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Surg Lectures


3 designated operating room ‘areas’ restricted area, semi-restricted, & free
Principles of Aseptic Technique I Surfaces contact: (Sterile: sterile, Unsterile: unsterile); sterile never w/unsterile; permeated sterile barrier is unsterile; edges of sterile container are unsterile once open
Principles of Aseptic Technique II (gowns) gowns sterile in front (shoulder to table level); sleeves sterile from 2 in. above elbow to cuff
Mayo tray versus back table Mayo: used in scrub prep & initial incision; back table:
surgical scrub: timed method 2-1/2 min each hand; wrist to fingertips; 1/2 min wrist; 1 min on hand; 1/2 min on fingers; 1/2 min on fingertips
surgical scrub: counted stroke method nails: 30 strokes (rinse after 10 strokes to remove dislodged dirt); all sides of each finger(s) & web spaces: 30 strokes each; palm & dorsum of hand: 20 strokes each; all surfaces of arm: wrist to 2 in. above elbow: 20 strokes each
Betadine Scrub soap solution of iodophor used first to remove dirt and oils, diluted with sterile saline. Used cautiously in patients allergic to seafood or IV dyes(iodine).
Alcohol (as scrub soln) removes soap, not to be used on open wounds
Betadine Solution (Providone Iodine) iodine complex, should not be wiped off because off cidal activity. Use cautiously with patients allergic to seafood, IV dyes.
Iodine 2% (scrub) -can cause skin irritations and burns, must be rinsed with alcohol after it is applied. Contraindicated in iodine-allergic patients. Used infrequently in neuro.
Chlohexidine (Hibiclens) (scrub) prevents staining. Substitute for iodine allergic patients. Can not be used on eyes and ears.
Benzalkonium Chloride (Zephiran) (scrub) available in single use bottles; usually for the face. Nonstaining.
2 solutions for surgical hand scrub Chlorhexidine gluconate or povidone idodine solutions (rapid-acting, broad-spectrum antimicrobials)
Part of gown that is sterile in front, from shoulder to waist level, and the sleeves to 2 inches above the elbow
Types of drapes towels, sheets, split sheets, fenestrated sheets, stockinette, and plastic incision drapes
Intrinsic factors that may increase the risk of infection Malnutrition; Age; Obesity; Chronic dz; Remote focus of infection; Impaired Defense Mechanisms (eg, on steroids / immunosuppressants); Stress
Extrinsic factors that may increase the risk of infection Duration of Preop hospn; Types of Ops (esp GI / GU); Duration of Procedure; Op Technique; Wound Site; catheters / drains; Abx use; Breakdown of isolation techniques
Wound Sites that are more infxn resistant b/c of vascularity Chest, face, scalp
Wound Sites that are more infxn susceptible b/c of amount of fat tissue Abdomen, thighs, calves, buttocks
Most common cause of wound infections in a surgical pt = Acute bacterial infections
2 most common pathogens Gram Neg bacteria and Staph aureus
Define wound classification: Clean no inflammation; no break in technique; GI, GU, and respiratory tracts not entered; Expected Rate of Infection: 1-3%
Define wound classification: Clean-contaminated no inflammation or infection; GI, GU, respiratory tracts entered under controlled conditions (no heavy spillage or unusual contamination); Expected Rate: 8-11%
Define wound classification: Contaminated acute non-purulent inflammation, gross spillage or contamination from GI, GU tracts; open fresh trauma wounds less than 4 hours old; Expected Rate: 15-20%
Define wound classification: Dirty and Infected existing clinical infection; abscesses; organisms present prior to surgery
Name 4 sources of wound contam People (major source): skin / hair (staph) / Nasopharynx; Fomites; Air (dust); Human Errors (breaks in sterile technique)
Methods used to control infections: Barriers; Good Housekeeping Techniques; Isolation; Abx tx; UV Radiation
Factors Determining Type of Position Type of Anesthetic; Pain; Site of Operation; Age and size of patient
Safety considerations in pt positioning Maintain good resp fn; good circulation; Prevent pressure on mx, nerves, bony prominences; Good exposure of op field; access for admin of anesthetics
Positioning Accessories Armboards; Pillows; Sandbags; Body rolls; Stirrups, canvas straps; Foot board; Shoulder braces; Kidney rest or braces; Tape (pref non-allergenic); Head rests; Blankets and towels
Abd incision: Right Subcostal gallbladder, biliary system
Abd incision: Left Subcostal spleen
Abd incision: Median Upper Abdominal stomach, duodenum, pancreas
Abd incision: Right Upper Paramedian stomach, duodenum, pancreas
Abd incision: Left Lower Paramedian pelvic structures, colon
Created by: Adam Barnard Adam Barnard