Basic concepts of asepsis and antisepsis. Aseptic and antiseptic. Types of asepsis and antisepsis General rules for observing asepsis and antisepsis

Aseptic and antiseptic means are different, but they complement each other, due to which a single goal is achieved - the prevention of wound infection. The tasks of asepsis include decontamination of objects in contact with the surface, as well as protecting the wound from contact with objects that cannot be freed from microbes. Asepsis rules must be observed during operations, as well as all medical and diagnostic procedures in which there is a danger of introducing bacteria into tissues or organs (, punctures, catheterization, etc.

The main links in the asepsis system are: 1) the correct maintenance of the surgical dressing block (see); 2) sterilization of materials and instruments; 3) preparation of the surgeon, his assistants and the operating sister for the operation; 4) preparation of the patient for surgery.

Bacteria can enter the wound in two ways - exogenous and endogenous. Exogenous route: from the air with dust, with drops of liquid, splashes and mucus when talking, coughing, (drip), through objects related to the wound (contact infection), through objects left in the wound intentionally (sutures, drains, tampons) or accidentally (threads of gauze, gauze balls or napkins) - implantation infection. The source of endogenous wound infection is the patient's body: microbes can enter the wound from the surrounding skin or from deep-lying organs (intestines, etc.) during operations on them. In addition, it is possible for microbes to penetrate the wound by transferring them along the lymphatic or from foci of infection distant from the wound (carious, etc.).

The main method of preventing bacteria from entering the wound by air and drop is the correct arrangement of operating rooms and, as well as compliance by medical personnel with the rules of conduct in them. The degree of air pollution in the operating room and dressing room is judged by the results of systematically conducted. During operations and dressings, conversations are prohibited. Before the operation, all those participating in it must take a shower, put on special light cotton clothing, slippers, a cap, and a mask. Mandatory systematic wet cleaning of the operating room and dressing room.

When preparing for an operation, a certain order must be strictly observed - the operating sister is the first to prepare for the operation. She puts on a mask, cleans her hands (see Hand Processing), puts on a sterile gown (with the help of a nurse) and then rubber ones (since no method of hand processing ensures their sterility for the entire operation), then lays sterile instruments on a sterile table, underwear.

The surgeon and his assistants treat their hands, with the help of their sister they put on sterile gowns, gloves and proceed to process the surgical field (see), after which they enclose it with sterile linen.

Visitors and spectators in the operating room must wear caps, masks, gowns, shoe covers. They must take their places before the start of the operation. Walking in the operating room and talking during the operation are unacceptable. If two or more work in the operating room, then the tables should be placed in such a way that the teams working on them do not interfere with each other and do not violate the rules of asepsis. No one, except for the operating nurse, should pass between the operating table and the table with sterile materials.

If there are infected areas near the surgical field or in it itself, for example, a decaying cancerous ulcer, etc., then they are carefully fenced off with sterile wipes from the line of the surgical incision, sealed, sometimes sutured, and only after careful processing of the surgical field, the operation is performed.

If the surgeon contaminated his hands during the operation, he must re-treat them, change the gown and gloves, as well as the underwear around the wound, and only then continue the operation.

In the postoperative period, the bandage or sticker on the surgical wound, when it gets wet, should be immediately changed, since when it is impregnated with wound discharge, it ceases to protect the wound, and conditions for the development of infection arise under it.

Preparing the patient for surgery - see.

Careful observance of asepsis rules minimizes the number of purulent complications in both planned and emergency surgical interventions.

Asepsis (from the Greek aseptos - not subject to decay; a synonym for a non-putrefactive method) is a method of preventing infection by preventing the penetration of microbes into a wound, tissue or body cavity during surgical operations, dressings and other therapeutic and diagnostic manipulations. Asepsis, like antiseptics (see), involves the use of the same means of chemical and physical effects on the microflora, however, their fundamental difference is that asepsis is aimed at preventing the introduction of pathogens, and antiseptics - at combating already introduced microbes.

The main element of asepsis is sterilization (see). The absence of microbes on instruments, materials, etc., in contact with an operating room or other wound, introduced into tissues, hollow organs, etc., ensures the prevention of contact and implantation infection. Asepsis includes a number of techniques for handling sterile and non-sterile objects, rules of conduct during surgical procedures, as well as a system of measures that minimizes the possibility of microbes entering by air, droplets or endogenous routes (see Operational dressing unit, Dressings, Surgical operation). The aseptic method is the most important of the foundations of modern surgery. Asepsis is also obligatory in cases where the intervention is performed on “tissues that already contain microflora, since violation of asepsis threatens the penetration of pathogens that are more dangerous than those already introduced (for example, the causative agent of erysipelas, anaerobic superinfection), or worsen the course of the wound process (Bact. pyocyaneum). Therefore, the rules of asepsis in the "purulent" operating room (dressing room) must be observed as strictly as in the "clean" one. Violations of asepsis during "clean" operations will certainly lead to an increase in the frequency of postoperative suppuration. If the wound is already contaminated or its contamination cannot be completely prevented, then asepsis is combined with an antiseptic effect on the wound, on the surrounding tissues (deep antiseptic) or on the body as a whole (chemotherapy). Antibiotics are the most reliable remedy that can compensate for aseptic disorders that are inevitable in some serious interventions (for example, resection of the stomach, intestines, esophagus, radical surgery for pulmonary suppuration, etc.). However, the calculation of such compensation cannot justify the neglect of the rules and techniques of asepsis.

Aseptic and antiseptic - what is it? In modern medicine, this question remains one of the most common. Knowledge of asepsis and antiseptics remains one of the main sections in the medical specialty.

Asepsis is a set of measures that are aimed at preventing the penetration of infectious agents into the wound, body tissues, organs and body cavities of the patient. These activities are carried out during the manipulation of the surgical profile and diagnosis.

Asepsis is the destruction of microorganisms by means of disinfection and sterilization processes using physical influences and chemicals.

Types of sources of surgical infections

There are two types of source of surgical infection: endogenous and exogenous. The first type is located directly in the patient's body, the second - in the environment that surrounds the patient.

In the prevention of endogenous infection, the main importance is given to antisepsis, exogenous - asepsis.

Prevention of endogenous wound infection involves the identification and sanitation of infectious foci in a patient who is being prepared for a scheduled surgical intervention. Such an operation is subject to transfer if the patient has a fever, he has a purulent skin lesion (asepsis in dermatology), tonsillitis, caries in the teeth (asepsis in dentistry) or other purulent foci.

When there is a contaminated lesion in the area adjacent to the surgical field, it is limited with sterile wipes, special films from the surgical incision, sealed with a medical plaster, in some cases they resort to suturing, followed by careful treatment of the operating area. And only then do the manipulation itself, strictly observing the rules of asepsis.

Prevention of exogenous infection

Asepsis methods are used in the fight against exogenous infection. The sources of the latter are sick and bacteriological carriers, especially if they are among medical personnel.

Prevention of droplet infection in operating rooms and dressing rooms is facilitated by equipping them with a special ventilation system (the predominance of air masses over the exhaust, installing a laminar flow of conditioned air), organizing a special mode of operation in them, taking measures that are aimed at destroying existing microorganisms: timely moist cleaning, irradiation of air masses with bactericidal lamps, as well as strict observance by medical staff of the required sanitary standards.

Prevention of contact contamination is ensured by sterilization of linen for surgery, dressings and suture materials, rubber gloves, instruments, special treatment of the surgeon's hands and the field for surgery. Everything that comes into contact with the wound must be free from bacteria, or, in other words, must be sterile. This is the basic principle of asepsis. Sterilization of suture material has a special purpose in the prevention of wound infection. Responsibility for properly performed sterilization rests with the operating room nurse.

Operating block mode

Visits to operating rooms by unauthorized persons are limited as much as possible, the movement of personnel is reduced. Persons participating in the operating process must be dressed in special medical clothing (sterile gowns, caps, masks, shoe covers). The level of contamination of air masses in the operating room and the dressing room is assessed through bacteriological studies carried out with a certain systematicity.

Preparation for the operation provides for a strictly established procedure for preoperative actions. The operating nurse should be the first to prepare for the operation. This process consists in the following sequence: putting on a mask, treating hands, putting on a sterile gown, with the help of junior medical staff, then sterile gloves. This is followed by laying out linen, sterile instruments, and suture material on a sterile table. Next, the operating surgeon with assistants process their hands, using the nurse of the operating unit, dress in sterile medical clothing and proceed to prepare the area for the operation, which is protected by pre-sterile linen.

When aseptic conditions are created, one of the main measures is the sanitation of the medical staff of the institution. And only in those cases when it does not bring a positive effect, they resort to the labor transfer of carriers outside the surgical departments.

Antiseptics and its types

Antisepsis (and asepsis as part of it) is a complex of therapeutic and preventive measures that are aimed at destroying microorganisms in a wound, other pathological focus, or in the whole organism.

There are the following types of asepsis and antisepsis:

1. Preventive antiseptic - is aimed at preventing the penetration of microorganisms through the wound surface or into the patient's body (treatment of the hands of medical staff, treatment of places of alleged skin damage with an antiseptic preparation, etc.).

2. Therapeutic antiseptic, which is divided into the following methods:

mechanical (removal of infected and non-viable tissues, primary surgical treatment of the wound, etc.);
physical (absorbent dressings, hyperosmotic solutions, the effect of ultrasound, etc.);
chemical (use of bactericidal and bacteriostatic agents);
biological (antibacterial drugs, antitoxins, bacteriophages, proteolytic enzymes, etc.);
mixed.

From the foregoing, the general principles of asepsis follow:

Everything that has contact with the wound (medical instruments) must be sterile.
Classification of all patients in surgical departments into "clean" and "purulent".

The role of the hands of medical personnel

The hands of health workers who are directly involved in the implementation of medical care can become a factor in the transfer of pathogens and conditionally pathogens. The microflora of the skin of the upper extremities can be of two types: permanent and transient. The first develops in the stratum corneum of the skin, sebaceous and sweat glands, hair follicles, and its representatives are epidermal staphylococcus, etc. The composition of the permanent microflora is more or less stable and forms the protective function of the skin. In places of the periungual folds and on the interdigital surfaces, there may additionally be Staphylococcus aureus, Pseudomonas, various types of Escherichia coli, Klebsiella and other conditionally pathogenic microorganisms.

Transient microflora enters the skin as a result of contact with contaminated areas of the patient's body or contaminated objects of the external environment. It remains on the surface of the skin for up to a day, it is represented by pathogenic and conditionally pathogenic microbes, like a permanent microflora, it depends on the profile of the medical institution.

Different types of effects on the stratum corneum of the skin, which lead to an imbalance of permanent microflora (the use of brushes, detergent for hands with an alkaline environment, aggressive antiseptics, the absence of softening components in alcohol-containing antiseptics), contribute to the formation of skin dysbacteriosis. A characteristic indicator of it is the predominance of gram-negative conditionally pathogenic microflora in a constant strain, including hospital strains that are resistant to antibacterial, antiseptic drugs and disinfectants. Thus, the hands of health workers can become both a factor in the transmission of an infectious principle, and their source.

If the transient microflora can be removed mechanically (by washing hands and using antiseptic preparations), then the permanent population is practically not subject to destruction in this way. Sterilization of the skin is impossible and undesirable, because the preservation of the stratum corneum and a constant population of microorganisms prevents colonization by more dangerous microbes.

Modern technique for processing the surgeon's hands

In connection with the physiology described above, in the countries of Western Europe, the main methods of processing the hands of a surgeon (according to Alfeld-Furbringer, Spasokukotsky-Kochergin) have undergone a change and improvement.

Of the large number of methods used at the present stage, disinfection of the skin of the hands, only one is carried out according to the European standard, and is fixed in the manner prescribed by law as the "European Norm 1500" (EN 1500). This norm is used by two-thirds of the countries of the European continent: Belgium, Ireland, Germany, the Netherlands, France, Greece, Iceland, Finland, Luxembourg, Holland, Norway, Portugal, Austria, Italy, Sweden, Spain, Switzerland, the Czech Republic, England.

It is recognized as the most suitable for hygienic and surgical treatment of the hands of medical staff. In the Russian Federation, there is instruction No. 113-0801 dated September 5, 2001, which provides for methods for various types of treatment of the skin of the hands and forearms of operating surgeons.

Hygienic treatment of brushes

The indications for such processing are as follows:

communication with patients with infectious diseases with a reliable or probable cause;
contact with physiological secretions of patients (pus, blood, feces, etc.);
manual and instrumental research and actions;
after visiting the box of the infectious diseases hospital;
after visiting the toilet room;
at the end of the work shift.

Special requirements for the processing of hands:

antiseptic is applied exclusively to dry skin;
use of elbow dispensers to avoid excess antiseptic;
it is forbidden to use additional items for applying an antiseptic;
mandatory alternation of antiseptics that contain active substances with different mechanisms of antibacterial action;
compliance with the established sequence of actions, the dose of the agent and the exposure during each stage of processing.

Hand hygiene steps

1. An antiseptic agent is applied to the skin in an amount of 3 ml and thoroughly rubbed for 30-60 seconds until completely dry. Next, you need to carry out the following manipulations:

rub the palmar planes against each other;
rub the palm of your right hand along the back of the left hand and vice versa;
rub the palmar surfaces, crossing and spreading your fingers;
rub the back surface of the bent fingers on the palms of the other hand;
rub the thumbs of the hands in circular steps;
in circular steps, alternately rub the palm surfaces with your fingertips and in reverse order.

2. Contamination with biological materials is removed with a sterile cotton swab or a napkin moistened with an antiseptic solution. Then, 3 ml of an antiseptic agent is applied to the surface of the brushes and rubbed into the skin until completely dry, paying special attention to the interdigital, palmar and back surfaces for at least ½ minute, and washed off with running water, followed by washing.

Surgical treatment of brushes and its stages

Surgical treatment of hands is a method of preparing limbs for surgical operations, dressings and other surgical procedures in order to disinfect the skin and prevent the penetration of microbes onto sterile objects and onto the wound surface.

Hands are surgically treated in case of contact (direct or indirect) with sterile formations of the body (catheterization of blood vessels, punctures, etc.).

Stages of surgical treatment:

Two-minute washing of hands and forearms without the use of additional products with warm running water, soap with a neutral pH.
Drying with a sterile towel.
5-minute rubbing of an antiseptic agent into the skin surface of the hands and forearms in the standard way.
Air drying of the skin.
Putting on sterile gloves.
At the end of the surgical manipulations, remove gloves and wash in warm water with liquid soap for two minutes. Then - lubrication with a nourishing cream.

Types of antiseptics

Types of asepsis depend on the method of using antiseptic drugs. Allocate local and general antiseptics. The first is subdivided into superficial (application of ointments, washing of wounds and cavities, etc.) and deep (administration of the drug into a wound or inflammatory focus).

General asepsis is the saturation of the whole organism with an antiseptic drug (antibacterial agent, sulfonamides), which subsequently enters the infectious focus with blood or affects the microorganisms contained in the blood itself.

When using this or that type of asepsis, it is necessary to remember about its possible side effects: intoxication (use of chemical antiseptics), damage to important anatomical structures (mechanical), photodermatitis (physical), allergies, dysbacterial reactions, addition of fungal infections (biological) and so on.

Requirements for antiseptics

Preparations that are used for antiseptic treatment must meet the following requirements:

a wide range of activities;
speed of action;
complete disinfection (asepsis) of transient microorganisms;
reduction of contamination of resident microflora to a normal level;
long-term effect after treatment (at least 3 hours);
lack of skin-irritating, allergenic, carcinogenic, mutagenic and other side effects;
slow development of microflora resistance;
price availability.

In conclusion, we can say that a set of measures that are aimed at preventing the penetration of microorganisms into the wound is called "asepsis". This can be achieved by complete disinfection of all used items in contact with the wound surface.

Aseptic and antiseptic - what is it? This issue remains one of the topical issues in the medical field.

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on the topic: "Asepsis and antisepsis. Types of asepsis and antisepsis"

Saratov 2016

INTRODUCTION

Before the introduction of aseptic and antiseptic methods, postoperative mortality reached 80%: patients died from purulent, putrefactive and gangrenous processes. The nature of putrefaction and fermentation discovered in 1863 by Louis Pasteur, having become a stimulus for the development of microbiology and practical surgery, made it possible to assert that microorganisms are also the cause of many wound complications.

This essay will consider such disinfection methods as aseptic and antiseptic.

These concepts should be considered in a set of activities that complement each other, one without the other will not have the best result.

Antiseptic means a set of measures aimed at the destruction of microbes on the skin, in a wound, pathological formation or the body as a whole. Allocate physical, mechanical, chemical and biological antiseptics.

Asepsis is a method of surgical work that prevents the entry of microbes into the surgical wound or their development in it. On all objects surrounding a person, in the air, in water, on the surface of his body, in the contents of internal organs, etc. there are bacteria. Therefore, surgical work requires compliance with the basic law of asepsis, which is formulated as follows: everything that comes into contact with the wound must be free from bacteria, i.e. sterile.

Antiseptics

Antiseptics (Latin anti - against, septicus - decay) - a system of measures aimed at the destruction of microorganisms in the wound, pathological focus, organs and tissues, as well as in the patient's body as a whole, using mechanical and physical methods of exposure, active chemical substances and biological factors.

The term was introduced in 1750 by the English surgeon J. Pringle, who described the antiseptic effect of quinine.

The introduction of asepsis and antiseptics into surgical practice (along with anesthesia and the discovery of blood groups) is one of the fundamental achievements of medicine in the 19th century.

Before the advent of antiseptics, surgeons almost never took the risk of operations associated with opening the cavities of the human body, since interventions in them were accompanied by almost one hundred percent mortality from surgical infections. Professor Erikoen, Lister's teacher, stated in 1874 that the abdominal and thoracic cavities, as well as the cranial cavity, would forever remain inaccessible to surgeons.

In the emergence and development of asepsis and antisepsis, five stages can be distinguished:

Empirical period (the period of application of individual, scientifically unsubstantiated methods);

Dolister antiseptic;

Lister antiseptic;

the occurrence of asepsis;

modern antiseptic.

Types of antiseptics

antiseptic exogenous infection infection

one). Mechanical antiseptic

2). physical antiseptic.

3). Chemical antiseptic

four). biological antiseptic.

Mechanical antiseptic is the destruction of microorganisms by mechanical methods. In practice, this is reduced to the removal of tissues containing microorganisms. Mechanical antiseptic is the most important, because. if the source of infection is not removed, it is practically useless to fight it with chemical and biological methods. Methods of mechanical antiseptics include:

one). Wound toilet (treatment of the skin around the wound, removal of wound exudate, necrotic tissue).

2). Primary surgical treatment of the wound (dissection, excision of infected and non-viable tissues, hemostasis, drainage for exudate outflow). PHO is performed to prevent suppuration of the wound.

3). Secondary surgical treatment (dissection, excision of necrotic tissues, removal of pus, wide drainage).

four). Other operations and manipulations (opening of abscesses, phlegmon, panaritium, osteomyelitis, etc., puncture of the maxillary sinus, pleural cavity).

Physical antiseptics are physical methods that create unfavorable conditions for microbes in the wound:

one). Use of hygroscopic dressing material (gauze, cotton wool). Tamponade of the wound should be done loosely, because. while significantly increasing the outflow of exudate.

2). The use of hypertonic sodium chloride solution (10%, in children 5%). When wetting tampons with a hypertonic solution due to the difference in osmotic pressure, the outflow of exudate from the wound is faster.

3). Drainage is based on the principles of capillarity and communicating vessels. There are 3 types of drainage:

· Passive drainage. They use rubber strips, tubes (rubber, silicone or PVC), as well as cigar drains (a swab moistened with an antiseptic is inserted inside the glove or its finger). Recently, double-lumen tubes have been more commonly used.

· Active drainage: a plastic accordion, a rubber bulb or a special electric suction is attached to the drainage tube. A negative pressure is created in them, due to which the exudate actively enters their cavity. Active drainage is possible only if the wound is completely sealed, i.e. it must be completely sutured.

Flow-flushing drainage: I install at least 2 drainages into the wound. According to one of them, antiseptics (antibiotics, proteolytic enzymes) are constantly injected, according to the other, it flows. The first drainage should be located in the upper corner of the wound, and the outlet in the lower one. Flow-flushing drainage is a typical example of mixed antiseptics, because it uses chemical, physical and biological methods.

4) Impact of environmental factors:

Treatment of wounds without dressing in rooms with high temperature and low humidity. This leads to the drying of the wound, a scab forms on it, under which the microorganisms die.

washing of the wound.

5). The use of sorbents.

Carbon-containing substances are used (polyphepan, SMUS-1 coal), as well as special napkins impregnated with sorbents (manufactured in the factory).

6). Application of technical means:

· Ultraviolet irradiation of the wound: causes the death of microbes, and also contributes to the drying of the wound.

· Ultrasonic treatment (cavitation): an antiseptic is poured into the wound and the tip of the device, which is the source of ultrasound, is inserted. Under the influence of ultrasound, microcirculation in the walls of the wound improves, necrotic tissues are more quickly rejected, and the metabolism of microorganism cells is disrupted.

Low power laser irradiation has a bactericidal effect. Typically, a gas (carbon dioxide) laser is used.

X-ray therapy is used to suppress infection in deep tissues and bones.

· Chemical antiseptics are based on the use of chemicals (antiseptics) to destroy microbes in the wound.

Biological antiseptics is the use of drugs that act directly on the microorganism, or indirectly, by affecting the human body.

Ways to use antiseptics

Topical application: washing wounds, applying a bandage with an antiseptic to the wound, periodically irrigating the wound through drainage, introducing an antiseptic into the purulent cavity by puncturing it, treating the skin around the wound, treating the surgical field.

Impregnation of tissues around the purulent focus with an antiseptic solution in novocaine (short blockade according to A.V. Vishnevsky).

The introduction of antiseptics into the focus with the help of physiotherapy procedures (electrophoresis).

Introduction of antiseptics in / m, / in, intra-arterially, into the thoracic lymphatic duct, intraosseously. This method also affects the entire body as a whole.

Directly on the microorganism and its metabolic products are:

· Antibiotics.

bacteriophages.

· Proteolytic enzymes (trypsin, chymotrypsin, chymopsin, terrilitin). Proteolytic enzymes are part of the Iruksol ointment.

· Means of specific passive immunization: therapeutic sera, antitoxins, specific gamma globulin, hyperimmune plasma.

Other methods act on the body, increasing its immunity:

· Vaccines (for example, anti-rabies).

Toxoids (eg tetanus).

· Methods stimulating nonspecific resistance: ultraviolet and laser irradiation of blood, quartzization, blood prefusion through the xenospleen, transfusion of blood and its preparations.

Immunomodulators: thymus preparations (thymalin, T-activin), prodigiosan, lysozyme, levamisole, inferons, interleukins.

· Vitamins.

Anatoxins (staphylococcal, tetanus).

Routes of administration of antiseptics

1. Enteral administration - through the gastrointestinal tract.

In this way, antibiotics and sulfonamides are administered.

2. External use - for the treatment of wounds: in the form of a powder, ointment, solution;

3. Abdominal administration - in the cavity of the joints, in the abdominal, pleural cavities;

4. Intravenous administration (intra-arterial);

5. Endoscopic introduction - through a bronchoscope into the bronchi, into the cavity

lung abscess; through FGS - into the esophagus, into the stomach, duodenum 12;

6. Endolymphatic injection - into the lymphatic vessels and nodes.

Thus, endolymphatic antibiotic therapy for peritonitis is widely used in surgery.

Asepsis

Asepsis is a set of measures aimed at preventing the entry of microorganisms into the wound.

Asepsis is a way to prevent suppuration of wounds. Asepsis should be distinguished from antisepsis, which aims to destroy the causative agents of inflammation already present in the wound, by means of certain chemicals, such as carbolic acid, sublimate, etc.

The German surgeon Ernst von Bergmann is considered one of the founders of asepsis. He proposed physical methods of disinfection - boiling, roasting, autoclaving. This happened at the X Congress of Surgeons in Berlin in 1890. In addition to them, there is a chemical method and a mechanical one.

In the aseptic method of treating wounds, only boiled water is used; all dressings and instruments are also supplied with flowing steam or boiling.

Asepsis is applicable before and during operations on healthy tissues, but is not applicable where the presence of inflammatory pathogens in the wound can be assumed.

Asepsis has undoubted advantages over antiseptics in terms of treatment results, and also because with the aseptic method of treating wounds there is no poisoning that is possible with the use of some antiseptics. Thanks to the aseptic measures taken, the need for antiseptics in the postoperative period is significantly reduced, which significantly reduces the cost of treatment.

Asepsis is a method of preventing wound infection. Preventive destruction of microbes, prevention of their entry into the wound. Observance of sterility during the operation, sterilization of instruments, instruments. Everything that comes into contact with the wound must be sterile.

Sterilization is the basis of asepsis.

Sources of infections

There are exogenous and endogenous sources of infection.

The main sources of exogenous infection are patients with purulent-inflammatory diseases and bacillus carriers. Infection occurs by airborne droplets (with splashes of saliva and other liquids), contact (from objects in contact with the surface of the wound), implantation (from objects left in the wound - sutures, drainage, etc.) by.

Sources of endogenous infection - chronic inflammatory processes in the patient's body outside the operation area (diseases of the skin, teeth, tonsils) or in the organs on which the operation is performed (vermiform appendix, gallbladder, etc.), as well as saprophytic flora of the oral cavity, intestines, respiratory tract, etc. Ways of infection - contact, lymphogenous, hematogenous.

Sterility control

1.physical

2.chemical

3.biological

1. Physical: a test tube is taken, where some substance is poured that melts at a temperature of about 120 degrees - sulfur, benzoic acid. The disadvantage of this method of control is that we see that the powder has melted and it means that the required temperature has been reached, but we cannot be sure that it was like this during the entire exposure time.

2. Chemical control: take a filter paper, place it in a starch solution, and then immerse it in Lugol's solution. It takes on a dark brown color. After exposure in an autoclave, starch is destroyed at temperatures above 120 degrees, the paper becomes discolored. The method has the same drawback as the physical one.

3. Biological control: this is the most reliable method. They take samples of the sterilized material and sow it on nutrient media, they did not find microbes - that means everything is in order. Found microbes - so you need to re-sterilize. The disadvantage of the method is that we receive an answer only after 48 hours, and the material is considered sterile after autoclaving in a bix for 48 hours. This means that the material is used even before receiving a response from the bacteriological laboratory.

The most dangerous source of contact infection is the surgeon's hands. Physical methods are not applicable for skin sterilization, in addition, the difficulty lies in the fact that after processing the hands, they again become contaminated due to the secretion of the sebaceous, sweat glands. Therefore, tanning of the skin with alcohol, tannin is used, while there is a sharp spasm of the excretory ducts of the sweat, sebaceous glands and the infection that is there is unable to come out.

In recent years, mainly chemical methods of hand treatment have been used: hand treatment with Pervomour is widespread. This method is extremely reliable: glove juice formed within 12 hours after putting on gloves (in the experiment) remained sterile.

Asepsis includes:

a) sterilization of instruments, materials, instruments, etc.;

b) special treatment of the surgeon's hands;

c) observance of special rules and methods of work during operations, research, etc.;

d) implementation of special sanitary-hygienic and organizational measures in a medical institution.

Sterilization methods

steam under pressure (linen);

boiling (metal tools, except for cutting ones);

dry-air cabinets (you can burn the instrument over the flame);

cold sterilization (immersion of rubber gloves in chloramine);

· 96% ethyl alcohol (30 min.).

Prevention of exogenous infection

Asepsis methods are used in the fight against exogenous infection. The sources of the latter are sick and bacteriological carriers, especially if they are among medical personnel. Prevention of droplet infection in operating rooms and dressing rooms is facilitated by equipping them with a special ventilation system (the predominance of air masses over the exhaust, installing a laminar flow of conditioned air), organizing a special mode of operation in them, taking measures that are aimed at destroying existing microorganisms: timely moist cleaning, irradiation of air masses with bactericidal lamps, as well as strict observance by medical staff of the required sanitary standards. Prevention of contact contamination is ensured by sterilization of linen for surgery, dressings and suture materials, rubber gloves, instruments, special treatment of the surgeon's hands and the field for surgery. Everything that comes into contact with the wound must be free from bacteria, or, in other words, must be sterile. This is the basic principle of asepsis. Sterilization of suture material has a special purpose in the prevention of wound infection. Responsibility for properly performed sterilization rests with the operating room nurse.

Requirements for antiseptics

Preparations that are used for antiseptic treatment must meet the following requirements:

1. wide spectrum of action;

2. speed of action;

3. complete disinfection (asepsis) of transient microorganisms;

4. reduction of contamination of resident microflora to a normal level;

5. long-term effect after treatment (at least 3 hours);

6. absence of skin-irritating, allergenic, carcinogenic, mutagenic and other side effects;

7. slow development of microflora resistance;

8. affordability.

Bibliography

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· Antibacterial therapy of abdominal surgical infection. Under the editorship of acad. Savelyeva V.S. - M., 2006

· http://vmede.org/sait/?page=3&id=Xirurgiya_objaya_petrov_2010&menu=Xirurgiya_objaya_petrov_2010

http://www.e-ng.ru/medicina/aseptika_i_antiseptika.html

Asepsis, antisepsis: textbook. manual for foreign students / V. A. Beloborodov, E. A. Kelchevskaya; GBOU VPO ISMU of the Ministry of Health of Russia. - Irkutsk: IGMU, 2013.

· T.Kh.Kayumov. Lectures

Completed by a student of the 3rd year of the 1st group of the Faculty of Veterinary Medicine Livoshchenko Taras Mikhailovich

Kharkiv State Veterinary Academy

Kharkov 2008

Antiseptics

Antiseptic is a complex of therapeutic and preventive measures aimed at the destruction of microbes in a wound or in the human body.

Many doctors of antiquity, independently of each other, came to the conclusion that it was necessary to decontaminate the wound. Later, they came to the conclusion that all accidental wounds were initially made with a red-hot iron, cauterized with vinegar, lime, balsamic ointments were applied to the wound, etc.

And only in 1843 Holmes (O. W. Holmes), and in 1847 Semmelweis (J. Semmelweis) proposed a bleach solution for disinfecting the hands of obstetricians. N. I. Pirogov used tincture of iodine, a solution of silver nitrate in wine alcohol, etc. to disinfect wounds in their treatment.

The concept of "antiseptic" was introduced into everyday practice by the Frenchman L. Pasteur. His work served as the basis for solving the problem of the causes of suppuration of wounds and measures to combat infection. He proved that the processes of fermentation and putrefaction in the wound are determined by the ingress of microbes and their vital activity.

The English surgeon D. Lister, based on the work of L. Pasteur on the role of microorganisms in the development of suppuration of wounds, came to the conclusion that they enter the wound from the air. To prevent suppuration of wounds, Lister suggested treating the operating room air with a spray of carbolic acid. Later, the surgeon's hands before the operation and the operating field were also irrigated with carbolic acid, as well as the wound after the operation, after which it was covered with gauze soaked in a solution of carbolic acid.

The antiseptic method allowed surgery to penetrate all organs of the human body. However, Lister's antiseptic method had a number of significant drawbacks. New research began, which led to the aseptic method of treating wounds.

Lister's method had disadvantages such as:

carbolic acid caused tissue necrosis in the wound area;

after washing the hands of the surgeon with a solution of carbolic acid, dermatitis occurred;

inhalation of carbolic acid led to poisoning of patients and the surgeon.

Other antiseptics were also used - a solution of sublimate 1: 1000, 1: 2000, zinc chloride, salicylic acid, boric acid, potassium permanganate, etc. But they, killing bacteria, also killed tissue cells. Phagocytosis with their use decreases or stops altogether.

Types of antiseptics

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

Mechanical antiseptic 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 antiseptics - 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 antiseptics - exposure to microorganisms with 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 antiseptics - the use of biological products that act both directly on microorganisms and their toxins, and acting through the macroorganism.

These drugs include:

antibiotics that have a bactericidal or bacteriostatic effect;

bacteriophages - eaters of bacteria;

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 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:

Ultrasonic antiseptic

Sorbent antiseptic

Laser antiseptic

X-ray therapy antiseptics

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 attribute 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.

Antiseptic preparations:

Chloramine B is a white or yellowish crystalline powder containing 25-29% active chlorine. It has an antiseptic and disinfectant effect. In surgery, 0.5-3% solutions are used for washing wounds, disinfecting hands, and non-metallic instruments.

Iodonate, iodopyrone, iodolan - an aqueous solution of a mixture of sodium alkyl sulfates with iodine. The drug is used instead of tincture of iodine to treat the surgical field in the form of a 1% solution.

Alcoholic iodine solution. Widely used for disinfection of the skin of the surgical field, wound edges, surgeon's fingers, etc. in addition to bactericidal and bacteriological action, it has a cauterizing and tanning effect.

Hydrogen peroxide solution. It is a colorless 3% solution of H2O2 in water. When it decomposes, oxygen is released, which at the time of release has a strong oxidizing effect, creating unfavorable conditions for the development of anaerobic and putrefactive wounds. I use it for dressing wounds.

Potassium permanganate. Dark or red-violet crystals, soluble in water. It is the strongest deodorizer. Apply aqueous solutions for washing wounds, rinsing the mouth and throat, douching. It has tannic properties.

Mercury oxycyanide is a strong disinfectant, which, at a dilution of 1:10,000, 1:50,000, is used to wash the bladder and disinfect cystoscopes.

Lapis (silver nitrate) is used as a disinfectant for washing purulent wounds (1-2% solution), for cauterizing wounds, with excessive granulation (10-20% solution). Strong antistatic.

Ethyl alcohol, or wine. A 70-96% solution of both pure and denatured alcohol is used. Widely used for disinfection and tanning of the skin of the surgeon's hands, preparation and storage of sterile silk, disinfection of instruments.

Penicillins are the most common group of antibiotics. Used for staphylococcal, streptococcal, meningococcal infections, such as erysipelas, wound infections, etc.

Streptomycin - especially effective in diseases caused by gram-positive bacteria, has an overwhelming effect on tubercle bacillus.

Tetracycline, doxycycline, metacycline hydrochloride - acts on coca, diphtheria bacillus, mycoplasmas, chlamydia, etc.

Levomycene is a broad-spectrum antibiotic that acts on both gram-positive and gram-negative microbes, Pseudomonas aeruginosa, chlamydia, mycoplasmas.

Erythromycin, oletethrin, etc. - effective in diseases caused by gram-positive coca

Streptocide, norsulfazol, sulfadimethoxine - they disrupt metabolic processes in the bacterial cell and cause a bacteriostatic effect.

Furacilin - has a high bactericidal property, acts on staphylococci, anaerobic microbes, E. coli. Applied in solutions of 1:5000 topically for washing wounds, cavities of the pleura, joints, peritoneum.

Octeniman-Octenidine hydrochloride, propanol-1, propanol-2 are used for hygienic treatment of the hands of surgeons and medical staff, prevention of hepatitis B, hand care and protection. The bactericidal action begins after 30 seconds and persists for 6 hours.

Dekosept Plus-2-propanol 44.7 g, 1-propanol 21.9 g, benzalkonium chloride 0.2 g - used for hygienic and surgical treatment of hands. Active against gram-positive and gram-negative (including tuberculosis) bacteria, viruses.

Lizanin-Ethyl alcohol, HOUR - antiseptic for hygienic and surgical treatment of hands. It has antimicrobial activity against gram-positive and gram-negative bacteria, including pathogens of nosocomial infections, Mycobacterium tuberculosis, fungi.

Biotenzid-Propanol-2, propanol-1, ethanol, chlorhexidine bigluconate. It has antimicrobial activity against gram-positive and gram-negative bacteria, tuberculosis microbacteria, pathogenic fungi, viruses. It is intended for hygienic processing of hands of medical staff and processing of hands of surgeons.

Ezemtan-Disinfectant - lotion for washing the hands of surgeons.

Vaza-Soft is a liquid antibacterial detergent for washing the skin. It is recommended in cases where frequent hand washing is necessary - before surgical and hygienic hand disinfection.

Octeniderm - Octenidine dihydrochloride, propanol-1, propanol-2. It is used to disinfect the skin before operations, punctures and other similar manipulations. It is also used for hygienic and surgical hand disinfection: the film formed after drying lasts for a long time.

The main classes of antiseptics and disinfectants

Alcohols lead to denaturation of structural and enzymatic proteins of microbial cells, fungi and viruses. The disadvantages of alcohols are: the absence of a sporicidal effect, the ability to fix organic contaminants, a rapid decrease in concentration due to evaporation. These shortcomings are deprived of modern combined products based on alcohols - sterillium, octeniderm, octenisept, sagrosept.

Aldehydes

Aldehydes are highly active compounds, strong reducing agents, irreversibly bind proteins and nucleic acids. Disinfectants containing aldehydes: gigasept FF, deconex 50 FF, desoform, lysoformin 3000, septodor forte, sideks - are widely used for various types of disinfection and sterilization of medical equipment.

Acids and their derivatives

Disinfectants - Pervomur, Deoxon-O, Odoxon, Divosan-Forte - contain formic and acetic acids. They have a pronounced bactericidal (including sporicidal), fungicidal and virucidal action. Their disadvantages include a strong odor, the need to work in respirators, as well as corrosive properties.

Group of halogens and halogenated compounds of chlorine, iodine and bromine

Modern chlorine-containing disinfectants - clorcept, sterin, neochlor, chlorantoin, etc. - do not have a strong irritating odor and effect on the skin, are highly effective and are used for various types of disinfection. Dezam (contains 50% chloramine B and 5% oxalic acid) is used for current and final disinfection.

Oxidizers

In practice, complex preparations based on hydrogen peroxide are widely used:

pervomur (a mixture of peroxide and performic acid) is used to treat the surgical field, the surgeon's hands, to sterilize products made of polymers, glass, optical instruments;

persteril (10% peroxide solution, 40% performic acid solution and 1% sulfuric acid solution) is used for various types of disinfection. In 1% persteril solution, all naturally occurring microorganisms and their spores die;

deoxon-1 (10% peroxide solution, 15% acetic acid solution + stabilizers) is also used for most types of disinfection.

Surfactants (detergents)

This group includes quaternary ammonium compounds (QAC), guanidine derivatives, amine salts, iodophors, soaps. These include:

decamethoxin and drugs based on it: amosept (0.5% alcohol solution for disinfecting surgical gloves), dekasan (wide-profile antiseptic);

degmin and degmicide - used to treat the surgeon's hands.

Asepsis

Asepsis is a method of prevention (sterilization of instruments, etc.), aimed against the penetration of microbes into a wound, tissue or body cavity during operations, etc.

There are 2 sources of surgical infection: exogenous and endogenous. The exogenous source is located in the patient's environment, that is, in the external environment, the endogenous source is in the patient's body.

Prevention of implantation infection consists in careful sterilization of devices, suture material, drains, endoprostheses, etc. This infection can be dormant and manifest itself after a long period of time, when the defenses of the human body are weakened.

Prevention is of particular importance in organ and tissue transplantation, as methods are used to weaken the body's defenses. Asepsis is the law of surgery. It is achieved by the use of physical factors and chemicals.

High temperature, which causes the denaturation of microbial cell proteins, was most often used in the past.

The sensitivity of microbes to high temperature depends on their type, strain and condition of the microbial cell (dividing and young bacteria are more sensitive, spores are more resistant to high temperature). In alkaline and acidic environments, the susceptibility of microbial cells is high. Cold delays the reproduction of microbial cells, without having a pronounced bactericidal effect.

Ultraviolet rays are capable of infecting microbes in the air, on the skin, human tissues, on the walls and floor of the premises. Gamma rays are radioactive isotopes of 60 CO and 137 Cs. Sterilization is carried out in special chambers at a dose of 1.5-2.0 million rubles. Linen, suture material, blood transfusion systems, etc. are sterilized. Specially trained people are working, provided with powerful protective devices. Particularly useful is the radiation sterilization of objects made of plastics, which cannot withstand high temperatures and steam under pressure.

Thermal sterilization, that is, high temperature, is the main method of disinfection used in medical practice. The upper limit of vegetative microorganisms is 50 ° C, and tetanus bacillus spores are in boiling water (up to 60 minutes). The most effective type of sterilization of any form of bacteria is steam under pressure. After 25 minutes, any infection dies, and the most common - after 1-2 minutes (132 ° C). Firing is used only in laboratory practice for the sterilization of plastic needles and loops used in bacteriological laboratories and in emergency situations - when the patient's life is threatened.

Sterilization by dry heat is carried out in dry heat sterilizers at a temperature of 180-200 °C. Tools, utensils, etc. are sterilized. This type of sterilization is widely used in dental practice.

Boiling is carried out in boilers: portable and stationary. Boiled distilled water is used with the addition of sodium bicarbonate at the rate of 2.0 g per 100.0 g of water. A 2% solution is obtained and the boiling point of water increases by 1-2 °C.

Steam sterilization under pressure is carried out in autoclaves. They can be stationary and traveling. Depending on the steam pressure (kgf/cm2), the temperature rises to strictly defined figures, for example, at a steam pressure of 1.1 kgf/cm2, the temperature in the autoclave rises to 121.2 °C; at 2 kgf / cm2 - up to 132.9 ° C, etc. Hence the sterilization exposure from 60 minutes to 15 minutes. Sterility control is carried out. It can be bacteriological, technical and thermal. The bacteriological method is the most accurate, but the result is issued too late. Take samples of the sterilized material and sow on nutrient media. Technical methods are used when installing a new autoclave. Thermal methods are used daily. They are based either on a change in the color of the substance, or on the melting of the substance.

Mikulich's test: write "sterile" on white filter paper with a simple pencil and lubricate the surface of the paper with a 10% starch solution. When the paper dries, it is smeared with Lugol's solution. The paper darkens, the word "sterile" is not visible. It is placed in the thickness of the material to be sterilized in the autoclave. At 100°C starch combines with iodine and the word "sterile" becomes visible again. The exposure must be at least 60 minutes.

Samples with powdery substances that melt at a certain temperature are more effective: sulfur - at 111-120 ° C, resorcinol - 110-119 ° C; benzoic acid - 121 °C, urea - 132 °C; phenacetin - 134-135 ° C.

To control dry heat sterilization: thiourea - 180 °C; succinic acid - 180-184 ° C; ascorbic acid - 187-192 ° C; barbital - 190-191 °C; pilocarpine hydrochloride - 200 °C.

The concept and varieties of chemical sterilization

Chemicals used for sterilization must be bactericidal and must not damage the instruments and materials they come into contact with.

Recently, cold sterilization, using antiseptic substances, has become increasingly used. The reason for this is the fact that in medical practice objects made of plastics are used. They cannot be sterilized by thermal methods. These include heart-lung machines (AIC), machines for anesthesia, artificial lung ventilation, etc. It is difficult and difficult to disassemble such devices, and beyond the power of medical workers. Therefore, methods were needed to sterilize the apparatus as a whole, either in the form or disassembled into large units.

Chemical sterilization can be carried out either with solutions, including aerosols (solutions of mercury, chlorine, etc.), or with gases (formalin vapor, OB mixture).

Sterilization with chemical solutions

Carbolic acid is included in the ternary solution (Krupenin's solution). They sterilize cutting tools and plastic items. It stores sterilized needles, scalpels, forceps, polyethylene tubes.

Lysol with green soap is used to wash the walls, floors, furniture of the surgical dressing unit, as well as to treat instruments, rubber gloves, objects contaminated with pus or feces during the operation.

Sublimate (mercury dichloride) 1:1000, 1:3000 Gloves, drains and other items are sterilized.

Mercury oxycyanide 1:10000 is used to sterilize ureteral catheters, cystoscopes and other instruments with optics.

Diocide is a preparation of mercury that combines antiseptic and detergent properties. Some use a surgeon to treat the hands - they wash their hands in the pelvis with a solution of 1: 3000, 1: 5000 - 6 minutes.

Ethyl alcohol is used to sterilize cutting instruments, rubber and polyethylene tubes, surgeons' hands are tanned with 96% alcohol before surgery (see preparing the surgeon's hands).

Although 70% alcohol is more bactericidal than 96%, however, the spore-like infection does not die for a long time. The causative agents of gas gangrene and anthrax spores can persist in alcohol for several months (N. S. Timofeev et al., 1980).

To increase the bactericidal activity of alcohol solutions, thymol (1: 1000), 1% brilliant green solution (Bakkal solution), formalin, etc. are added to them.

The bactericidal properties of halogens have long been used. N. I. Pirogov used alcohol iodine 2%, 5% and 10%, not yet knowing about the existence of microorganisms. Iodine has a bactericidal and sporicidal effect. It has not lost its significance even today. However, its complex compounds with the surface are used more often - active substances, the so-called. iodophors, which include iodonate, iodopyrodon, iodolan, etc. They are more often used to treat the hands of the surgeon and the surgical field.

Chlorine compounds have long been used for disinfection (bleach) and sterilization (sodium hypochloride, chloramine, etc.). The bactericidal activity of these drugs depends on the content of active chlorine in them. In chloramine, active chlorine is 28-29%, and dichloroisocyanuric acid - 70-80%, sodium hypochloride - 9.5%.

Hydrogen peroxide (33% hydrogen peroxide - perhydrol) in 3% and 6% concentrations is used for sterilization and disinfection. It is harmless to humans.

A mixture of hydrogen peroxide with formic acid, proposed by I. D. Zhitnyuk and P. A. Melekhoy in 1970, was called Pervomour. In the process of preparing C-4, performic acid is formed - it is the active principle. Used to clean the surgeon's hands or sterilize instruments (preparation method C-4, see the Practical Guide to General Surgery).

In Czechoslovakia, persteril was proposed for sterilizing rubber and polyethylene tubes.

Beta-propiolactone released in Russia. At a concentration of 1: 1000 Pseudomonas aeruginosa in a 2% solution dies within 10 minutes.

Sterilization with gases

Sterilization with gases is quite promising. It does not damage the sterilized objects, does not change their properties.

Sterilization with formalin vapor is of the greatest practical importance. Cystoscopes, catheters and other objects in glass cylinders are sterilized.

Ethylene oxide is widely used. The bactericidal action occurs due to the alkylation of bacterial proteins. Ethylene oxide is soluble in water, alcohol, ether. Automatic gas sterilizers MSV - 532 with a useful volume of 2.3 liters are used. At an ethylene oxide concentration of 555 mg/l, sterility of test objects is achieved in 2-4 hours. In this case, after 1 hour, streptococcus, E. coli, Pseudomonas aeruginosa die. Micrococcus dies after 2 hours and staphylococcus after 4-7 hours. The most resistant are hay bacillus and mold fungus, which is associated with a high content of lipids in them. With a reduction in exposure to 3 hours, the concentration of the drug is increased to 8500 - 1000 mg / l. Due to the fact that ethylene oxide is explosive, it is most often used in a mixture with inert gases (10% ethylene oxide and 90% carbon dioxide). This mixture is referred to in the literature as cartox or carboxy. The activity of ethylene oxide increases with increasing temperature (by a factor of 2.74 for every 100 oC increase in temperature). The usual temperature regime is 45 - 65 oС with an hourly exposure and a drug concentration of 1000 mg/l. With the help of gas sterilization, only those objects that cannot withstand sterilization in an autoclave and a dry heat chamber should be treated. All items that have been exposed to ethylene oxide should be ventilated for 24 - 72 hours.

Treatment of the surgeon's hands

On the hands of people, the microflora of dual origin is distinguished:

transient, easily washed off;

permanent, nesting in the folds and pores of the skin, constantly living and multiplying on the skin of the hands.

The task of hand treatment is twofold - the destruction of microbes on the surface of the skin and the creation of conditions that prevent the release of microbes from the deep layers of the skin to the surface.

Therefore, the methods of processing the hands of the surgeon are composed of 3 components:

mechanical cleaning;

treatment with antiseptic solutions;

tanning leather or covering it with a thin film.

Wearing rubber gloves is mandatory for all hand washing methods.

The Spasokukotsky-Kochergin method involves washing hands with soap and water under a tap of warm water. Then they are washed with a gauze napkin in 2 basins for 3 minutes in a 0.5% solution of ammonia. Hands are dried with a sterile towel and treated with a small cloth soaked in 96% alcohol. The nail beds and skin folds of the back of the hand are smeared with a 5% iodine solution. The method is reliable, the skin is not irritated.

The Alfeld method involves washing hands from fingertips to elbows with soap and a brush under a tap of warm water for 10 minutes (changing the brush twice). Hands are dried with a sterile towel and treated with 96% alcohol for 5 minutes. Nail beds are lubricated with 5% tincture of iodine.

The Srubringer method involves washing hands with soap and brushes for 3 minutes. Hands are dried and treated with 70% alcohol for 3 minutes, and then with a solution of sublimate 1: 1000 for 3 minutes. The nail beds are smeared with tincture of iodine.

Pervomour hand treatment technique. Hands are washed with soap (without a brush) for 1 min and dried with a sterile cloth. Then the hands are immersed in Pervomur solution for 1 min. Hands dry. Put on rubber gloves. Every 40-60 minutes, gloved hands are immersed in a basin with a 2.4% solution of pervomur.

Gibitan hand treatment technique (chlorhexidine bigluconate solution). Hands are washed with warm soapy water and dried with a sterile towel. Then, for 2-3 minutes, wipe the hands with a 0.5% solution of chlorhexidine (gibitan).

The means suitable for preoperative treatment of hands and the surgical field in accordance with modern requirements include:

- alcohols (ethanol 70%, propanol 60% and isopropanol 70%);

- halogens and halogen-containing drugs (chlorhexidine bigluconate or gibitan, iodopyrone, iodonate, etc.);

- performic acid (recipe C-4);

– surfactants or detergents (degmicide, benzalkonium chloride, etc.).

Preparations

Javelion-Sodium salt of dichloroisocyanuric acid is an instant tableted chlorine-containing agent for washing and disinfecting any surfaces, sanitary equipment.

Amocide - 2-biphenylol. Used for final, current and preventive disinfection of surfaces.

Lysoformin-special-Didecyldimethylammonium chloride, a guanide derivative. Recommended for disinfection of indoor surfaces, dishes, sanitary equipment and cleaning material.

Vapusan 2000-Alkyldimethylbenzylammonium chloride, ethanol is a disinfectant, detergent, cleaner, deodorizer for washing and disinfecting surfaces in rooms and sanitary equipment for infections of bacterial (including tuberculosis), viral etiology. Used for disinfection combined with pre-sterilization cleaning (including dental instruments, rigid and flexible endoscopes).

Bromosept 50% solution - Didecyldimethylammonium bromide, HOUR 50%, Ethyl alcohol 40%. Use for disinfection of surfaces of rooms, rigid furniture, sanitary equipment, utensils, cleaning material. And also for pre-sterilization cleaning of medical instruments. Triple solution - for sterilization of dressings, tools: 20 ml of formalin, 10 ml of 3% carbolic acid, 30 g of soda, 1 liter of water.

Germicide-1% - for processing the surgical field, hands.

Rokkal-1/1000 - for processing tools, gloves, drainage.

Treatment of the operating field.

In recent years, the following antiseptic preparations have been used to treat the surgical field: 1% degmine solution with which tampons are abundantly moistened and the skin is treated twice; 05% solution of chlorhexidine (water-alcohol) with which the skin is treated twice with an interval of 2 minutes.

A rational substitute for an alcoholic solution of iodine is iodonate - an aqueous solution of a complex of a surfactant with iodine. The drug contains 45% iodine. To process the surgical field, a 1% solution is used, for which the initial iodonate is diluted 45 times with distilled water. The skin is smeared twice with this solution before the operation. Before suturing the skin, it is treated again.

Borodin F.R. Selected lectures. Moscow: Medicine, 1961.

Zabludovsky P.E. History of domestic medicine. M., 1981.

Zelenin S.F. A short course in the history of medicine. Tomsk, 1994.

Stochnik A.M. Selected lectures on the course of the history of medicine and cultural studies. - M., 1994.

Sorokina T.S. History of medicine. -M., 1994.

Reference book of a general practitioner / N. P. Bochkov, V. A. Nasonov, N. R. Paleeva. Moscow: Eksmo-Press, 2002.

Asepsis

Operation in the field

Asepsis- a set of measures aimed at preventing the entry of microbes into the wound.

Asepsis is a non-septic way of treating wounds. Asepsis should be distinguished from antisepsis, which aims to destroy the causative agents of inflammation already present in the wound, through certain chemicals, such as carbolic acid, sublimate, etc.

Ernst von Bergmann, a German surgeon, is considered one of the founders of asepsis. He proposed physical methods of disinfection - boiling, roasting, autoclaving. This happened at the X Congress of Surgeons in Berlin. In addition to them, there is a chemical method and a mechanical one.

In the aseptic method of treating wounds, only boiled water is used; all dressings and instruments are also supplied with flowing steam or boiling.

Asepsis is applicable before and during operations on healthy tissues, but is not applicable where the presence of inflammatory pathogens in the wound can be assumed.

Sterilization is the basis of asepsis.

Sterilization methods:

steam under pressure (linen);
boiling (metal tools, except for cutting ones);
dry-air cabinets (you can burn the tool over the flame);
cold sterilization (immersion of rubber gloves in chloramine);
96% alcohol (30 min.).

Equipment: autoclave, boiler, dry-air cabinet. The autoclave has several modes:

sparing - with a temperature of 120 ° C and a pressure of 1.1 atmospheres;
working - with a temperature of 132 ° C and a pressure of 2.2 atmospheres;
with a temperature of 160 °C and a pressure of 3.3 (3.2) atmospheres.

Asepsis and antiseptics are a single set of measures, they cannot be separated. According to the source of infection, they are divided into exogenous and endogenous. Ways of penetration of endogenous infection: lymphogenous, hematogenous, through intercellular spaces, especially loose tissue, contact (for example, with a surgical instrument). For surgeons, an endogenous infection does not pose a particular problem, unlike an exogenous one. Depending on the route of penetration, exogenous infection is divided into airborne, contact and implantation.

Airborne infection: since there are not many germs in the air, the likelihood of airborne infection is not great. Dust increases the likelihood of contamination from the air. In general, measures to combat airborne infections come down to dust control and include ventilation and ultraviolet radiation. Cleaning is used to control dust. There are 3 types of cleaning:

preliminary consists in the fact that in the morning, before the start of the operating day, all horizontal surfaces are wiped with a napkin moistened with a 0.5% solution of chloramine;
current cleaning is done during the operation and consists in the fact that everything that falls on the floor is immediately removed.
final cleaning is carried out after the operation day and consists of washing floors and all equipment with a 0.5% chloramine solution and turning on ultraviolet lamps. It is impossible to sterilize the air with the help of such lamps, and they are used in the place of the greatest sources of infection;
airing is a very effective method, after which microbial contamination drops by 70-80%.

For a very long time it was believed that air infection was not dangerous during operations, however, with the development of transplantation with the use of immunosuppressants, operating rooms began to be divided into 3 classes:

first class - no more than 300 microbial cells in 1 cubic meter of air;
the second class - up to 120 microbial cells - this class is intended for cardiovascular operations.
the third class - the class of absolute asepsis - no more than 5 microbial cells per cubic meter of air. This can be achieved in a sealed operating room, with ventilation and air sterilization, with the creation of an increased pressure inside the operating area (so that the air rushes out of the operating rooms). And also, in such operating rooms, special lock doors are installed.

Droplet infection is those bacteria that can be released into the air from the respiratory tract of everyone in the operating room. Microbes are released from the respiratory tract with water vapor, water vapor condenses, and together with these droplets, microbes can enter the wound. To reduce the risk of droplet infection spreading in the operating room, there should be no unnecessary talk. Surgeons should use 4-layer masks, which reduce the chance of droplet infection by 95%.

Contact infection is all microbes that are able to penetrate into the wound with any instrumentation, with everything that comes into contact with the wound. Dressing material: gauze, cotton wool, threads - tolerates high temperatures, so the sterilization temperature should not be less than 120 degrees, the exposure should be 60 minutes.

Sterility control. There are 3 groups of control methods:

physical. A test tube is taken, where some substance is placed that melts at a temperature of about 120 degrees, for example, sulfur, benzoic acid. The test tube is placed together with the objects to be sterilized. The disadvantage of this method of control is that we see that the powder has melted, which means that the required temperature has been reached, but we cannot be sure that it was like this during the entire exposure time;
chemical control. Take filter paper, place it in a starch solution, and then immerse it in Lugol's solution. It takes on a dark brown color. After exposure in an autoclave, starch at temperatures above 120 degrees is destroyed, the paper becomes discolored. The method has the same drawback as the physical one.
biological control. This method is the most reliable. Take samples of the sterilized material and sow on nutrient media. If no microbes are found, then everything is in order. Found microbes - so you need to re-sterilize. The disadvantage of the method is that we receive an answer only after 48 hours, and the material is considered sterile after autoclaving in a bix for 48 hours. This means that the material is used even before receiving a response from the bacteriological laboratory.

In recent years, mainly chemical methods of hand treatment have been used: hand treatment with Pervomour is widespread. This method is extremely reliable: glove juice formed within 12 hours after gloves were put on (in the experiment) remained sterile.

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See what "Asepsis" is in other dictionaries:

- (Greek). Aseptic treatment of wounds: everything that should come into contact with the wound is disinfected in advance. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. asepsis (and ... gr. septikos putrid) warning ... Dictionary of foreign words of the Russian language

See antiseptic. (Source: "Microbiology: glossary of terms", Firsov N.N., M: Bustard, 2006) Asepsis is a complex of precautionary measures in clinical practice, microbiol. or production work aimed at preventing drift into the working area ... ... Dictionary of microbiology Big Encyclopedic Dictionary

ASEPTICA, a set of measures aimed at the destruction of pathogens. Aseptic techniques are used to kill bacteria during surgery, wound care, or other medical procedures. All items in... Scientific and technical encyclopedic dictionary

- [se], asepsis, pl. no, female (from Greek a without and septikos putrefactive) (med.). Protection against infection during surgical operations and in the treatment of wounds. Explanatory Dictionary of Ushakov. D.N. Ushakov. 1935 1940 ... Explanatory Dictionary of Ushakov

- [se], and, female. (specialist.). Protection of tissues from infection during operations, in the treatment of wounds. | adj. aseptic, oh, oh. Explanatory dictionary of Ozhegov. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Explanatory dictionary of Ozhegov

Asepsis- conditions and a set of measures aimed at preventing microbial and other contamination during the production of sterile products at all stages of the technological process...