Surgical Preparation and Techniques Quiz

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Questions and Answers

What is a key benefit of using 280-count scrubs over 140-count scrubs?

More comfortable

Better barrier properties (correct)

Easier to launder

Less expensive

Which of the following is NOT a component of the surgeon's preparation?

Mask

Wearing jewellery (correct)

Theatre hat

Aseptic hand prep

Which principle is vital for preventing surgical site infections during the peri-operative period?

Inadequate hand washing

Post-op scab care

Using unsterilized instruments

Prophylactic antibiotics (correct)

How does laundering affect scrub attire in surgical settings?

Barrier properties are lost after 75 cycles (D) Signup and view all the answers

What is one of Halsted's principles related to surgical technique?

Minimize the use of force (B) Signup and view all the answers

Why is it important to prepare the instruments before surgery?

To prevent the spread of infection (D) Signup and view all the answers

Which of the following should NOT be included in patient preparation for surgery?

Encouraging open scars post-surgery (B) Signup and view all the answers

What role do theatre shoes play in surgical preparation?

They help in preventing the spread of bacteria (B) Signup and view all the answers

What is the primary benefit of using prophylactic antibiotics in a surgical setting?

Lower infection rates (C) Signup and view all the answers

In which of the following surgical procedures should prophylactic antibiotics be used?

Contaminated surgeries (D) Signup and view all the answers

What is the recommended time frame for administering prophylactic antibiotics before a surgical incision?

30 minutes prior to incision (C) Signup and view all the answers

Which of Halsted's principles of surgery emphasizes the importance of minimizing blood loss during operations?

Meticulous haemostasis (D) Signup and view all the answers

What type of procedure necessitates the use of antibiotics post-operatively if there is a break in asepsis?

Clean-contaminated procedures (B) Signup and view all the answers

What is the primary purpose of wearing a theatre hat during surgery?

To reduce contamination of the surgical wound (D) Signup and view all the answers

Which statement about theatre shoes or shoe covers is correct?

They help maintain a mental barrier between clean and dirty areas. (C) Signup and view all the answers

What is a major drawback of using masks during surgical procedures?

They can redirect airflow towards the incision site. (B) Signup and view all the answers

How long should the thorough scrub last during aseptic hand preparation?

4 minutes (B) Signup and view all the answers

Which antiseptic is effective at killing bacteria, fungi, and viruses at 0.1% concentration?

Iodophors (C) Signup and view all the answers

What is a consequence of prolonged scrubbing during aseptic hand preparation?

It can cause trauma to the skin. (B) Signup and view all the answers

What is the immediate action of alcohol as an antiseptic?

It works quickly as a bactericidal agent. (D) Signup and view all the answers

What effect does chlorhexidine have more than 6 hours after application?

It is toxic to fibroblasts. (D) Signup and view all the answers

Which antiseptic is known to cause necrosis in open wounds?

Alcohol (A) Signup and view all the answers

What is a significant drawback of using masks in surgical procedures?

They can restrict airflow around the surgical site. (A) Signup and view all the answers

What is the primary purpose of using prophylactic antibiotics in peri-operative care?

To protect against anticipated bacterial infection (A) Signup and view all the answers

Which action is NOT considered part of effective patient preparation for surgery?

Administering general anesthesia (B) Signup and view all the answers

What is a major disadvantage of reusable gowns for surgeons?

Poor barrier properties leading to contamination (B) Signup and view all the answers

What factors can contribute to dermatitis at the surgical site?

Endogenous bacterial microflora (C) Signup and view all the answers

Which of the following statements about gloving is TRUE?

A percentage of gloves may have holes at the start or end of surgery. (D) Signup and view all the answers

What is the primary goal of ‘draping’ during surgery?

To provide a sterile working area (A) Signup and view all the answers

Which type of antiseptic action allows for a cumulative effect after several days of use?

Residual action (C) Signup and view all the answers

What is a disadvantage of using disposable gowns for surgeries?

They can be expensive and require large storage space. (A) Signup and view all the answers

During the final aseptic skin prep, which method is generally recommended?

Utilizing back and forth/friction movements (A) Signup and view all the answers

Which of these is a significant risk when using prophylactic antibiotics in surgical settings?

Development of antibiotic-resistant bacteria (C) Signup and view all the answers

What is essential to ensure before the surgery begins regarding the surgical instruments?

They must be cleaned, disinfected, and sterilized (C) Signup and view all the answers

What is one common issue that can arise from clipping hair at the surgical site?

It can cause inflammation and liberate bacteria from skin pores. (C) Signup and view all the answers

Which of the following statements about skin flora is TRUE?

Endogenous flora normally lives on skin and hair. (C) Signup and view all the answers

Which method should be avoided when preparing surgical sites?

Using razors for shaving site hair (D) Signup and view all the answers

What is the primary benefit of meticulous haemostasis during surgery?

It improves visualisation and healing. (C) Signup and view all the answers

Which factor increases the risk of infection in injured or crushed tissue compared to uninjured tissue?

Lower bacterial threshold for infection (D) Signup and view all the answers

What does the elimination of dead space in a surgical wound primarily help to reduce?

Fluid accumulation and tension (B) Signup and view all the answers

How does minimizing tension on tissues during surgery benefit healing?

It enhances perfusion and reduces inflammation. (C) Signup and view all the answers

What is a primary goal of strict asepsis in surgical procedures?

Minimizing bacterial contamination (B) Signup and view all the answers

Which aspect is crucial for accurate tissue apposition during surgery?

Ensuring leak-proofing in certain areas (D) Signup and view all the answers

What is the risk associated with a weak fibrin seal in post-operative care?

It can easily be disrupted by certain actions. (C) Signup and view all the answers

What is an effective method to reduce contamination of a surgical wound during post-operative care?

Applying barriers in an aseptic manner (D) Signup and view all the answers

In surgical techniques, what is the relationship between perfusion and healing?

Good perfusion enhances healing by delivering essential components. (A) Signup and view all the answers

What is a consequence of allowing bacterial entry into a post-operative wound?

Infection development (B) Signup and view all the answers

What primarily distinguishes an incisional (superficial) SSI from an incisional (deep) SSI?

Location of the infection (B) Signup and view all the answers

Which treatment is recommended if there are no systemic signs of infection in an SSI?

Swab for culture and sensitivity (D) Signup and view all the answers

What is an important method to reduce the transmission of nosocomial infections?

Maintaining routine hospital cleaning protocols (C) Signup and view all the answers

What is a characteristic sign of deep incisional SSIs?

Purulent discharge from deep incision (A) Signup and view all the answers

Under what circumstances is antibiotic treatment not needed according to the guidelines?

If the incision is clean and closed (A) Signup and view all the answers

What is the focus of the PROTECT protocol regarding antibiotic use?

Implementation of strategies to prevent antibiotic resistance (A) Signup and view all the answers

Which protocol is crucial for managing infected wounds effectively?

Swabbing and culturing non-fresh contaminated wounds (B) Signup and view all the answers

What is a recommended method for ensuring hand hygiene in a hospital setting?

Cleaning hands before touching patients with any wounds (B) Signup and view all the answers

When would aggressive treatment of an SSI be warranted?

When the patient presents with septic symptoms (C) Signup and view all the answers

What is a recommended strategy for wound hygiene in preventing SSI transmission?

Keeping wounds covered at all times (C) Signup and view all the answers

Study Notes

Learning Objectives

Students will be able to achieve surgical asepsis for elective surgery and apply these principles in practice
Recognize the importance of aseptic products and the methods for sterilizing surgical instruments and materials
Understand correct instrument sterilization and preparation techniques
Comprehend and describe Halsted's surgical technique principles
Appreciate the significance of these principles and the repercussions of not following them

Prevention of SSI

Pre-operatively: Hospital and theatre design, instrument preparation (cleaning, disinfection, sterilization), surgeon preparation, patient preparation
Peri-operatively: Prophylactic antibiotics, surgical decision-making/technical skills, Halsted's principles
Post-operatively: Post-op incisional care and advice

Surgeon Preparation

Surgeon should wear a theatre hat, no exposed hair, a mask, gloves, and gown
Ensure no jewellery is worn and aseptic hand preparation is done
Utilize theatre shoes and shoe covers
Using scrubs
Scrubs decrease debris and bacteria in the theatre
Comfortable, lint-free, durable, easy-to-launder scrubs are recommended
Scrubs should have a 280+ count for better performance than a 140-count alternative
Scrub properties decrease after repeated laundering
Laundering does not sterilize scrub materials
Regular sterilization is required
Correct tucking is important
Theatre hats reduce surgical wound contamination with microorganisms
All healthcare professionals in the operating room should wear theatre hats

Surgeon Theatre Preparation

Theatre shoes or shoe covers shield the operating room from hospital bacteria and external bacteria
Shoe coverings maintain a clean/dirty area separation

Surgeon Theatre Preparation - Masks

Surgeons should wear masks to protect the surgical wound from saliva droplets and microorganisms
Airflow should be directed away from the incision site to avoid infections

Surgeon Preparation- Aseptic Hand Prep

Thorough hand prep before procedures
Removing dirt and oil, and cleaning under short nails
Scrubbing is important for reducing the risk of infections associated with the use of surgical tools on surgical patients
Avoid prolonged scrubbing as it could cause skin trauma
Use of brushes is not recommended because it could cause injury to the skin
Alcohol-based solutions are increasingly preferred for hand sanitization

How to handwash

Handwashing process with clear steps to follow
The process takes 40-60 seconds
Visual inspection is necessary when hands are overtly soiled

Antiseptics

Antiseptics are chemicals used on patients or surgeons to kill microorganisms
Asepsis is the absence of microorganisms on living tissue

Antiseptics Types

Iodophors
Chlorhexidine
Alcohol-based Sterillium

Antiseptics Mechanism of Activity

Different mechanisms of activity depending on the antiseptic type.
Iodophors block cell synthesis
Chlorhexidine interferes with cell membranes
Alcohol denatures proteins

Antiseptics actions

Immediate action: Removes a certain amount of microorganisms quickly
Persistent action: Prevents recolonization for a longer amount of time
Cumulative antimicrobial actions: Effectiveness lasts for more than 5 days

Surgeon Preparation - Gowning

Disposable or reusable gowns
Sterility is achieved from lower shoulder level to table height and sleeves
Important to maintain appropriate use of drapes

Surgeon Preparation - Gloving

Proper gloving practices are crucial
Replenishing hair follicles is important

Surgeon Preparation - Open Gloving

Hands are kept clear and free from infection and the spread of potential contagions

Surgeon Preparation - Closed Gloving

Techniques for safe handling and use of gloves are required

Surgeon Preparation - Plunge Gloving

Staff assistance is required

Patient Preparation

Removing transient organisms from the patient's skin
Reducing endogenous bacterial microflora on the skin
Bathing controversial
Clipping and primary aseptic prep
Vacuum and lint roller
Clean and disinfect
Use Chlorhexidine or povidone-iodine for scrubbing
Position for surgery
Final aseptic skin prep

Patient Preparation- Draping

Impermeable to fluids
Resistant to tearing
Secure to the patient
Sterile working area between instruments and surgeon.
Fenestrated
Four-corner draping

Patient Preparation - Cover hands and incision

Hand-covering to protect hands.
Location of incision and hand placements

Patient Preparation- Drape Placement

Last drape is furthest, first drape closest

Prevention of SSI(reiterate)

Pre-operatively, peri-operatively, and post-operatively

Peri-operative Prophylactic Antibiotics

Prophylactic antibiotics protect against anticipated bacterial infections
Risks of use include anaphylaxis and antibiotic resistance
Benefits are lower rates of infection
Costs may vary

Peri-operative Prophylactic Antibiotics- Indications

Risk of infection is high, catastrophic development of SSI is likely
Suggested uses include clean-contaminated, contaminated and dirty procedures, and clean orthopedic procedures

Treating SSI

If no systemic signs- Treat as a traumatic infected wound
Swab for culture and sensitivity
Broad spectrum antibiotics pending results
Encourage resolution with surgical treatment Open, explore, debride, lavage, repair Remove any implants if possible
Close over drain or manage open implant
Antibiotics if implant - 4-8 weeks
If systemic signs - 5-7 days
Recurs attempt implant removal where possible

Treating SSI - If septic

Aggressive treatment is necessary
IV antibiotics, analgesia
Surgery, once the body is stable.

Responsible Antibiotic Use

Awareness of antimicrobial resistance.
One health
Cooperation between animal and human physicians

Wound Preparation

Wound clipping and cleaning
Aseptic skin preparation

Top Tips

Many theatre practices are based on assumption with little evidence
Effective theatre scrubs are important for discipline
Hand hygiene, glove use, surgical site disinfection should be standard practices in the operating room
Further research is needed regarding other possible causes of SSI
Good technique and principles are crucial
Responsible use of antibiotics is paramount

Noscomial Infections

Lots of antibiotics used in hospitals to manage infections
Resistant bacteria are a threat
Horizontal and vertical transmission reduction is vital
Barrier practices should be standard
Swab and culture infected wounds for treatment

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Description

Test your knowledge on the essential principles of surgical preparation and techniques. This quiz covers the benefits of scrub attire, components of surgeon preparation, and critical surgical principles to prevent infections. Enhance your understanding of the steps necessary for a successful surgical procedure.