Question | Answer |
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 |