ASEPSIS AND ASEPSIS AND ANTISEPSISANTISEPSIS

The notion about antisepsis (anti The notion about antisepsis (anti suppurative) was brought by the English suppurative) was brought by the English surgeon Pringl J. (1750) on the base of surgeon Pringl J. (1750) on the base of his observations. He studied the anti-his observations. He studied the anti-putrefactive effect of mineral acids, putrefactive effect of mineral acids, which were used for disinfecting of which were used for disinfecting of sewage. In the beginning of the XIX sewage. In the beginning of the XIX century Pirogov N.I, used for the century Pirogov N.I, used for the treatment of wounds the solution of treatment of wounds the solution of carbolic acid, silver nitrate, zinc sulphate, carbolic acid, silver nitrate, zinc sulphate, spirits, iodium. He considered a wound spirits, iodium. He considered a wound processing an. infection and believed the processing an. infection and believed the possibility of fighting against it possibility of fighting against it

The Hungarian obstetrician-The Hungarian obstetrician-gynecologist Zemmelvase noticed that gynecologist Zemmelvase noticed that the hands of a surgeon were the source the hands of a surgeon were the source of puerperal fever among women in of puerperal fever among women in childbirth. He was the first doctor who childbirth. He was the first doctor who used chloral water for treatment of the used chloral water for treatment of the surgeon's hands, birth tracts, surgeon's hands, birth tracts, instruments and materials. Increase the instruments and materials. Increase the purulent secretion from wombs of purulent secretion from wombs of women suffering from puerperal fever, women suffering from puerperal fever, the proved the presence of infections in the proved the presence of infections in this secretion. He managed to decrease this secretion. He managed to decrease the birth sepsis in 10 times. the birth sepsis in 10 times.

In 1882 Trendelenburg constructed an In 1882 Trendelenburg constructed an apparatus for sterilization of surgical material apparatus for sterilization of surgical material and instruments with dry steam. In 1886 and instruments with dry steam. In 1886 Bloodgood invented rubber gloves for Bloodgood invented rubber gloves for protection of a surgeon's hands from protection of a surgeon's hands from infections. Since 1890 Holoted Y. and Isege infections. Since 1890 Holoted Y. and Isege (since 1897) became to use gloves for (since 1897) became to use gloves for protection of a wound from a surgeon's hands.protection of a wound from a surgeon's hands.

Bergman E. and Shimelbus K. constructed Bergman E. and Shimelbus K. constructed a sterilizing machine for boiling the a sterilizing machine for boiling the instruments; they created metallic drums for instruments; they created metallic drums for sterilization of clothes and dressing, perfected sterilization of clothes and dressing, perfected an autoclave.an autoclave.

The measures to prevent an infection from entering The measures to prevent an infection from entering a wound are referred to as a wound are referred to as asepsis, asepsis, while those to while those to cause the exclusion or destruction of harmful microbes cause the exclusion or destruction of harmful microbes are generally called are generally called antisepsisantisepsis..

The two principles represent the united whole in The two principles represent the united whole in the prophylaxis of surgical infections. They have to be the prophylaxis of surgical infections. They have to be considered in terms of the interrelationship between considered in terms of the interrelationship between the source of infection and its mode of transmission the source of infection and its mode of transmission and the susceptibility of the body.and the susceptibility of the body.

The source is taken to mean the place of dwelling, The source is taken to mean the place of dwelling, growth and proliferation of microorganisms. Relative growth and proliferation of microorganisms. Relative to the patient the source of infection can be either to the patient the source of infection can be either exogenous (from outside) or endogenous (from within exogenous (from outside) or endogenous (from within the body).the body).

The main sources of exogenous infections include The main sources of exogenous infections include patients with purulent inflammation or healthy carriers patients with purulent inflammation or healthy carriers of the microbes, and occasionally animals.of the microbes, and occasionally animals.

The modes of transmission from exogenous sources The modes of transmission from exogenous sources are usually as follows: airborne, direct contact and are usually as follows: airborne, direct contact and implantation.implantation.

The major The major sources sources of endogenousof endogenous infections infections incorporate chronic infections incorporate chronic infections outside the area of the operation (e.g. outside the area of the operation (e.g. skin diseases, dental or tonsillar skin diseases, dental or tonsillar conditions) or of the organs operated on conditions) or of the organs operated on as is (e.g. appendicitis, cholecystitis, as is (e.g. appendicitis, cholecystitis, osteomyelitis), as well as the oral, osteomyelitis), as well as the oral, intestinal and respiratory saprophytes.intestinal and respiratory saprophytes.

Among the Among the modes modes ofof transmissiontransmission of of endogenous infections are direct endogenous infections are direct contact, lympho- and haematogenous contact, lympho- and haematogenous spread.spread.

Types of antisepsisTypes of antisepsisPhysicalPhysical - the creation of unfavorable - the creation of unfavorable

conditions for development of microorganisms in conditions for development of microorganisms in a wound and for suction of microbe toxins and a wound and for suction of microbe toxins and products of tissue decay. The drainage provides products of tissue decay. The drainage provides the outflow of wound contents and promotes the the outflow of wound contents and promotes the removal of toxins, microbes and products of removal of toxins, microbes and products of tissue decay. Irrigation of gauze with hypertonic tissue decay. Irrigation of gauze with hypertonic solutions highly increases its hydroscopic quality solutions highly increases its hydroscopic quality but tampons with wound exudation prevent the but tampons with wound exudation prevent the outflow from the wound, which is why they are outflow from the wound, which is why they are not good for drainage.not good for drainage.

The open method of treatment can be used The open method of treatment can be used (ATU). The wounds are dried; as a result, (ATU). The wounds are dried; as a result, unfavorable conditions for development of unfavorable conditions for development of microorganisms are created. microorganisms are created.

► The mechanical The mechanical antisepsis: the hygienic bath, antisepsis: the hygienic bath, shaving, and extermination of tissues lacking vital shaving, and extermination of tissues lacking vital capacity. In 1898 Fridrih P. proposed the primary capacity. In 1898 Fridrih P. proposed the primary surgical treatment of a wound by means of cutting off surgical treatment of a wound by means of cutting off its borders, walls and a bottom within healthy tissues.its borders, walls and a bottom within healthy tissues.

► ChemicalChemical - the use of different chemical substances - the use of different chemical substances with bacterial and bacteriostatic effects. These with bacterial and bacteriostatic effects. These substances must be safe for the human organism and substances must be safe for the human organism and its cells. They are used for treatment of the its cells. They are used for treatment of the operational field, hands of a surgeon, sterilization of operational field, hands of a surgeon, sterilization of gloves, surgical instruments, stitch materials, gloves, surgical instruments, stitch materials, desinfection of rooms.desinfection of rooms.

► Biological - Biological - is the procedure aiming to increase the is the procedure aiming to increase the immunity and to strengthen the protective power of immunity and to strengthen the protective power of an organism. A includes specific vaccines, immuno-an organism. A includes specific vaccines, immuno-serums, globulin, blood transfusion, plasma, serums, globulin, blood transfusion, plasma, anatoxins.anatoxins.

► MixedMixed - - the simultaneous use of some types of the simultaneous use of some types of antisepsis. For example for treatment of wounds: the antisepsis. For example for treatment of wounds: the primary surgical treatment is mechanical, washing a primary surgical treatment is mechanical, washing a wound and surrounding skin - chemical, the use of wound and surrounding skin - chemical, the use of antibiotics -biological, putting the dressing-physical.antibiotics -biological, putting the dressing-physical.

Chemical substances.Chemical substances.1.1. The group of haloids - the derivatives of chlorine The group of haloids - the derivatives of chlorine

and iodine. Their interaction with hydrogen of a and iodine. Their interaction with hydrogen of a microbe cell causes coagulation of protoplasm microbe cell causes coagulation of protoplasm proteins. They use chloramin B (0,5 – 2% solution), proteins. They use chloramin B (0,5 – 2% solution), iodonate (1% water solution), uodopiron, and iodonate (1% water solution), uodopiron, and iodophorm.iodophorm.

2.2. Oxidants, getting in contact with tissue, release Oxidants, getting in contact with tissue, release oxygen with possesses a strong oxidizing effect, oxygen with possesses a strong oxidizing effect, thus unfavorable conditions for anaerobic and thus unfavorable conditions for anaerobic and putrefactive microbes are created. They use: the putrefactive microbes are created. They use: the solution of hydrogen peroxide (3% water solution), solution of hydrogen peroxide (3% water solution), potassium permanganate (0,1-2% water solution).potassium permanganate (0,1-2% water solution).

3.3. Acids and alkalis - more often salicylic acid and Acids and alkalis - more often salicylic acid and boric acid, sodium hydrocarbonat are used.boric acid, sodium hydrocarbonat are used.

4.4. Aldehydes are strong bactericidal preparations: Aldehydes are strong bactericidal preparations: formaldehyde, glutaldehyde, and formaldehyde, glutaldehyde, and hexamethylentretramine. Severe toxic.hexamethylentretramine. Severe toxic.

5.5. Spirits are strong disinfective means. As usual Spirits are strong disinfective means. As usual ethyl spirits (70-96% solution) are used.ethyl spirits (70-96% solution) are used.

6.6. Hypertonic solutions - are weak antiseptics Hypertonic solutions - are weak antiseptics possessing irritating and counter-attracting effects. possessing irritating and counter-attracting effects. They use the hypertonic solutions of sodium chloride They use the hypertonic solutions of sodium chloride (10%), glucose (10% and 40% solutions).(10%), glucose (10% and 40% solutions).

7.7. Salts of heavy metals - are strong and drastic Salts of heavy metals - are strong and drastic antiseptics clocking sulphohydrical groups and antiseptics clocking sulphohydrical groups and causing the protein coagulation of microorganisms. causing the protein coagulation of microorganisms. Many substances of this type are not used now Many substances of this type are not used now because of their toxic effects. They use the because of their toxic effects. They use the preparations of silver.preparations of silver.

8.8. Phenols are processing products of coat-tar, oil and Phenols are processing products of coat-tar, oil and resins. They denaturate and coagulate proteins of resins. They denaturate and coagulate proteins of protoplasma in bacteria. There are phenocarbolic protoplasma in bacteria. There are phenocarbolic acid, birch tar, ihtiol, and naphtalene oil.acid, birch tar, ihtiol, and naphtalene oil.

9.9. Dyestuffs – are organic combinations dying tissue and Dyestuffs – are organic combinations dying tissue and processing bactericidal effect: methylene blue, processing bactericidal effect: methylene blue, brilliant green, and acridine lactate (rivanol).brilliant green, and acridine lactate (rivanol).

10.10. Detergents – are drastic surface-active combinations, Detergents – are drastic surface-active combinations, retailing to the group of ammonium bases. They are retailing to the group of ammonium bases. They are widely used ammonium bases. They are widely used widely used ammonium bases. They are widely used in surgerv and an operating field. They are widely in surgerv and an operating field. They are widely used in surgery for treatment. There are cerigel, used in surgery for treatment. There are cerigel, degmicide, hexidine chloride, roccal etc.degmicide, hexidine chloride, roccal etc.

Alexander Fleming made Alexander Fleming made discovery of the penicillin mold discovery of the penicillin mold

in 1928.in 1928.►The group of penicillin The group of penicillin ►The group of cephalosporines The group of cephalosporines ►Macrolids Macrolids ►The group of levomycetine The group of levomycetine ►Tetracyclines Tetracyclines ►RiphamRiphamppicins icins ►Antibiotics of different groups Antibiotics of different groups ►Antibiotics of last generation Antibiotics of last generation ►Antifungous antibiotics Antifungous antibiotics

Sulphanilamid Sulphanilamid preparations.preparations.

It is large group with antimicrobial It is large group with antimicrobial action. They break methabolic processes action. They break methabolic processes in bacterial cells and cause bacteriostatic in bacterial cells and cause bacteriostatic effect. They differ the sulphanilamids of effect. They differ the sulphanilamids of short activity: streptocid, etazol, short activity: streptocid, etazol, sulphadimezin and the sulphanilamides of sulphadimezin and the sulphanilamides of prolonged activity: sulphapiridasin, prolonged activity: sulphapiridasin, sulphadimetoxin, sulphalen and others. sulphadimetoxin, sulphalen and others. Because of their bad dissolubility, Because of their bad dissolubility, sediments may fall out thus blocking liver sediments may fall out thus blocking liver balls.balls.

ZonesZones in the surgical block: in the surgical block:1.1. The sterile zoneThe sterile zone, , i.e. the operating theatre i.e. the operating theatre

(to operate on patients), scrub-up room (for (to operate on patients), scrub-up room (for preoperative cleansing surgeons' hands and preoperative cleansing surgeons' hands and arms) and the room for sterilisation (to arms) and the room for sterilisation (to sterilise the instruments to be used during sterilise the instruments to be used during the operation).the operation).

2.2. The clean zone, i.e. the rooms for personal The clean zone, i.e. the rooms for personal hygiene and changing clothes of the staff.hygiene and changing clothes of the staff.

3.3. The technical zone, i.e. the rooms where The technical zone, i.e. the rooms where apparatus for air-conditioning or oxygen apparatus for air-conditioning or oxygen supplying and vacuum devices are stored.supplying and vacuum devices are stored.

4.4. The dirty zone,The dirty zone, i.e. the sister's room, the i.e. the sister's room, the room of the head of surgery and the one for room of the head of surgery and the one for dirty clothes etc dirty clothes etc

Cleaning of the operating room Cleaning of the operating room Cleaning of the room is doing by a damp cloth (1 % Cleaning of the room is doing by a damp cloth (1 %

chloramin, 3 % hydrogene oxide, 0,5 % detergents).chloramin, 3 % hydrogene oxide, 0,5 % detergents).• The current cleaning - they pick balls of cotton from the The current cleaning - they pick balls of cotton from the

floor; wipe the blood from the floor.floor; wipe the blood from the floor.• The cleaning of the operating room after the operation The cleaning of the operating room after the operation

provides its cleanness before the next operation.provides its cleanness before the next operation.• The every day cleaning at the end of the operational day The every day cleaning at the end of the operational day

and after some extra operations.and after some extra operations.• The general cleaning if fulfilled once a week according to The general cleaning if fulfilled once a week according to

the plan, in a day free from operations - they use hot the plan, in a day free from operations - they use hot water with soap, 3-6 % solution of hydrogene peroxisde, water with soap, 3-6 % solution of hydrogene peroxisde, 0,5 % solution of detergent.0,5 % solution of detergent.

• In the morning before the beginning of work all horizontal In the morning before the beginning of work all horizontal surfaces are wiped by means of a damp cloth. surfaces are wiped by means of a damp cloth. Bactericidal ultraviolet lamps are used for disinfections of Bactericidal ultraviolet lamps are used for disinfections of air. Ventilation is fulfilled by means of conditioners, the air. Ventilation is fulfilled by means of conditioners, the filter of which exterminates microorganisms. filter of which exterminates microorganisms. Temperature is no more than 24° C, humidity is no more Temperature is no more than 24° C, humidity is no more than 50 %. For special clean operations they use than 50 %. For special clean operations they use operating rooms with laminar airflow.operating rooms with laminar airflow.

Preventive measures of contact and implantation Preventive measures of contact and implantation infections.infections.

Sterilization is achieved by means of physical and chemical Sterilization is achieved by means of physical and chemical methods.methods.

Physical - thermal and ray sterilization - boiling, the sterilization by Physical - thermal and ray sterilization - boiling, the sterilization by steam under pressure, dry heat sterilization, gamma-radiation.steam under pressure, dry heat sterilization, gamma-radiation.

Chemical - the sterilization by ethylene oxide, the treatment byChemical - the sterilization by ethylene oxide, the treatment by acetic acid,acetic acid, the chemical therapeutic treatment. Sterilization the chemical therapeutic treatment. Sterilization in the autoclave (water steam) is fulfilled with 120-132° C, in the autoclave (water steam) is fulfilled with 120-132° C, pressure - 1,1 atm/sm2 during 45 min. The ray sterilization - is pressure - 1,1 atm/sm2 during 45 min. The ray sterilization - is by ionic radiation of high energetic power. They use beta- and by ionic radiation of high energetic power. They use beta- and gamma-radiations. The ultra-ionic sterilization is also possible - gamma-radiations. The ultra-ionic sterilization is also possible - the sterilizer is filled with some antiseptic, which under the the sterilizer is filled with some antiseptic, which under the influence of ultrasonic waves sterilizers surgical instruments.influence of ultrasonic waves sterilizers surgical instruments.

The chemical sterilization: ethylen oxide possesses a bacterial The chemical sterilization: ethylen oxide possesses a bacterial effect. By means of gas sterilization they treat the instruments effect. By means of gas sterilization they treat the instruments of which cannot be treated in autoclaves or air sterilizators. of which cannot be treated in autoclaves or air sterilizators. They use ethylen oxide for sterilization of catheters, gloves, They use ethylen oxide for sterilization of catheters, gloves, endoscopes, apparatuses for the artificial blood-circulated endoscopes, apparatuses for the artificial blood-circulated room.room.

The sterilization is controlled by means of a color thermodicator or The sterilization is controlled by means of a color thermodicator or a hydroquinion. They put on the paper the thermoindicator a hydroquinion. They put on the paper the thermoindicator paint of pale green color; under the temperature of 175-180°C paint of pale green color; under the temperature of 175-180°C it becomes dark brown.it becomes dark brown.

Except every day control they have a bacteriological control once Except every day control they have a bacteriological control once a week or every 10 days a week or every 10 days

The sterilization of The sterilization of instruments.instruments.

► In air sterilization procedure is carried out during In air sterilization procedure is carried out during 60 min with t° - 180°C.60 min with t° - 180°C.

► Instruments made of corrosion-resistant metals Instruments made of corrosion-resistant metals or of plastics are sterilized in the 6% solution of or of plastics are sterilized in the 6% solution of hydrogen peroxide with temperature 180°C hydrogen peroxide with temperature 180°C during 360 min. Instrument are sterilized also induring 360 min. Instrument are sterilized also in thethe solution of 3 components (2 % formaline, 0,3 solution of 3 components (2 % formaline, 0,3 % phenol, 1,5 % sodium bicarbonate) during 45 % phenol, 1,5 % sodium bicarbonate) during 45 min.min.

► Syringes are sterilized in dry-hot case with Syringes are sterilized in dry-hot case with temperature - 180°C during 60 min.temperature - 180°C during 60 min.

► Endoscopes, catheters, cistoscopes are sterilized Endoscopes, catheters, cistoscopes are sterilized by means of glutar dialdehyde and sodium by means of glutar dialdehyde and sodium hypochloride, the duration of treatment is 45-180 hypochloride, the duration of treatment is 45-180 min. min.

Sterilization of dressing and Sterilization of dressing and operational linen operational linen

►Before packing, the drums must be wiped Before packing, the drums must be wiped dry. The lid must be closed and fastened dry. The lid must be closed and fastened and the grid opened. All non-sterile and the grid opened. All non-sterile drums, as a rule, are kept apart from the drums, as a rule, are kept apart from the drums containing sterile material.drums containing sterile material.

►Dressing and linen are sterilized in Dressing and linen are sterilized in autoclaves, the pressure —1,1 atm, t - autoclaves, the pressure —1,1 atm, t - 120°C, during 45 min, or 2,0 atm, t -120°C, during 45 min, or 2,0 atm, t -132°C during 20 min. Linen can be kept 132°C during 20 min. Linen can be kept in 3 days.in 3 days.

Disinfections of surgeon’s Disinfections of surgeon’s handshands

Disinfections of hands are a good removal of Disinfections of hands are a good removal of microorganisms from the hands. And such a microorganisms from the hands. And such a case they use the tannage of skin, which case they use the tannage of skin, which prevents the penetration of microorganisms prevents the penetration of microorganisms onto the surface of the skin. The principal of onto the surface of the skin. The principal of surgical treatment: care of hands, care of nails, surgical treatment: care of hands, care of nails, the mechanical cleaning is with soap and a the mechanical cleaning is with soap and a brush during 2- 5 min, then disinfections. A brush during 2- 5 min, then disinfections. A disinfectant must be:disinfectant must be:

1.1. exterminate the micro flora quickly;exterminate the micro flora quickly;2.2. exterminate microbes in the juice of gloves;exterminate microbes in the juice of gloves;3.3. possess a cumulative effect - hands must be possess a cumulative effect - hands must be

free from microorganisms even in the intervals free from microorganisms even in the intervals of disinfections;of disinfections;

4.4. not irritate the skin.not irritate the skin.

The preparation of the operating The preparation of the operating fieldfield

Starts from the hygienic bath, shaving of Starts from the hygienic bath, shaving of hair. For the treatment of the operating field hair. For the treatment of the operating field they use iodonate, iodopiron, chlorhexidin they use iodonate, iodopiron, chlorhexidin before its usage, dissolving the initial solution before its usage, dissolving the initial solution in 4,5-5 times boiled or sterilized water. They in 4,5-5 times boiled or sterilized water. They use the other antiseptics for the treatment of use the other antiseptics for the treatment of the operating field 1% solution of degmycide, the operating field 1% solution of degmycide, 1% solution of roccal or catamine A-B, 2,4 % 1% solution of roccal or catamine A-B, 2,4 % solution of pervomur. For the disinfections of solution of pervomur. For the disinfections of the mucous membrane they use 1 % solution the mucous membrane they use 1 % solution of diamond green, 3 % solution of hydrogen of diamond green, 3 % solution of hydrogen peroxide, 1 % solution of iodonate or peroxide, 1 % solution of iodonate or iodopiron, 0,5 % spirits solution of hibitan iodopiron, 0,5 % spirits solution of hibitan