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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
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.
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.
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.
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 oftransmissionof endogenous infections are direct contact, lympho- and haematogenous spread.
Types of antisepsis Physical - the creation of unfavorable conditions for development of microorganisms in a wound and for suction of microbe toxins and products of tissue decay. The drainage provides the outflow of wound contents and promotes the removal of toxins, microbes and products of tissue decay. Irrigation of gauze with hypertonic solutions highly increases its hydroscopic quality but tampons with wound exudation prevent the outflow from the wound, which is why they are not good for drainage. The open method of treatment can be used (ATU). The wounds are dried; as a result, unfavorable conditions for development of microorganisms are created.
The mechanical antisepsis: the hygienic bath, shaving, and extermination of tissues lacking vital capacity. In 1898 Fridrih P. proposed the primary surgical treatment of a wound by means of cutting off its borders, walls and a bottom within healthy tissues. • Chemical - the use of different chemical substances with bacterial and bacteriostatic effects. These substances must be safe for the human organism and its cells. They are used for treatment of the operational field, hands of a surgeon, sterilization of gloves, surgical instruments, stitch materials, desinfection of rooms. • Biological - is the procedure aiming to increase the immunity and to strengthen the protective power of an organism. A includes specific vaccines, immuno-serums, globulin, blood transfusion, plasma, anatoxins. • Mixed - the simultaneous use of some types of antisepsis. For example for treatment of wounds: the primary surgical treatment is mechanical, washing a wound and surrounding skin - chemical, the use of antibiotics -biological, putting the dressing-physical.
Chemical substances. • The group of haloids - the derivatives of chlorine and iodine. Their interaction with hydrogen of a microbe cell causes coagulation of protoplasm proteins. They use chloramin B (0,5 – 2% solution), iodonate (1% water solution), uodopiron, and iodophorm. • Oxidants, getting in contact with tissue, release oxygen with possesses a strong oxidizing effect, thus unfavorable conditions for anaerobic and putrefactive microbes are created. They use: the solution of hydrogen peroxide (3% water solution), potassium permanganate (0,1-2% water solution). • Acids and alkalis - more often salicylic acid and boric acid, sodium hydrocarbonat are used. • Aldehydes are strong bactericidal preparations: formaldehyde, glutaldehyde, and hexamethylentretramine. Severe toxic. • Spirits are strong disinfective means. As usual ethyl spirits (70-96% solution) are used.
Hypertonic solutions - are weak antiseptics possessing irritating and counter-attracting effects. They use the hypertonic solutions of sodium chloride (10%), glucose (10% and 40% solutions). • Salts of heavy metals - are strong and drastic antiseptics clocking sulphohydrical groups and causing the protein coagulation of microorganisms. Many substances of this type are not used now because of their toxic effects. They use the preparations of silver. • Phenols are processing products of coat-tar, oil and resins. They denaturate and coagulate proteins of protoplasma in bacteria. There are phenocarbolic acid, birch tar, ihtiol, and naphtalene oil. • Dyestuffs – are organic combinations dying tissue and processing bactericidal effect: methylene blue, brilliant green, and acridine lactate (rivanol). • Detergents – are drastic surface-active combinations, retailing to the group of ammonium bases. They are widely used ammonium bases. They are widely used in surgerv and an operating field. They are widely used in surgery for treatment. There are cerigel, degmicide, hexidine chloride, roccal etc.
Alexander Fleming made discovery of the penicillin mold in 1928. • The group of penicillin • The group of cephalosporines • Macrolids • The group of levomycetine • Tetracyclines • Riphampicins • Antibiotics of different groups • Antibiotics of last generation • Antifungous antibiotics
Sulphanilamid preparations. It is large group with antimicrobial action. They break methabolic processes in bacterial cells and cause bacteriostatic effect. They differ the sulphanilamids of short activity: streptocid, etazol, sulphadimezin and the sulphanilamides of prolonged activity: sulphapiridasin, sulphadimetoxin, sulphalen and others. Because of their bad dissolubility, sediments may fall out thus blocking liver balls.
Zones in the surgical block: • The sterile zone, i.e. the operating theatre (to operate on patients), scrub-up room (for preoperative cleansing surgeons' hands and arms) and the room for sterilisation (to sterilise the instruments to be used during the operation). • The clean zone, i.e. the rooms for personal hygiene and changing clothes of the staff. • The technical zone, i.e. the rooms where apparatus for air-conditioning or oxygen supplying and vacuum devices are stored. • The dirty zone,i.e. the sister's room, the room of the head of surgery and the one for dirty clothes etc
Cleaning of the operating room Cleaning of the room is doing by a damp cloth (1 % chloramin, 3 % hydrogene oxide, 0,5 % detergents). • The current cleaning - they pick balls of cotton from the floor; wipe the blood from the floor. • The cleaning of the operating room after the operation provides its cleanness before the next operation. • The every day cleaning at the end of the operational day and after some extra operations. • The general cleaning if fulfilled once a week according to the plan, in a day free from operations - they use hot water with soap, 3-6 % solution of hydrogene peroxisde, 0,5 % solution of detergent. • In the morning before the beginning of work all horizontal surfaces are wiped by means of a damp cloth. Bactericidal ultraviolet lamps are used for disinfections of air. Ventilation is fulfilled by means of conditioners, the filter of which exterminates microorganisms. Temperature is no more than 24° C, humidity is no more than 50 %. For special clean operations they use operating rooms with laminar airflow.
Preventive measures of contact and implantation infections. Sterilization is achieved by means of physical and chemical methods. Physical - thermal and ray sterilization - boiling, the sterilization by steam under pressure, dry heat sterilization, gamma-radiation. Chemical - the sterilization by ethylene oxide, the treatment by acetic acid, the chemical therapeutic treatment. Sterilization in the autoclave (water steam) is fulfilled with 120-132° C, pressure - 1,1 atm/sm2 during 45 min. The ray sterilization - is by ionic radiation of high energetic power. They use beta- and gamma-radiations. The ultra-ionic sterilization is also possible - the sterilizer is filled with some antiseptic, which under the influence of ultrasonic waves sterilizers surgical instruments. The chemical sterilization: ethylen oxide possesses a bacterial effect. By means of gas sterilization they treat the instruments of which cannot be treated in autoclaves or air sterilizators. They use ethylen oxide for sterilization of catheters, gloves, endoscopes, apparatuses for the artificial blood-circulated room. The sterilization is controlled by means of a color thermodicator or a hydroquinion. They put on the paper the thermoindicator paint of pale green color; under the temperature of 175-180°C it becomes dark brown. Except every day control they have a bacteriological control once a week or every 10 days
The sterilization of instruments. • In air sterilization procedure is carried out during 60 min with t° - 180°C. • Instruments made of corrosion-resistant metals or of plastics are sterilized in the 6% solution of hydrogen peroxide with temperature 180°C during 360 min. Instrument are sterilized also inthesolution of 3 components (2 % formaline, 0,3 % phenol, 1,5 % sodium bicarbonate) during 45 min. • Syringes are sterilized in dry-hot case with temperature - 180°C during 60 min. • Endoscopes, catheters, cistoscopes are sterilized by means of glutar dialdehyde and sodium hypochloride, the duration of treatment is 45-180 min.
Sterilization of dressing and operational linen • Before packing, the drums must be wiped dry. The lid must be closed and fastened and the grid opened. All non-sterile drums, as a rule, are kept apart from the drums containing sterile material. • Dressing and linen are sterilized in autoclaves, the pressure —1,1 atm, t - 120°C, during 45 min, or 2,0 atm, t -132°C during 20 min. Linen can be kept in 3 days.
Disinfections of surgeon’s hands Disinfections of hands are a good removal of microorganisms from the hands. And such a case they use the tannage of skin, which prevents the penetration of microorganisms onto the surface of the skin. The principal of surgical treatment: care of hands, care of nails, the mechanical cleaning is with soap and a brush during 2- 5 min, then disinfections. A disinfectant must be: • exterminate the micro flora quickly; • exterminate microbes in the juice of gloves; • possess a cumulative effect - hands must be free from microorganisms even in the intervals of disinfections; • not irritate the skin.
The preparation of the operating field Starts from the hygienic bath, shaving of hair. For the treatment of the operating field they use iodonate, iodopiron, chlorhexidin before its usage, dissolving the initial solution in 4,5-5 times boiled or sterilized water. They use the other antiseptics for the treatment of the operating field 1% solution of degmycide, 1% solution of roccal or catamine A-B, 2,4 % solution of pervomur. For the disinfections of the mucous membrane they use 1 % solution of diamond green, 3 % solution of hydrogen peroxide, 1 % solution of iodonate or iodopiron, 0,5 % spirits solution of hibitan
