Asepsis

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Asepsis
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• Asepsis -
• important to prevent contamination and infection
• aseptic technique
• maintain asepsis
• broken asepsis

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• disinfection -
• sanitization -
• sterilization -
• antiseptic -

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• Aseptic Technique - limit contamination as much
  as possible
• -
• -
• -
• -
• -

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• microorganisms contaminate surgery via 2 routes
• -
• -
• exogenous factors are the ones we can best control

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• risk of contamination ____________ under
  anesthesia
• contamination does not mean __________
• dependent on
• -
• -
• -
• -

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• classification of surgical procedures
• clean -
• clean-contaminated -
• contaminated -
• dry/dirty -

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• sx classification affects
• use of sterile or cold sterile instruments
• level of PPE
• location of procedure
• perioperative meds
• other aspects (cost, etc)

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Sterilization
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Physical SterilizationChemical Sterilization
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• Physical Sterilization
• -
• -
• -

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• filtration -
• radiation -
• filtration and radiation are typically performed
  by the manufacturer before shipments
  - anything that comes pre-sterilized
  - items which cannot
  be heat sterilized (cant be cooked
  in-house)

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• heat - most common sterilization technique
• dependent on
• temperature
• duration of exposure
• /- pressure
• Dry Heat or Wet Heat

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• dry heat
• -
• -
• -
• -
• -

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• wet heat - boiling or pressure/steam
• boiling is unreliable (can add an alkalinizing
  agent to increase efficacy) - cannot be used for
  rubber or glass
• pressure/steam - autoclave

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• Autoclave
• heat -
• pressure -
• time -

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• steam ______ __________ ___ _______ of the pack
• Gravity Displacement (
  )
• Pre-Vacuum Sterilizers
• -

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• proper pack preparation is critical
• wrap materials must be _______ _____________
• _________ or _____________
• double thickness muslin
• crepe paper, polypropylene fabric, plastic
  pouch/tube
• many practices double wrap

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• flash sterilization
• instruments are placed in a __________ _______
  tray
• -
• removed with detachable handles and carried to
  surgery
• -

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• after standard autoclaving, packs must cool
  slowly to prevent condensation
• -
• -
• -
• -
• door should be cracked to _______ _______ - 15-20
  minutes
• dont leave packs in autoclave longer than needed

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• QC
• ensure proper technique
• autoclave maintenance - autoclave cleaner
• sterility indicators
• must be used in combination as not one covers all
  requirements

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• sterility indicators
• -
• -
• -
• -

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• handling sterile packs - the outside is not
  sterile
• dust free, dry, well-ventilated, away from
  contaminated areas - closed cabinet is safer than
  open
• broken sterility - tape is broken, dropped on
  floor, wet, broken outer wrap
• never assume sterility - autoclave again
• monitor dates for expired sterility (clinic
  protocol)

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• Chemical sterilization - liquid or gas used to
  eliminate microorganisms
• liquid -
• gas -

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• EO - at room temperature is a colorless gas,
  flammable and explosive, toxic (skin burns, resp
  irritation, V, headaches, birth defects)
• requires special unit with ventilation and proper
  training, is known to be very expensive

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• -
• -
• -
• -

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• chamber is typically kept at 70-140 degrees F
• double dose exposure can half duration
• minimum 35 humidity required
• 48 mins - 24 hrs (12 hrs at room temperature)
• packs must be quarantined in well ventilate area
  for 7 day or an aerator for 12-18 hrs after
  sterilization
• basically - _________ to sterilize with EO

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• Gas Plasma -
• cannot be used for wood, paper, linen, some
  plastics, liquids
• debate over use on endoscopes
• wrap in non-woven polypropylene fabric or plastic
  pouch

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• Gas Plasma Sterilization
• packs placed in chamber (or suite)
• vacuum is drawn
• hydrogen peroxide is vaporized
• after 50 minutes the pressure is lowered and
  radio waves create gas plasma
• free radicals kill microorganisms
• sterilization in 1 hr total

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• Cold Sterilization -
• Cold Sterilization -

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• instruments are immersed in a liquid disinfectant
  with intent to dramatically decrease or
  completely eliminate microorganisms
• cold tray - a metal tray, usually with a shelf
  system, dedicated to cold sterilization

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• glutaraldehyde for __________ - sterile
• used for arthroscopes an endoscopes
• has to be reconstituted and will expire
• -
• chlorhexadine - good for dirty surgery, dentistry
  - do not leave in for more than ___ hrs

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INSTRUMENTS
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Brown-Adson Thumb Forceps
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Rat ToothThumb Forcep
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Mayo-Hegar Needle Holders
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No. 3 Bard Parker Scalpel Handle
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No. 10 Scalpel Blade
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Allis Tissue Forcep
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Rochester-Carmalt Forcep
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Kelly Forcep
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Halsted Mosquito Forcep
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Snook Spay Hook
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Mayo Operating Scissor
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Metzenbaum Operating Scissor
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Blunt-Sharp Operating Scissor
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Backhaus Towel Forcep/Clamp