ASEPSIS

From Big Medical Encyclopedia

ASEPSIS (grech, and - otritsa. +septikos is purulent, causing suppuration) — system of the preventive actions sent against a possibility of hit of microorganisms to a wound, fabrics, bodies, a perigastrium of sick (wounded) at surgeries, bandagings, endoscopy and other medical and diagnostic manipulations. And. includes:

a) a sterilization of instruments, materials, devices and so forth,

b) special processing of hands of the surgeon,

c) observance of special rules and working methods by production of operations, researches, etc., d) implementation special a dignity. - a gigabyte. and organizational actions in to lay down. establishment.

Method A. is further development of a method of antiseptics and it is closely connected with it (see. Antiseptics ).

Founders And. — the German surgeons E. Bergmann and C. Schimmelbusch, and in Russia — M. S. Subbotin, P. I. Dyakonov.

In 1890 on the X International congress of doctors in Berlin E. Bergmann for the first time proclaimed the fundamental law And.: everything that comes to contact with a wound, shall be free from bacteria.

In the beginning method A. it was directed to protection of the patient and personnel from harmful effect of antiseptic drugs (carbolic to - that, corrosive sublimate, etc.). Physical. factors, destroying microbes on everything that adjoins to a wound, allowed to avoid immediate effect on a wound of toxic antiseptic agents.

Further it became clear that one And. is not able to provide prevention of suppurations and that complex use is necessary And. and antiseptic agents. The set of the new highly active antiseptic substances and drugs (antibiotics, streptocides, nitrofuran connections, etc.) exerting less adverse effect on an organism is created.

For providing And. in recent years a row physical began to be used. factors (radoactive radiations, ultraviolet rays, ultrasound, etc.).

Allocate two sources of a surgical infection: exogenous and endogenous. The endogenous source is in an organism of the patient, exogenous — in the environment.

In the prevention of endogenous infection the main role belongs to antiseptics, exogenous infection — an asepsis.

The exogenous infection is subdivided on air, drop, contact, implantation.

Source of an air infection the microbic cells which are airborne in suspension are. Air of the cities, enclosed space, hospitals is especially sated with microbes.

Fight against an air infection is first of all fight against dust. The main actions directed to reduction of an air infection are as follows:

1) device of the correct ventilation of operating rooms and dressing rooms (air conditioning);

2) restriction of visit of operating rooms and reduction of movement on them of personnel and visitors;

3) protection against the static electricity promoting dispersion of dust;

4) wet cleaning of rooms;

5) regular airing and radiation of the room of the operating room ultraviolet rays;

6) reduction of time of contact with air of an open wound.

Droplet infection — a kind of an air infection when a source of infection is the air contaminated by droplets of saliva from a mouth and respiratory tracts of the patient, personnel or small drops of other infected liquids. Droplet infection is, as a rule, most dangerous to the patient.

The main actions directed to fight against droplet infection — prohibition of a talk in the operating room, obligatory wearing the gauze masks covering a mouth and a nose of personnel and also timely current cleaning of operating rooms.

Contact infection — infection of a wound at contact with it of the unsterile tools infected hands, materials, etc.

Prevention of a contact infection consists in sterilization of all devices, tools and materials adjoining to a wound (see. Sterilization , in surgery), and strict observance of rules of processing of hands of the surgeon (see. Processing of hands ). The importance is attached also to operating in gloves and to performance of the majority of manipulations with fabrics by means of tools, but not hands.

Implantation infection — the infection brought in a wound by a suture material, tampons, drainages, prostheses, etc.

Prevention of this infection consists in careful sterilization of a suture material, drainages, endoprostheses etc. and whenever possible more rare use of the foreign bodys (use of a bestamponny method of treatment of wounds, the resolving suture materials, etc.) left in a wound.

The implantation infection can often be dozing (latent) and prove only through a long span during the weakening of protective forces of an organism.

Prevention of an implantation infection is of particular importance at organ transplantation and fabrics since at use of various immunodepressor substances protective forces of an organism therefore usually avirulent saprophytic microflora becomes very dangerous are suppressed.

Method A. for destruction of microorganisms and their dispute demands use physical. factors and chemical substances.

From physical. factors action of the high temperature causing a denaturation of proteins of a microbic cell is most often used. Disputes of the majority of microbes are steadier against action of high temperature.

Sensitivity of microbes to temperature depends on their type, a strain and a condition of a microbic cell (the sharing and young bacteria are more sensitive). Also Wednesday in which there are bacteria is important (proteins, sugar reduce sensitivity, and alkalis and acids increase it). Cold detains reproduction of microbic cells, without having the expressed bactericidal effect.

Ultraviolet rays possess the expressed bactericidal action. Microbes in air, on the surface of fabrics, on skin of live objects, on walls and half of rooms, etc. perish from their action.

Recently arsenal And. was replenished scale - beams which source usually are radioisotopes 60 With and 137 Cs. Sterilization will see off these beams in special cameras at a dose 1,5 — 2 million rubles. By this method it is possible to sterilize linen, a suture material, systems for hemotransfusion, etc.

Ultrasonic sterilization demands powerful generators of ultrasound and practical value has no yet.

Fluid mediums can be exempted from microbes and a dispute, subjecting them to filtering via bacterial filters, however they do not detain the filtered viruses.

The chemicals applied to sterilization shall be bactericidal and not damage tools and materials, with to-rymi they adjoin.

Except the traditional substances borrowed from an arsenal of antiseptics (iodine, alcohol, chloroamine, etc.), other substances also are applied to disinfecting of devices, tools, materials (e.g., Diocidum).

In prevention of infection of wounds additional actions are of great importance: an obkladyvaniye of edges of a wound sterile napkins, step-by-step change of tools and linen, repeated washing of hands of surgeons or change of gloves after «dirty» stages of operation, closing of a wound napkins at a forced stop of operation, and also imposing of a postoperative bandage.

Recently instead of bandages sometimes apply filmogens to closing of a wound (like a plastubol) which are usually packed into aerosol cans.

For providing measures And. organizational actions are of extremely great importance. Among them the correct design of surgical departments and surgery blocks is most important (see. Operating room , Operative-dressing block ), the reducing danger of an airborne and intrahospital infection. For especially «pure» operations (organ and tissue transplantation) build «superpure» operating rooms and «superpure» departments where high extent of isolation of patients from personnel is reached that becomes possible during the use of monitor systems for overseeing by patients (see. Monitor observation ).

Important action for providing And. sanitation of service personnel is. Researches of the last years show that quite often a source of a surgical infection is the medical staff in which pharynx and a nasopharynx often there is antibiotic-resistant pathogenic flora. In cases when sanitation does not yield results, it is necessary to resort to employment of resistant bacilli carriers out of surgical departments.

Knowledge and strict observance of rules A. all employees shall be the law of work of surgical departments. See also Surgery .


Bibliography: Breydo I. S. History of antiseptics and an asepsis in Russia, L., 1956, bibliogr.; An 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; Mashkovsky M. D. Pharmaceuticals, p. 2, page 436, M., 1972; V. I Pods. Sketches on the general and urgent surgery, page 77, M., 1959; U s ade 1 W. Die Aseptik und die Antiseptik in der Chirurgie, in book: Chirurgie, hrsg. v. M. Kirschner u. O.Nordmann, Bd 1, S. 393, B. — Wien, 1940.

V. I. Struchkov, V. A. Sugars.

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