Round Table Presentation Asepsis &

Instruments

Asepsis
Definitions
Pathogenic = the ability to cause disease in a

living organism
Asepsis = the maintenance of a pathogen-free
environment; the reduction of micro-organisms
to a level that will not cause infection
Sterilization = the destruction or elimination of
all living micro-organisms and their spores
Disinfection = the destruction of pathogenic
microorganisms on an object to a harmless level
Some disinfectants are not effective against spores

Definitions
Antiseptic = destroys pathogenic organisms

on living tissue
Sanitation = the reduction of the number of
organisms on an object to an acceptable
health standard; also refers to rendering an
object aesthetically pleasing and clean
Suffixes
cidal has a killing action
static inhibits growth

Animal prep
Prep/scrub of surgical site(s) Surgical site(s) must be prepared by closely

clipping and removing the hair

This should be done in an area separate from
where the surgical procedures are to be
performed
Avoid skin abrasions and thermal injuries during
clipping and avoid clipping excess hair as this
may exacerbate hypothermia

Animal prep
Preparation of the site should include
Use of an appropriate skin disinfectant applied
in three cycles of scrubbing with a surgical soap
(Chlorhexidine, Iodophore)
Rinsing with sterile water or 70% isopropyl
alcohol between each scrub with soap
Using sterile cotton swabs or gauze,
disinfection should begin along the incision line
and extend outward in a circular pattern

Animal prep
Draping of animal/surrounding area
The use of a sterile drape over the animal is
used to prevent contamination of suture
material and to assure a sterile field at the
surgical site

Surgeon Prep - Scrubbing

After donning scrubs, mask & cap
Wash hands for 30-60sec
Scrub hands and fingers
Wash and then scrub forearms
Rinse and repeat
Dry with sterile towel

beginning with fingers and moving towards the

forearms, use new towel for each hand

Total scrub time should be around 5 minutes

Surgeon Prep - Gowning

Grasp the exposed

inside surface and lift

the gown away from
the table
Unfold the gown by
placing hands into the
arm holes
Continue placing
hands and arms
through the sleeves
An assistant fastens
the neck and the
inside waist ties
Proceed with gloving
before the fastening of
the final outside tie

Surgeon prep
Gloving
Closed gloving is performed after the surgeon

has donned his/her gown, but BEFORE the

surgeon pushes his/her hands through the cuffs
of the gown; gloves are pulled on as the hands
are pushed through cuff
Open gloving is also done after donning the
gown, but the hands are pushed completely
through the cuffs

Surgical Area
Traffic - access to persons not directly

involved in the activities should be limited

during the surgical procedure
Designated support areas ideally should
include components such as animal prep,
surgeon scrub, holding and recovery areas
outside of the OR

Surgical Area
OR - the area in which surgery is conducted

should be free of clutter and disinfected prior

to beginning the surgical session.
This area should be located away from air

supply ducts or other drafts to minimize

hypothermia of the animal and limit
accumulation of dirt and dust contamination on
surfaces

Creative
Draping/Sterilization
Draping accessory and support equipment (e.g.
lights, microscopes, monitoring
equipment/leads, anesthesia machine,
cautery equipment, etc.) can allow the
surgeon to maintain a sterile field if
adjustments to equipment are needed during
the procedure

Sterilization
Autoclave
types/methods
Moist heat
Effectiveness dependent upon temperature,
pressure, and time (normal is 121C / 15psi / 15min)
Indicators range from exterior color changes on
packages, to interior and load indicators for the
specific type of autoclave

Ionizing Radiation
Gamma Radiation

Requires special equipment and training

Sterilization
Gas
types/methods
Ethylene oxide, Plasma Vapor

ETO requires 30% or greater relative humidity for

effectiveness against spores and requires safe
aeration time
Plasma vapor can not be used on cellulose-based or
absorbable materials
Both gasses are good for heat/moisture sensitive
instruments/devices
Specialized pouches have color indicators, also need
load and interior pack indicators

Cold
Gluteraldehyde, Clidox
All materials must be rinsed in sterile saline
Most are corrosive to instruments and require
prolonged contact times

Sterilization
types/methods
Flashing and Bead sterilizers
flashing in the autoclave = normal is 131C /

30psi / 3 min; instruments must be placed in

special metal containers with aeration holes
flashing via open flame = not recommended
as it is hard to regulate the temp and time,
often resulting in warped, permanently
damaged tips on fine instruments
Bead sterilizer = ~15 seconds/instrument

Instruments
Handling /cleaning/care basics
Lubricant also called instrument milk for

all instruments with metal on metal moving

parts
Scissors, hemostats, needle drivers, self-

retaining retractors, etc.

Do NOT use WD-40 or motor oil !!

Ultrasonic Cleaner best way to clean any

instrument, but especially good for hinges and

any instrument with teeth or grooves

Handling / cleaning/care
basics
Packing and wrapping
Disposable pouches Great for single instruments,

make sure theyre wide enough to accommodate

the instrument in an unlocked/open position
Trays use towels or other absorbent layer in the
bottom if autoclaving to prevent wet packs
Never lock an instrument during autoclaving!
Steam will not penetrate all areas (true for gas sterilization
too)
Will develop cracks in hinges because of heat expansion
during cycles

Handling / cleaning/care
Staining with use basics
Brown/orange = phosphate deposits (from dirty autoclave

water source, high alkaline soaps) or blood

A pencil eraser will remove these, but not true rust

Black stains = acidic detergent residue during autoclave/high

heat processing

Always rinse with DI water before sterilization

Rainbow stains = excessive heat, may have lost metal

integrity

Use heat source that has set ranges/know temps (e.g.: Germinator)

Out of the box Stained Sometimes carbon steel instruments come with an oily coating

on them from the manufacturer, this is normal and helps

prevent corrosion its just mineral oil; this should be cleaned
off prior to initial sterilization

Material selection
Carbon Steel is the hardest of materials
Tips may become brittle with excessive heat
Highly magnetic and stains easily

Stainless Steel an alloy (mix of metals)

many different types and grades

Varying levels of stain resistance and magnetism
Can still rust, corrode and pit

Titanium lightest of the alloys used

Extremely corrosion, heat and stain resistant

Completely non-magnetic

Ceramic offered mostly as a coating

Very hard, scratch resistance, no reflection for work

under microscope
Anti-corrosive, biocompatible

Instrument Selection
Use and user preference may dictate tip

shape and angle, overall weight, and handle

length and type
Surgeon preference

Hand size
Height

Tissue to be manipulated

Bone, brain, muscle, skin, etc

Position / location of tissue

Depth, surrounding structures

Instrument Selection
Why different tips?
Smooth, Teeth or

grooves?
Tissue retention
holes, catheter
holding grooves,
vessel dilation?

Instrument Selection

Instrument Selection
Straight vs. curved

vs. angled?

Instrument Selection
Colors or Plating on handles
Can color code by type of pack, by PI, etc.
Black plated rings typically mean a razor edge
on one blade and serrated blade on the other

Easier to cut soft tissues without crushing, making

for clean smooth-edged cuts

Gold plated rings indicate tungsten carbide

inserts

In scissors this is preferred for use when cutting

thick skin or cartilage

Types / categories / uses:

Forceps / Clamps / Hemostats
Needle Holders (Drivers)
Retractors
Scissors / Scalpels
Electrocautery
Other

Forceps
Adson tissue forceps
Adson- Brown tissue

forceps

Rat toothed forceps

Dressing forceps
Dumonts

Needle
Drivers
Olsen-Hegar

Mayo-Hegar

Castroviejo

Clamps
Satinsky clamp

Cooley clamp

DeBakey clamp

Bulldog clamps

Bone

Bone curette

Rongeurs

Trochar
Osteotome

Periosteal Elevator

Allis tissue forceps

Alligator forceps

Duval forceps
Babcock forceps
Vulsellum forceps

Retractors
Army-Navy retractor

Gelpi retractor

Wilson rib spreader

Weitlaner

Retractors
Finochietto

retractor

Balfour retractor

Senn retractor

Scissors

Iris scissors

Lister bandage

scissor

Mayo scissors
Metzenbaum

scissors

Scissors
Strabismus

Ragnell

Doyen
Micro-Vannas

Scalpels & Blades

Handles come in #3 or #4 sizes
Blades 11,12, 15 & 10 fit #3 handle
Blades 22 and 23 fit #4 handle

Forceps
Kelly forceps

Mosquito hemostats

Crile forceps

Hemostats
Rochester-Carmalt

hemostat

Rochester- Peans

hemostat

Other
Stereotaxic

gear

Bovie

Human hands!

Batch Rodent Surgery /

tricks
Start with a sterile pack
Sterilize between uses =

resetting the stage