asepsis

1. AsepSiS in surgery

2. Historyof asepSIS
Empirical asepsis
In ancient times, demons and evil spirits were though to be the causes of pestilence
and infections. Hippocrates (460-377 BC), the great healer of his time irrigated wounds
with wine or boiled water foreshadowing asepsis. Galen (130-200 A.D.), a Greek that
practiced medicine in Rome and was the most distinguished physician after Hippocrates
boiled his surgical instruments used in the caring of wounded gladiators. The writing of
Hippocrates and Galen were the established authority for many centuries. In the early to
mid 1800's, people like Ignaz Semmelweis, Louis Pasteur, and Robert Koch introduced
us to the world of microorganisms. Since this time, we have witnessed the invention of
the first steam sterilizer (1886), the practice of passive and active immunization, and the
use of antibiotics. Today, we practice asepsis and sterile technique based on scientific
principles. Infection control, asepsis, body substance, and sterile technique should
always be a part of patient care at any level.

3. Father of Asepsis
Gustav Adolf Neuber has been frequently overlooked as the inventor
ofasepsis. In 1884 he founded a clinic which used the principles of
asepsis to treat each patient. Neuber implemented strict rules and
regulations that his apprentices were obligated to follow to ensure the
cleanliness of the rooms and instruments. Surgical were required
to wash their hands, faces, and arms before entering the operating rooms.
The rooms were also isolated from other parts of the building so that no
materials could enter or exit the operating rooms. Even the air was
sterilized by running through vents that passed the building’s heating
system, heating the air and kill bacteria. Furthermore, Neuber used dry,
peat aprons when operating on patients which would dry very quickly
and would stay sterilized longer than aprons and articles of clothing
soaked in antiseptic fluids. In 1886 Neuber published a monograph
which described his techniques that kept the environment around the
patient sterile. He set the standard for aseptic practice.

4. Modern methods of asepsis includes:
thermal sterilization methods (autoclave), ultraviolet and x-ray, Chemical antiseptics,
antibiotics, etc.
Aseptic in surgery
Topics:
 Introduction - difference between aseptics and antiseptics.
 Aseptics - definition, aseptic processes.
 Sterilization -
 Definitions - sterilization & sterility.
 Measures of sterilization - physical & chemical.
 Difference between sterilization of dry heat or moist heat.
 Methods of sterilization control - physical, chemical, & bacteriological.
 Sanitization / Disinfection.
 Condition of surgical room.
Surgeon’s hands preparation and protection.
 Measures for patient’s protection.
 Antiseptics - definition, types (mechanical, physical, chemical, biological, & mix),
remedies.

5. Introduction:
The adjectives, aseptic & antiseptic, are partly synonymous, but
something that is antiseptic kills bacteria inside the living organism,
while something aseptic is “surgically clean or sterile”.
(Sepsis is the state of putrefaction or decay. While asepsis is the
absence of contaminants).
Asepsis is the state of being free from disease-causing/harmful
contaminants (such as bacteria, viruses, fungi, and parasites) or,
preventing contact with microorganisms. The term asepsis also often
refers to those practices used to promote or induce asepsis in an
operative field in surgery or medicine to prevent infection. Ideally, a field
is "sterile" — free of all biological contaminants, not just those that can
cause disease, putrefaction, or fermentation — but that is a situation that
is difficult to attain. However, elimination of infection is the goal of
asepsis, not sterility.
Antiseptics are antimicrobial substances that are applied to living
tissue/skin to reduce the possibility of infection, sepsis, or putrefaction.

6. 2 types / sources of surgical infection are differentiated:
1. Exogenous – source is located in the external medium.
2. Endogenous – source is located in patient’s body.
The decisive role (main role) in fighting against endogenous infection
is given to antisepsia, for fighting exogenous infestation is used asepsia.
Antisepsia ⇒ fighting against Endogenous infection.
Asepsia ⇒ fighting against Exogenous infestation / infection
(prevention)
The main ways of achieving this are:
the washing of hands
adherence to antiseptic and asepsis rituals
aggressive attention to basic surgical principles
compliance with antibiotic guidelines
patiently accepting the measures that are necessary to prevent the
spread of resistant organisms
the adoption of universal precautions to prevent diseases due to blood-
borne viruses.

7. Aseptics
Definition - Aseptic (Greek a – negation + septicas – purulent) – is a
complex of prophylactic / preventive measures, which prevent the
contamination of wounds, tissues, organs with pathogenic germen’s
colonies, from exogenous sources, during surgical interventions and
other medical manipulations. (Aiming at the complete exclusion of
harmful microorganisms).
Aseptic process includes:
1. Instruments’, materials’, and equipment’s’ sterilization.
2. Scrubbing surgeon’s hands.
3. Respecting some rules and processes during the interventions.
4. Effectuation / accomplishment of some special sanitary-hygienic and
managerial procedure measures in curative institutions.

8. Sterilization
Definitions-
Sterilization is a procedure which destroys all the existing forms of microorganisms,
which live on objects’ surfaces and deep inside.
Sterility is the freedom from viable form of microorganisms (all alive forms of
microorganisms). It represents an absolute state, there are no degrees of sterility (all
organisms die).
Measures - During the sterilization are used physical and chemical measures:
1. Physical measures of sterilization:
a. Sterilization by humid warm / moist heat – using Autoclave device.
Autoclave works by creating steam and then through series of valves increasing the
pressure, so that the steam becomes superheated.
Instruments placed into an autoclave should be packaged to allow the free flow of steam
to the equipment. The purpose of packaging is to protect instruments from
contamination after removal from the sterilizer and during storage. Such as by placing
instruments in paper bags or rapping them in cotton clave.
In the moist heat we sterilize all the cotton, gauze / bandage, and soft materials used in
medical practice.

9. Difference between sterilization of dry heat or moist heat
(under steam) -
Dry heat is most commonly used to sterilize glass ware items, that can
withstand heat but are susceptible to rust. Also instruments made of
metal (susceptible to rust). by Poupinel (dry sterilizer machine).
Moist heat is more efficient than dry heat because it is effective at
much lower temperatures and requires less time. The container usually
used for providing steam under pressure is called “Autoclave”.
Advantages of moist heat sterilization over dry heat are it’s
effectiveness & speed.
Disadvantages include the tendency of moist heat to dull (make them
less intense) and rust instruments and the cost of autoclave is expensive.

10. Sterilization control (e.g. sometimes when the electricity cut, we
need to control the sterilization):
1. Physical method:
a. Thermometer. (used for poupinel)
b. Manometer (under pressure).
c. Sterilization’s time.
Chemical methods to control sterilization – (e.g. for big autoclave with many shells) control
substances or special tests which change their color at a the temperature higher than 110
°C:
. Benzonafton with fuxin becomes dark red at the temperature of 110 °C.
a. Sulfur becomes yellow at 115 °C.
b. Glucose with sodium citrate becomes yellow-brown at 123 °C.
Bacteriological method – now we use biotests (collection of some probes from instrument’s,
material’s surfaces and theirs application on mediums of adequate culture) after a
successful sterilization colonies of microbes are not developing on culture’s mediums.
Take from surface of the instrument from cotton and check the presence of bacteria.
This is a long method (takes time).

11. The conditions of surgical room
1. Its’ execution (the cleaning) before and after work program or as often as you see
visible contamination during the work program.
2. Collection of garbage and used materials (as often as it is possible).
3. Cleaning has to be done by using humid (moistened in disinfectant solutions) textiles.
4. To prevent infections extension the cleaning begins from the most clean area and
finished with the most contaminated zone.
5. Airing and quartz lamp’s (bacterisic lamp) using in room are obligatory
It is very important to remember during medical interventions medical staff is in risk to
be contaminated with pathogenic agents from patient’s organism, that’s why is
necessary to realize a protection by using special equipment (protection equipmets) –
like smock, slippers, cap, face mask, and special glasses.
General cleaning should be made twice a week in surgical room or hospital.

12. Surgeon’s hands preparation and protection
Staff’s hands are an important source of infections by collecting and
transporting a lot of different pathogen or conditionally pathogen
colonies of microorganisms to the wounds because:
1. A lot of microorganisms can be found at nails’ level.
2. Watches, bracelets’ and rings’ areas (these should be taken off).
3. (MOST important) Medical staff has to be careful and to maintain
their teguments integral.
To prepare surgical hands are recommended next procedure and rules:
1. Hands are washed with water and soup before every surgical
intervention (also part of arms).
2. Hygienic washing is followed by hands disinfection with:
Clorhexidine solution 0.5% and ethyl alcohol 70-80 %.
3. Dressing sterile uniform (the assistance need to help the doctor to wear
it).