TABLE OF CONTENTS
Disinfection: application of a chemical substance (disinfectant) with the
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General principles of aseptic technique have
been established to minimize the likelihood of
wound contamination and subsequent wound
infection.
An infection may develop due to impaired host defenses and
characteristics of the bacterial inoculums
, and as a result of
various local factors such as:
• Tissue necrosis
• Dead space
• Reduced blood supply
• Presence of foreign material
One goal of the surgical team must be to preoperatively
address patient characteristics listed above as well as
evaluate perioperative and intraoperative measures.
5. The drapes used to cover the patient, patient table, and
instrument table(s) should be impermeable to moisture. This
will ultimately lead to prevention of strikethrough
contamination.
(Strikethrough contamination is defined as the translocation
of bacteria from the nonsterile side to the sterile side of a
surgical barrier due to the material becoming saturated with
either body fluid or irrigation fluid.)
Terminologies
Importance of Aseptic Technique
Perioperative Measures
Rules to Minimize Intraoperative Contamination
Aseptic Solutions used for Veterinary Medicine
Prevention of bacterial contamination is of utmost
importance in surgical wounds. Consequences of bacterial
contamination and pursuant infection include systemic
disease, increased healing times, prolonged pain, delayed
recovery, and altered cosmesis.
Therefore, it is important to know and be aware of the
sources of bacterial contamination in the operating theater.
Perioperative measures include:
• Proper patient preparation
• Proper sterilization of surgical instruments
• Proper scrubbing of the surgeon
• Donning of sterile barriers (on both surgeon and patient)
The following slide will be a list of rules commonly followed
to minimize intraoperative contamination
6. Gowns, once donned, are considered sterile from just
below the shoulders to the waist and from gloved finger tips
to 2 inches above the elbow. Because of this, hands should
be kept above the level of the waist, close to the body, and
clasped together when not in use.
7. Scrubbed personnel that sit during a surgical procedure
should remain seated until the procedure is completed.
Sepsis: condition in which there are pathogenic
microorganisms, or byproducts of the said microorganisms,
present in the tissue.
Asepsis: condition in which there are no viable pathogenic
microorganisms present in the tissue.
Antisepsis: safe application of an agent (antiseptic) with the
purpose of removing or inactivating offending microorganisms.
An antisepticis a chemical substance that can be topically
applied toliving tissue.
These sources include:
• Scrubbed and non-scrubbed personnel within the
operating room
• Surgical equipment
• Operating room equipment
• Patient (most common source of bacteria for surgical
wound infections)
If aseptic techniques are properly followed, wound
infection is unlikely unless there is a gross breach in the
established surgical barriers.
1. Scrubbed personnel are tostay insideand only touch
objects locatedwithin the sterile field
. The converse is
equally true that non-scrubbed personnel are only allowed
outside of the sterile field.
2. Talking and unnecessary movement must be kept to an
absolute minimum.
8. Only use properly sterilized equipment that has sterility
indicators bothwithin the packand on theouter wrapping.If
sterility of an object is not known or is questioned for any
reason, consider it contaminated.
9. If a sterile instrument, contained in a sterile pouch,
touches
the open edge of that pouchwhile being opened, the
instrument is considered contaminated and a new instrument
must be opened. A surgical pack/pouch whose outside barrier
has becomedamaged, wet, or compromised in any way must
be considered contaminated and must not be used.
purpose of destroying the vegetative forms of bacteria but not the spores. A
disinfectant is a chemical substance that
can be applied to inanimate objects,
such as certain surgical instruments or operating room furnishings.
Sterilization:destruction of all microorganisms
and spores on anobject.
Sterilization can be performed by:
• application of heat (steam autoclave)
• ethylene oxide gas
• vapor phase hydrogen peroxide
• Irradiation
• chemicals (glutaraldehyde)
Sterilization is usedfor surgical instrumentsand any objectthat will have
direct contact within or around open surgical wounds .
The air in the room acts as a vehicle for introduction of
bacteria into the wound. Therefore, it is important to keep
air turbulence to a minimum by limiting:
• Number of unnecessary personnel
• Amount of needless action
• Amount of talking while in the operating theater.
This being said, there is no such thing as a sterile surgery and
there is a level of contamination that is present in all
wounds.
In most cases, an immunocompetent individual would be
able to clear pathogens in lower concentrations without
intervention.
3. Members of the surgical team should visualize the sterile
field at all times. The reason is that direct visualization of
sterile objects decreases the likelihood of contamination
with nonsterile objects.
4. The patient table and instrument table, once donned with
sterile barriers are only considered sterile at table height.
The drapes and cords that hang off of the tables are out of
the surgical team’s sight and must be considered
contaminated.
10. Pouring sterile liquid into a sterile bowl should be
performed by a nonsterile person with the sterile person
holding the bowl away from the sterile field. The nonsterile
person should carefully pour the liquid without splashing or
dripping onto the sterile field. The nonsterile fluid receptacle
must not touch the sterile bowl.
There are several antiseptic
Aliphatic alcohols
solutions that are currently
isopropyl alcohol, are effective
used in veterinary practice
against a wide range of bacteria
today.
and many viruses and it is:
Examples of these include:
• Aliphatic alcohols
• Iodophors
• Chlorhexidine.
Iodophors, such as povidone-iodine solution,
are effective against a wide range of
bacteria, fungi, viruses, protozoa, and
yeasts,
and can also be effective against bacterial
spores with prolonged contact times and it
is:
• Rapid in action
• This work by penetrating the cell wall
and
replacing the intracellular molecules with
free iodine that has been liberated by the
iodophor solution.
Chlorhexidineis effective against a
wide range of bacteria; however, it is
minimally effective against fungi and
viruses and it is:
• Rapid in action
• Works by disrupting the cell
membrane and precipitating
cellular components such as
proteins.
, such as 70%
include skin irritation, desiccation, and tissue necrosis in open wounds.
for surgical incision. But there are instances that should be taken note
• Rapid in action
• They denature bacterial cell
walls and cell wall proteins.
Dilute iodophor solutions are considered more efficacious
due to the fact that more free iodine molecules are liberated
in weaker solutions.
There is minimal residual action (therefore, reapplication
every 4 to 6 hours is warranted) and there is inactivation in
the presence of organic material, such as red and white
blood cells and necrotic tissue.
There is good residual action (up to two days) and
chlorhexidine is not inactivated in the presence of organic
material. The efficacy of chlorhexidine solution increases
with repeated applications.
Systemic absorption and hypersensitivitydo not appear to be
significant disadvantageswith chlorhexidine as with the
iodophors. However, one disadvantage of
these solutions isoptic and corneal toxicityso care should be
taken to avoid contact with the tympanic membrane and the
cornea.
There is minimal residual action when used alone and side effects
Another to take note is to know what kind of surgery is being done.
Alcohol must also be avoided in preparation of patient skin for laser
surgery to prevent the possibility of an intraoperative fire when the
Alcohols are commonly used with other agents when preparing skin
laser beam contacts the alcohol.
when to use it with other agents.
One example is using isopropyl alcohol with chlorhexidine. Alcohol
may decrease the residual activity of chlorhexidine, therefore it is
recommended not to follow chlorhexidine application with an
isopropyl alcohol rinse during skin preparation.
Higher concentrationsof iodophors have been shown to cause tissue Iodine containing detergents are commonly used when
necrosis; therefore, a1% solutionhas been advocated (1:10 dilution preparing the patient’s skin for surgical incision or the surgeon’s
of 10% stock solution). skin prior to donning sterile surgical gloves.
Side effects include cutaneous hypersensitivity reactions (up to 50%
of canine patients).
Systemic absorption of iodine is of concern on patients with open
wounds especially to very young animals, patients with large open
wounds and severe burns because it will
• Increase in systemic iodine concentration
• Cause transient thyroid dysfunction.
• Repeat application cause metabolic acidosis
A concentration of 0.05% chlorhexidine has been shown to be
effective when used as an antiseptic solution (1:40 dilution of
stock solution) in wounds.
Chlorhexidine containing detergents are commonly used when
preparing the patient’s skin for surgical incision or the
surgeon’s skin prior to donning sterile surgical gloves.