Modern methods of antiseptics. Antiseptics. Methods

In clinical practice, mechanical, physical, chemical and biological methods of influencing microbes in the wound are used.

1) removal from the wound of foreign bodies on which microbes are located;

2) excision of contaminated wound edges (primary surgical treatment of the wound);

3) removal of dead tissues from the wound, which are a nutrient medium for the development of microbes;

4) opening the cavity of abscesses and dissection of the walls of "blind pockets" and streaks containing pus;

5) washing of purulent wounds and cavities with hydrogen peroxide solutions, etc.

All this helps to reduce the number of microbial bodies in the wound and creates conditions that prevent their further development.

Physical antiseptic

The method of active removal from a purulent wound or purulent cavity of the contents is called drainage. It can be done with drains.

The most common type of drainage is a gauze strip of various lengths and widths. The use of gauze is based on its hygroscopic property, which is enhanced if the swab is impregnated with a hypertonic sodium chloride solution (5-10% solution is used). The gauze drainage loosely standing in the wound pushes its edges apart, preventing the accumulation of purulent contents in it.

Rubber tubes and rubber strips can be used as drains when draining a purulent wound or a purulent strip. Often in clinical practice, a combination of rubber and gauze drainage is used for wound drainage (Fig. 10).

The evacuation of the contents from a wound or cavity during their drainage can be passive (into a bandage located on the wound above the drainage) and active - vacuum drainage according to Redon (Fig. 11).

b

a

Rice. eleven. Active open antibacterial drainage

one(a) and two(b) tubes

Physical antiseptics also include the use of

open method of treating wounds, ultraviolet rays, ultrasound and laser rays.

With the open method of treating wounds, due to the drying of their tissues, unfavorable conditions for the development of microbes arise, especially in cases where the wound surface is in an abacterial environment created with the help of special devices.
Ultraviolet rays have a bactericidal effect, stimulate local immunity and accelerate the processes of wound cleansing and regeneration.

The bactericidal effect of ultrasound is based on the phenomenon of cavitation - the effect on the microbial cell of pressure pulses at a speed exceeding the speed of sound, which increases the pressure in the cell up to 300 atm. and temperatures up to 700°C (physical effect), as well as on the release of H from a water molecule + and OH - , which stop redox reactions in microbial cells (chemical effect).

Under the action of high-energy laser beams, the following changes occur in the tissues:

1) the temperature rises sharply, which resembles a thermal burn;

2) there is an "explosive effect" due to the instantaneous transition of solid and liquid substances into a gaseous state, which sharply increases intracellular and interstitial pressure;

3) an electric field appears, which changes the electrical parameters, specific gravity, dielectric constant of tissues, as a result of which a sterile coagulation film is formed on their surface, which prevents the absorption of toxins.

Low-energy laser beams change the chemical reaction of tissues, sensitivity to red or infrared radiation.

Among other physical factors, diadynamic currents (Bernard currents), electrophoresis of various antiseptic substances, and X-ray therapy are widely used in clinical practice.

Chemical antiseptic

1. 
   have a pronounced antimicrobial effect;
2. 
   not have a harmful effect on the tissues of the wound and the body of the patient;
3. 
   maintain its activity in the wound for a long time;
4. 
   be produced in a dosage form convenient for use;
5. 
   be available for use in a wide clinical practice.

The following methods of application of antiseptics are known:

1. Topical application in the form of solutions, ointments, powders by:

a) constant presence in the wound (wetting tampons with an antiseptic solution, impregnating them with ointment, pouring powder into the wound, washing the wound or abscess cavity with an antiseptic solution through the drainage in them);

b) a single injection of an antiseptic into a wound or cavity (thoracic, abdominal, etc.) after prolonged and traumatic operations or during primary surgical treatment of the wound;

c) periodic introduction of an antiseptic into the wound (irrigation of a wound or a purulent cavity with fractional injections of solutions through drainage), the use of baths with antiseptic solutions;

d) introduction of an antiseptic solution into the purulent cavity by puncturing it (preliminary evacuation of pus from the cavity is mandatory);

e) treatment of the skin around the wound (treatment of the surgical field) with an antiseptic solution.

2. Impregnation of tissues around the inflammatory focus with an antiseptic solution (most often with antibiotics dissolved in novocaine - a “short block” according to A.V. Vishnevsky).

3. The introduction of an antiseptic into the tissues of the inflammation zone using physiotherapeutic procedures (iontophoresis).

4. The introduction of antiseptic solutions intramuscularly, intravenously, intraarterially, into the lymphatic duct, intraosseously. This method of introducing antiseptics affects the entire body, creating a therapeutic concentration of the drug in the patient's blood, and is used in cases where the local inflammatory process is accompanied by symptoms of general intoxication of the body, as well as to prevent its development.

All chemical antiseptics used in surgical practice are divided into groups according to their properties.

The halogen group. The antibacterial action of antiseptics of the halogen group is based on the combination of a chemical substance with the hydrogen atoms of a bacterial cell and the denaturation of the protein of its protoplasm.

Iodine tincture(Tinctura jodi) at a concentration of 5-l0% (alcohol) is used to treat the skin of the surgical field, the edges of the wound and the surgeon's hands (tanning method).

Iodonate(Iodonatum) - an aqueous solution of a mixture of sodium alkyl sulfites with iodine. A solution at a concentration of 1% is used to treat the skin in the area of ​​the surgical field.

Lugol's solution(Sol. Lugoli) serves to sterilize catgut and wash cavities, fistulous tracts and granulating wounds. Contains 10.0 g of pure iodine, 20.0 g of potassium iodide and 1000 ml of distilled water (aqueous solution) or 1000 ml of 96º alcohol (alcohol solution).

Antiseptic substances containing iodine are contraindicated for use in patients with hypersensitivity to iodine.

group of oxidizers. Preparations of this group during decomposition easily split off atomic oxygen, which at the time of release has a strong oxidizing property, which creates unfavorable conditions for the development of anaerobic and putrefactive microbes.

Hydrogen peroxide solution(Sol. Hidrogenii hyperoxidati) at a concentration of 3% is used to wash purulent wounds. When the solution comes into contact with the tissues, oxygen is released, an abundant foam is formed, which comes out of the wound, taking with it small foreign bodies, dirt, blood clots, and fibrin films.

Potassium permanganate solution(Sol. Kalii hypermanganici) at a concentration of 0.01-0.1% is used for rinsing the oropharynx, 0.1-0.5% for washing wounds, 2-5% for lubricating ulcerous and burn surfaces of the body, bedsores.

Hydroperite(Hidroperitum) is a complex preparation of hydrogen peroxide and urea. It is produced in tablets of 1.5 g. It is used for washing cavities in the form of a 1% solution (2 tablets of the drug are dissolved in 100 ml of water).

Salts of heavy metals. Under the conditions of a living organism, these substances react with proteins, forming albuminates. At low concentrations, they cause compaction of proteins in the surface layer of the cellular protoplasm (astringent action), at high concentrations, deep denaturation of proteins (cauterizing effect).

Protargol(Protargolum, Argentum proteinicum) in a solution of 1-5% concentration is used to wash the urethra and bladder.

Collargol(Collargolum, Argentum colloidal) in a solution of a concentration of 0.2-2% is used to wash purulent wounds and the bladder cavity.

Alcohols dehydrate and denature proteins.

Ethyl (wine) alcohol (Spiritus aethylicus ) 70º has a disinfectant property, and 96º has a tanning effect. It is used as an external antiseptic for hand treatment and sterilization of suture material. 40º alcohol has an active irritating property. It is used for compresses, causing vasodilation of the skin in the area of ​​​​its application.

sour t s. The mechanism of action of acids is based on their denaturation of protoplasmic proteins of cells, which leads to the death of microbes.

Boric acid(Acidum boricum) in the form of 2-4% solutions is used for rinsing the mouth, pharynx and washing the eyes. In dry form, it is poured into the wound if there is a Pseudomonas aeruginosa in the last. A sign of the presence of Pseudomonas aeruginosa in the wound is the detection of a greenish color in the wound discharge.
Salicylic acid(Acidum salicylicum) has a good keratolytic effect, accelerating the development of tissue necrosis, which leads to its use for the treatment of carbuncles (in the form of a powder it is applied to the necrosis zone in the center of the carbuncle). It is part of the Lassar paste (1.0 g of salicylic acid, 1.0 g of zinc oxide, 12.5 g of talc, 50.0 g of petroleum jelly), which is used as a drying agent to protect the skin from exposure to purulent wound secretions, intestinal and other fistulas.

Performic acid(Acidum formici superior) - a mixture of formic acid and hydrogen peroxide. A solution of this acid at a concentration of 2.4% has a good bactericidal and sporicidal effect, which allows it to be widely used to treat the surgeon's hands. This drug was called "Pervomur".

Dyes - colored organic compounds that fix and stain tissues, and also have an antimicrobial effect.

methylene blue(Methylenum coeruleum) in the form of 1-3% alcohol solutions is used as a tanning and antiseptic agent in the treatment of burns, pyoderma. Aqueous solutions of 1:5000 are used to wash the urinary tract.

brilliant green(Viride nitens) in the form of 1-2% water-

nyh or alcohol solutions are used externally as an antiseptic. Selectively acts on Staphylococcus aureus.

Rivanol(Rivanolum) in the form of a freshly prepared solution 1:1000-1:2000 is used for washing purulent cavities and wounds. It is most effective in coccal flora.

Nitrofurans. With a high bactericidal effect, these drugs are widely used in pathological processes caused by staphylococci, anaerobic bacteria and Escherichia coli.

Furacilin(Furacilinum) is used in a solution of 1:5000 for washing wounds, purulent cavities, and also in the form of an ointment 1:500 for the treatment of wounds.

Furagin soluble(Furaginum solubile) in solutions is administered intravenously (0.1% solution in the amount of 300-500 ml) or administered orally in tablets (daily dose 0.3-0.5 g).

Furadonin(Furadoninum) in tablets of 0.1-0.15 g is taken 3-4 times a day for diseases of the urinary tract.

Nitrofuran preparations are part of a film-forming aerosol - lifusol(Lifusolum), which is used to treat superficial wounds, burns. This film has an antimicrobial effect and protects the wound from secondary infection. It persists for 5-7 days.

Osmotic preparations have an antimicrobial effect, causing a decrease in fluid pressure in the cavity of the microbial cell.

sodium chloride(Natrium chloratum) - hypertonic (10%) solution of sodium chloride. A tampon impregnated with a hypertonic solution of sodium chloride more actively evacuates purulent contents from the wound.

The same properties have 10-25-40% solutions of magnesium sulphate (Magnesium sulfuricum), urotropin (Urotropinum) and glucose (Glucosae).

Detergents - surface-active antiseptics, the mechanism of action of which is based on the denaturation of microbial cell proteins, disruption of the enzymatic metabolism of microorganisms and osmotic balance.

Novosept(Novoseptum) - an aqueous solution of this drug at a concentration of 3% is used to treat the surgeon's hands and the operating field, disinfect gloves and drains.

Rokkal(Roccal) in the form of a 0.1% aqueous solution is used to treat the surgeon's hands, and a 1% solution is used to treat the surgical field.

Chlorhexidine(Chlorgexidinum) is available as a 20% aqueous solution of chlorhexidine bigluconate. It is used for washing wounds (1:400), cavities with purulent inflammation (1:1000), for which 1 ml of a 20% solution is diluted with distilled water 400 and 1000 times, respectively. The prepared solutions are sterilized in an autoclave at a temperature of 115 0 C for 30 minutes.

Quinoxaline derivatives. quinoxidine(Chinoxydi-num) has a wide spectrum of antibacterial action. It is especially effective against Escherichia and Pseudomonas aeruginosa, Proteus vulgaris, gas gangrene pathogens. Apply inside 0.25 g 3 times a day.
Biological antiseptic
Biological antiseptics include drugs obtained during the life of certain microorganisms and having a specific effect on a certain type of infectious agent, as well as increasing the immunobiological activity of the body (antibiotics, vaccines, sera, bacteriophages, various immune preparations). Biological antiseptics also include proteolytic enzymes.

The range of application of these drugs is quite wide, and the ways of their use and the direction of action are different.

Antibiotics inhibit the development and reproduction of microbial cells and create favorable conditions for effective control of microflora. In therapeutic doses, as a rule, they do not have a harmful effect on the tissues of the patient's body, do not lose activity when mixed with blood and pus, and do not have a cumulative effect. However, it should be noted that these drugs can cause an allergic reaction in the patient, and sometimes anaphylactic shock. Prolonged use of an antibiotic in large doses causes a change in the microflora of the body - dysbacteriosis, which leads to damage to it by various fungi and to the development of a serious disease - candidiasis.

In this regard, when using antibiotics to treat a patient, the following rules must be observed:

1. Treat with antibiotics according to strict indications.

2. Use for treatment only that antibiotic (or a combination of them) to which the microflora of the lesion is sensitive.

3. Prescribe antibiotics in doses indicated in the instructions for their use, maintaining the appropriate single and daily dosage of the drug.

4. Before the introduction of a therapeutic dose of an antibiotic, it is necessary to identify the allergic predisposition to it of the body (either from the anamnesis of treating the patient with antibiotics, or by testing the tolerance of this antibiotic to patients - intradermal administration of an antibiotic solution in a small dose).

5. Do not conduct short and long courses of antibiotic therapy, and in the absence of a therapeutic effect, replace one type of antibiotic (or combinations thereof) with another.

6. Do not prescribe treatment with a combination of antibiotics of the same group.

7. With the simultaneous use of several antibiotics, the possibility of their combination should be considered (Table 1).

8. Consider possible side effects of antibacterial drugs on the patient's body.

In case of complications during antibiotic therapy, it is necessary to immediately stop the administration of antibiotics and conduct desensitizing therapy: intravenous 10% calcium chloride solution, 2% diphenhydramine or suprastin solution (1–2 ml), vitamin therapy (group B vitamins) and nystatin, levorin.

Table 1

Compatibility of antibiotics with their simultaneous administration

Conventions: + + total drug effect; + sometimes increased action;

+ - sometimes weakening of action; - the combination is dangerous due to toxicity.

Currently, a large number of antibacterial drugs are known, obtained both biologically and synthetically, which are divided into groups.

1. Penicillin group: benzylpenicillin sodium, potassium, novocaine salts; bicillin-1, bicillin-3, bicillin-5; phenoxymethylpenicillin; methicillin sodium salt, oxacillin sodium salt; ampicillin carbeni-

cillin disodium salt, etc. Preparations of this group are effective against gram-positive bacteria (streptococci, staphylococci, meningococci, spirochetes, etc.).

2. Streptomycin group: streptomycin sulfate, streptomycin calcium chloride complex, etc. Preparations of this group are effective against most gram-negative and some gram-positive and acid-resistant bacteria (E. coli, staphylococci, streptococci, pneumococci, gonococci, bacilli of plague and tuberculosis).

3. Tetracycline group: tetracycline, tetracycline hydrochloride, oxytetracycline dihydrate, morphocycline, etc. Antibiotics of this group have a wide spectrum of action.

4. Levomycetin group: levomycetin, synthomycin, etc. The drugs of this group have a wide spectrum of action and are effective against bacterial strains resistant to penicillin and streptomycin.

5. A group of macrolide antibiotics: erythromycin, oleandomycin phosphate, oletethrin, olemorphocycline, etc. These antibiotics act on gram-positive bacteria and have little or no effect on gram-negative ones.

6. Aminoglycoside group of antibiotics: gentamicin sulfate, neomycin sulfate, sisomycin sulfate, monomycin, kanamycin, tobramycin, amikacin. This group of antibiotics has a wide spectrum of action.

7. Antifungal antibiotics: nystatin, levorin, amphotericin B, etc.

8. Group antibiotics cephalosporins: ceporin (cephaloridin), ceporex (cephalexin), cephalothin, cefazolin. Their use is indicated in the treatment of purulent infection caused by both staphylococcus and mixed flora (with the exception of blue-green pus sticks).

9. Carbapenem group: imipenem, pleropenem, thienam.

10. Fluoroquinolone group: ofloxacin, ciprofloxacin, levofloxacin.

Vaccines – preparations obtained from microbes and their metabolic products and used for active immunization of people for prophylactic or therapeutic purposes.

Currently, the following types of vaccines are known: 1) live, 2) killed, 3) toxoids and toxins, 4) chemical. Depending on the number of antigens included in the vaccine, monovaccines are distinguished - preparations for immunization against any one infection (cholera monovaccine, typhoid), divaccines - preparations for immunization against two infections (typhoid-dysenteric divaccine, etc.) and polyvaccines (RISI polyvaccine , consisting of antigens of typhoid, dysentery and cholera microbes and tetanus bacillus toxoid).

Serums - immune preparations obtained from the blood of animals immunized with any antigen of microbial and non-microbial origin, and containing the appropriate specific antibodies (anti-tetanus, anti-gangrenous serum).

bacteriophage - a bacterial virus capable of reproducing in a bacterial cell and causing its lysis. In clinical practice, anti-staphylococcal, anti-streptococcal bacteriophages, bacteriophage-anticols are used. A polyvalent bacteriophage containing several phages is also used when the causative agent of the infection is unknown. Bacteriophages are used to irrigate purulent wounds; infiltration of tissues surrounding the wound; they are introduced into purulent cavities through drains; with sepsis - intravenously.

To immunostimulating drugs that increase the nonspecific immunological defense of the body include:

prodigiosan - bacterial polysaccharide, stimulating leukopoiesis, phagocytosis, activating the T-system of immunity;

levamisole(decaris), stimulating the formation of T-lymphocytes, phagocytes, increasing the synthesis of antibodies;

lysozyme, acting bactericidal, enhances the action of antibiotics;

thymalin(timarin) - a drug obtained from the thymus gland (thymus) of cattle, stimulates the reaction of cellular immunity, regulates the number of T- and B-lymphocytes, enhances phagocytosis;

staphylococcal toxoid and tetanus toxoid used for prophylactic purposes for the production of specific antibodies by the human body (active immunization).

Proteolytic Enzymes have the ability to lyse (melt) necrotic tissue, fibrin, pus. They have a decongestant effect and enhance the therapeutic effect of antibiotics.

Known enzyme preparations animal(trypsin, chymotrypsin, chymopsin, ribonuclease, collagenase), bacterial(terrilitin, streptokinase, asperase, iruksol) and vegetable(papain, bromelain) origin

Proteolytic enzyme preparations are used locally in the treatment of purulent wounds, trophic ulcers, in the form of powder or ointments; in solutions, they are injected into the cavity (pleural, joint), inhaled into the respiratory tract, and soft tissues are infiltrated by electrophoresis.
Together with novocaine solution, proteolytic enzymes can be used for tissue infiltration during the initial phases of inflammation (novocaine blockades).

Biological antiseptics should include transfusion blood components- antistaphylococcal, antipseudomonal, anticolibacillary hyperimmune plasma containing the corresponding antibodies, as well as antistaphylococcal γ-globulin, antitetanus γ-globulin.

In clinical practice, a combination of antiseptic drugs and methods of their introduction into the body and into the zone of localization of the inflammatory process is most often used. This contributes to more effective treatment of the patient.

At the end of the lesson, the student should know:

1. 
   What is an antiseptic?
2. 
   What distinguishes antisepsis from asepsis?
3. 
   What do antiseptics and asepsis have in common?
4. 
   Types of antiseptics.
5. 
   Methods of mechanical antiseptics.
6. 
   What is a physical antiseptic and how is it used in clinical practice?
7. 
   Ways and rules of drainage of wounds.
8. 
   Requirements for chemical antiseptics.
9. 
   The mechanism of action of antiseptics.
10. 
    Possible dangers and complications when using antiseptics.
11. 
    What is a biological antiseptic?
12. 
    What drugs are biological antiseptics?
13. 
    Rules for antibiotic therapy.
14. 
    How to use antiseptics.
15. 
    Methods of introducing antiseptics into the area of ​​​​inflammation.

At the end of the course, the student should be able to:

1. 
   Apply antiseptics of various types (powders, ointments, solutions).
2. 
   Make a mechanical treatment of a purulent wound.
3. 
   Apply knowledge of antiseptics while working in the dressing room.

Currently, antiseptics are an integral part of surgical science and include the following types: mechanical, physical, chemical, biological and mixed antiseptics.

Mechanical antiseptic

This is the mechanical removal of infected and non-viable tissues. In essence - the primary surgical treatment of the wound. Done in a timely manner, it turns an infected wound into an aseptic surgical wound that heals by primary intention.

Mechanical antiseptic is used in the form of a surgical toilet of the wound, in which foreign bodies, necrotic and non-viable tissues are removed, streaks and pockets are opened, the wound is washed and other manipulations are aimed at cleansing the infected wound.

Physical antiseptic

Prevention and treatment of wound infection through the use of physical factors that ensure the death of microbes or a significant decrease in their number, as well as the destruction of their toxins.

Physical antiseptics include hygroscopic dressings that suck out wound secretions with a mass of bacteria and their toxins; the use of hypertonic solutions, pulling its contents out of the wound into a bandage. However, one should be aware that hypertonic solutions have a chemical and biological effect on the wound and microorganisms. Physical antiseptics also include the action of light, dry heat, ultrasound, ultraviolet rays on microbes. The mechanism of their action is not only physical, but also physicochemical and biological.

Chemical antiseptic

Exposure of microorganisms to chemicals that have a bactericidal or bacteriostatic effect. It is better if these substances adversely affect the microflora and do not have a negative effect on the cells and tissues of the human body.

Biological antiseptic

The use of biological products that act both directly on microorganisms and their toxins, and acting through the macroorganism.

These drugs include:

1. antibiotics that have a bactericidal or bacteriostatic effect;

2. bacteriophages - eaters of bacteria;

3. antitoxins - specific antibodies formed in the human body under the action of sera. Antitoxins are one of the immunity factors in tetanus, diphtheria, botulism, gas gangrene and other diseases.

Mixed antiseptic

This is the effect on the microbial cell, as well as on the human body, of several types of antiseptics. More often than not, their action is complex. For example, the primary surgical treatment of a wound (mechanical and chemical antiseptics) is supplemented with biological antiseptics (introduction of tetanus toxoid, antibiotics) and the appointment of physiotherapeutic procedures (physical antiseptics).

Depending on the method of application of antiseptics, local and general antiseptics are distinguished; local, in turn, is divided into superficial and deep. With superficial antiseptics, the drug is used in the form of powders, ointments, applications, for washing wounds and cavities, and with deep antiseptics, the drug is injected into the tissues of the wound inflammatory focus (chopping, penicillin-novocaine blockade, etc.).

General antiseptics mean saturation of the body with antiseptic agents (antibiotics, sulfonamides, etc.). They are brought into the focus of infection by blood or lymph flow and thus affect the microflora.

When prescribing antiseptics, one should always remember the maximum allowable doses of drug interactions, possible side effects and allergic reactions in patients.

There are several antiseptic methods:

1. Ultrasonic antiseptic

2. Sorbent antiseptic

3. Laser antiseptic

4. X-ray antiseptic

one . Ultrasound is used in the treatment of purulent wounds. An antiseptic solution is poured into the wound and the tip of the device with low-frequency ultrasonic vibrations is inserted. The method is called "ultrasonic cavitation of the wound", fluid vibrations improve microcirculation in the walls of the wound, necrotic tissues are more quickly rejected, in addition, water ionization occurs, and hydrogen ions and hydroxyl ions disrupt redox processes in microbial cells.

2. Recently, the sorption method of treating wounds has been increasingly used, when substances are introduced into the wound that adsorb toxins and microorganisms on themselves. Usually these are carbonaceous substances in the form of powder or fibers. The most commonly used polyphepan and various coals intended for hemosorption and hemodialysis, such as SMUS-1.

3. Low-power laser radiation (usually a gaseous carbon dioxide laser is used) is actively used in purulent surgery. The bactericidal effect on the walls of the wound makes it possible to guarantee the success of operations in cases where a purulent process usually develops. Recently, laser and ultraviolet radiation have been used to irradiate blood both extracorporeally and intravascularly. Special devices have been created for this, however, these methods are more appropriate to refer to biological antiseptics, since it is not the bactericidal effect that is important here, but the stimulation of the patient's body's defenses.

4. X-ray radiation is used to suppress infection in small, deep-seated foci. So it is possible to treat bone panaritium and osteomyelitis, inflammation after operations in the abdominal cavity, etc.

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Antiseptics - a set of measures aimed at preventing infection of a wound and the destruction of microbes in a wound, pathological formation or the body as a whole using mechanical, physical, chemical, biological methods and means.

Mechanical antiseptic – This is a surgical method consisting in the release of the wound from foreign bodies, non-viable tissues, microorganisms, which is achieved by primary surgical treatment. Mechanical antiseptics also include washing purulent wounds and cavities, opening streaks and removing necrotic tissues.

Physical antiseptic - a method that includes the impact on the wound of various physical agents and methods .

Dressing material: gauze swabs, turundas, napkins, balls are made of gauze, which has hygroscopic properties, which contributes to the outflow of wound discharge. To enhance the hygroscopic properties, gauze swabs can be moistened with a hypertonic solution of sodium chloride or another therapeutic agent (glucose, magnesium sulfate). Strengthening the outflow from the wound is facilitated by wet-drying dressings moistened with an antiseptic solution. Drying from the surface, these dressings help to remove the contents from the wound due to the capillarity of the dressing. However, after a few hours, the tampon becomes saturated with blood or pus and stops sucking the discharge, turning into a plug that prevents the emptying of the wound cavity, and therefore it is not recommended to use gauze tampons for drainage.

The outflow of the contents of the wound is facilitated by sorption dressings, dressings with water-soluble ointments containing enzyme preparations, and other biologically active substances.

For drainage of a wound, tubes of various diameters (drainages) are more often used. Drainages- are rubber or plastic tubes or strips of thin (usually glove) rubber. They are introduced into the cavity of the wound, often located along its bottom, or into the cavity of the abscess in order to remove the contents or to introduce antibacterial agents into the wound, to wash the cavities.

Evacuation of the contents of a wound or cavity can be passive or active. With passive evacuation, the contents through the drainage enter the bandage or jar (it is advisable to use Bobrov's jar) located below the level of the wound. In the case of drainage of the pleural cavity, it is advisable to use the Bulau principle. On the outer part of the drainage tube, a finger from a rubber glove is hermetically fixed, at the end of which an incision is made with scissors, after which it is immersed in a container with an antiseptic solution located at the edge of the bed. The valve formed from the finger of a rubber glove, when exhaling, will release the contents from the pleural cavity (pus, air), and when inhaling, it will prevent air and fluid from entering the vessel.

Active aspiration is carried out by connecting the drain to a three-jar suction according to Subbotin-Perthes, an electric vacuum pump, or using a Redon system (a rubber bulb or corrugated container in a compressed state will be attached to the outer end of the drain).

Physical methods include the treatment of wounds in a controlled abacterial environment, for which the limb or the patient himself is placed in a chamber in which an abacterial environment is created using a special installation.

The methods of physical antisepsis include the use of ultraviolet irradiation, ultrasonic cavitation, microwave fields, high-energy or low-energy lasers, argon-plasma flows, and X-ray therapy for wound healing.

Chemical antiseptic - prevention of infection of the wound and the destruction of microbes in it, in the pathological focus and in the body as a whole through the use of chemicals that must meet the following requirements.

They should have a pronounced bactericidal or bacteriostatic effect.

They should not have a harmful effect on the cell, tissues and the macroorganism as a whole.

They, ceteris paribus, should not sharply lose their activity in the blood, pus and living tissues of the body.

Availability, ease of use and not too high cost.

Only those products that are officially approved by the Department of State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia and have State Registration Certificates, a Certificate of Conformity of the GOST system and guidelines for use can be used in medical institutions.

Chemical antiseptics include the following groups of drugs.

HALOIDS.

Iodine preparations: alcohol iodine tincture 1% - 5% and 10% - for treating wound edges and sterilizing catgut, iodoform in the form of powders and ointments, Lugol's solution for lubricating the pharyngeal mucosa and for sterilizing catgut.

Alcoholic solutions of iodine have provided invaluable assistance in medical practice in combating infection, but at present it is not recommended to use it to treat the surgical field and the surgeon's hands (prohibited by order No. 720 of the Ministry of Health). A fairly large number of iodine-resistant strains of microorganisms have been formed. Iodine practically does not suppress fungi and yeast, is not active enough against some viruses, and does not destroy spores.

Of the other drugs, iodonate, iodinol, iodopyrone, povidone-iodine are used. These drugs have low toxicity and are mainly used as skin antiseptics.

Chlorine preparations.

Chlorine-containing preparations, when applied, release active chlorine into the air. Along with the antimicrobial action, damage to the tissues of the skin, mucous membranes occurs, the pungent odor irritates the respiratory tract, so respiratory and eye protection is necessary. In addition, chlorine-containing preparations have a strong corrosive effect. Unfortunately, in Russia the use of chlorine-containing preparations still prevails, while in Western Europe less toxic complex preparations are used for disinfection.

Chlorine amine B - used to disinfect non-metallic instruments, wash wounds and treat hands in the form of a 0.5% solution.

Bleaching powder(active principle calcium hypochlorite) contains active chlorine at a concentration of 28 to 36%. It is used in the form of 0.5-10% solutions as a disinfectant for disinfecting water, dishes, rooms, patient secretions.

Calcium hypochlorite neutral contains 60% active chlorine, and is more resistant to storage than bleach. It is used in the form of 0.25, 0.5%, 1% solutions. Calcium hypochlorite solutions are used for the same purposes as bleach.

Precept- composition, which includes sodium salt of dichloroisocyanuric acid, adipic acid and sodium carbonate. Produced in the form of tablets containing 0.5, 2.5 and 5 g of the drug. The shelf life of tablets is 2 years, working solutions are not more than 5 days. It has bactericidal activity, sporicidal and fungicidal action, destroys tubercle bacillus and viruses. It has a slightly irritating effect on the skin, mucous membranes, and respiratory organs. It is used for current and final disinfection.

Neutral anolyte- a colorless transparent liquid with the smell of chlorine, is produced in the STEL-10 N-120-01 installation by electrochemical treatment of a solution of sodium chloride in drinking water. Depending on the purpose, an anolyte with an active chlorine content of 0.01%, 0.02%, 0.05% and a pH of 7.2 to 8.4 is obtained and used. Anolyte has antimicrobial and detergent properties, it is used without dilution, once for the disinfection of various objects (premises, patient care items, sanitary equipment, etc.). It is active against bacteria, viral and fungal infections. It is used for pre-sterilization cleaning and sterilization of products made of glass, rubber, metals (titanium alloys).

Sodium hypochlorite. The drug is used at a concentration of 0.125-0.5%. A 0.125% solution of the drug is less toxic and is used with a 0.5% solution of detergents.

DP - 2T(Russia) - tablet product contains 40% active chlorine. Work with the drug is carried out with the protection of the skin of the hands with rubber gloves.

Sanojin- has 7 times greater antimicrobial activity compared to other chlorine-containing drugs; Class 4 low-hazard substances, destroys odors.

“Javel”(France), contains HPCHN, is produced in the form of a liquid concentrate and tablets. It is used for disinfection of premises, equipment, patient care items, medical products. It has an antimicrobial effect, destroys viruses, fungi of the genus Candida, dermatophytes.

Septabic(Israel) - a highly effective remedy. It is produced in the form of a white powder, odorless, satisfactorily soluble in water up to a concentration of 0.5%, does not have corrosive activity, does not irritate the skin and mucous membranes. It is used in 0.15% concentration, disinfection time is 30 minutes.

Deochlor tablets (France). Universal agent for general disinfection, for disinfection of surgical instruments. It does not smell, does not spoil the processed products, does not have a corrosive effect.

OXIDIZERS

Hydrogen peroxide produced by industry in the form of an aqueous solution of 29 - 30% concentration called perhydrol. It is used in the form of a 3% solution. It is broken down in tissues with the release of free oxygen. Creates unfavorable conditions for the development of anaerobic and putrefactive infections. It has a weak bactericidal effect, but it cleans wounds well from pus, dead tissues, bacteria, facilitates the removal of bandages, and accelerates blood clotting in a fresh wound. In 3 - 4% concentration with detergents it is used for blood washing and disinfection. A 0.5% solution with a 0.5% detergent solution is used for pre-sterilization treatment at a temperature of 45 - 50 degrees C.

In recent years, derivatives of hydrogen peroxide - perborates - have become widespread. They contain hydrogen peroxide in solid form and are easier to transport and store. Diluted in water without noticeable decomposition. These include the following drugs.

Virkon(Slovenia) - powder, 0.5% working solution of which is used once. 1 - 2% solutions are applied repeatedly within 1 working day. Top quality disinfectant. It has bactericidal and fungicidal action. Effective against all viruses dangerous to humans. It is used for simultaneous cleaning and disinfection of surfaces, equipment, glass objects, instruments, endoscopes. Belongs to the 3rd class of medium toxicity. Wear gloves and avoid contact with eyes.

Perform(Germany) - white powder for disinfection of surfaces, equipment, inventory. Method of application - wet cleaning. Suppresses bacteria, fungi, viruses. Possesses the high washing ability and a pleasant smell, it is environmentally friendly, not toxic, working solutions store 24 hours.

Potassium permanganate is an energetic oxidizing agent. Bactericidal action is weak, strong deodorant. It is used in the treatment of ulcers, wounds, bedsores in the form of a 2-5% solution, for washing the bladder and urethra (0.01 - 0.1% solution).

ACID AND ALKALINE

Boric acid in the form of a 2-3% solution, it is used for washing wounds, wet dressings and powders, mainly when the wound is infected with Pseudomonas aeruginosa.

Formic acid- used in a mixture with hydrogen peroxide in the form of the preparation "C-4" (pervomura) for the treatment of the surgeon's hands.

Sodium carbonate (sodium carbonate, soda)- white, water-soluble powder. Soda solutions have a weak antimicrobial effect; when heated, their activity increases. In 1-2% concentrations, they are used for soaking dirty linen, dishes and other materials. In 1 - 3% concentrations, soda is added to water during disinfection by boiling linen, dishes, patient care items.

Deoxon- a colorless liquid with a pronounced smell of vinegar, containing 5 - 8% peracetic acid, which is an active substance. Aqueous solutions of deoxon with the content of the drug in the range of 1-2% are used for the disinfection of various objects. 10 - 20% deoxon solutions are recommended for sterilization of products made of plastic, rubber, glass and corrosion-resistant metals. They are also used for pre-sterilization treatment of medical products in combination with synthetic detergents.

Quaternary ammonium compounds and their analogues

After chlorine-containing preparations, this is the largest group of disinfectants, most commonly used in Western Europe, and is increasingly being used in Russia. Quaternary ammonium compounds (QAC) are cationic surfactants. HOUR in its pure form are rarely used because of the slow and weak action. Used in combination with other preparations for disinfection of instruments and antiseptic treatment of the skin. Of the drugs in this group are used septodor, septabic(Israel), Bromosept 30%.

COMPOSITE ANTISEPTICS

Many modern antiseptics include several active ingredients, that is, they are multicomponent.

Alaminol(Russia) - odorless blue liquid, low current. It has an irritating effect on the skin and mucous membranes. You should work with gloves.

Veltolen (Russia) - liquid universal antiseptic, refers to 4 class of low-hazard substances.

Dulbak DTB/L ( France) - a liquid concentrate of dark blue color, odorless, diluted with water, does not cause corrosion of metals, does not spoil the treated surfaces. It has a washing effect, bactericidal (except for tuberculosis) and virucidal activity. It is used in the form of a 2% solution. Exposure for bacterial infection - 15 minutes, for viral - 45.

Ethanol widely used in surgery in the form of 70% and 96% solutions for the treatment of the surgeon's hands, disinfection of instruments, silk.

The mechanism of action of alcohols is the irreversible coagulation of proteins and membranotropic action. Alcohol-based products are mainly skin antiseptics. In recent years, alcoholic solutions of chlorhexidine bigluconate have become widespread.

Carbolic acid used only in Krupenin's solution (triple solution) for disinfection of cutting tools, plastic items.

Tar is part of Vishnevsky's ointment, which is used in the treatment of wounds.

Phenol preparations are used to disinfect floors, walls, furniture, disinfect items that are not in contact with patients. Of the modern preparations of phenol, it can be noted Amocide(Germany). It is a green liquid concentrate, highly soluble in water, and has detergent properties. Working solutions 1-1.5%. You can work with them with the obligatory protection of the skin of the hands with rubber gloves and avoid contact with the eyes.

DYES

brilliant green- in the form of 0.1 - 2% alcohol or aqueous solution is used in the treatment of pyoderma and burns.

methylene blue- a weak antiseptic, in the form of a 1-3-5% solution is used for the same purpose.

Rivanol (ethacridine lactate) at a concentration of 1:500, 1:2000 is used to wash the cavities and the bladder.

ALDEHYDES

This is a large class of chemical compounds, the active principle of which is glutaric or succinic aldehyde. In medical practice, a limited number of aldehydes are used due to their high toxicity. The simplest of the aldehydes is formaldehyde.

Formaldehyde as a 40% aqueous solution ( formalin) is used for sterilization of rubber products, urological instruments. In paraformalin chambers, formalin is used to sterilize instruments equipped with optics. The drug is toxic and very unstable.

Glutaraldehyde has a pronounced sporicidal activity. It is widely used for sterilization of products made of thermolabile materials - rubber, plastics, etc., as well as for products equipped with optics, instruments. When sterilized, it does not give corrosion.

Lysoformin - 3000 (Germany)- transparent liquid concentrate of blue color with a slight smell of perfume. The working solution is prepared by diluting the concentrate with water, used repeatedly for 14 days. Belongs to the 3rd class of moderately toxic agents. Disinfection of premises is carried out in the absence of patients.

Bianol (Russia) - the liquid is a bright blue concentrate. Working solutions 0.25 - 20%. Moderately toxic. Irritating to skin and eyes. Work with the solution in rubber gloves, avoiding contact with the eyes.

Sidex. It is used for disinfection and sterilization of instruments that do not tolerate heat (instruments equipped with optics, etc.). It has a bactericidal and fungicidal effect, destroys spores and viruses.

Steranios 20%(France) is intended for disinfection and sterilization of medical devices. It has bactericidal, sporocidal, virusocidal and fungicidal action. Working solutions: 1% - used for disinfection, 2% - for sterilization.

DETERGENTS

Detergents - synthetic substances with high surface activity, have a bactericidal and detergent effect, enhance the effect of antibiotics, and help to liquefy pus. Preparations of the cationic type: cetylperidinium chloride, which is part of the preparations "diotsid" and "tserigel", alkyldimethylbenzylammonium chloride (rokkal), degmin, chlorhexidine digluconate.

Rokkal used for disinfection of the surgeon's hands (0.1%) and the surgical field (1%), for the prevention and treatment of wound infection (1:5000, 1:10000).

Degmicide used to treat the surgeon's hands (1% solution).

Zerigel forms a film when applied to the skin. Used to treat the surgeon's hands. 3 - 4 grams of the drug is applied to dry skin of the hands and rubbed for 8 - 10 seconds. After drying, a film is formed, which allows for a small surgical intervention. After work, the film is washed off with ethyl alcohol.

Chlorhexidine bigluconate (gibitan)- bactericidal, antiseptic and fungistatic agent. Produced in the form of a 20% solution. It is used in the form of a 0.5% solution for the treatment of the surgeon's hands, the surgical field, and the sterilization of instruments. For the treatment of wounds, burns, an aqueous solution of 1:400 is used.

Iodonate- has a high bactericidal activity against Escherichia coli, Staphylococcus aureus, Proteus, Pseudomonas aeruginosa, has a fungistatic effect. It is used to treat the surgical field in the form of a 1% solution, which is diluted 3 times with distilled water before use.

Septustin- domestic disinfectant, has an excellent washing effect. Working solutions remain effective for 7 days. Used repeatedly.

This group of antiseptics also includes manusan and disteril. They are used to treat hands and the surgical field.

NEW GENERATION CHEMICAL ANTISEPTICS

Vegasept forte- a colorless transparent liquid with a specific odor. It has high antimicrobial activity against gram-positive and gram-negative microorganisms, Mycobacterium tuberculosis, fungi, viruses, including hepatitis and HIV. Possesses the expressed washing and deodorizing properties. It is used in the form of a 0.025% solution for disinfecting surfaces in rooms, linen, dishes, patient care items, for pre-sterilization cleaning of medical devices.

Diamond(concentrate) is used for disinfection of indoor surfaces, general cleaning, disinfection of medical devices, including dental and endoscopic equipment. It has a wide spectrum of antimicrobial activity, the shelf life with repeated use is 14 days.

Microcide - Liquid- “instant disinfection”. Produced in the form of a ready-made solution. It is intended for disinfection of objects, equipment and surfaces in hard-to-reach places. Method of application - spraying and irrigation. Suppresses bacteria, viruses, including HIV and hepatitis. Has a pleasant smell, dries quickly without leaving marks.

TRN 5225 (theramine)- it is intended for disinfection and cleaning of surfaces and equipment at the same time in medical institutions. Suppresses the vital activity of bacteria, fungi and viruses. Has detergent properties.

Means for processing medical devices

Gigasept FF - (concentrate, dilution 1:30) is used for disinfection and sterilization of endoscopes, instruments, objects for anesthesia and resuscitation. Method of application - soaking by immersion. Suppresses the entire spectrum of microorganisms, including spores. Ready solution is used repeatedly within 16 days. Does not have a corrosive effect.

Lisetol AF (concentrate, dilution 1:50) - is intended for disinfection and pre-sterilization treatment at the same time. Method of application - soaking by immersion. Active against fungi, viruses, bacteria. Used repeatedly (at least 7 days). Does not have a corrosive effect. Eco-friendly, has a pleasant smell

Antiseptics for the treatment of skin and mucous membranes

A fundamentally new qualitative level of solving the problem of disinfection of the skin and mucous membranes and other human tissues is the use of antiseptics, based on which the active ingredient is octenidine. On the basis of octenidine, Schalke and Mayr produces three mucocutaneous antiseptics - octeniman, octeniderm, octenisept.

Okteniman is a ready-made solution for gentle and reliable disinfection of the hands of surgeons and medical personnel. It has a quick bactericidal effect (within 15 seconds), destroying bacteria, fungi, viruses. Duration of bactericidal action up to 6 hours.

Octeniderm - in its composition is almost adequate to octineman, but is intended mainly for disinfection of the skin of patients, wounds and sutures in order to decontaminate the skin before injections and other manipulations. The effect lasts 6 hours.

Octiniderm - active against bacteria, including tuberculosis, fungi, viruses. Produced as a solution in bottles of 250 ml and 1 liter. Method of application - spraying, smearing with a swab or rubbing. It is used for skin treatment before operations, punctures, injections and other manipulations. The bactericidal effect occurs after 15 seconds and lasts up to 6 hours. Does not irritate the skin even with eczema, promotes wound healing.

Other modern antiseptics include:

Zagrosept used to disinfect the hands of surgeons and medical personnel. Active against bacteria, including tuberculosis, fungi, viruses (including HIV and hepatitis B). Method of application - rubbing. The disinfecting effect occurs after 30 seconds and lasts up to 6 hours. Softens and disinfects the skin, non-toxic. Produced and used in the form of a solution (bottles of 1 liter and 450 ml).

Veltosept - an agent used for the hygienic treatment of the hands of medical personnel, the treatment of the surgeon's hands, the skin of the surgical field, the skin during injections and other manipulations, for the disinfection of surfaces, disinfection of instruments, flexible endoscopes. Acts on bacteria (including tuberculosis, viruses (including hepatitis A, B, C, influenza, parainfluenza, herpes, HIV), OOI (plague, cholera), spores, fungi.

When hygienic treatment of the hands of medical personnel, 3 ml of the product is applied to the skin of the hands and rubbed for 30 seconds.

Treatment of the surgeon's hands before the operation includes: washing the hands under a tap, drying with a sterile gauze cloth, applying the drug to the hands in 5 ml (at least 2 times) and rubbing it in for 5 minutes.

The treatment of the surgical field is carried out by rubbing the skin twice with gauze swabs, abundantly moistened with the agent for 2 minutes.

The release form is a ready-to-use solution of 75 ml, 1 l and 5 l.

Manopronto(“Johnson-Johnson”, USA). Effective against bacteria, viruses, Mycobacterium tuberculosis, fungi. Does not cause allergic reactions and skin irritation, contains protective and nourishing components for the skin. Available in bottles of 100 and 500 ml.

NITROFURANS

Nitrofurans are broad-spectrum drugs with low toxicity. Effective against gram-positive, gram-negative flora, Trichomonas, Giardia, spirochetes, large viruses. This group of drugs: furadonin, furazolidone, furagin - furazolin - are applied internally solafur or furagin-K- intravenously, furacillin externally. They are excreted mainly in the urine, which allows them to be used for urinary tract infections. Furacillin is used externally for the treatment and prevention of purulent-inflammatory processes in the form of an aqueous solution of 1:5000, an alcohol solution of 1:1500 and an ointment of 0.2%. For washing the cavities, a solution of furacillin 1: 1000 is used. To increase the antiseptic properties of the solution, 1 g of a 20% solution of chlorhexidine is added to 1000 ml of furacillin 1: 1000 solution.

SULFANILAMIDE DRUGS

Sulfa drugs: sulfaetidol, sulfadimethoxine, sulfalene and others. They have a bacteriostatic effect. In surgery, they are often used in combination with antibiotics.

OTHER CHEMOTHERAPEUTIC DRUGS

Metronidazole (trichopol) and its derivatives: metrogil, flagyl- are used to treat anaerobic infections, go well with sulfonamides and antibiotics. Effective in giardiasis and amoebiasis.

fluconazole (diflucan) is a thiozol derivative. Effective in various fungal infections.

Quinoxaline derivatives:

quinoxidine- a broad-spectrum drug, effective against Proteus, Pseudomonas aeruginosa and Escherichia coli, staphylococcus, streptococcus, pathogens of gas gangrene. Applied at 0.25, three times a day

Dioxidine - very effective broad-spectrum antibacterial agent. It is used to treat pleurisy, peritonitis, phlegmon. Effective in anaerobic infections and infections caused by Pseudomonas aeruginosa.

Biological antiseptic

Biological antiseptic - the use of biological agents to prevent infection and fight infection in the human body. These agents include antibiotics, enzymes, bacteriophages, and immune preparations.

Antibiotics

Antibiotics are substances of microbial, animal, or plant origin that have an antibacterial effect. They are characterized by the following properties:

Most of them in therapeutic doses are non-toxic or low-toxic.

Many of them, having a strong antibacterial effect, at the same time, in therapeutic doses, do not damage the tissues of the macroorganism.

They have a specific effect only on certain types of microbes. At the same time, the range of their action, the so-called spectrum, is quite wide.

In the presence of pus and blood, their activity does not decrease.

They do not have a cumulative property.

Depending on the nature of the action on the microflora, antibiotics are distinguished with a narrow, broad and intermediate spectrum of action. In addition, there is a concept - reserve antibiotics (fluoroquinolones, carbopenems). They are used in cases where the sensitivity of the pathogen to infection is unknown; when the flora that caused the infectious process is insensitive to traditionally used antibiotics and with a nosocomial (nosocomial) infection.

Preparations of the penicillin group have a bactericidal effect, are effective against gram-positive flora, spirochetes. In surgery, benzinepenicillin sodium salt is more often used.

Long-acting drugs: bicillin -1, bicillin - 3, bicillin - 5 are administered intramuscularly 1 time per week, 1 time in 3 days, 1 time in 4 weeks, respectively. They are used in cases where it is necessary to create a long-term therapeutic concentration of penicillin in the blood.

Semi-synthetic penicillins: oxacillin sodium salt (oxacillin), ampicillin, methicillin sodium salt (methicillin), carbenicillin, ampiox. They are effective against strains of mycoorganisms resistant to benzylpenicillin. Ampicillin and carbenicillin are active against gram-positive and gram-negative microorganisms

Inhibitor-protected penicillins: amoxacillin / clavulant, ampicillin / sulbactam (sulmtamicillin), ticarcillin / clavulant - have an extended spectrum due to PRSA, producing betylactamases; piperacillin/tazobactam has a broad spectrum of activity, covering most gram-positive and gram-negative microorganisms, and is used for nosocomial infections.

Cephalosporins represent one of the most extensive classes of antibacterial drugs. There are 4 generations of cephalosporins, with the first three presented for oral and parenteral use. Indications for the use of drugs of each generation depends on the characteristics of their antimicrobial activity.

1st generation cephalosporins: cefazolin (kefzol), cephalexin (keflex), cephalothin - have high antistaphylococcal activity, are effective against streptococcus and gonococcus. The level of activity against gram-negative bacteria is not high.

CephalosporinsIIgenerations: cefamandol, cefuroxime, cephalothin, cefoxitin - have a wider spectrum of action against gram-negative microorganisms.

CephalasporinsIIIgenerations: cefaperazone (cefobid), ceftazidime (fortum), ceftaxime (claforan). More active than preparations of I and II generations, especially in relation to gram-negative flora.

Cephalosporins:IVgenerations: cefepime - along with the properties characteristic of third-generation cephalosporins, they have greater activity against non-fermenting microorganisms, against microorganisms - hyperproducers of class C beta-lactamase, higher resistance to ESBL hydrolysis. They are mainly used for severe nosocomial infections caused by multiresistant microflora, infections against the background of neutropenia and other immunodeficiency states.

Inhibitor-protected cephalosporins(cefaperazone / sulbactam) have a wider spectrum of action due to activity against anaerobic microorganisms, the drug is also active against most strains of enterobacteria producing broad and extended spectrum beta-lactamase.

Carbapenems are antibiotics of an extremely broad spectrum of action, belong to the reserve group and are intended for the treatment of severe infections of various localizations with the ineffectiveness of antibiotics of other groups, as they have unsurpassed resistance to beta-lactamase, while the release of endotoxins is minimal. They are prescribed in cases where in a patient with a severe infection, the resistance of the flora to antibiotics is unknown and in the case of a hospital (nosocomial) infection. This group includes: thienem, meropenem, ertrapenem.

Imipenem used in combination with cilastatin in a ratio of 1: 1. Meropenem - a new carbapenem is 2 to 4 times more active than imipenem against aerobic gram-negative microorganisms, but has less activity against staphylococci, some streptococci and enterococci. Its activity against Gram-positive anaerobic bacteria is similar to that of imipenem.

Ertapenem differs in the spectrum of antibacterial activity against gram-positive and gram-negative aerobic and anaerobic microorganisms, is convenient in the dosing regimen (1 g once a day) and the possibility of choosing between intravenous and intramuscular administration.

Macrolides:erythromycin, spiramycin, clarithromycin and etc. – active against gram-positive cocci and intracellular pathogens. Low toxicity. They have a bacteriostatic effect, but in high concentrations they can act bactericidal on some types of hemolytic streptococcus and pneumococcus. They have a slight anti-inflammatory and immunomodulatory effect.

Lincosamides.(lincomycin, clindamycin). Lincomycin - highly effective antibiotic, especially against streptococci and pneumococci. Clindamycin 8 times more active than lincomycin against aerobic gram-positive coca, wider range of its activity against many gram-positive and gram-negative anaerobic bacteria, as well as protozoa.

Aminoglycosides- preparations of bactericidal action. There are currently three generations of aminoglycosides: 1 generation - streptomycin, neomycin, kanamycin; 11th generation gentamicin, tobramycin, netilmecin; 111 generation - amikacin.

Aminoglycosides are of primary clinical importance in the treatment of nosocomial infections caused by aerobic Gram-negative pathogens.

Aminoglycosides are nephrotoxic, ototoxic, and may cause neuromuscular blockade.

Tetracyclines - bacteriostatic drugs, although in large doses they can act bactericidal on some groups of microorganisms. They have a wide spectrum of action, but their use is limited due to the emergence of a large number of resistant microorganisms and side effects: hepatotoxicity, allergic reactions, increased intracranial pressure, and when administered intravenously due to the development of phlebitis and thrombophlebitis.

Quinolones and fluoroquinolones. Quinolones act mainly on gram-positive microorganisms, are active against some strains of Pseudomonas aeruginosa. Fluoroquinolones wider spectrum of action. They are active against most gram-negative and some gram-positive bacteria, anaerobes are insensitive to them.

Glycopeptides -vancomycin and teicoplanin are the drugs of choice in the treatment of nosocomial infections caused by gram-positive microorganisms, they are active against gram-positive aerobic and anaerobic microorganisms. Gram-negative microorganisms are resistant to glycopeptides.

Oxazolidinone group is one of the new groups. An antibiotic from this group is used in clinical practice. linezolid. It is of primary importance as a drug for the treatment of infections caused by multiresistant gram-positive cocci, as it has activity against most aerobic and anaerobic gram-positive microorganisms.

Preparations of the chloramphenicol group(chloramphenicol, berlicetin, levomycetin succinate, etc.) have a wide spectrum of activity, are active against gram-positive and gram-negative cocci, many bacteria, rickettsia, spirochetes. The preparations are extremely effective against some anaerobic microorganisms (peptococci, bacterioids), penetrate well into body fluids and tissues, and have moderate activity against other anaerobes. However, chloramphenicol has a number of disadvantages - it inhibits hematopoiesis and can cause aplastic anemia.

Polymyxin group- characterized by a narrow spectrum of activity and high toxicity. Polymyxins have a bactericidal effect and are mainly used in the treatment of Pseudomonas aeruginosa.

Antifungal antibiotics: levorin, nystatin, amphotericin B, fluconazole.

Basic rules for the use of antibiotics:

Antibiotics should be used according to strict indications and taking into account the sensitivity of the pathogen to them. If the resistance of the flora that caused the pathological process is unknown, broad-spectrum antibiotics are prescribed in combination, taking into account synergism, antagonism of action and toxicity. It is desirable to combine the appointment of a bacteriostatic antibiotic with the use of an antibiotic that acts bactericidal.

Before prescribing antibiotic therapy, it is necessary to know the condition of the organs (liver, kidney, etc.) and systems of the patient. Antibiotics should be used taking into account their toxic side effects.

Determination of the sensitivity of microflora to antibiotics is mandatory. Upon receipt of the results of the study, drugs are prescribed to which the microflora is sensitive. It is also mandatory to determine the sensitivity of microflora to antibiotics during treatment, but at least once every 7 days.

If prolonged use of antibiotics is necessary, drugs should be changed every 6 to 7 days to avoid the emergence of resistant strains of microorganisms. In case of ineffectiveness, the antibiotic should be changed.

In the process of treatment, it is necessary to maintain the optimal concentration of antibiotics in the patient's body, strictly observing the frequency of administration of the drug and the dose. In case of severe infection, the dose of the drug can be increased by 1.5-4 times, while the concentration of the antibiotic in the blood should be 2-4 times higher than its minimum inhibitory concentration.

In severe infections and reduced immunity, bactericidal drugs should be used. To prevent toxic shock, detoxification must be carried out simultaneously.

When carrying out detoxification, it should be borne in mind that antibiotics are also excreted from the patient's body along with toxins.

In severe infection and unstable hemodynamic parameters, it is necessary to use drugs that do not lead to additional release of toxic decay products of the bacterial cell. Currently, only carbapenems have an ultra-broad spectrum of activity, including anti-anaerobic activity, while the release of endotoxin is minimal.

If possible, it is necessary to combine the routes of administration of antibiotics (local and general application).

When prescribing vitamins, it should be remembered that B vitamins inactivate antibiotics.

It is necessary to prescribe antibiotics with caution to the elderly, debilitated patients and children.

In case of prolonged use of antibiotics, antifungal drugs should be prescribed.

In order to prevent postoperative complications, antibiotics are used on the day of surgery, during surgery and for 1 to 3 days after surgery. Prescribing antibiotics a few days before surgery is impractical.

In severe infections, antibiotic therapy should be combined with the use of immune agents.

Complications associated with the use of antibiotics

allergic reactions that may occur with increased individual sensitivity to drugs , especially the penicillin series. They can be manifested by the appearance of a rash such as urticaria, headache, joint pain, chills, fever, angioedema. Perhaps the development of anaphylactic shock with the appearance of cyanosis, shortness of breath, a drop in blood pressure, loss of consciousness. With untimely assistance, a fatal outcome is possible.

To eliminate allergic reactions, diphenhydramine (1 ml of a 5% solution), 10% calcium chloride solution - 10 ml intravenously, ephedrine (1 ml of a 5% solution), caffeine (1 ml of a 10% solution), cordiamine 2 ml subcutaneously are administered intramuscularly. For severe reactions, corticosteroids are given.

In case of anaphylactic shock, 1 ml of a 0.1% solution of adrenaline is immediately injected intramuscularly, calcium chloride intravenously, diphenhydramine, caffeine subcutaneously. Assign oxygen inhalation, warm the patient. If necessary, the patient is intravenously transfused with polyglucin and prednisolone. If the shock is associated with an injection of penicillin, penicillase is administered, a drug that destroys penicillin (1000,000 IU intramuscularly).

Dysbacteriosis develops with prolonged use of antibiotics as a result of suppression of the normal intestinal microflora. With dysbacteriosis, digestion is disturbed, ulcers may form on the mucous membranes of the gastrointestinal tract, and sepsis may develop.

candidomycosis- severe complications associated with the use of antibiotics. They are caused by yeast-like fungi of the Candida family. Complications can be severe with the development of fungal sepsis.

Aggravation reaction, up to toxic shock, is associated with the ingress of a large amount of bacterial toxins into the blood as a result of the bactericidal action of antibiotics, the death and destruction of microorganisms.

Superinfection- invasion into the body during antibiotic treatment of another microflora resistant to them. Often such an infection is more dangerous than the one against which therapy is undertaken. This is usually a nosocomial (nosocomial) infection.

bacteriophages

Bacteriophages are ultramicroscopic agents that have all the basic properties of viruses and lyse bacteria. In the treatment of purulent infection, staphylococcal, streptococcal, proteus, pseudomonas and other bacteriophages are used. These antibacterial drugs have strict species and type specificity, they should be used only after bacteriological determination of the leading microflora in the purulent process.

Enzymes

enzyme therapy- the use of enzymes and antienzymatic drugs. Proteolytic enzymes are used that can melt necrotic tissues, fibrin, pus, in addition, they have an anti-inflammatory effect, help reduce edema and increase the activity of antibiotics. The most common are drugs of animal origin - trypsin, chymotrypsin, chymopsin, ribonuclease, collagenase.

Preparations of bacterial origin - deoxyribonuclease, terrilitin, streptokinase. Based on the preparations of this group, ointments are prepared for enzymatic cleansing of wounds - iruksol, asperase. Herbal preparations - papain, bromelain are used for the same purpose.

Proteolytic preparations are applied topically in the treatment of purulent wounds, trophic ulcers in the form of a 0.5 - 2% solution, which is moistened with tampons, or in powder, which is poured into the wound. In chronic osteomyelitis, enzymes are used to wash fistulous passages, cavities, or injected intraosseously by puncture, or into the bone marrow canal through tubes inserted during surgery. For intracavitary administration, enzymes are used for purulent arthritis, purulent pleurisy, abscesses.

In purulent lung diseases, the inhalation method of enzyme therapy is widely used, which is advisable to combine with the introduction of antibiotics.

Trypsin and chymotrypsin can be administered intramuscularly at a dose of 0.7 mg/kg 2 times a day. Injections of these drugs have an anti-inflammatory effect. In solutions with novocaine and antibiotics, proteolytic enzymes can be used to infiltrate tissues around the focus of inflammation in the initial stages, for example, with mastitis.

For the prevention of postoperative complications, a method of systemic enzyme therapy (SET) has been proposed. The main drugs for this purpose are Wobnzim(available as a dragee, one dragee contains pancreatin, papain, bromelain, lipase, amylase, trypsin, chymotrypsin, rutoside) and Phlogenzyme ( bromelain, trypsin and rutoside). Preparations are produced by "Muko-Firma" (Germany).

SET preparations enhance fibrinolysis, improve microcirculation, have a decongestant effect, accelerate the resorption of hematomas, and have anti-inflammatory, analgesic and immunonormalizing effects.

In recent years, methods have been developed to use the vital potential of actively proliferating and regenerating tissues as a counteraction to necrobiotic processes. The most intensively developed methods are autotransplantation of multilayer tissue flaps or muscle structures on a supplying vascular pedicle after a full-fledged surgical treatment of a purulent-necrotic wound. Transplanted flaps, formed from the tissues of neighboring areas, simply move. In the case of using tissues from distant areas, the vascular pedicle that feeds them is isolated and cut, and then, using microsurgical techniques, it is connected to one of the large vessels located close to the treated wound.

For the treatment of wounds with a protracted course of wound infection, attempts are being made to use differentiated or pluripotent stem cells.

Mixed antiseptic

In surgery, only one type of antiseptic is rarely used. As a rule, a complex of antiseptic methods is used. For the treatment of wounds, for example, chemical antiseptics (treatment of the skin along the edges of the wound), mechanical (excision of the wound), biological (prescription of antibacterial drugs) and physical (bandages, physiotherapy, etc.) are used. For wound treatment, for example, active irrigation drainage is used. A tubular drainage is introduced into the wound, through which a solution of antibiotics or antiseptics is dripped. Through the drainage, the contents of the wound are suctioned out using aspirating systems. Thus, chemical, biological and physical methods of antiseptics are combined.

The method of membrane drainage of a wound or wound dialysis by using special semiconductor membranes that are introduced into the wound and ensure the diffusion of drugs into the tissues, as well as remove toxic compounds. Thus, mixed antiseptics is called the complex use of various types of antiseptics.

IMMUNE MEANS

Vaccines and toxoids are used for active immunization. More commonly used staphylococcal toxoid. It is injected subcutaneously at 0.1 ml into the scapular region every 3 days, gradually increasing the dose by 0.1 ml, bringing it to 1.0 ml.

Passive immunization is carried out with preparations containing antibodies to pathogens of surgical infection.

Antistaphylococcal hyperimmune plasma is the plasma of donors immunized with staphylococcal toxoid. The action of plasma is strictly specific. It is used for septic diseases caused by staphylococcus aureus.

Antistaphylococcal gamma globulin are made from the blood of donors immunized with staphylococcal toxoid. Used for the treatment and prevention of diseases caused by staphylococcus aureus.

Sandoglobulin- freeze-dried polyvalent human immunoglobulin. The drug contains antibodies against bacteria, viruses and other microorganisms. It is used intravenously for severe infectious complications: sepsis, peritonitis, etc.

Immunomodulatory drugs. Roncoleukin- analogue of endogenous human interleukin-2. Available in powder form in ampoules. 1 ampoule contains human interleukin-2 0.25, 0.5, 1 mg (250,000, 500,000 or 1,000,000 IU).

Roncoleukin has an immunomodulatory effect, replenishes the deficiency of endogenous interleukin-2 and reproduces its effect.

It is used in severe septic conditions accompanied by immunosuppression, in malignant neoplasms, and in kidney cancer. The contents of the ampoule are dissolved with two ml of saline, and then transferred to a container - 400 ml. . It is administered intravenously, slowly - 1-2 drops of the solution per minute.

Derinat- a preparation of sodium deoxyribonucleate, obtained from the extract of sturgeon milk. It has an immunomodulatory effect, stimulates regeneration and hematopoiesis. It has a wound healing, anti-inflammatory, antitumor effect, improves blood supply to the myocardium and lower extremities.

Immunofan - It has an immunostimulating, detoxifying, hepatoprotective, antioxidant effect. It is used for burns, in patients with long-term non-healing wounds, with severe purulent-septic postoperative complications, in cancer patients.

Thymogen- has an immunomodulatory effect, stimulates cellular factors of immunogenesis, enhances nonspecific resistance.

Prodigiosan- a bacterial polysaccharide that stimulates leukopoiesis and phagocytosis, activates the T - immune system.

Levamisole increases the synthesis of antibodies, stimulates the formation of T-lymphocytes and phagocytes.

Prevention of tetanus

Emergency specific prophylaxis of tetanus is carried out with:

Injuries, with violation of the integrity of the skin and mucous membranes;

Frostbite and burns of the second, third and fourth degrees;

community-acquired abortions;

Childbirth outside medical institutions;

Gangrene or tissue necrosis of any type, abscesses;

Animal bites;

Injuries with damage to the gastrointestinal tract.

For emergency specific prophylaxis of tetanus, apply:

AC - toxoid;

Tetanus toxoid human immunoglobulin (PSIT);

In the absence of PSCHI - concentrated liquid

tetanus toxoid purified by the method

peptic digestion.

Anti-tetanus horse serum, purified concentrated liquid (PSS) is a serum containing specific immunoglobulins, a protein fraction of the blood of horses hyperimmunized with tetanus toxoid or toxin, purified and concentrated by one of the methods of peptic digestion. Serum is available in ampoules with a capacity of 2.3 and 5 ml, containing one prophylactic dose complete with 1 serum ampoule, diluted 1:100.

PSS for the purpose of emergency prevention of tetanus is administered at a dose of 3000 IU subcutaneously. Before the introduction of PSS to detect sensitivity to a foreign protein, an intradermal test with a serum diluted 1: 100 is mandatory (the ampoule is marked in red). 0.1 ml of diluted serum is injected intradermally on the flexor surface of the forearm. The reaction is evaluated after 20 minutes. The test is considered negative if the diameter of the edema or redness at the injection site is less than 1 cm. If the edema and redness reach 1 cm or more in diameter, the test is considered positive.

With a negative intradermal test from an ampoule marked in blue (not diluted serum), PSS is injected subcutaneously in a volume of 0.1 ml. If there is no reaction after 30 minutes, the remaining dose of serum is administered.

With a positive intradermal test, or in cases of an anaphylactic reaction to a subcutaneous injection of 0.1 ml of PSS, further administration is contraindicated. In this case, the introduction of PSCHI is indicated.

The introduction of the drug is recorded in the established accounting forms indicating the date of vaccination, dose, institute - manufacturer of the drug, batch number, reaction to the introduction.

In modern conditions, for emergency specific prophylaxis of tetanus, it is necessary to adhere to the following rules.

In case of emergency prophylaxis of tetanus, it is possible to use ADS-M toxoid.

Apply PSCH or PSS. In this case, it is preferable to use PSCI, if this drug is not available, then PSS should be administered.

If children and adolescents have completed a full course of vaccinations in accordance with their age, the next scheduled or emergency revaccinations should be done no more than once every 5 years.

For infected wounds, if more than 5 years have passed since the previous revaccination, 0.5 ml of AC-toxoid is administered.

Adults who have completed a full course of immunization, if more than 5 years have passed since the last vaccination, are injected with 0.5 ml of AC-toxoid.

If 2 vaccinations have been carried out and a period of not more than 5 years, 0.5 ml of AS - toxoid is administered, if the period is more than 5 years, then 1.0 ml of AS - toxoid, 250 IU of PSCI or 3000 PSS are administered.

If 1 vaccination has been carried out and for a period of not more than 2 years, 0.5 ml of AS - toxoid is administered, if the period that has passed after vaccination is more than 2 years, 1.0 ml of AS - toxoid and PSCHI 25 IU or PSS 3000 IU are administered.

Unvaccinated or if the vaccination history is not known to children under 5 months of age. inject 250 IU PSCI or 3000 IU PSS, the rest of the PS - toxoid 1.0 ml, 250 IU PSCI or 3000 IU PSS.

Prevention of gas gangrene

In order to prevent gas gangrene, anti-gangrenous serum is used. It is also used to treat gas gangrene. The action of antigangrenous serum is expressed in the ability to neutralize the toxins of anaerobic microorganisms.

Antigangrenous serum is a protein fraction of the blood serum of horses hyperimmunized with toxoids of the three main pathogens of gaseous anaerobic infection, containing specific immunoglobulins against Cl. perfringens, Cl. edematiens and Cl. septicum..

The prophylactic dose of antigangrenous serum is 30 thousand IU (international units), 10 thousand IU of antiperfringens, protivoedematiens and antisepticum.

For prophylactic purposes, serum is administered intramuscularly as soon as possible after injury.

The therapeutic dose of serum is 150 thousand IU, 50 thousand IU against the same bacteria and is administered intravenously, slowly mixed with sterile saline heated to body temperature.

Before the introduction of serum, to determine the sensitivity to a foreign protein, an intradermal test is performed with a serum diluted 1: 100. In case of a negative intradermal test, 0.1 ml of undiluted serum is injected subcutaneously and, if there is no reaction, after 30 minutes. enter the entire prescribed dose.

The main ways to use antiseptics

There are several ways to use antiseptics.

Enterally, through the mouth, antibiotics, sulfanilamide and other drugs are prescribed. Rectally, these drugs can be used in the form of therapeutic enemas, suppositories, etc.

Surface antiseptic method- with exposure through the skin and mucous membranes. Solutions, ointments, aerosols, emulsions are used. In surgery, the method is used to treat wounds by washing, as well as using the flow method by introducing irrigators into the wound and active drainage.

The introduction of antiseptics into the cavity with purulent arthritis, peritonitis, pleurisy with mandatory drainage.

Deep antiseptic method includes the administration of drugs intramuscularly, intravenously, intra-arterially and intra-aortally. Intra-arterial and intra-aortic, it is possible to introduce the drug into the artery supplying the affected organ using a probe, and to achieve the destruction of the infectious process in the organ by increasing the concentration of the antibacterial drug in the artery supplying the organ. The intraosseous method of drug administration also belongs to deep antiseptics. Endolymphatic use of antibiotics is considered effective.

Physical antiseptic is a set of methods to combat infection based on the use of physical factors. Methods of physical antiseptics are aimed at creating unfavorable conditions for the life of microflora, reducing the absorption of bacterial toxins and decay products of one's own tissues. The active factors of physical antiseptics are physical phenomena - heat, light, sound waves, all kinds of radiation, in addition, physical antiseptics include various therapeutic methods based on the use of physical laws (hygroscopicity, capillarity, diffusion, osmosis, etc.)

One of the main elements of the fight against infection is to ensure the timely removal of bacterial toxins and tissue decay products from the purulent focus. To do this, it is necessary to ensure an adequate outflow of exudate. Among the methods of physical antisepsis used for this purpose, it should be noted: the use of hygroscopic dressings, hypertonic solutions, sorbents, drainage of wounds and cavities.

HYGROSCOPIC dressing

For the treatment of infected wounds, various dressings have long been used. Dressings are used to protect the wound from the environment and local application of drugs, while the dressing used itself has a healing effect. Due to its hygroscopicity, blood, exudate, and pus are removed from the wound, which helps to eliminate the nutrient medium for microorganisms. As a dressing, cotton, viscose, synthetic fabrics, linens, tapes, fibrous structures, neti, and other coatings are used. Dressings are made from them (gauze, cotton wool, bandages, etc.)

The most commonly used cotton-gauze bandages. For superficial wounds, gauze pads or cotton-gauze swabs are applied to the wound surface. If there are deep cavities, then gauze swabs or turundas are introduced into them. Duration of operation of gauze swabs is about 8 hours, later it loses its hygroscopic properties and, having been saturated with exudate, it begins to prevent the outflow of wound discharge. In order not to make dressings 3-4 times, the tampon is introduced loosely into the bag. In this case, after the loss of hygroscopicity, it will not play the role of a "plug", since the outflow will be carried out past the tampon. For a long time, a Mikulich tampon is used. A large gauze napkin with a thread sewn to the middle is placed in the wound, lining the bottom and walls. The resulting "bag" is filled with gauze balls. After the balls are saturated with wound discharge. they are replaced, while leaving a gauze napkin in the cavity. The balls are changed several times a day. The swab is removed after the outflow of exudate stops, the napkin is removed by pulling the thread.

HYPERTONIC SOLUTIONS

To enhance the hygroscopic properties, gauze wipes and tampons are moistened with hypertonic solutions. The most commonly used 10% solution of NaCl (official hypertonic solution). The osmotic pressure of a hypertonic solution is higher than in blood plasma. Due to the difference in osmotic pressure, the outflow of fluid is more active.

DRAINAGE

An effective method of combating wound infection is the drainage of wounds and cavities. Drainages ensure the removal of exudate from internal natural and pathological cavities into the environment, reducing the absorption of bacterial toxins and tissue decay products from the focus. Currently, several types of drainage are used. All of them are based on the use of various physical factors (capillarity, surface tension, pressure difference, etc.).

There are three types of drainage:

• passive drainage
• active drainage
• flow-flush drainage

Passive drainage

In passive drainage, rubber strips, silicone and PVC tubes are used as drains. Drainage is brought to the lowest point of the cavity and brought out through the wound or a separate incision. If a tube is used, then several holes are made on the side surfaces. The outer end is left in a bandage (rubber strips) or lowered into a vial with an antiseptic, special sealed plastic bags can be used. Receiving containers should be placed below body level. Drainages introduced into the cavity should be fixed with skin sutures, this measure avoids the migration of the drainage both outward and inward. For the effective functioning of the drains, it is necessary to monitor them. The lumen of the tube may be blocked by necrotic tissues, and, accordingly, the outflow of exudate will stop.

If it is necessary to drain the chest cavity, Bulau drainage is used. It should be referred to as passive drainage, since forces outside the body are not used for functioning. The drainage tube is inserted into the pleural cavity, a petal valve made of a rubber fingertip is fixed on its outer end, which is immersed in an antiseptic solution. Breathing changes the pressure in the chest cavity. When exhaling, the pressure rises - the exudate enters the vial through the tube (the valve is open), while inhaling, the valve closes, preventing the solution from entering.

Active drainage

Active drainage involves the application of an external force that ensures the outflow of the wound discharge. The functioning of this type of drainage is based on creating a pressure difference in the wound and outside. Currently, many models of active drainage are used, but the principle of their operation is the same. A negative pressure is created at the outer end of the drain due to the suction effect from wounds exudate is removed. Active drainage is used if a sealed cavity is being drained (sutured wound, abscess cavity, chest cavity, joint cavity). This type of drainage cannot be used for interventions in the abdominal cavity, since the omentum or intestines can be sucked into the holes of the drainage tube. At best, it will cease to function, but necrosis of the intestinal wall may develop.

Drainage is carried out as follows. One or two silicone and PVC tubes with holes on the walls are inserted into the drained cavity. They should be carried out not through the wound, but through a separate small incision. If necessary, several skin sutures can be applied for better sealing. The outer end of the drain is attached to a container in which negative pressure is created. For this purpose, a plastic accordion, special plastic cans or various types of suction (water jet, electric) are used.

The simplest vacuum drainage is performed according to Redon. The essence of the method is as follows. The bottle heated to 100°C in water is hermetically sealed with a rubber stopper. As the vessel cools, a vacuum of up to 75–100 mm is gradually created.

rt. Art. Connecting such a system to the drainage ensures the removal of up to 180 ml of exudate from it.

A very original system for vacuum drainage in pleural empyema was proposed by MS Subbotin. The vacuum at the end of the tube inserted into the pleural cavity is created due to the movement of fluid in two banks according to the law of communicating vessels. The liquid from the upper jar is poured through a tube into one of the lower ones, while in the upper jar (hermetically sealed) the pressure decreases. The decrease in pressure in the upper bank leads to the suction of air from the second lower bank, which is hermetically connected to a tube installed in the pleural cavity.

In the absence of special devices, you can use a simple hermetically sealed vial. The vacuum in it is created by suction of air using Janet's syringe.

This type of drainage is also called closed or vacuum. It can only be used when sealing the cavity. It is believed that active drainage is the most effective method. In addition to removing the contents, it contributes to the rapid reduction of the wound cavity.

Flow-flush drainage

In the treatment of purulent wounds and purulent-inflammatory diseases of the cavities, it becomes necessary to remove not only exudate from the wound, but tissue decay products. Passive and vacuum drainages for this purpose may be ineffective, since they cannot ensure the removal of thick pus, necrotic tissues. In such cases, flow-flushing drainages are used. Drainage is carried out as follows. Drainage tubes are inserted into the wound or cavity in the same way as with passive or active drainage. Additionally, usually on the opposite side of the outlet of the drainage tubes, a tube of smaller diameter is inserted. Through it, the introduction (drip or jet) of antiseptic solutions is constantly carried out, which flow through the drainage tubes. The antiseptic constantly flushes the cavity, while exudate, decayed, necrotic tissues are removed from it. It is necessary to ensure that there is no delay in the solution. To do this, take into account the amount of injected and flowing fluid. It shouldn't be different. You can use two translucent drains, the thin channel of which serves to introduce an antiseptic, the wide one - to remove fluid from the cavity. The flow-flush drainage method is very effective. When using it, in some cases even infected wounds are tightly sewn up. Flow-flush drainage can be used to drain the abdominal cavity (peritoneal dialysis). In addition to antiseptics, proteolytic enzymes can be introduced into the wound, which contribute to the melting of non-viable tissues (enzymatic dialysis). Flow-flushing drainage can be used simultaneously with vacuum aspiration. This type of drainage should rather be attributed to the methods of mixed antiseptics, because in addition to physical factors, chemical and biological ones are used.

The choice of drainage method depends on a number of factors, but preference should not be given to passive. Active and flushing drainage allows you to quickly stop the purulent-inflammatory process.

Sorbents

Recently, the sorption method of treating wounds has been increasingly used, which involves the introduction into the wound of substances that adsorb toxins and microorganisms on themselves. Usually these are carbonaceous substances in the form of powder or fibers. The most commonly used polyphepan. and various coals intended for hemosorption and hemodialysis, for example, SM US - 1.

The development and use of sorbents is one of the greatest achievements of medicine in the second half of the 20th century. In the beginning, hemosorption became widespread, then enterosorption, and, finally, more recently, application or wound sorption, although historically, sorbents were first used for treatment wounds and poisoning.

During wound sorption, substances capable of adsorbing toxins and microflora are introduced into the wound. As application sorbents, activated carbon in the form of granules or fibrous materials, polyphepan, algipor, gelevin, gelecel, debris, gentatsykol, lysosorb, cygerol, cellosorb, etc. are used.

The sorbents included in the dressings or directly introduced into the wound have a therapeutic effect in all phases of the wound process.

In bacteriological studies, it was found that the introduction of sorbents into the wound leads to a decrease in the number of microbes by several orders of magnitude.

The effectiveness of sorbents will be reliable when antiseptics are used simultaneously with them or when the sorbent changes as its sorption properties are lost.

Physical factors

Drying. Wound healing can be perforated without the use of dressings. Apply this method for extensive wounds, burns. Patients are placed in special wards, where low humidity and elevated temperature are maintained. The wound surface gradually dries up and a scab is formed, which is a biological dressing that creates unfavorable conditions for the vital activity of microorganisms. It is even better when the method of treatment is applied in an abacterial environment. The patient or limb is placed in a special chamber, in which an abacterial environment is created using a special installation.

Washing.

In addition to flow-washing drainage, washing with a pulsating jet is used to treat wounds. A pulsating jet of liquid is formed using a special apparatus that alternately creates phases of increased and normal pressure. In the “pressure” phase, the water jet, due to turbulent motion, washes all areas of the wound and captures tissue detritus in the fluid flow. Microbes, blood clots, small foreign particles that remained in the wound after surgical treatment. In the “decompression” phase, the liquid flow carries all the contents into the reservoir. Treatment of the wound with a pulsating jet is carried out both before and during surgery, but it gives the greatest effect after surgical processing.

As a result of wound treatment with a pulsating jet, the number of microbes in the wound is reduced by 1–2 orders of magnitude, and when combined surgical processing and pulsating jet - by 3 - 5 orders of magnitude compared with the original amount.

vacuum processing.

The vacuum is created using vacuum suction. An antiseptic or antibiotic solution is fed into the wound and tissue detritus, foreign particles, blood clots, microorganisms are sucked into the sump from the bed, walls, pockets with the tip of the vacuum apparatus. The procedure lasts 5-10 minutes until diffuse capillary bleeding.

Ultrasound.

Low frequency ultrasound has a bactericidal effect. In a liquid medium, ultrasonic waves cause a pronounced cavitation effect - shock waves appear in the form of short pulses with the formation of cavitation bubbles. Fluctuations of the solution contribute to the improvement of microcirculation in tissues, the rejection of necrotic tissues. In addition, under the action of ultrasound, water is ionized with the release of H+ and OH- ion molecules from it, which cause disturbances in redox processes in microbial cells. Treating a wound with ultrasound is called ultrasonic wound cavitation.

Ultrasonic processing is performed as follows. The wound cavity is filled with solutions of antiseptics (antibiotics). Then the solution is exposed for 3-10 minutes to low-frequency or medium-frequency ultrasound. As a result of the combined surgical, antimicrobial and ultrasonic treatment, the wound is quickly and completely cleansed of necrotic tissues, and reparative processes are accelerated.

For the treatment of purulent wounds, low-power radiation is used. It has a bactericidal effect, while not having a damaging effect on the tissue. For this purpose, lasers with low-intensity radiation are used, in particular, a helium-neon laser, which emits monochromatic polarized light with a penetration depth of up to 0.61 mm into the skin and up to 2.04 mm into the muscles. The laser can be applied in the form of a “laser scalpel”. In this case, a high power focused beam carbon dioxide laser is used. Surgical treatment of a wound or a purulent focus is bloodless. The laser beam has an evaporative effect on necrotic tissues and microorganisms, which leads to the rapid and complete removal of damaged tissues. A thin coagulation film is formed on the walls of the wound, which prevents the penetration of microorganisms and their toxins into the tissues. In addition, the C0 2 - laser beam has a direct bactericidal effect. Therefore, the wound is almost completely freed from microorganisms.

Laser radiation is also used for blood irradiation both extracorporeally and inside the vessels. But these methods should be attributed to biological antiseptics, since in this case not a bactericidal effect is used, but the ability to stimulate the body's defenses.

X-ray therapy»

X-ray radiation has anti-inflammatory effects. X-ray therapy is used if necessary to suppress the infection in small, deep-seated foci.

Cryosurgery*

Low-temperature impact on the wound leads to a decrease in the number of microbes to a level below the critical level, reduces the acidosis of the wound contents, and increases the phagocytic activity of leukocytes. As a result, wound cleansing and regeneration are accelerated, and treatment times are reduced.

Ultraviolet irradiation (UFSI.

Ultraviolet irradiation has a bactericidal, anti-inflammatory and desensitizing effect. To prevent the spread of infection and resorption of the inflammatory infiltrate, ultraviolet irradiation is used in an erythema dose.

Electric field of ultrahigh frequency (EPUHF), It

causes expansion of blood vessels, acceleration of blood flow, enhancement of immunobiological processes, especially the phagocytic activity of leukocytes.

Medicinal electrophoresis. During electrophoresis, the pH of the medium changes, which activates the activity of enzymes; under its action, a long-term depot of medicinal ions is created.

CHEMICAL ANTISEPTICS

Chemical antiseptics is a set of methods for fighting infection in a wound, pathological focus or patient's body, based on the use of various chemicals. This type of antiseptic is widely used in the treatment of surgical diseases. Currently, a huge number of drugs have been proposed that have bactericidal and bacteriostatic effects.

SESSION PLAN #5

the date according to the calendar-thematic plan

Groups: Medicine

Number of hours: 2

Topic of the lesson:Antiseptics

Lesson type: lesson learning new educational material

Type of training session: lecture

The goals of training, development and education: sf to form knowledge about the main types of antiseptics, the scope of their application;

about the main chemical antiseptics and the principles of rational antibiotic therapy.

Formation: knowledge on:

1. Antiseptic, definition. Types of antiseptics: mechanical, physical, chemical, biological, mixed.

Development: independent thinking, imagination, memory, attention,students' speech (enrichment of vocabulary words and professional terms)

Upbringing: feelings and personality traits (ideological, moral, aesthetic, labor).

SOFTWARE REQUIREMENTS:

As a result of mastering the educational material, students should know: main types of antiseptics, areas of their application;basic chemical antiseptics and principles of rational antibiotic therapy.

Logistics support of the training session: presentation, situational tasks, tests

STUDY PROCESS

1. Organizational and educational moment: checking attendance for classes, appearance, protective equipment, clothing, familiarization with the lesson plan - 5 minutes .

2. Familiarization with the topic, questions (see the text of the lecture below), setting educational goals and objectives - 5 minutes:

4. Presentation of new material (conversation) - 50 minutes

5. Fixing the material - 8 minutes:

6. Reflection: control questions on the material presented, difficulties in understanding it - 10 minutes .

2. Survey of students on the previous topic - 10 minutes .

7. Homework - 2 minutes . Total: 90 minutes.

Homework: pp. 24-26 pp. 10-16

Literature:

1. Kolb L.I., Leonovich S.I., Yaromich I.V. General surgery. - Minsk: Vysh.shk., 2008.

2. Gritsuk I.R. Surgery. - Minsk: New Knowledge LLC, 2004

4. L.I.Kolb, S.I.Leonovich, E.L.Kolb Nursing in Surgery, Minsk, Higher School, 2007

5. Order of the Ministry of Health of the Republic of Belarus No. 109 "Hygienic requirements for the arrangement, equipment and maintenance of healthcare organizations and for the implementation of sanitary-hygienic and anti-epidemic measures to prevent infectious diseases in healthcare organizations.

6. Order of the Ministry of Health of the Republic of Belarus No. 165 "On disinfection, sterilization by healthcare institutions

Teacher: L.G. Lagodich

TEXT OF THE LECTURE

Topic: Antiseptics

Questions:

2. Classification of chemical antiseptics. Requirements for chemical antiseptics.

3. Principles of rational antibiotic therapy.

4. Hygienic and surgical hand antisepsis (EN-1500 standard). Preparation of the operating field.

5. Preparation of personnel for the operation.

6. Disinfection, types, methods. Disinfection of medical instruments, equipment, surfaces, cleaning equipment.

1. Antiseptics, definition. Types of antiseptics: mechanical, physical, chemical, biological, mixed.

Antiseptics- a set of measures aimed at the destruction of microbes, their spores and toxins in the macroorganism. It is a kind of tool in ensuring the sanitary and anti-epidemic regime in the surgical department.

For the prevention and treatment of local infectious diseases and their accompanying septicopyemia, antiseptics have been used since ancient times. It is difficult for a modern surgeon to imagine a pre-antiseptic period, when many patients died from infection. Even N.I. Pirogov noted that "most of the wounded die not so much from the injuries themselves, but from hospital infection." In the past, on the basis of empirical experience, and in the future, on the basis of scientific research, various means have been used by surgeons to prevent and treat surgical infection. The scale of their application since the time of I.F. Semelweis, Joseph Lister, N.I. Pirogov, D.K. Zabolotny began to grow. In the first half of the twentieth century, antiseptics became one of the most common means for the prevention and treatment of infectious diseases.

Antisepsis is extremely important for surgery. The development of antiseptics as a method opened a new era in surgery, made it possible for the development of new surgical areas - cardiac surgery, microsurgery, organ transplantation, and the like.

Types of antiseptics

Mechanical

Physical

Chemical

biological

Mechanical:

Removal of blood clots

Removal of foreign bodies

Removal of dead tissue

Physical:

hypertonic solutions

Hydrophilic bases

Drainage

hyperthermia

Hypothermia

UHF

microwave

Ultraviolet radiation

laser radiation

Ultrasound

Chemical:

See below "Groups of antiseptics"

Biological:

Antibiotics

Proteolytic Enzymes

bacteriophage

Immunological agents (toxoids, hyperimmune plasma, sera, gamaglobulins)

Nonspecific immune stimulants

Combined:

inorganic substances

Bioorganic substances and their synthetic analogues

Organic compounds of a synthetic nature

2. Classification of chemical antiseptics. Requirements for chemical antiseptics.

Classification of antiseptics (A.P. Krasilnikov, 1995)

Origin: inorganic substances, organic substances (bioorganic substances and their synthetic analogues, organic compounds of a synthetic nature).

By chemical structure: halogens and their organic and inorganic derivatives, inorganic and organic acids and their derivatives, hydrogen peroxide and potassium permanganate, aldehydes, alcohols, heavy metals and their organic and inorganic salts, dyes, phenol and its derivatives, 8-hydroxyquinolones, 4-quinolones , nitrofurans, sulfonamides, imidazoles, quaternary ammonium analogues, higher fatty acids, antiseptics of plant and animal origin, antibiotics of synthetic origin, immobilized antiseptics.

According to the mechanism of action: destructive, oxidizing, membrane attacking, antienzymatic, antimetabolic.

According to the spectrum of antimicrobial action: universal, broad-spectrum, moderate-spectrum, narrow-spectrum.

For end effect: microbicidal, microbostatic, microbostatic-cidal, reducing the number of microbial populations.

In composition: monopreparations, complex, multicomponent.

By purpose: prophylactic, therapeutic, prophylactic-therapeutic, binary, multipurpose.

Place of application: wound, skin, oral, ophthalmic, ENT, urological, genital, dental, inhalation, those that enter the area of ​​action through the circulatory or lymphatic system.

Classification of antibiotics mechanism of action and chemical nature

Bacterial wall synthesis inhibitors: beta-lactam antibiotics - penicillins (benzylpenicillin sodium, potassium and novocaine salts, bitsilin-1 -3, -5, phenoxymethylpenicillin, ampicillin, carbenicillin, carbecillin) and cephalosporins (cephalosporin, cefazolin cephalexin); vancomycin.

Protein synthesis inhibitors at the ribosome level: aminoglycosides (streptomycin, neomycin, monomycin, kanamycin, pentamycin, sisomycin, amikacin); tetracyclines (tetracycline, oxytetracycline, chlortetracycline, morphocycline, metacycline, doxycycline); nitrobenzenes (levomycetin); steroids (fusidin-sodium); macrolides (erythromycin, oleandomycin); pyranoside (lincomycin).

Nucleic acid synthesis inhibitors: rifamycin (rifamycin SV, rifampicin).

Antibiotics that disrupt the molecular organization and function of cell membranes: polyene (nystatin, levorin), cyclic decapeptides (gramicidin, polymyxin M sulfate).

Requirements for chemical antiseptics.

High bactericidal;

Harmlessness to people;

Failure to cause damage to processed items;

Solubility in water;

Storage stability;

Ease of use;

Preservation of bactericidal action in the presence of organic substances;

Cheapness of production.

3. Principles of rational antibiotic therapy.

Prevention of the development of complications of antibiotic therapy and its negative consequences consists primarily in observing the principles of rational antibiotic therapy (antimicrobial chemotherapy):

microbiological principles. Before prescribing the drug, it is necessary to establish the causative agent of the infection and determine its individual sensitivity to antimicrobial chemotherapeutic drugs. According to the results of the antibiogram, the patient is prescribed a narrow-spectrum drug that has the most pronounced activity against a specific pathogen, at a dose 2-3 times higher than the minimum inhibitory concentration. If the causative agent is still unknown, then drugs of a broader spectrum are usually prescribed, which are active against all possible microbes that most often cause this pathology. Correction of treatment is carried out taking into account the results of bacteriological examination and determination of the individual sensitivity of a particular pathogen (usually after 2-3 days). It is necessary to start treatment of the infection as early as possible (firstly, at the beginning of the disease there are fewer microbes in the body, and secondly, the drugs are more active on growing and multiplying microbes).

pharmacological principle. The characteristics of the drug are taken into account - its pharmacokinetics and pharmacodynamics, distribution in the body, frequency of administration, the possibility of combining drugs, etc. Doses of drugs should be sufficient to ensure microbostatic or microbicidal concentrations in biological fluids and tissues. It is necessary to present the optimal duration of treatment, since clinical improvement is not a basis for discontinuation of the drug, because pathogens may persist in the body and there may be a relapse of the disease. The optimal routes of drug administration are also taken into account, since many antibiotics are poorly absorbed from the gastrointestinal tract or do not penetrate the blood-brain barrier.

clinical principle. When prescribing a drug, it is taken into account how safe it will be for a given patient, which depends on the individual characteristics of the patient's condition (severity of infection, immune status, gender, pregnancy, age, state of liver and kidney function, concomitant diseases, etc.) , life-threatening infections, timely antibiotic therapy is of particular importance. Such patients are prescribed combinations of two or three drugs to ensure the widest possible spectrum of action. When prescribing a combination of several drugs, one should know how effective the combination of these drugs will be against the pathogen and how safe for the patient, i.e., so that there is no antagonism of drugs in relation to antibacterial activity and there is no summation of their toxic effects.

epidemiological principle. The choice of a drug, especially for an inpatient, should take into account the state of resistance of microbial strains circulating in a given department, hospital, and even the region. It should be remembered that antibiotic resistance can not only be acquired, but also lost, while the natural sensitivity of the microorganism to the drug is restored. Only natural stability does not change.

pharmaceutical principles. It is necessary to take into account the expiration date and follow the rules for storing the drug, since if these rules are violated, the antibiotic can not only lose its activity, but also become toxic due to degradation. The cost of the drug is also important.

In simpler terms: When to use antibiotics?

Antibiotics (anti - against, bios - life), literally translated - a remedy against life, in an applied sense - a means that kills microorganisms.

Since their discovery, antibiotics have saved millions of human lives, and gained fame as a very strong, but very harmful medicine. As a result, all patients were divided into three large groups. Alone take antibiotics only as prescribed by a doctor. Other they do not let these medicines get close to them for a cannon shot. BUT third pounce on antibacterial drugs for any sneeze. Which of them is right?

“Antibiotics should be treated in much the same way as snake venom: a little will cure, a lot will poison,” says Professor Sergei Sidorenko, head of the laboratory. Laboratory of Medical Microbiology and Chemotherapy of the State Research Center for Antibiotics.

People from the second and third groups are wrong. Those who say “never” can harm their health, and if the infection is extremely severe, they will still receive antibiotics.

But those who drink them senselessly and uncontrollably are simply dangerous, and not only for themselves, but also for others, because thanks to the massive use of antibiotics, bacteria quickly develop resistance to them. And when the medicine is really needed, it just won't work.

But people in the first group (taking prescription medication) are also at risk. The thing is that, for example, surgeons very often in difficult cases prescribe courses of antibiotic therapy that are longer than necessary, and besides, they like to prescribe them for preventive purposes. And this, in addition to unnecessary material costs, leads to the formation of the same drug resistance in microorganisms.

General rules for prescribing antibiotics:

1. Antibiotics are prescribed ONLY for bacterial infections. with viral infections, they are not effective;

2. Prescribing antibiotics to prevent bacterial infections, “just in case”, to reassure parents or your own reassurance should be PROHIBITED (author's opinion);

3. Antibiotics are prescribed after identifying the pathogen and testing its sensitivity to antibiotics. Until this result is obtained, broad-spectrum antibiotics are used.

4. Antibiotics are prescribed in the optimal dose, starting with broad-spectrum antibiotics, and then, after studying the sensitivity of microorganisms to antibiotics, the most effective antibiotic is selected. It is better to overdosing than underdosing. The optimal dose involves not only a single dose, but also the frequency of administration;

5. Unjustified prescription of antibiotics causes real harm to the patient, especially children. It is sometimes psychologically easier for a doctor to write a prescription, rather than risk his reputation and spend time explaining the inappropriateness of prescribing antibiotics;

4. Hygienic and surgical hand antisepsis (EN-1500 standard). Preparation of the operating field.

Scheme of surgical hand antisepsis according to European standard EN-1500

Hand preparation for surgery. There are many ways to handle hands: Furbringer, Spasokukotsky-Kochergin, Alfed. All of them are of historical importance. With the invention of effective antiseptics, accelerated methods of hand treatment are currently being used:

1% solution of degmin, 3 min, with two napkins;

0.5% solution of chlorhexidine, 2-3 minutes with 2 napkins;

Pervomur 2.4% solution (formic acid solution prepared ex tempore) in 2 basins for 1 min;

Diocide for 3 minutes and alcohol - 2 minutes;

3% Novosept solution;

Hibiscrab for 2-3 minutes with 2 napkins, etc., depending on the healthcare institution

Before treatment with these substances, hygienic washing of hands with water and liquid soap is performed for 1-2 minutes. Brushes are not used. Hands dry. Then - rubbing the antiseptic according to the European standard

Treatment of the surgical field with modern methods

Treatment of the surgical field

When the patient takes the required position on the operating table and the anesthesiologist gives the necessary permission, the surgical field is processed.

To treat contaminated skin, the nurse gives the surgeon a forceps with a ball soaked in ether. After processing, the forceps are dropped into the pelvis. Then use a forceps with an alcohol ball, and after that - two cotton swabs on sticks or tools moistened with iodopyrone, chlorhexidine.

After treatment with an antiseptic, the surgical field is wiped dry with a sterile cloth, and the surgeon isolates the surgical field. The sister provides sheets and towels. See didactic material

5. Preparation of personnel for the operation.

Wearing sterile clothes

Preparation of the operating team. Wearing sterile gloves by the nurse. Having treated her hands with 96% alcohol, the operating sister takes sterile gloves from the bix and puts them on in such a way that the edges of the gloves cover the ties of the sleeves of the gown. Unfold the package with gloves (a), take the glove with the left hand by the lapel so that the fingers do not touch its inner surface. The fingers of the right hand are closed and inserted into the glove, the fingers are brought in and the glove is pulled over them (b), without breaking its lapel (c). Then, II, III and IV fingers of the right hand, dressed in a glove, are brought under the lapel of the left glove; hold the left glove II, III, IV with the fingers of the right hand vertically; straighten the cuffs on the gloves with fingers II, III, first on the left, then on the right, pulling them over the sleeves. After that, the gloves are rubbed with a ball treated in alcohol.

Putting on sterile operating clothes by the surgeon. After processing the hands, the surgeon puts on a sterile gown. The nurse opens the bix and removes the gown from it, then unfolds the gown facing her so that it does not touch her. The nurse holds the gown at the collar by the shoulder seams so that her hands are covered by the gown. She hands the unfolded gown to the surgeon so that he can slip both hands into the sleeves at once. Then the operating nurse throws the top edge of the gown over the surgeon's shoulders. The surgeon independently or with the help of an operating sister ties the ribbons on the sleeves. The nurse pulls on the dressing gown from behind, tying the ribbons and the belt. The surgeon puts on a sterile mask, as a rule, in the preoperative room before processing the hands.

The final stage of preparation for the operation is the putting on of gloves by the assistant and the surgeon.

Putting on sterile gloves by the surgeon. If the operating sister is without gloves, then when putting on sterile gloves on the hands of the surgeon, she takes the glove by the cuff and puts the tips of the II and III fingers of both hands inside the glove. Then he stretches the cuff of the glove, and presses the IV and V fingers to the palmar surface of the hands; the surgeon, putting on a glove, raises the brush up, and the nurse, removing her fingers from the glove, straightens the cuff. When putting on gloves, they should be fed with the palm side to the surgeon, guided by the first finger. In conclusion, the nurse gives the surgeon a ball moistened with alcohol to process gloves.

If the operating nurse gives gloves to the surgeon, having sterile gloves on her hands, then in order to avoid infection of her hands, she takes the glove to be put on by the cuff with her fingertips, twists it, covering her fingers with the cuff, and takes both I fingers to the side. The glove should be turned to the surgeon with the palm side. The nurse spreads the cuff after the surgeon puts on the glove; performs a similar manipulation with the second glove. After putting gloves on the surgeon, she gives the surgeon a ball moistened with alcohol for processing.

Rules for setting up a sterile dressing table.

Target: maintaining the sterility of instruments and dressings on the table for six hours, subject to asepsis rules. Equipment: manipulation table; 1% solution of chloramine, 2 containers for disinfectant solution; bixes with sterile linen, dressings, sterile instruments.

Preparation for the procedure

Put on overalls: gown, hat, mask, gloves.

Treat the table with rags moistened with a disinfectant solution twice, starting from the frame, then sequentially, applying one smear to another so that there are no gaps between them.

Let dry.

Wash your hands with soap and water at the surgical level.

Put on a sterile gown.

Performing a procedure

Remove the sheet folded in four layers with gloved hands from a sterile bix.

Cover the surface of the tool table so that the edges of the sheet hang from it by 15-20 cm on three sides.

Raise the top two layers of the sheet, folding it "accordion".

Close all previous layers with the last layer of "accordion" so that the inside of the sheet is on top, and the edges are folded back away from you.

Arrange sterile instruments in groups and dressings on a sterile table using a sterile forceps.

Attach the toe caps to the top two layers of the sheet.

Close the table with a two-layer sheet with the help of caps so that its edges are 3-5 cm higher.

End of procedure Attach a tag to the right leg with the date and time of its setting, sign the nurse who set the table.

6. Disinfection, types, methods. Disinfection of medical instruments, equipment, surfaces, cleaning equipment.

Disinfection - methods and means of destruction of pathogenic microorganisms on the routes of transmission from the source of infection to a healthy organism. The main task of disinfection is to interrupt the infection transmission mechanism by disinfecting various objects (water, food, household items, etc.). Reusable products to be sterilized are subjected to pre-sterilization cleaning before sterilization. Pre-sterilization cleaning is carried out in order to remove protein, fat and mechanical contaminants from products, as well as drug residues.

Disinfected Item- this is an object on the surface of which there are no pathogenic microorganisms.

Sterile An object is considered to be on the surface of which there are no microorganisms, as well as their spores and toxins.

Objects to be disinfected differ from each other in their purpose and application, in the degree of their contamination, in their significance, structure and consistency, chemical and physical properties, in density, location and biological form of infectious agents.

There are the following methods of disinfection:

Mechanical,

Physical,

Chemical

Biological disinfection methods

mechanical method. The basis of the mechanical method is: cleaning objects, wet cleaning, washing, filtering, ventilation, etc. These methods can free objects from dust and dirt, and together with the latter from a significant amount of microbes. So, with the help of a vacuum cleaner, up to 98% of microbes are removed along with dust. When airing the room for 15 minutes, the number of microbes decreases sharply, and after 30 minutes the air in the room is almost completely freed from them. Air conditioning gives good results. An air conditioner supplies air at a certain temperature and humidity. The advantage of the mechanical method of disinfection is its simplicity and availability for implementation, however, this method can only reduce the microbial contamination of the object, but complete disinfection cannot be achieved.

physical method. Physical methods of disinfection involve the impact (destruction) on microorganisms by various physical factors. This can be boiling, baking, roasting, exposure to sunlight, the use of ultraviolet radiation, blowing hot air, ironing, drying, using water vapor, drying and even burning. As can be seen from the list, the main physical method is heat treatment, this is due to the fact that microbes are not able to withstand high temperatures. The expediency of using each type of physical impact is determined depending on the type of surface to be treated, the environment (type of room) or other factors.

Sunlight. Direct rays of the solar spectrum have a detrimental effect on pathogenic microorganisms. The action is complex, it involves drying, heat and ultraviolet rays. Causative agents of typhoid fever, dysentery, cholera quickly die from exposure to sunlight; tubercle bacilli and spore forms of bacteria are less sensitive. Pathogens found in mucus, sputum, feces, blood, etc., withstand exposure to sunlight much longer than unprotected ones.

Boiling- this is the simplest and most affordable method of disinfection, in which it is possible to destroy all pathogenic microbes on many objects (linen, dishes, toys, food products, patient care items, wooden and rubber products, etc.). Boiling can be carried out in any container (bucket, pan, sterilizer) on any heating. By boiling things infested with lice in water, you can achieve complete extermination of lice and nits in linen and other washable things within 15 minutes, using ordinary tanks with lids for this. Better insect extermination is ensured by using special installations. Boiling should not be used to disinfect woolen, semi-woolen, viscose, leather and fur items, glued and polished items in order to avoid their damage.

Water vapor. Water vapor is the most effective disinfectant that penetrates into the depth of the treated objects. Steam is widely used in disinfection chambers and autoclaves for disinfection and sterilization in the form of saturated steam at a temperature of 100 degrees and above.

Drying. Many pathogenic pathogens cannot withstand prolonged drying and die. The rate of death depends on the type of microbes, their resistance and the conditions under which drying occurs. So, for example, cholera vibrio withstands drying for several hours, and the pathogens of tuberculosis and staphylococci do not die within 10 months; anthrax spores can remain virulent for many years.

dry hot air. causes dehydration and coagulation of the protoplasm of the microbial cell. At a temperature of hot air of 100 degrees, vegetative cells die completely within 60-90 minutes. Pasteur ovens use dry hot air to disinfect laboratory glassware (porcelain, glass, metal).

Ironing. Ironing linen, clothes, dresses should be considered as a disinfection measure. With prolonged ironing (temperature 200-250 ° C) of tissues in their thickness, the temperature can reach 98-170 ° C, at which vegetative forms of microbes, lice, and nits die. Iron things should be on both sides.

Calcination. A method most commonly used in laboratories to decontaminate glass pipettes, platinum loops, tweezers, and other small metal items used in medical practice, and to decontaminate other contaminated items if they cannot be boiled.

Burning. One of the reliable ways to destroy infectious waste trash. Incineration, as one of the methods of physical disinfection, is rarely used, since there are not always conditions for incineration. However, burning garbage, paper, unnecessary old wallpaper, rags, toys of little value, etc. is the best and most reliable way to destroy the infection. In addition to low-value infected items, the sputum of tuberculosis patients, as well as the corpses of animals and people who died from especially dangerous infections, can be burned.

ultraviolet irradiation. Ultraviolet irradiation is used to disinfect the air in the premises of infectious diseases hospitals, children's hospitals, maternity hospitals, operating rooms, boxes and other premises in order to prevent the occurrence of nosocomial infections. To do this, special “veils of ultraviolet rays received from BUV lamps” are arranged above the entrance to the room. In rooms of this kind, lamps (at the rate of one lamp with a power of 15 W per 15 cubic meters of air) are used mainly during the absence of people. The duration of the bactericidal effect of sunlight can be from several minutes to several hours and depends on the sensitivity of pathogenic microbes and the intensity of this physical factor.In the presence of people, the lamps are equipped with visors that prevent direct rays from reaching a person.In such cases, only the upper or lower layers of the air are exposed to radiation.Irradiation can free from pathogenic microorganisms in the air and reduce its contamination with other microorganisms by 80-90%.

Chemical method. The chemical method involves the destruction of microorganisms by using various chemicals that have bactericidal, virucidal, fungicidal and sporicidal effects. This method is most often used in practice, since almost any object or surface can be treated with chemicals without causing mechanical harm to it. However, there are only a few products created exclusively for disinfection. Therefore, in practice, various chemical agents are used, the use of which is determined depending on the type of pathogen, environmental conditions and the type of surface being treated.