Department of General Surgery Medical Academy named after S.I. Georgievskiy, The Federal State Autonomous Educational Establishment of Higher Education “Crimean Federal University named after V.I. Vernadsky” Ministry of Education and Science of the Russian Federation For the 3rd year students The text of the lectures and the minimum amount of knowledge necessary for a understanding of the subject material. Topic: Aseptics & Antiseptics in surgery Authors: prof.Mikhailychenko V.Yu, Starykh A.A. 2015 Aseptics & Antiseptics in surgery History of aseptic and antiseptic 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. Joseph Lister (5 April 1827 — 10 February 1912) was a Scottish surgeon who picked up the work of Louis Pasteur and used it to change the success rates of surgery. In 1865 Lister read about Pasteur's work on how wine went bad because of microorganisms in the air. Lister was convinced that microorganisms in the air were also the cause of the infections which killed up to half of his patients after they had successfully survived surgery. The open wounds made it easy for the germs to get into the body. Lister had heard that carbolic acid had been used to get rid of a cattle parasite in fields, and to treat sewage. He decided to see if it could also stop wounds becoming infected. He started to clean the wounds of his patients with carbolic acid, and soak the dressings in antiseptic liquid as well. In the years from 1864-66 the death rate for Lister's surgical patients was 45.7%. Between 1867-70, when he introduced his new antiseptic treatment, this fell to 15% Lister in theatre Lister went on to develop an antiseptic spray which was used in operating theatres during surgery to keep the wound clean. This spray was not used for long though, because carbolic acid actually damages the tissues and breathing it in causes many problems. More successful was the special dressings he developed which contained carbolic acid to keep the wound clean but a barrier to keep it away from the flesh so it didn't cause any damage. Lister's work revolutionised surgery once his aseptic techniques were accepted. Although the antiseptics and disinfectants used have changed, aseptic surgery is still the basis of saving millions of lives. 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. Neuber’s Followers Ernst von Bergmann of Berlin and his assistant, Curt Schimmelbusch, established their reputations in the field of asepsis in 1890 at tenth International Medical Congress held in Berlin. The congress hosted 7,000 visitors in total from all over the world and Bergmann gave a group of visiting surgeons a tour of their clinic. The tour group was impressed with their demonstrations on the effects of unsterilized instruments, utilizing culture plates to show the manifestation of infection. They wanted to show surgeons that practicing asepsis made a very large difference in the outcome of a surgery. Bergmann even went as far to show off his patients and their wounds from recent surgeries to allow visitors to see how quickly their scars and wounds were healing using the aseptic method. Schimmelbusch also made a name for himself starting a few years after the tenth International Medical Congress, when he invented the “Schimmelbusch drum”, which was a machine used to sterilize wound dressing materials and surgical garb. Perfecting Asepsis Although surgeons washing their hands with soap and/or alcohol was common practice by the 1890’s, the advent of surgical gloves even further decreased the rate of infection in hospitals. Starting in 1842, Thomas Watson suggested the use of surgical gloves during operations, but it wasn’t until the late 1890’s when the trend really caught on. William Stewart Halstead, a surgeon from Johns Hopkins University in Baltimore, MD, started this craze when he had two pairs of gloves made for one of his scrub nurses, who was having allergic reactions to the sublimate hand washed being used in the hospital. Eventually, the rest of the surgical team started wearing gloves too, and by 1897, all of the surgeons at Hopkins were wearing rubber gloves. Soon the whole nation was wearing gloves to prevent infection. Modern methods of asepsis and antisepsis includes: thermal sterilization methods (autoclave), ultraviolet and x-ray, Chemical antiseptics, antibiotics, etc. Aseptics & Antiseptics in surgery Topics: Introduction - difference between aseptics and antiseptics. Aseptics - definition, aseptic processes. o 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. o Sanitization / Disinfection. o Condition of surgical room. o Surgeon’s hands preparation and protection. o Measures for patient’s protection. Antiseptics - definition, types (mechanical, physical, chemical, biological, & mix), remedies. 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. 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. 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. Sterilization Definitions- Sterilization is a procedure which destroys all the existing forms of microorganisms,