Slide 1 Asepsis antiseptics. Processing of hands of the surgeon and operational field. Sterilization of linen and dressing.

Slide 2

The ASEPSIS – represents system of the preventive actions directed against hit of microorganisms to a wound, fabrics and bodies at surgeries, endoscopy and other medical and diagnostic actions.

Slide 3

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

Slide 4

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

Slide 5

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

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

Slide 6

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

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

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

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

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

Slide 7

The basic principle of an asepsis is underlain in the term: everything that adjoins to a wound has to be sterile, that is is deprived of microorganisms.

All surgical patients taking into account rendering this or that type of an operational grant to them have to be divided into 2 streams: pure and infected. Therefore, the asepsis includes the following complex of actions directed against hit of an infection to a wound.

It: a) implementation of special, sanitary and hygienic, organizational events in medical institution; b) observance of special rules of work of the surgeon and crew in general (during operation, bandaging); c) special processing of hands of the surgeon, d) sterilization of tools, materials, devices.

To prevent hit of an infection in a wound, it is necessary to know its sources and ways of distribution.

Slide 8

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

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

Slide 9

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

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

Microorganisms from environment can get into a wound in three ways:

In the air way – from air, air with dust particles on which settle microorganisms, allocations from a nasopharynx and the top airways of patients, visitors and medical staff, wound separated from purulent wounds.

Contact (tools, linen, dressing)

In the implantation way of infection (sutural material, grids, artificial limbs of vessels, etc.)

The principle of observance of rules of an asepsis is the cornerstone of planning and the organization of a surgical hospital. The main structural divisions of a surgical hospital are: a) reception, b) medical and diagnostic offices and c) operational block.

The main objective of a reception – division of a flow of patients on "pure" and "purulent", sanitary and hygienic processing of patients (partial, full) depending on planned or emergency hospitalization. For observance of this principle surgical offices of versatile hospitals are located on the top floors of buildings, and rooms are adapted for repeated damp cleaning with application of antiseptics.

The access control of offices limited for visitors, the most strict working hours of surgical divisions, including special methods of their cleaning also belongs to organizational measures.

Слайд 10

Prevention of an airborne infection. The main methods of prevention of hit of microorganisms include in air and their destructions: correct planning and corresponding equipment of rooms; carrying out regular damp cleaning of rooms; air sterilization by the bactericidal ultra-violet lamps placed over an entrance to the room at distance of 2-3 m from each other (operational, dressing, procedural offices, postoperative and resuscitation chambers, chambers for purulent patients). In operational, dressing obligatory wearing masks, the personnel of surgical divisions it is obliged to observe and control personal hygiene, carrying overalls, hats and boot covers in the operational.

Слайд 11

The operational block is the purest place of a surgical hospital where observance of rules of an asepsis is strictly obligatory. The device of the operational block is based on the principle of zonality which consists in increase of requirements of an asepsis as approaching the operational hall.

There are 4 zones of sterility in the operational:

1 zone (absolute sterility) – includes rooms to which concerning an asepsis strict requirements are assumed (these are operational halls and sterilizing).

Слайд 12

2 zone (relative sterility) are rooms which are directly connected with operational (preoperative, narcotic).

3 zone (the limited mode) – make rooms for storage of blood, the figurative equipment, devices for service operational, the room of surgeons, nurses, anesthesiologists, laboratory.

4 zone (the all-hospital mode) – includes rooms the entrance in which isn't connected with passing through the sanitary inspection room or a lock.

The corresponding mode of sterility is reached by observance of certain measures of the prevention, distribution of microorganisms in operational. For this purpose there are following types of cleaning operational: