Download - Asepsis.ppt
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The asepsis is a complex of actionsaimed to prevent the contamination of
wound, tissues, organs and organismas a whole. Unlike of antisepsis, that
destroy microorganisms already fallen
into the wound, asepsis preclude its
penetration in the patient’s organism.
DEFINITIONDEFINITION
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The purpose of surgical asepsis
is to prevent the contamination of
the open surgical wound by
isolating the operative site from the
surrounding nonsterile
environment.
PURPOSEPURPOSE
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The main rule ofThe main rule of
asepsis is –asepsis is –
““One and all that getOne and all that getinto the contact ithinto the contact ith
ound o!ligate to !eound o!ligate to !e
sterile"sterile"#
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Source of infection$Source of infection$
Caries as a nidus
of infection
Wound
E%oE%ogenous
source of
infection
EndoEndogenous source of
infection
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There are three a&s ofe%ogenous contamination $
'#(ir!orne spread)*#+ontact spread)
,#+ontamination !& implantation
of infected materials
-implantation infection.#
/(0S$/(0S$
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(ir!orne a& of contamination(ir!orne a& of contamination
Infection from respirator&
tract of patients and
health1care or2ers
Infected !andages andinfected ound discharge
Infected dust in the
operating roomPathogenic germs from
clothes and s2in of
or2ers and patients
INFE+TED (IR IN
OPER(TIN3ROO4
INFE+TED
/OOND
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Pre5ention of air!orne infection#Pre5ention of air!orne infection#
Separation of patients#
SEPTI+
SUR3I+(6
DEP(RT4ENT
(SEPTI+
SUR3I+(6
DEP(RT4ENT
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Pre5ention of air!orne infection#Pre5ention of air!orne infection#
+onsecution of operations #
“(!solutel& clean" inter5entions
!vascular surgery, hernia repair "
“Relati5el& clean" inter5entions
!cholecystectomy, gastric re#ection "
“Infected" inter5entions
!colon surgery, purulent surgery "
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Restricted access of
unauthori7ed persons into
department and operating room
especiall
Pre5ention ofPre5ention of
air!orne infectionair!orne infection
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'#7one of general regime
*#7one of restricted regime
,#relati5e sterile 7one
8#a!solute sterile 7one
Four 7ones of operatingFour 7ones of operating
room$room$
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Persons or2ing in a!solutePersons or2ing in a!solute
sterile 7onesterile 7one $$
STERI6E
-“S+RU99ED".4E49ERS$
surgeon
surgeon’s
assistants
scrub nurse
NONSTERI6E
PERSONNE6$
anaesthetist
nurses
students, medical
re#idents
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The second and third 7ones are di5ided
!& mar2ed red linered line painted on the
floor#
IIII
IIIIII
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4edical clothes#4edical clothes#
:one of general
regime
Sterile 7one
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4edical clothes#4edical clothes#
“Scru!!ed" persons in sterile 7one
Sterile
surgical
glo5es
Sterile
surgical
gon
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Test for carrier ofTest for carrier of
Staph&lococcus#Staph&lococcus#
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cleaning prior to start operations
current cleaningcleaning after each finished
operationcleaning after termination of
or2ing da&
+leaning in the operation+leaning in the operation
room#room#
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The complete cleaning; ith
profound and prolonged
disinfection of all accessi!le
surfaces and facilities in
operating room should !e
performed ee2l& and that da&
is considered operation1free#
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+6OSED +IR+UIT OF (IR IN+6OSED +IR+UIT OF (IR IN
OPER(TIN3 ROO4#OPER(TIN3 ROO4#
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Proph&la%is ofProph&la%is of
contact infectioncontact infection
““One and all that getOne and all that getinto the contact ithinto the contact ith
ound o!ligate to !eound o!ligate to !esterile"#sterile"#
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surgeon=s hands ith glo5es
surgical gon
drapes and !andages
surgical instruments
operating field -patient=s s2in.
/hat enter into direct contact/hat enter into direct contact
ith a oundith a ound >>
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Surgeon=s hands#Surgeon=s hands#
''
/ashing ith soap and !rush in
running ater#
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**
Surgeon=s hands#Surgeon=s hands#
(fter thrice1repeated ashing; hands
should !e dried ith sterile toel#
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,,
Surgeon=s hands#Surgeon=s hands#
Decontamination ith antiseptic$
Per5omur; Degmin; Tserigel; Eurosept#
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Surgeon=s hands#Surgeon=s hands#
In our clinic e use forthis purpose the
?#@ spirituous?#@ spirituous
solution ofsolution of
chlorhe%idinechlorhe%idine#
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88
Surgeon=s hands#Surgeon=s hands#
(fter decontamination 1 sterile surgical
gon and sterile surgical glo5es#
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Sterili7ation of te%tile products#
',?A+
Sheemel!ush=s
container
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one hour under pressure of steam
eBual to '#' atm 8@ minutes under pressure of steam
eBual to '#@ atm
,? minutes under pressure of steam
eBual to * atm
Cariants of sterili7ation inCariants of sterili7ation in
autocla5eautocla5e $$
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rinsing
disinfecting
cleaning
dr&ing
sterili7ation
Processing of surgicalProcessing of surgical
instrumentsinstruments $$
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Sterili7ation ofSterili7ation of
surgical instruments#surgical instruments#
'1st step$
Rinsing of instruments
under arm running ater
for remo5ing of !lood andorganic tissue#
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Sterili7ation of surgicalSterili7ation of surgical
instruments#instruments#
Instruments immersed in solution
of h&drogen pero%ide during ?
minutes
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Sterili7ation ofSterili7ation of
surgical instruments#surgical instruments#
+leaning of instruments !& means of
soa2ing in the detergent ith
temperature of @? – ?A + for *?
minutes# (fter that; instruments should
!e ashed in this solution ith !rush
and rinsed ith running ater#
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Sterili7ation of surgicalSterili7ation of surgical
instruments#instruments#
Dr&ing of instruments in the special
electric o5en#
,?= 1 G?A
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Sterili7ation of surgicalSterili7ation of surgical
instruments#instruments#
Door closed and sterili7ation
performed #
?= 1 'G?A
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Hualit& control of thermalHualit& control of thermal
sterili7ationsterili7ation $$
DIRE+T 4ET
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Hualit& of sterili7ation#Hualit& of sterili7ation#
4elt su!stantionUnmelt su!stantion
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Decontamination of operationDecontamination of operation
field$field$
The s2in must !e cleaned more idel&
than area of planned inter5ention)
+leaning must !e performed from the
center to peripher&)
The more contaminated areas are cleans
in the latter time#
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Decontamination of operation field#Decontamination of operation field#
Three times !efore
limitation of operationfield ith surgical drapes
Prior to
incision
9efore and after insertion
of ound suture
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Implantation of infected material in
the human !od& ine5ita!l& results
in de5elopment of septic–purulent
process# This 2ind of suppuration is
5er& resistant to anti!acterial
treatment and remo5ing of infected
item is reBuired as usual#
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Surgical sutures#Surgical sutures#
N(TUR(6$N(TUR(6$
Silk
Catgut
S0NT
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Surgical sutures#Surgical sutures#
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Implanta!le surgical o!Jects#Implanta!le surgical o!Jects#
Sutures
(rtificial heart
5al5esOrthopedic de5ices
S&nthetic meshes
for hernia repair
Cascular grafts
S fSt ili ti f i l t !l
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Sterili7ation of implanta!leSterili7ation of implanta!lesurgical o!Jects#surgical o!Jects#
The methods ofsuture sterili7ation$
+laudis
Sit2o5s2&
Koher
3u!are5
3OIN3 DO/N IN
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Sterili7ation of implanta!leSterili7ation of implanta!lesurgical o!Jects#surgical o!Jects#
4ET(66I+
ORT
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Principal rules of !eha5ior intoPrincipal rules of !eha5ior into
operating room$operating room$'#Onl& sterile persons function ithin a
sterile field#
*#Sterile drapes are used to create a sterilefield#
,#(ll items used ithin a sterile field must
!e sterile#
8#( sterile field should !e maintained and
monitored constantl
P i i l l f ! h i i tP i i l l f ! h i i t
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Principal rules of !eha5ior intoPrincipal rules of !eha5ior into
operating room$operating room$
@#If there is dou!t regarding an itemMs
sterilit&; consider it not sterile#
#Nonsterile personnel should ala&s
remain in nonsterile areas and contact
onl& nonsterile items#
#Nonsterile personnel must ala&smaintain a margin of safet& hen
approaching sterile fields and personnel#
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Endogenous infection#Endogenous infection#
+hronic
inflammator&
diseases$
chronic
p&elonephritis;
chronic
!ronchitis;
chronic
tonsillitis;
caries
Surgical
siteinfection
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Nosocomial infection#Nosocomial infection#
The most common nosocomialinfections are ( urinary tract infections,
pneumonia and surgical(site infections.
)n most cases, the nosocomial infection
has been caused by antimicrobial(
resistant pathogens.
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INFE+TION
(SEPSIS
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