Aseptic Surgery Aseptic SurgeryLocation* Date* MM slash DD slash YYYY Observers* Copies Sent to* (List the Facility Manager, Department Chair or other responsible personnel)General Considerations location minimizes traffic/contamination (Guide, p 144) functional components (surgical support, animal preparation, surgeon scrub, operating room, postoperative recovery) are designed and separated (physically or otherwise) (Guide, p 144) appropriate drug storage, control, expiration date monitoring (Guide, pp 115, 122) safe sharps disposal system (Guide, p 74) adequate records of anesthesia and perioperative care (Guide, p 122) aseptic procedures in use for all survival surgery (Guide, pp 118-119) Score - Construction and Operation*Please SelectAcceptableMinor DeficiencySignificant DeficiencyChange in ProgramNot ApplicableSuggestion for ImprovementNotes - Construction and Operation*Operating Room effective contamination control procedures (Guide, p 144) effective cleaning procedures/dedicated tools (Guide, p 145) interior surfaces smooth and impervious to moisture (Guide, p 145) HVAC system meets Guide requirements (Guide, p 145) lighting safe and appropriate (Guide, p 145) outlets safe and appropriate (Guide, p 145) scavenging of anesthetic gases implemented (Guide, p 145) Score - Operating Room*Please SelectAcceptableMinor DeficiencySignificant DeficiencyChange in ProgramNot ApplicableSuggestion for ImprovementNotes - Operating Room*Surgical Support facility for washing, sterilizing, storing instruments and supplies (Guide, p 145) autoclave monitoring procedures are implemented (Guide, pp 119, 145) storage of autoclaved materials maintains sterility (Guide, p 145) cold sterilization procedures are appropriate (Guide, p 119) Score - Surgical Support*Please SelectAcceptableMinor DeficiencySignificant DeficiencyChange in ProgramNot ApplicableSuggestion for ImprovementNotes - Surgical Support*Animal Preparation · contains large sink to facilitate cleaning of animal and operative site (Guide, p 145) Surgeon Scrub · outside operating room, non-hand-operated sink (Guide, p 145) Postoperative Recovery · allows adequate observation, easily cleaned, supports physiologic functions, minimizes risk of injury (Guide, p 145) Dressing Area · place for personnel to change (Guide, p 145) Score - Animal Preparation*Please SelectAcceptableMinor DeficiencySignificant DeficiencyChange in ProgramNot ApplicableSuggestion for ImprovementNotes - Animal Preparation*Additional Notes Δ