Aseptics is a set of measure aimed on the prevention of an infection attending to the wound, in an organism of the affected person, creation of sterile circumstances for surgical work by use of organizational actions, lively disinfecting chemical substances, in addition to technical means and bodily elements.
Two primary rules are underlined in fashionable aseptics:
Every thing that adjoins to the wound must be sterile.
All surgical sufferers must be divided into two teams: “pure”and “purulent”.
It’s unattainable to work with out aseptics guidelines observance in surgical procedure.
It’s essential to know its sources and methods of unfold to stop an infection from attending to the wound
Exogenous an infection will get to the wound from the surroundings by three primary methods: respiratory, contact and implant.
With the air-drop approach of spreading the an infection will get to the wound from the air.
The advanced of measures is offered to stop respiratory an infection.
So as to forestall an infection all sufferers ought to cross sanitaryand-hygienic therapy at admission: bathe, altering garments of the affected person, particular processing — underneath indications.
The group of medical-diagnostic departments is arrenged in response to a contingent of sufferers, sanitary norms.
Cautious, repeated damp cleaning with antiseptic means must be carried out within the surgical division.
The rooms are to be ventillated in response to the ventillating schedule, which cleans the air.
The utilization of particular garments (surgical coates, particular fits, headdresses, masks, slipper, stockings) is important within the division. It’s prohibited to depart the division in particular garments.
The strict observance of aseptics guidelines is compulsory within the operational block, as it’s the cleanest place within the surgical hospital. For prevention of dirtying the air and rooms in fast proximity to the operational wound a zone-like precept is noticed within the group of the working room: zones of absolute sterility, relative sterility, restricted routine and normal hospital mode (non sterile).
There are some sorts of cleaning within the working room: present, after every operation, on the finish of the working day, to start with of the working day and normal (as soon as every week).
Preventive upkeep of contact and implantation infections consists in reaching sterility (full clearing from microorganisms of every part that adjoins the wound): surgical instruments, dressing materials and surgical linen, fingers of the surgeon, working space (pores and skin of the affected person), in addition to in upkeep of the strict sterility of all topics launched in an organism of the affected person (materials for suturing, drainages, catheter, synthetic limbs, steel constructions, transplanted organs, and so on.).
Sterilization is the idea of aseptics. It’s the achieved by strategies and technique of sterilization are used which give destruction of pathogenic and non-pathogenic microorganisms. Therefore they need to be efficient in relation to bactericidal and sporiсidal exercise, secure for the affected person and medical personnel.
Bodily and chemical strategies of sterilization are utilized in aseptics.
Bodily Strategies of Sterilization
Burning and boiling will not be utilized in surgical clinic for sterilization now, as these strategies of sterilization don’t create circumstances for destruction of microbes, spores particularly.
Steam sterilization underneath stress of two atmospheres (in theautoclave) permits to lift a boiling level of water and accordingly temperature of the steam as much as 132.9°C . At this methodology of sterilization the instruments, dressing, the linen and different supplies are loaded into the autoclave in a particular steel bins of Schimmelbusch. At stress of 1,1 atmospheres a mode of sterilization spend lasts for 1 h, at 1,5 atmospheres — 45 min, at 2 atmospheres — 30 min.
Sterilization by scorching air (dry warmth) is carried out in dry-heatcases sterilizers inside 1 h on the temperature of 180°C .
Central sterilizing must be organized in hospitals.
Ray sterilization is carried out with the assistance of γ-ray, ultraviolet ray, ultrasound.
Chemical Strategies of Sterilization
Fuel sterilization is carried out in particular airtight wards withthe use of formalin or ethylene steams inside 6–48 h. This methodology is used to start with for sterilization of optical instruments.
Sterilization by options of chemical antiseptics is utilized firstof all for processing reducing surgical instruments. Chemical antiseptics are 6% resolution of hydrogen peroxide, chlorhexidine alcoholic resolution, pervomure, threefold resolution, 96° ethanol. Instruments wetted within the given options for two–6 h are thought of to be sterile.
Sterilization of Devices
The perfect methodology of devices sterilization is boiling in a 2% resolution of sodium hydrocarbonate or in water for 45 min. Earlier than sterilization the devices are cleansed — washed with scorching water for 30 s, then washed in a washing resolution on the temperature of fifty°C for 15 min. After that they wash in a washing resolution for 30 s, rinse in working water, boil in distilled water for five min, dry with scorching air on the temperature of 85°C . The standard of the sterilization is decided with the assistance of amidopyrine, benzidine and phenolphtalein exams for the presence of residual parts of the washing preparation within the blood. With the presence of pus disinfection of the software is carried out — it’s boiled for 30 min in a 2% resolution of sodium hydrocarbonate. Moreover boiling, the devices are sterilized in dry exciccators or autoclave, and bear chemical sterilization (threefold resolution, spirit, and so on.).
Sterilization of Gloves
Gloves are sprinkled with powder or talc, wrapped in a gauze serviette and stored in sterilizer bins. Sterilization is on underneath stress of 1.5 atm on the temperature of 120°C for 45 min. Gloves are additionally boiled in water for 45 min or dipped right into a detergent resolution for 60 min. Gloves are sterilized with ethylene oxide in moveable fuel sterilizers. After utilizing gloves wash underneath working water with cleaning soap, disinfect in a 1% resolution of chloramines for 30 min, rinse underneath working water, dry.
Sterilization of Suture Materials
Sterilization of suture materials takes place in several methods: thermal, chemical, gamma irradiation. The suture materials utilized in surgical procedure differs by chemical construction, bodily properties and origin. It’s largely silk, cotton and artificial supplies. Now the silk isn’t nearly used, because it irritates very a lot.
Typically, silk sutures are acquired sterile. But when they aren’t processed, the next measures are used:
Silk is washed in heat water with cleaning soap, dried, reeled on a coiland dipped into ether for 12–24 h, then dipped right into a 70% resolution of ethanol for a similar time interval, then boiled for 10 min and saved in hermetically sealed cups in response to the Cocher’s methodology (in 95% ethanol). Earlier than utilizing this silk is boiled once more for two min in an answer of corrosive sublimate.
Silk is washed with cleaning soap twice, rinsed with heat water, driedand wound on the reels. They degrease, dip into ether for 12–24 h. Then they boil in distilled water for 45 min and sink into the hermetically sealed cup with 96% spirit for six–12 h. After that, the silk is appropriate for software. Within the cup, the spirit is changed each 7 days. Kapron and lavsan sutures are sterilized within the steam autoclave (like operational linen) or boiled (like instruments) for 45 min.
Catgut is produced with a preserving resolution (96% spirit — 89.0 ml, glycerin — 6.0 ml, gasoline aviation — 1 ml, distilled water — 4.0 ml), sterilized by gamma irradiation. Polymers hydroxyacetic acid (dexon) or polypropylene (proflax), and likewise vicryl are synthetic sutures, that are absorbed.
Preparation of the Surgeon’s Fingers and the Working Discipline
Preparation of the surgeon’s fingers performs a particular position within the preventive measures of wound infections. The surgeon ought to keep away from of air pollution of fingers, diligently watch the situation of the pores and skin, for occurrences of microtraumas (cracks); the pores and skin is processed with particular lotions, oil options (glycerin, liquid ammonia, and so on.).
There are lots of totally different strategies of surgeon’s fingers processing. Numerous strategies of surgeon’s fingers processing might be divided into three teams:
strategies with mechanical cleansing of the pores and skin and its subsequent stiffenning with totally different antiseptics;
strategies of solely stifenning;
strategies of processing with the appliance of surface-activesubstances — detergents.
The Furbringer’s and Ahlfeld’s strategies belong to the primary group. In accordance with the Furbringer’s methodology the fingers are washed with heat water and cleaning soap with the assistance of brushes for 10 min, after drying fingers are processed with 70% ethanol (3 min) and 0.5% resolution of corrosive sublimate (3 min). Ahlfeld modified this methodology — excluded the processing with the answer of corrosive sublimate and changed 70% ethanol by 96% one.
These strategies at the moment are nearly not utilized due to vital trauma to the dermis by the brushes and the incidence of dermatitis.
Strategies that are primarily based solely on the stiffenning of the pores and skin are utilized, principally, underneath discipline circumstances and in emergency conditions. The strategies of Brun (processing of fingers with 96% spirit), Heisner (processing of fingers with a mix of iodine and gasoline in a ratio of 1:1), Pokotilo (processing of fingers with 5% water resolution of tannin), Zabludovsky (processing of fingers with a 5% spirits resolution of tannin), Bakkala (processing of fingers with a 1% resolution of good inexperienced) belong to this group. An important drawback of those strategies is their destructive affect on the pores and skin (burns, dermatitis, and allergy).
The third group of strategies with the appliance of detergents is probably the most wide-spread. A excessive sterility is seen as a result of detergents deep penetrate into pores and skin. Having excluded mechanical cleansing and lengthy pores and skin stiffenning, injury to the dermis and the incidence of dermatitis is prevented. The Spasokukotsky—Kochergin’s methodology of hand processing with a 0.5% resolution of liquid ammonia in two basins by 3 min every, after drying up — with 96° spirit, fingertips — with the iodine resolution belongs to this group.
Lately, such detergents are extensively utilized in processing fingers as: 0.5% spirit resolution of chlorhexidine bigluconate, 3% water resolution of novosept, 1% resolution of degmine or degmicide, 0.02% resolution of dioxide, resolution of pervomur (hydrogen peroxide with antacid). Dioxide, the preparation of mercury, may be very poisonous, accumulates within the kidneys, could cause dermatitis of the hand pores and skin. Sterilium, hospisept are utilized for processing fingers of the surgeon now.
OP-7, rocal are additionally utilized in fingers processing. Nevertheless, all these strategies don’t assure 100% sterility, due to this fact surgeons use gloves (rubber, latex, and so on.) after processing fingers.
The operational discipline is processed by the modified Grosich— Filonchikov’s methodology: twice processing of the pores and skin with 70% spirit and rubbed with 2–5% resolution of iodine. Options of Iodonatum, iodoperonium, 1% resolution of degmicidium, 1% resolution of rocal, 2.4% resolution of pervomurium are additionally used to course of the operational discipline.
Methods of Management over Sterility
Strategies of the management over sterility are divided into direct and oblique.
The direct methodology of sterility consists in bacteriological examination of sterilized instruments, fingers of the surgeon, the operational discipline, operational linen, dressing. Sampling is carried out by means of smear taking with a sterile wadded tampon, inoculation of medium is carried out in an effort to decide bacterial air pollution.
The oblique strategies permit to get rapidly information on sterility and is utilized at every sterilization. At autoclaving an ampoule with a powder substance which temperature of fusion ranges inside 110–120°C is packed within the field. If throughout sterilization the substance has fused, the fabric is sterile and vice versa. Benzoic acid, resorcin, antipirin are used for this goal. Related strategies are utilized for sterilization in dry heater: ascorbic acid, succinic acid, tiourea.
Antiseptics is a system of measures directed on destruction of microorganisms in a wound, the pathological focus, in organs and tissues, and an organism of the affected person as an entire, utilizing lively chemical substances and organic elements, and mechanical and bodily strategies of affect as properly.
There are mechanical, bodily, chemical, organic and blended antiseptics.
Mechanical antiseptics is elimination of microorganisms by mechanical strategies: removing of tissue websites sated with micro organism, infectioned clots of blood, purulent exudation. The strategies of mechanical antiseptics include:
A bathroom of a wound which is made at any bandaging. Thebandage utilized earlier than is eliminated, the pores and skin is processed across the wound. Purulent exudation, the contaminated clots, free necrotizing tissue are deleted from the wound. The wound processing with a pulsing jet of antiseptics is utilized with the identical goal.
Major surgical processing of the wound, which makes aninfected wound sterile by means of incision the perimeters, partitions and flooring of the wound along with alien our bodies and necrotic zones.
Secondary surgical processing of the wound which is carriedout with the presence of a purulent wound, consists of the removing of necrotizing tissues, revision of the wound itself, finishing up further incisions for offering free outflow of pus.
Different operations and manipulations: lancing of abscesses, phlegmons, a puncture of abscess, and so on.
Bodily antiseptics is elimination of microorganisms with the assistance of bodily strategies. The essential strategies of bodily antiseptics are as follows:
Utilization of hygroscopic dressing for exudate evacuation: gauzetampons, balls, napkins, cotton wool, cotton-gauze tampons.
Utilization of hypertonic NaCl 10% resolution for enchancment ofoutflow from the wound, which osmotic stress is larger than within the blood plasma.
Drainage, as an necessary factor of bodily antiseptics, isapplied for therapy of every kind of wounds and primarily based on a capillary precept and speaking vessels. Passive, lively and flowwashing drainage are distinguished.
The sorptional approach of wounds therapy is utilized with sorbents utilization — substances which adsorb toxins and microorganisms. They’re carbon-containing substances as a powder or fibres.
In therapy of wounds with the aim of battle againstmicrobes the tactic of drying is utilized: particular wards with the managed abacterial medium, varied units for native use.
Use of technical means:
— ultrasonic units for ultrasonic cavitation of wounds;
— laser units for processing wound surfaces with targeted and unfocused ray, irradiations of blood;
— use of ultra-violet ray for processing wounds, blood;
— use of X-ray radiation for suppression of an an infection in tissues.
The chemical antiseptics is elimination of microorganisms within the wound, pathological focus or an organism of the affected person and within the surroundings round with the assistance of assorted chemical substances.
The essential teams of chemical antiseptics.
Group of haloids:
Iodine — 1–5% alcohol tincture;
— iodinol — 1% resolution;
— iodonate, iodopirol, povidon-iodine
— natural compounds of iodine;
— water and alcohol resolution of iodine and potassium iodid;
— chloramin — 3% water resolution.
Salts of heavy metals:
— corrosive sublimate (sulema) — in focus 1:1,000;
— mercury oxycyanid — desinfectant means;
— preparations of silver — 0.1–2% and 5–20% options of nitrate of silver;
— protargol, collargol — antiseptic technique of exterior software.
Spirits — ethanol 70%, 96%.
Aldehydes — formalin — 37% resolution of formaldehyde — astrong disinfectant, lisol, a 2% resolution — a disinfectant.
Phenols — carbolic acid, a threefold resolution (20 g of formalin,10 g of carbolic acid, 30 g of natrium bicarbonate and water as much as 1 l).
Dyes — good blue 1–2% an answer, good inexperienced 1–2percentresolution.
Acids —boric acid — 2–4% an answer, salicylic acid.
Alkalis — liquid ammonia — for exterior software.
Oxidizer — hydrogen peroxide — 3–6% resolution, potassiumpermanganate — 0.02–0.1% and a couple of–5% options.
Detergents (superficially lively substances) — chlorhexidinbigluconate — 0.5% alcoholic resolution and 0.1–0.2% water resolution, cerigel, degmin, degmicid.
Derivatives of nitrofuran — furacillin 1:5,000, furadonin, furagin, furasolidon.
Derivatives of 8-oxychinolon — nitroxolin (5-NOX), enteroseptol, intestepan.
Derivatives of chinoxalin — dioxydin — 0.1–1% water resolution.
Derivatives of nitroimidasol — metronidazole (metragil, flagil, trychopol).
Vegetable antiseptics — phytoncides, chlorophylipt, ectyricide, balis.
Sulfonamides — streptocide, ethasol, sulfadimesin, sulfasin,sulfadimetoxyn, sulfalen, biseptol (Bactrim).
Organic Antiseptics
The essential preparations and strategies:
Proteolytic enzymes — trypsin, chemotrypsin, chemopsin, terralitin.
Technique of passive immunization — antitetanus serum, antitetanus gamma-globulin, antigangren serum, antistaphylococcal, antistreptococcal, anticoli bacteriophages, antistaphylococcal and anticoli hyperimmune plasma.
Strategies of stimulation of nonspecific immunity — ultra-violetirradiation, vitamin therapy, a full-value vitamin, ultra-violet and laser irradiation of blood, haemotransfusion and its preparations (a suspension of lymphocytes).
The substances stimulating nonspecific immunity — Thymalin,T-activin, prodigiosan, levomisol, reaferon, roferon, roncoleukin, β-leukin.
The preparations stimulating particular immunity — staphylococcal and tetanic anatoxin.
The essential technique of organic antiseptics are antibiotics.
Antibiotics (AB) — merchandise of the microorganism’ very important exercise, inhibiting progress and growth of sure teams of different microorganisms and used for therapy and prophylaxis of a surgical an infection.
In accordance with the mechanism of motion AB are divided into:
Inhibitors of the mobile wall synthesis (β-lactam АB — penicillins, cephalosporins, carbopenems, monobactams; glycopeptids — vancomycin and teicoplanin.
Inhibitors of protein synthesis (aminoglycosides, tetracyclines,macrolids, lincosamines, streptogramines, chramphenicol, fusidic acid, oxasolidones).
Inhibitors of the nucleinic acids synthesis (the inhibitors synthesis predecessors — sulfonamides; the DNA replication inhibitors — chinolones; the RNA-polymerase inhibitors — rifampicin.
Different АB (cytoplasmic membranes inhibitors — polymyxines; the preparations altering DNA — nitroimidasols).
Primary Teams of Antibiotics
Рenicillins: penicillin, oxacillin, methycillin, ampicillin, amoxycillin, bicillin, ampiox, augmentin, unasin.
Streptomycins.
Tetracycline: methacyclin, doxacyclin.
Macrolids: erythromycin, oleandomycin, roxythromycin, azythromycin, clarythromycin.
Aminoglycosides: kanamycin, gentamycin, thobramycin, sizmomycin, amycacin, netromycin.
Chloramphenicols.
Rifampicins.
Antifungal antibiotics: levorin, nystatin.
Polimyxin B.
Lincosamins: lincomycin, clindamycin.
Cephalosporins: 1st era — ceporin, cephalexin, cephazolin, cephamesin, kefzol, 2nd era — cephamandol, cephmetazol, cephoxitin, cephaclor, cephuroxim, cephotetam, third era — cephthriaxon, cephotoxim, cephixim, cephtibuten, cephpiramid, cephtazidim, 4th era — cephpirom (caten).
Carbopenems: imipenem, meropenem, tienam.
Glycopeptids — vancomycin and teicoplanin.
The seek for new АB preparations final years are focused on preparations lively in opposition to Gr+ microorganisms.
The primary consultant of artificial antibiotics of a brand new class — oxasolidons is Zivox (linesolid).
For rational selection of АB we should always know probably the most typically brokers of nosocomial and outhospital infections and their resistency to those preparations within the given hospital. It’s essential to make a listing of medication preferable for administration within the given surgical hospital which is revised 1–2 instances a 12 months taking into consideration epidemic information, showing of recent АB, adjustments of approaches for prophylaxis and therapy of pyo-septic problems.
The brand new strategy to software of АB is their rotation — cyclic change of antibacterial means used as preparations of selection. Rotation promotes discount of amount, however doesn’t get rid of resistant microorganisms strains.