ANTISEPTICS (grech, anti-against - + septikos causing suppuration putrefactive; synonym antiputrefactive method) — in initial value — a way of the prevention and treatment of a surgical (wound) infection influence on its activators. In a crust, time under the term «antiseptic agent» the complex is meant to lay down. - professional, the actions directed to destruction of microbes in a wound, pathological education or an organism in general unlike allocated as an independent method asepsises (see), a task a cut — the prevention of hit of microbes in a wound by use of various ways sterilizations (see) and the relevant organization of work in the operating room. This division to a nek-swarm of degree is conditional, and in some cases differentiation of antiseptics and an asepsis is difficult.
Many doctors still in the ancient time empirically came to a conclusion about need of disinfecting of a wound. Applied cauterization to this purpose the heated iron, the boiling oil, used vinegar, lime, balsam ointments and other substances (Hippocrates, Tsels, Ibn-Xing, etc.).
In 1843 Holmes (O. of W. Holmes), and in 1847 I. Semmel weis suggested to apply solution of lime chloride to disinfecting of hands of obstetricians.
N. I. Pirogov used for disinfecting of wounds at their treatment various substances (tincture of iodine, solution of caustic silver on spirit of wine, etc.).
Origin of the term and development of a method
Origin of the term and development of a method A. it is in many respects connected with a name of Louis Pasteur who in 1863 a number of experiences proved that processes of fermentation and rotting are caused by hit and life activity of microorganisms. Having transferred Pasteur's idea to surgery, J. Lister gave scientific justification to suppuration of wounds, having explained it with hit in a wound and development of bacteria in it.
The work «About a New Way of Treatment of Changes and Abscesses with Notes on the Reasons of Suppuration» (1867), in Krom stated the principles of its doctrine, J. Lister made a revolution in surgery, having opened a new «antiseptic» era. For destruction of the microbes which are airborne J. Lister suggested to disinfect air in the operating room before and during operation by spraying from a spray (shpreya) of solution carbolic to - you. The surgery field, hands of the surgeon, tools and everything that during operation adjoined to a wound, was exposed to processing of 2 — 5% solution carbolic to - you. The wound after operation was isolated from air by the multilayer bandage which is also impregnated with carbolic acid — «протектив», the impregnated 5% solution carbolic to - you in pitches, pressurized a wound a first coat. Over it eight more layers of the gauze impregnated with mix carbolic to - you, paraffin and rosin were imposed. This bandage was covered with an oilcloth or proof fabric, edges was kept on a wound by the bandage which is also impregnated carbolic to - that. Thus, Lister's method combined the principles of an asepsis and antiseptics in modern understanding. Use of this technique led to sharp reduction of number of suppurations and quickly found a large number of supporters. In Russia this method was for the first time applied by I. I. Burtsev in 1870.
Broad use of a method of Lister revealed also his negative sides: 1) carbolic to - that caused necroses of fabrics in the field of a wound; 2) washing of hands of surgeons solution carbolic to - you caused dermatitis; 3) inhalation carbolic to - you quite often led both patients, and surgeons to poisoning.
In a crust, time And. developed in the important direction of surgical science and is an integral part of a surgical medical method.
Its development is caused by accumulation of knowledge not only in the field of surgery, but also in such industries as microbiology, pharmacology, physics, chemistry and a number of other sciences. Distinguish the following types And.: mechanical, physical, chemical, biological and mixed.
The mechanical antiseptics
One of the most important components of the prevention and treatment of a wound fever is mechanical removal of the infected and impractical fabrics. Primary surgical treatment of wounds — one of the most often applied types mechanical And. At the correct performance of this intervention (terms from the moment of wound, technology of operation) the accidental contaminated wound turns into the aseptic operational wound healing first intention (see. Surgical processing of wounds). As the medical action directed to reduction of number of microbes in a wound and creation of unfavorable conditions for their life activity, mechanical And. it is widely applied in the form of a surgical toilet of a wound (removal of foreign bodys, nekrotizirovanny and impractical fabrics, opening of zatek and pockets, a bathing of the wound and other manipulations directed to clarification of a contaminated wound). Primary surgical treatment of wounds of wartime and listerovsky method at their treatment the Russian surgeon K. K. Reyer during the Russian-Turkish war of 1877 — 1878
Physical antiseptics also for the first time applied one of the most important methods of prevention and treatment of a wound fever by use of various physical factors causing death of microorganisms or reduction of their number, and also destruction or elimination of the toxins produced by microbic cells. To physical And. it is necessary to refer use of hygroscopicity of a bandage which as a result of capillary properties creates conditions of active suction of the wound secret containing a large number of microbes and their toxins. Use of hypertonic salt solutions to their high osmotic pressure exceeding oncotic pressure in a wound on the mechanism of action on a wound process is close to the physical phenomenon of a capillarity too. The difference of pressure created by hypertonic salt solutions promotes outflow wound separated in a bandage. However action of hypertonic salt solution is not limited only to a physical factor (high osmotic pressure); hypertonic salt solutions make also chemical and biological impact on a wound and on microorganisms, i.e. include elements chemical and biological And. Effect of light, dry heat, ultrasound, ultraviolet rays and other physical factors on a microbic cell cannot also be explained with only purely physical phenomena. Mechanism of their action not only physical, but also biological and physical and chemical. Thus, under physical And. use of an extensive complex of the physical factors and phenomena which are closely connected with all other types is understood And.
Chemical antiseptics — use of various chemicals possessing bactericidal or bacteriostatic action (see. Antiseptic agents ). Except impact on microflora, these substances in a large number of cases have also biological effect on fabrics around use (in a wound) and on an organism in general. Use of the means possessing the maximum bakteriotropny action at minimum organotropic is the most reasonable. Can be an example sulfanamide drugs (see). Using chemical And., it is worth to remember that it, as well as any medical action, shall be strictly dosed.
Biological antiseptics — use of big and very various group of the drugs on the mechanism of action influencing as directly a microbic cell or its toxins, and group of the substances operating indirectly through a macroorganism. The drugs having preferential direct effect on a microorganism are: 1) antibiotics (see), having bacteriostatic or bactericidal action, 2) bacteriophages (see) and 3) antitoxins (see), entered, as a rule, in the form of serums (antitetanic, antidiphtherial).
The vaccines entered into an organism, anatoxins, immunoglobulins and many other drugs, hemotransfusion and plasmas work indirectly through a macroorganism, raising it immunity (see) and by that increasing protective properties (specific and nonspecific).
Special mentioning is deserved proteolytic enzymes, applied at treatment of wounds which, lyseing nekrotizirovanny fabrics, promote bystry clarification of wounds and deprive microbic cells of nutrients. There are also instructions that, changing the habitat of microbes, proteolytic enzymes do a microbic cell more sensitive to other types of antiseptic agents. Together with it proteolytic enzymes thanks to existence in living tissues of fermental inhibitors do not damage their cellular structures.
For successful use biological And. it is necessary to know not only properties of microbic cells, often very various (an antibiotikorezistentnost, serological specificity, etc.), but also a condition of a macroorganism and optimum schemes of specific and nonspecific immunization.
The mixed antiseptics
As it was already told above, the majority of types And. on impact on a microbic cell and a macro-organism it is impossible to reduce to the uniform mechanism. More often them action complex. For increase in efficiency of antimicrobic action several types are widely used And. A classical example of use mixed And. modern tactics of treatment of wounds is.
Primary surgical treatment (mechanical and chemical And.) it is, as a rule, supplemented biological And. (administration of antitetanic serum, antibiotics), purpose of physiotherapeutic procedures (physical And.).
Depending on a method of use of antiseptic agents distinguish And. local and the general, and local And. in turn shares on superficial and deep. At the first — drug is used in the form of powders, ointments, applications, washing of wounds and cavities; at the second — drug is injected in fabric of area of a wound or the inflammatory center (an obkalyvaniye, blockade).
Under the general And. or «the big sterilizing therapy» (therapia sterilisans magna) understand saturation of an organism the antiseptic agent (antibiotics, streptocides, etc.) coming to the center of an infection with a blood flow or influencing the microflora which is contained in blood. Boundary between the general and local And. the method of regional infusion of antiseptic drugs in the blood vessels feeding the body affected with an infection or department of an extremity is. This method allows to create very high concentration of medicinal substance in the place of development of an infection at low (harmless) concentration it in an organism thanks to big cultivation of drug in fluid mediums of an organism after washing of the center of defeat.
Applying this or that look And., it is necessary to consider its possible side effects which in some cases can be dangerous, causing intoxication (chemical And.), damage of the vital anatomic educations (mechanical And.), photo dermatitis (physical And.), allergic shock, dysbacteriosis, candidiases (biological And.).
Bibliography: Belovo 3. M. Antibacterial therapy in clinic of internal diseases, M., 1971; B r e y d about I. S. Istoriya of antiseptics and asepsises in Russia, L., 1956; The Infection in surgery, in book: the 24th kongr. Mezhdunarodn. islands of surgeons, under the editorship of B. V. Petrovsky, t. 1, page 21, M., 1972; M and sh to about in with to and y M. D. Pharmaceuticals, p. 2, page 437, M., 1972; V. I Pods. General surgery, page 30, M., 1972; V. I. Pods, etc. Proteolytic enzymes in purulent surgery, M., 1970; Lister J. On a new method of treating compound - fracture, abscess etc., Lancet, v. 1, p. 326, v. 2, p. 95, 1867.
V. I. Struchkov, V. A. Sakharov.