Methodical development for practical employment №5
Module 1
Semantic module 1.
Theme: Sterilization of bandaging material and operating linen. Organization of work in an operating-room. Surgical treatment of hands of surgeon and operating field.
I. Actuality of theme
The prophylaxis of hit of infection in a wound matters very much at the grant to the patients of surgical help. Attaining it is possible thanks to adherence of rules of asepsis, basic position of which the following is: all, that runs into a wound. it is to be from microorganisms at leisure, that is sterile. During the given employment the students are to capture the rules of asepsis during organization of work in an operating block, at preparation to the use of operating linen and bandaging material, to master the rules of dressing of operating linen, methods of before sterilization treatment of hands and operating field. Those knowledge’s are important as for the subsequent teaching on the departments of surgical type so for work already as future specialists.
II. Whole teaching
To have imagination about history of development of asepsis (α =І).
To know determination of asepsis, ways of transmission of exogenous infection (α =ІІ).
To know the structure of operating block, methods of providing of the sanitation-hygiene mode in an operating block (α =ІІ).
To know the structure and principle of work to the autoclave, accident prevention during work in an autoclave to her (α =ІІ).
To master preparation to sterilization and methods of sterilization of bandaging material and operating linen, tests on quality of sterilization (α =ІІ).
To know the methods of preparation of hands of surgeon to the operation, elements of care of hands of surgeon (α =ІІ).
To know the methods of treatment of the before sterilization field (α =ІІ).
To be able to transport patients in an operating-room and from an operating-room (α =ІІІ).
To be able to conduct cleaning up in an operating-room (α =ІІІ).
To be able to dress operating linen (α =ІІІ).
To be able prepare solutions and process hands before operative interference (α =ІІІ).
To be able to conduct preparation of the operating field (α =ІІІ).
ІII. Providing of initial level of knowledge’s - abilities
Literature:
The basic literature:
Butyrsky A. General surgery. – Simferopol. 2004.
Schevchenko S.I. and others. Surgery. – Kharcov. 2004
The additional literature:
Kushnir R. Lectures of General surgery. – 2005.
Lyapis M.A. Methods of examination of a surgical patients. – 2004.
Methodological recommendations on surgical patients care. – Vinnitsa medical national university. 2006.
Tests for verification of initial level of knowledges
The founders of aseptic method in surgery are:
A. Pirogov
B. Bergman (+)
V. Paster
G. Shimelbush (+)
D. Lister
Methods of control after sterility of bandaging material and operating linen:
A. Fuse rezortsin
B. Bacteriologichniy method (+)
V. Fuse urea (+)
G. Fuse sulphurs
D. Metod Miculicha
Choose the modes which sterilization in an autoclave is at:
And. 2,5 atm, 145оC, 10 hv.
2,0 Atm, 132 оC, 20 hv. (+)
In. 1,5 atm, 125 оC, 30 hv.
G. 1,1 atm, 120 оC, 45 hv. (+)
D. 0,5 atm, 110 оC, 35 hv.
Which from the transferred methods are the methods of conclusion in bics?
A. Universal (+)
B. Layer (+)
V. Materialniy
G. many purpose
D. Aseptic
An exogenous surgical infection is passed by next ways
A. mechanical
B. rotary
V. hospital
G. implantation (+)
D. contact (+)
In an operating block the following areas are distinguished:
A. aseptic mode
B. general mode (+)
V. mode antiseptic
G. implantation (+)
D. unsterile mode
In an operating-room the following types of cleaning up are executed:
A. repeated
B. current (+)
V. mechanical
G. previous (+)
D. evening
The conclusion in drum Shimelbush can be:
A. universal(+)
B. sector (+)
V. base
G. sectional
D. air-tight
In work to the autoclave the following phases are distinguished:
A. slow elimination
B. balancing (+)
V. rise of pressure in chambers
G. pressurization
D. elimination (+)
For the control in quality of sterilization it is possible to apply in an autoclave:
A. bacteriological method (+)
B. termoindicatori (+)
V. indexes to the barometer to the autoclave
G. study of color of the sterilization of linen
D. chemical microbes method
Treatment of hands to the operation can be executed after the following methods:
A. with the use of solution “Pervomour” (+)
B. after a method Kocher
V. after a method Bilrota-Micoulicha
G. after a method Spasocoucotscogo-Cochergina (+)
D. with the use of a 40% solution of ethyl alcohol
For treatment of the operating field use:
A. solution “Dezactin”
B. solution “Yodobac” (+)
V. solution “Yodonat” (+)
G. solution “Yodopiridol”
D. a 100% solution of ethyl alcohol
During the general cleaning up of operating-room it is possible to apply the following solutions:
A. solution of chloramin 10%
B. solution of hydrogen peroxide 10% from a 0,5% cleanser
V. solution of hydrogen peroxide 6% from a 0,5% cleanser (+)
G. solution of chloramin 1% (+)
D. solution of chloric lime 5%
The general cleaning up is conducted:
A. at the end of working day
B. in the planned order a 1 time per a week (+)
V. in the planned order 2 times per a week
G. not provided for by the plan after the operations, during which contamination of operating-room happened by intestinal maintenance (+)
D. every time before the beginning of operating day
It is necessary to use for preparation of solution of pervom:
A. a 6% solution of hydrogen peroxide
B. pergidrol (+)
V. a 96% solution of ethyl alcohol
G. a 100% vinegar acid
D. a 100% ant acid (+)
IV. Table of contents of teaching
History of development of asepsis and antiseptic.
The weakness of surgeons before infectious complications in IX age was simply scare. Very exactly the large Russian surgeon N.A.Velyaminov after the visit of one of large Moscow clinics described the state of surgery in those times: “Saw the brilliant operations and... tsarstvo of death”. So proceeded until at the end of XIX age in surgery did not get distribution of teaching about an asepsis and antiseptic in the origin of which it is possible to select the five perietapiv:
Empiric period
Before Lister antiseptic of XIX age
Antiseptic Listera
Origin of asepsis
Modern asepsis and antiseptic
Empiric period. First, as we name now, “methods antiseptic”, it is possible to find in works of doctors of still ancient times. Some of them: they were considered obligatory by deleting of strange body from rani, in the laws of moses was banned to touch a wound by hands, Gippocrat preached principle of cleanness of hands of doctor, applied for treatment of wounds a rain-water, wine; shaved off a hair cover from the operating field; spoke about the necessity of cleanness of bandage material. However purposeful, intelligent actions of surgeons in relation to warning of festering complications began considerably later – only in the middle of XIX age.
Before Lister antiseptic ХA Х age. A Hungarian accoucheur Ignats Zemmelveys in 1847 assumed that at women the post-natal fever develops as a result of skidding of ptomaine in privy parts by students and doctors during implementation of vaginal research (students and doctors got busy also in an anatomic theater). Zemmelveys offered before internal research to process hands by a chloric lime and obtained phenomenal results: post-natal lethality as a result of development of sepsis went down from 18,3% to 1,3%. However, did not support Zemmelveys, and persencution and humiliation, that he tested, was led to that he was hospitalized in a funny house, and later died from a sepsis as a result of to the whitlow.
M.I.Pirogov did not create whole works on the fight against an infection. But he was in a half-pace from creation of teaching about antiseptic. Still in 1844 he wrote: “From us there is near that time, when the careful study of traumatic and hospital will give miazm to surgery other direction”. M.I.Pirogov respectfully behaved to labours I.Zemmelveys and, still to Listera, applied on occasion for medical treatment the row of matters antiseptichnih (nitric acid silver, chloric lime, winy and camforniy alcohol).
Works Zemmelveys, M.I.Pirogov could not do revolution in science. In appearance of “lister antiseptic” the robots of Lewie Pastera about the role of microorganisms in the processes of fermentation and decay (1863г).
Origin of antiseptici. Successes of microbiology, labours L.Pastera and R.Coha pulled out the row of new principles in the basis of prophylaxis of surgical infection. They became in a basis for creation of study Listera about a method antiseptic. Main from them was out contamination by the bacteria of hands of surgeon and objects, that run into wound. Thus, in surgery entered treatment of hands of surgeon, sterilization of instruments, bandage material and linen. Development of aseptic method is related to the names E.Bergman and his student C. Shimelbush.
On Х International congress of surgeons in Berlin in 1890 principles of asepsis at medical treatment of wounds got common confession. E.Bergman showed the patients operated in aseptic terms without application of “lister antiseptic”. The basic postulate of asepsis was here accepted: “All, that runs into wound, there must be the sterile”.
For sterilization of bandage material a high temperature was used above all things. R. Cochom (in 1881) and E. Esmarch were offered method of sterilization by fluid steam. In the same time in Russia Heydenreych first in a world led to, that sterilization of steam under the promoted pressure is most accomplished, and in 1884 suggested to use an autoclave for sterilization.
A large merit belongs to the Russian surgeons M.S. Subotin and L.L.Levshin, which created, strictly speaking, the about type of modern operating-rooms. N.V. Sclifosovskiy suggested distinguishing operating-rooms for the different on infectious contamination operations.
Modern asepsis and antiseptic. A high temperature, that is the basic method of asepsis, could not be used for treatment of living fabrics. Thanks to successes of chemistry for medical treatment of festering wounds and infectious processes the row of new facilities antiseptic was offered. Similar matters began to be used for treatment of surgical instruments and articles of care of patients. Thus, gradually asepsis very tightly interlace with antiseptic, and now without unity of these two disciplines surgery it is simple unthinkable.
Theodore Bilrot, which still recently make fun of antiseptic Listera, in 1891 said: “Now by clean hands and clean conscience an inexperienced surgeon can attain the best results, than earlier the most famous professor of surgery”.
The model following numbers: before introduction of asepsis and antiseptic after operation lethality in Russia in 1857 made 25%, and in 1895 – only 2,1%.
Asepsis – complex of the cure - prophylaxis measures directed on warning of hit of microorganisms in a wound or in the organism of man in whole one.
Ways of distribution of infection in an organism:
An infection is considered exogenous, that inculcate in a wound from an external environment: and) from air – air infection; ) with the breezes of saliva or other liquids – drops infection (sometimes unite in one kind – air-drops infection); in) from objects, that run into wound – contact infection; g) from objects, that remain in a wound (stitches, drainages, metallic or plates the bars, artificial valves of heart and etc) – implantation infection.
The transfer of pathogenic microorganisms from a patient to the patient is reflected as a cross infection.
Endogenous an infection is considered, that is found in an organism or on his scinofbody. An endogenous infection gets in a wound either directly (contact), or on vascular ways (limfogenic or gematogenic). Inflammatory processes on a skin (furuncles, carbuncles, piodermii, eczema and in.) are the basic hearths of endogenous infection, hearth infection GCT (tooth decay, gingivitis’s, holetsistitis, holangitis, pancreatitis and in.), infection of respiratory tracts (sinusitis, traheitis, bronchitis, bronhoectaticha illness), infection of urogenitalis ways (pielitis, cystitis’s, prostatitis, ouretritis, salpingoooforitis), hearths of criptogenus infection.
Operating block – it is the set of the special apartments for implementation of operative interferences and conducting of measures, that they are provided. An operating block must be disposed in the separate apartment either wing of building and be the united corridor with the surgical separation, or on the separate floor of multistory surgical corps. More frequent are present division between itself operating-rooms for implementation of interferences at “clean and “festering” patients”, although more expedient is to foresee separate, the isolated operating block at the festering surgical separations.
An operating block is separated from the surgical separations by the special platform – more frequent it is part of corridor, in which the apartments of operating block of the general mode go out. For providing of the mode of sterility in an operating block the special functional areas are selected.
The area of the sterile mode unites an operating-room before operation and sterilization room. In the apartments of this area execute: in an operating-room – directly operations; in before sterilization – preparation of hands of surgeon to the operation; in sterilization room – sterilization of instruments.
Such apartments enter in the area of the strict mode, how sanitation room is that consists of rooms for undressing of personnel, shower-bath options, booths for dressing of sterile clothes. These apartments are disposed consistently, and a personnel goes out from a booth for dressing straight or through a corridor in before sterilization. The apartments for saving of surgical instruments and vehicles, anesthesia apparatus and medicines enter in this area, cabinet of blood transfusion, apartment for a duty brigade, senior operating sister, and sanitary knot for the personnel of operating block.
The area of the limited mode, or technical area, unites the production apartments for providing of work of operating block: an apparatus for disinfection of air is here found, vacuum options, options for providing of operating-room by oxygen and narcotic gases, accumulator substation for the emergency enlightening, photographic laboratory for the display of x-ray photography tapes.
In the area of the general mode the cabinets of manager, senior medical sister, apartment for sorting of muddy linen and others like that are found.
The mode of operations of operating block foresees the limited his visit; in the area of the sterile mode a personnel must be found only, that takes part in the operation (surgeons and their assistants, operating sisters, anaesthetists and anestezist, junior nurses). In the area of the sterile mode students and doctors, that pass internship are assumed. A man is the main source of infection in an operating-room, therefore working of operating block wear special clothes: dressing-gowns or jackets and pantaloons, that differ in color from the clothes of employees of other separations. In this clothes to them it is banned to go out from an operating block. The hygiene of employees of operating block must be ever-higher. They must regularly pass the bacteriological control, sanouvati the chronic hearths of infection.
The apartment of operating block must be built so that maximally lighten support of surgical cleanness. The walls of apartment dye to ceiling by an oil paint or cover by a tile, corners round off. On windows there must be large glass with transoms that are opened inward. A floor is covered by a tile. The area of operating hall on a 1 operating table must make not less than 40 m2.
The equipment of operating-room consists of operating table, special lamp, special movable lamp, anesthesia apparatus, anesthesia dinner-wagon, large instrumental table, movable dinner-wagon for instruments, dress box on supports with a pedal occasion, wall or ceiling bactericidal lamps, surgical tool, vehicles for electro-coagulation and other.
Furnitures in an operating-room is to be light, easy (from a metal, glass, plastic), comfortable, simple after construction, it is easily to wash.
For the rise of sterility of air facilities are used for cleaning of air. For this purpose use to the wave drawing ventilation and transoms which open during cleaning up. In an operating-room the humidity must be not less than 60%, temperature 22-23oC. The promoted pressure in an operating-room is instrumental in the current of air from an operating-room in other apartments – it allows in a few one time to decrease the number of before operating complications.
Disinfection of air is executed by local or centralized methods. Deleting of air takes place through the drawing opening, that are disposed on an opposite wall. Efficiency of measures on cleaning of air in an operating-room is controlled by sowing of air to, under time and after the operation, from the hands of operating brigade.
Transporting of patients in an operating-room and in a chamber is executed on heel - stretcher, which are covered by polyethylene tape or oilcloth which process properly disinfectant.
It is necessary for warning of contact infection, that all, that is to run into a wound, was sterile. It is achieved by sterilization of operating linen, bandaging and stitch material, instruments, by treatment of hands of surgeon and operating field. Sterilization of stitch material is directed on warning both contact, and implantation infection of wound.
Sterilization of instruments, bandaging material and linen includes the following basic stages:
before sterilization preparation of material.
Conclusion and preparation to sterilization.
Sterilization.
Saving of sterile material.
Gauze marbles, serviettes, tampons, belong to bandaging material, bandages. Apply them during the operation and bandaging with the purpose of drainage of wound, stops of bleeding, for dreinage or tamponadi wound. Bandaging material is prepared from a gauze and cotton wool, rarer from a viscose and lignin.
All wares which are used during the operation enter in notion of operating linen, and also in work of bandaging, manipulation and specialized cabinets. Dressing-gowns surgical, sheets, towels, masks, little caps, bahili, belong to operating linen. Cotton fabric serves by material for their making. Operating linen of reusing must have the special mark and seem for elimination separately from other linen in the special waterproof sacks. At dressing-gowns must not be pockets, belts.
Usually bandaging material that operating linen is sterilized in an autoclave. The for this purpose provided and prepared to sterilization material is inlaid in drum. In default of bicsiv sterilization in linen sacks is assumed. There are next methods and types of conclusions of material in bicsi Shimelbush.
Universal conclusion – in drum place the material intended for one small typical operation (apendectomi, flebectomi and others like that).
Conclusion having a special purpose – in drum inlay the necessary set of bandaging material and operating linen, intended for implementation of concrete operation (pnevmonectomi, resection of stomach and others like that).
Specific conclusion – in drum inlay the definite type of bandaging material or linen (drum with dressing-gowns, drum with serviettes and others like that).
Basic rules of technician of safety during work with an autoclave:
Exploitation to the autoclave is possible at presence of permission of Inspection from the care of caldrons.
Before work with an autoclave the persons, that handed over a technical minimum from exploitation to the autoclave and that a proper license is had, are assumed.
Necessarily it is needed to earth a steam sterilizer with the electric warming up.
Not to proceed to work on a defective vehicle.
During work not to abandon a vehicle without examination.
Not to refill water in a watering-can during work of sterilizer.
After sterilization to disconnect heater from the network of feed and cover the valve of admittance steam in sterilization camera from steam for make camera.
To open the lid of sterilization chamber only since the pointer of manometer will go down to the zero.
Dressing material
Operation linen
overalls sheets towels pilovs mask cap clots
gauze
swabs napkins tampons turundas bandages
Stages of
preparation
to apply
Packing
and praparation to sterelization
Before sterilization
preparation
Sterilization
Preserve sterilization of
material
In
drum of Shimelbush In
sack steam
under the pressure rays-sterilization universal purpose view lager sector
Direct
Undirect
Methods of control for
sterilization
Bacteriological
Apply
of thermometers Apply
of thermoindication Apply
of substance with definite mark of fuse
Autoclave
Destruction
Balance
Cold
Heating
Works fases
Add
Base
Regime of work
Pressure
– 1,1 at.
Temperature
– 120o Exposition
– 45 min Pressure
– 2 at.
Temperature
– 132o Exposition
– 20 min
Preparation of hands to the operation.Treatment of hands — important mean of prophylaxis of contact infection. Doctors-surgeons, operating and dressing nurse must constantly care of cleanness of hands, to look after after a skin nails. Most of microorganisms are saved under nails, in the region of nail valiciv, in the cracks of skin. Departure after hands foresees warning of cracks and defeats of skin, cutting of nails (they must be short), deleting of scratch’s. The work related to contamination and infection skins of hands, it is needed to execute in gloves. Correct departure after hands needs to be considered as a stage in preparation of them to the operation. Treatment of hands by any method is begun with the mechanical cleaning.
Methods Furbringer belong to the classic methods of treatment of hands, Alfeld, Spasocucotsciy-Cochergin, which now, however, are not practically used. Methods Furbringer, Alfeld and others foresee the previous washing of hands by a sterile brush and soap. Brush, that hold in a right hand, soap by soap, then nicely conclude on the back surface of brush and retain by a palm which a brush is found in. Whether brush the serviette must move in direction from fingers to the forearm, brushes — to be found higher than forearms and stream of warm running water — to be sent from fingers to the elbow. In such the position begin and conclude washing by a brush, out edema of water from an elbow to the brush. Palm's surface of every finger is washed at first, then back surface and nail beds, interfinger intervals of the left brush, then right, then palm and rear of the left and right brushes and, finally, forearm to granitsi of the their overhead and middle third. Soap-suds are constantly washed off by running water, a brush is soaped as far as a necessity. For all time of washing of hands do not touch to the faucets, the stream of water and its temperature is regulated before washing. On ending of washing brush and nicely conclude on a dinner-wagon, hands rinse by water and, still holding the brushes of hands at the level of breasts, dry out a skin by sterile gauzes or serviettes by a towel, not touch to the unwashed-up areas of skin. Farther (in dependence on the method of treatment) fingers, brushes, the lower third of forearms is wiped by serviettes, abundantly moistened by an alcohol, solution of cerigel or other antiseptic. On the method of the Alfeld hand wipe by a 96% alcohol during 5 hv. For Furbringer after the mechanical cleaning of hand wipe hv during 1. by solution of soulemi by a 1:1000 and then 96% alcohol during 3 hv.; in conclusion nail beds grease by a 5% brandy of iodine.
A method Spasocucotsci-Cochergin and treatment of hands of pervomour (preparation C-4), gibitan is presently more widespread methods of washing of hands (hlorgecsidinabigluconat).
A method Spasocucotsci-Cochergin foresees the mechanical cleaning of hands by a 0,5% solution of liquid ammonia. Hands wash in two pelves on 3 hv. by a napkin, execute to motion consistently, as at washing by a brush, beginning with the fingers of the left hand. In the first pelvis the hands are washed to the elbows, in the second – to granitsi of overhead and middle third of forearm. On ending of washing of hand rinse by solution of liquid ammonia and brush lift up so that drops of water flowed down to the elbows. From this time of brush of hands are constantly found higher than forearms. The skin of hands is drained by sterile napkin: at first both brushes (this napkin is given up), then consistently lower and middle third of forearms. Disinfect a skin by the serviettes moistened by a 96% alcohol, processing twice on 2,5 hv. brushes to lower third of forearms, then tags of fingers, nail valici; nail beds and folds of skin of fingers to oil by a 5% alcoholic solution of iodine.
Treatment of hands of pervomur (preparation C-4). Pervomur – mixture which appears at the reaction of ant acid and of hydrogen peroxide. At first basic solution is prepared in correlation of a 81 ml 85% ant acid and 171 ml 33% solution of hydrogen peroxide, that mix up in a glass crockery with a cork grinding in and place in a refrigerator on 2 hours, periodically shaking off a mixture. Nadmouravin acid will appear at co-operation of ant acid and of hydrogen peroxide, that owns strong bactericidal action. From the noted quantity of basic solution it is possible to prepare 10 l of working solution of pervomur, mixing up him with the distilled water. Working solution suitable to application for a day. At preparation of solution it is necessary to work as in rubber gloves for warning of burns the concentrated solutions of ant or acids of hydrogen peroxide. Treatment of hands foresees the previous washing of them during 1 by hv running water with soap. Then brushes and forearms to the level of the middle third wash by napkin in a pelvis with solution of pervomur during 1 hv. And drain by sterile serviettes; in one pelvis the treatment of hands can be done by 10 persons.
Treatment of hands of chlorgecsidinbiglyoconat. He as a 20% water solution is let out. For treatment of hands a 0,5% alcoholic solution is prepared: a to 500 ml 70% alcohol is added to a 12,5 ml 20% solution of chlorgecsidinbiglyoconat. Preliminary wash hands by running water with soap, drain by sterile napkin or towel, and then wipe by the gauze serviette moistened by the prepared solution, during 2-3 hv.
The speed-up methods of treatment of hands are applied in ambulatory practice or in extreme situations. For speed-up disinfection of hands preparation of cerigel is used, that differs by strong bactericidal action. In his composition enter from make fiem and a 96% ethyl alcohol. Hands are washed by water with soap, drain carefully. On a palm pour 3-4 ml cerigel and carefully during 10 seconds moisten them the fingers, nail beds and nail fold, brushes and lower part of forearm. Half-bent fingers hold in the divorced position during 2-3 hv., while tape of cerigel will not appear on a skin. Tape, that appeared, is protective and bactericidal characteristics, on ending of operation she is easily taken off by the gauze marbles moistened by an alcohol.
Preparation of the operating field. Previous preparation of place of the supposed operating cut (operating field) begins in eve the operation and includes general hygienical bath, change of linen, shaving of hair by a dry method directly in the place of operating access. After shaving of hair a skin is wiped by an alcohol.
At treatment of operating field i directly in an operating-room it is needed to observe the following principles:
treatment must be considerably wider, than area of operative access
sequence the treatment – «from centra to periphery»
recurrence of treatment during the operation (to beginning and before imposition of stitches)
most muddy areas are processed in the last turn
Before surgical operation on operating table the field of operation widely lubricate by a 5% alcoholic solution of iodine. Insulate the direct place of operation by sterile linen and again lubricate by a 5% alcoholic solution of iodine. Before imposition and after put of stitches on the skin of her process by the same alcoholic solution. This method is known as a method Grossicha-Filonchicova.
At intolerable of iodine by a skin at adult patients and at children conduct treatment of operating field by a 1% alcoholic solution of brilliant green (method Baccala).
For treatment of the operating field use 0,5% alcoholic solution of gibitan (chlorgecsidinbiglyoconat), as well as for treatment of hands of surgeon before the operation.
Treatment of the operating field of pervomur can be applied (3-multiple, during 1,5 minutes).
During the urgent operation the preparation of the operating field consists in shaving of hair, to treatment of skin by a 0,5% solution of liquid ammonia, and then apply one of methods for treatment of the operating field.
Sterilium is used for hygienical and surgical disinfection hands. Instantaneous action of alcoholic constituent against microorganisms is complemented by antimicrobial additions which simultaneously guarantee optimum of long duration action. Additions for the care of skin protect hands even at frequent application of preparation.
Numerous researches led to the wide spectrum of action, instantaneous of action (at the hygienical use – 30 s) and remaining action (over 3 hours under a glove) Sterilium in the relation of microorganisms.
Sterilium is preparation for frequent application.
Sterilium is a universal and everywhere applicable mean. The systems of dosage allow to take away him uncontact. Metering devices can be placed wherein necessary hygienical disinfection hands.