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chapter 7

preventing preoperative disease transmission

antisepsis on test is the process by which most organisms not all located on animate surfaces are destroyed. antiseptic : name used to describe the solutions that are used by the sterile surgical team members to perform the surgical scrub and the prep solutions used on the patient for perspective skin preparation of the surgical site.
bioburden on test the number of microbes or amount of organic debris on an objects at any given time; gross contamination on surgical interments or supplies.
formatie on test inamiate object that harbors mircootgmaisms .
strike - through contamination on test is contamination of a sterile field or package that occurs from the passage of fluid through a microbial barrier.
sepsis on test infection usually serious and systemic ; a compined by fever, results from the presence of pathogenic microorganisms.
glutaraldehyde on test is a high-level disinfectant . its common commercially as cidex. soak for 20 minutes sterilitet 10 hours it must be used during a 14- to 28- day period to determine its concentration strength. all items that are disinfected with this must be rinsed off in sterile water before use on patient.
sodium hypochlorite on test is also known as household bleach is an effective disinfectant for surfaces, floors, and equipment.
phenol or carbolic acid on test is usually as a concentrate with detergent additives and is diluted with tap water. phenol is used to disinfect larger areas such as floors and conuntertops and may be used on a general basis as a health care facility cleaning agent.
Quaternary ammonium compounds on test these compounds are commonly called quats , are bactericidal , fungicidal and pseudoimonaical . they aren't spheroidal , virusicdial or TB cidal they only stun them
prions on test is short for proteinaceous infectious particle . prions are different from other infectious agents in that they are nonliving protein strands and do not contain DNA or RNA. Prions are very resistant to chemical and physical sterilization methods such as steam under pressure , ethylene oxide, dry heat.
packaging (envelope fold) step 1) items to be wrapped are prepared for sterilization, 2) assemble all necessary supplies , 3) place the wrapper diagonally on a flat surface, 4) place item to be wrapped in the center of the wrapper , 5) place the internal indicator near the center of the package in a visible location, 6) the nearer corner of the wrapper is folded of the item, 7) a tab is created by folding 2-3 in, of the corner the item , 8) one side of the wrapper is foleded over the item , 9) the corner is mitered if nescessary, 10) a tab is created by folding 2-3 in. of the corner back onto the self , 11) the opsite side of the wrapper is folded over the item, 12) the corned is miltered, 13) the final flap is folded ove the item, 14) the coner is miltered, 15) the corner is tu
tucked , and 16) repeat the process if second wrapper is required , 17 label the item according to facility and 18) the wrapped item is sterilized.
principle 1: sterile field is created for each surgical procedure: 1) if in doubt about the sterility of an item , consider it nonsterile and dont use it, 2) the sterile field should be created as close as possalbe to the time of use and be monitored at all times, 3) a sterile feild should never be covered with a sterile drape beaceause its impossialbe to remove the drape without contaming the steirle suppiles and instruments, 4) the ST must check the chemical indcators/ integrators to ensure the instruments have ben exposed to streilzation process, 5) instruments and sharps that come into contact with the skin of the patient should not be reused. 6) for clean-contaminated and cominated procedures seperate setups should be used for the clean and dirty portions of the procedure, 7) when removing contents from autoclave
the ST must not touch the edge of the sterilzer with the instruments, 8) the inner edge of a heat-sealed peel pack is considered the demraction line betwteen streile and nonsterile, 9) the inside of paper wrappers containg linens or otehr streile items
is considered sterile except for a 1 -in premeter around the outside edge of the wrapper , 10 ) the ciruclator is responsialbe for opeing streile packing , 11) the top of a sterile dreaped table is the only portion that is consiered streile, 12any item
extending or falling below the table edge is considered non sterile. 13) once sterile drapes have been placed they should be respotiton , 14) the integerity of sterile packages must be checked before opening , 15) sterile package found in storage
areas commonly used for stroage of nonsteile ites must not be used, 16) if sterile pacakge that is wrapped before woven material drops to the floor this can allow for the imposion of air into package, 17) puncutres , tears or strikes thorugh compromies
the sterility of the drapes, 19) if a permeable drape covers table or sterile field and any liquid falls on it the drape either from above or below the drape is non sterile , 20) sterile package and drapes should be stored smooth clean, dry surfaces to
prevent damage to packing materials, 21) unnecessary pressure should not be placed on sterile packs to prevent forcing out air to pull forward and 22) if towel clip used on the sterile filed is punctured any draping meatial the tips of the instruments mus
clamed unstierle an should be left in place unitl the end of the prodcure.
principle 2: sterile team members must be apporrivitly attired prior to entering the sterile field 1) the surgical gown is sterile in front 2 in . below the neckline to tabe level, bilaterally, and sterile glove hands and gown sleeves up to 2in above. 2) when team member is standing at table the gown is considered sterile to the top of the operating table or the back table's top surface, 3) the arms should not be folded with the hands tucked into the armpits. 4) hands should be not allow to fall below table level, 5) the back of the surgical gown is considered unsterile, 6) a separate sterile surface should be used for gowning and gloving to avoid contaminating the back table , 7) the stockinette cuff of the surigcla gown is considered nonsteirle and should be covered by the cuff of the steriel glives all the time. 8) members of the sergical team sho sit only when the entire surgical procedure will be performed in the sitting position, last one : if a member must stand on platform should be positioned before the person approaches the filed.
principle 3: 1) only sterile items and sterility attired person's many contact sterile areas, 2) only sterile members are able to touch sterile surfaces and items , 3) the circulator and other non sterile personnel must not touch or come into the steirel surfces or items or wlak in steild fild , 4) scrubbed personal should stay close to the sterile filed thorugh the proceudre , 5) movment within the steirle field should be kept to a minimum , 6) sterile surical team members should either pass while facin oneonther or pass back to back by rotating 360 degrees, 7 ) talking especially within the sterile field should be kept to a minimum to prevent contamination from airborne moisture and 8) a non sterile person must maintain distance of 12 in from any steril area , or field to prevent contamination,
vector on test living carrier that transmits disease , may show no signs of disease itself.
surgically clean on test mechanically cleaned and chemically disinfected but not sterile.
sterilization on test destruction of all microorganisms on inanimate surface.
classification of patient care items on test critical , non critical and semi- critical. critical - items used for invasive procedures or vascular access and carries a higher potential for causing SSI's . semi- critical : items that come into contact with mucous membranes or intact skin. non- critical items that come in contact with the patient's skin and clean environment equipment items pose to the least risk of infection.
technquies in OR when done with toals a basin with sterile water should be available with the sterile field for soaking and cleaning instruments . never saline as the saline solution can cause pitting and corrosion of the metal.
things to do before putting it in machine instruments sterile water , use an enzymatic solution , which are proteolytic enzymatic and lipolytic enzymatic cleaner.
manual cleaning on test the first step is use , 2 ) is to immerse in a solution of lukewarm water , detergent and or enzymatic cleaner with a natural ph.
what type of wrapping works with hydrogen peroxide ? on test Tyvek
bowie-dick test on the test the bowie - dick test is used in the prevacuum - type sterilization cycle to check for air removal and entertain and is conducted daily, it is perform at the first run of the day before or if it was repaired.
gravity sterilization is at on the test 15- 20 PSI
pre vacuum sterilization at on the test 27 to 30 PSI
on the test first you must pop the bi indicator an incubate if for 24 hours before the recording .
the biological indicator for hydrogen peroxide is on test baillus atrpopeaus
general characteristics of a microbe : a microbe are tiny life forms invisible to the naked and a natural part of the world in which we live. they include nonpathogenic a, parasitic life forms and viruses. in nature microorganisms convert complex organic compunds such as animal and plant matter into more simple forms through process of decay. some organisms take inorganic compounds and convert them to higher forms that can be used these organisms in the production of food products such as yogurt , beer, cheese , and antibiotics the microbial world, accounts for an estimated 60 percent of the total organic matter
human -microbe relationships when a person becomes sick or develops an infection a wound , he or she becomes keenly aware of the interaction of the microbial world with humans. microbes that live in the skin an in the body are reffered to indenous mircoflora, they include bacteria , fungi and viruses, and protozoa. indigenous microflora also commonly opportunistic pathogens . under normal circumstances these microbes are harmless , but given an opportunistic such as the ability to enter the body through a surgical or traumatic wound they become pathogens. the relationship between human host and indigenous microflora is called symbiosis.
Pathogens Associated with Surgical Site Infection Multiplication of organisms in tissues of a host is Infection. an infection that develops while a patient is in a health care facility was previously called a nosocomial infection. more recently , government agencies involved with patient care. infection control , and public health have broadened the category of these infections to health care - associated infections . these infections may affect not only a patient but also an individual who has contact with the health care faciltiy , including health care workers and visitors. HAI's may become apparent during inpatient stay, but as many as 25% of surgical site infection do not become evident until the patient has been discharged from hospital. the most recent cases by the CDC is show that in 2011 there were 72,0000 HAI's in acute care facilities with 75,000 deaths of hospitalised patients
bacteria all living thing cells are classified into two groups prokaryotes and eukaryotes . the cellar strucutre of a eukaryote is complex . thus classification includes protozoa , fungi, green, brown and red algae, and all plant and animal cells. the prokaryotes are least complex organisms whose organelles are not membrane bound like those of a eukaryote . bacteria are classified based on specific characteristics that are observed in the lab. the identification of these characterized not only helps in classifying the bacteria , but also identifies the relationship of the microbes to other microbes and humans .
Tuberculosis (TB) TB is caused by mycobacterium tuberculosis and transmitted through airborne droplet nuclei , usually affects the lungs but it also can affect the kidneys , bone , joints and skin. surgical procedures performed on known TB carriers require implementing isolation precautions including wearing gloves , protective eyewear , gown and N-95 mask. the patient must be advised of precautions including how he or she can prevent cross- contamination , and must wear a mask if outside of an isolation room.
Viruses are nonliving particles that are completely reliant on the host cell for survival . the largest virus measures 300nm, approximately the size of a small bacterium an the smallest virus is the poliovirus measuring at 30 nm. characteristics uniuqe to a virus is : viruses are obligate intracellular parasites, viral replication is directed by the viral nucleic acid within the host cell, viral cells contain either DNA or RNA and a protein coat that encases the nucleic acid, viral cells depend on the protein production of the host cell; the viral particle does not contain the enzymes required for the production of energy. the DNA or RNA is surrounding by a protein covering called the casipd that is composed of protein molecules called a capsomers . the protein coat protects the DNA and RNA an contains components that help the attachment of the virus to the host cell . the nucleic acid capsid combination is symmetrical shapes including 20 sides. helices, or even more complex shapes.
emerging infectious diseases humans are more mobile than ever before allowing microorganisms to be easily transmitted on a global basis . this is a major change for the past when there were epidemics of infection now they can be pandemics. another catogery of emerging infectious disease is increasing numbers of emerging infectious disease is increasing are becoming more drug resistant against diseases that are MDR-TB . more resistant xdr-TB that has risen because of the misuse of or mismanagement .
parasites the study of parasites is called parasitology . there are two types of parasitic human pathogens : unicellular protozoa and multicellular protozoa . common unicellular anaerobic protozoan is Trichomonas vaginalis. T. vaginalis is part of the indigenous microflora of the vagina and urethra. If normal acidity of the vagina is altered, the protozoal population will grow and cause trichomoniasis. helminth and arthropod groups belong in the metazoans category and are endoparasites. Helminths are popularly known as worms. Worms can damage body tissues and organs Helminths also cause intestinal blockage may rupture the intestinal wall if there is a large colony. Abdominal surgical procedure, to remove and repair the internal organs
fungi – Mycology: study of fungi – Eukaryotic organisms that are either unicellular yeasts or multicellular molds and mushrooms • Fungi reproduce either sexually or asexually by producing spores. • true spore is formed by either • asexual cleavage or Fungal Diseases are called mycoses (plural of mycosis) – Most are opportunistic pathogens and cause disease if patient is immunocompromised. common in HIV/AIDS patients particular fungal infection, o zygomycosis, caused by a common bread mold. o increase in number of cases of zygomycosis isfollowed the increase in the number of • organ transplants • use of immunosuppressive drugs • antibiotics. • One type o
Prevention of Disease Transmission natural defenses are the skin and mucous membranes, circulatory and chemical responses and the immunity active or passive , innate and adaptive. the CDC defines the evidence -based work practice such as hand hygiene , wearing PPE respiratory hygiene and cough etiquette and safe handling of contaminated surface in a patient care area.
Transmission-based precautions are separate guidelines for infection and prevention of cross-contamination of patients when the disease process had been diagnosed . the 4 types of precautions apply to the modes of transportation direct, indirect airborne and droplets. hosptails might have surgical team members change after cases where patients had MRSA or VRE .
methods of transmission any infection requires a primary agent , such as a bacterium , virus, fungi, or parasite. in hostpial sittings most infections are caused by bacteria and viruses m although fungi and parasites , our common in HAI's a frequent hand washing reduces it.
source pf surgical site infections or SSI"S are acquired at the time of the procedure , rather than at some point after the surgery , the major sources of microbes causing these of microbes causing these infections can be divided into two groups endogenous and exogenous sources. exogenous include preoperative, pressonal , the environment , and contaminated instrumentation.
personal the skin, hair and nares of surgical personnel are reservoirs of bacteria , which can fall from them therefore poses a risk for SSI's. so the proper PPE is required which is gloves, gown , eyewear and botnets.
environment is the second source of microbial transmission is environmental both form the fomites and through the air. SSI's have also been documented from such envrioment sources as contaminated antiseptic solutions , wound dressing, improper sterilization of instruments
the patient the two primary sources of SSI's risk is to the patient are the endogenous microflora encountered in contaminated procedures and indigenous microflora of the skin. preoperative antibiotic prophylaxis has been show to reduce SSI's. S. areus are a particular risk of SSI , even in clean procedures carriers ,ave collines of these bacteria living in the deeper laver of their skin making preoperative skin preparation less effective.
factors that increase the risk of surgical site infection. age, obesity, general health , carriers of s . aureus or MRSA, remote infections, preoperative hoplizations, pre existing illness and related treatment. other effects can be DM , maliencay , and immunosuppression. also can be hair removal , type of procedure duration of procedure,
surgical conscience is the basis for the practice of strict adherence to sterile technique by all surgical team members it involves a level of honesty and mortal integrity that every ST must uphold in order to deliver quality patient care. a ST who hesitates or can't carry through with this duty has no place in the OR. there can't be no compromise of sterile technique . Surgical conscience requires practices that put the safety and well-being of the patient first , avoiding any lapse in technique that puts the patient at risk of immediate of physical harm or potential SSI.
Disinfection Principles and Disinfecting Agents cleaning: the physical removal of Bioburden from an inanimate objects, disinfection: destruction of pathogenic microorganisms or their toxins and vectors, high levl disnfition : kills everything except sores and CJD , intermediate level disinfection kills organisms and sterilization destroys all microorganisms
basic hand washing step1: turn on faucet and adjust the water temperature, step 2: inspect hands and wrist, step 3: wet hand and wrist , step 4 app soap , step 5 use moderate frication and circle motions, 6 interlace fingers to clean the web spaces, 7 continue washing for seconds to a minute , step 8 rinse, step 9 get paper towel to dry hands , and 10 is to throw way paper towel.
modes of transmission contact: direct, indirect , droplet 0.5mm , and airborne spread 0.5mm
symbiosis the relationship between human host and indigenous microflora.
mutualism both organisms benefit from and depend on one another to a certain extent
commensalism one organism benefits but the second organism is neither benefits or is harmed
paratistim one organism benefits and the host is harmed
Created by: mlester451



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