for other purposes) -appropriately ventilated (positive pressure, laminar flow, high turnover) -closed off -low traffic -clean and dirty OR (if possible for different surgical procedures) |
