Asepsis and antisepsis — what is it? In modern medicine, this issue remains one of the most common. Knowledge on the issues of asepsis and antisepsis remains one of the main topics in the health professions.
Asepsis is a complex of measures aimed at preventing the penetration of infectious agents into the wound, tissues, organs and the body cavity of the patient. These events are held during the manipulation of the surgical patients and the diagnosis.
Asepsis is the destruction of microorganisms by way of doing the disinfection and sterilization processes employing physical forces and chemical agents.
Types of sources of surgical infections
Divided into two kinds of source of surgical infections: endogenous and exogenous. The first type is located directly in the patient's body, and the second in the environment that surrounds the patient.
In the prevention of endogenous infection the main value withdrawn antiseptics, exogenous — asepsis.
Prevention of endogenous infection of the wound involve the identification and rehabilitation of infectious foci in a patient who is being prepared to grafikom surgery. Such action is subject to transfer in the case when the patient is in a fever, he revealed the presence of suppurative lesions of the skin (asepsis in dermatology), a sore throat, cavities in the teeth (asepsis in dentistry) or other purulent foci.
When in the zone adjacent to the operating field, there is a contaminated injury, restricting it with a sterile napkin, special films from the incision, glued medical plaster, in some cases, resort to stitching, followed by thorough processing of the operating zone. And then perform the manipulation itself, strictly observing the rules of asepsis.
Prevention of exogenous infection
Methods of asepsis used in the fight against exogenous infection. Sources of the latter are sick and bacteriological media, especially if they are among the medical staff.
Prevention of droplet infection in the operating rooms and dressing rooms contribute to the improvement of their special ventilation system (predominance of inflow of air masses over the hood, install a laminar flow of conditioned air), organization of a special regime of work, the implementation of measures aimed at the destruction of existing microorganisms: timely wet cleaning, exposure of air masses using germicidal lamps, and in strict adherence to the medical staff the required sanitary standards.
Prevention of contact contamination is provided by the sterilization of linen for surgery, bandaging and suture materials, rubber gloves, tools, special treatment of the surgeon's hands and fields of operation. Everything that comes in contact with the wound must be freed from bacteria, or in other words, should be sterile. This is the basic principle of asepsis. Sterilization of material for joints has a specific function in the prevention of infection of the wound. The responsibility for correctly performed sterilization imposed on the operating nurse.
Mode operating units
Visit the operating rooms to which outsiders limited the maximum movement of staff is reduced. Persons involved in operating the process, must wear a special medical garment (sterile gowns, caps, masks, Shoe covers). The level of contamination of air in operating theatres and dressing Cabinet is assessed through a bacteriological examination, conducted with a certain regularity.
Preparations for the operation provides for a strictly established procedure for preoperative actions. The scrub nurse should prepare yourself first by carrying out the operation. This process consists in the following sequence: donning the mask, the handling of arms, donning a sterile gown, resorting to Junior medical staff, then sterile gloves. Followed by the sowing of sterile table linen, sterile instruments, suture material. Next, the operating surgeon and his assistants treated their own hands, leveraging the operational unit nurse, dressed in sterile clothing and medical are starting to prepare the area for surgery, fenced pre-sterile linen.
When the conditions of asepsis, one of the main measures is the rehabilitation of the medical staff of the hospital. And only in those cases when it does not bring positive effect, resort to the employment transfer media outside the offices of a surgical profile.
Antiseptic and its types
Antiseptic (and as part of it — asepsis) is a complex of treatment-and-prophylactic measures aimed at the destruction of microorganisms in the wound, otherwise the pathological focus or in a whole organism.
There are the following types of asepsis and antisepsis:
1. Prevention aseptic technique aims to prevent the penetration of microorganisms through the wound surface or in the body of the patient (treatment of hands of medical staff, treatment antiseptic drug places of the alleged damage to the skin and so on.).
2. Therapeutic antiseptic, which is divided into the following ways:
- mechanical (removal of infected and devitalized tissues, primary surgical processing of wounds, etc.).
- physical (absorbent dressings, hyperosmotic solutions, the action of ULTRASONIC, etc.)
- chemical (use of bactericidal and bacteriostatic drugs)
- biological (antibiotics, antitoxins, phages, proteolytic enzymes, etc.).
From the above, derive the General principles of asepsis:
- Anything that has contact with the wound (medical instruments) should be sterile.
- Classification of all patients of surgical departments on the “clean” and “purulent”.
The role of the hands of medical personnel
The hands of health care workers who are directly involved in the implementation of medical care can be a factor in transfer of pathogenic and conditionally pathogenic microorganisms. Microflora of the skin of the upper extremities can be of two types: permanent and transient. The first develops in the Horny layer of the skin, sebaceous and sweat glands, hair follicles, and representatives of it are epidermal Staphylococcus, etc. is part of the permanent microflora more or less stable and forms a protective function of the skin. In areas around the nail folds and interdigital surfaces additionally mgot to be Staphylococcus aureus, pseudomonad, different types of Escherichia coli, Klebsiella and other conditionally pathogenic microorganisms.
Transient microflora gets into the skin as a result of contact with contaminated parts of the body of the patient or contamination of objects of environment. It remains on the skin surface prior to the day presented pathogenic and conditionally pathogenic microbes, like the constant microflora, it depends on the profile of the medical institution.
Different effects on the stratum corneum of the skin, which lead to a permanent imbalance of microflora (the use of brushes, detergent for alkaline environment, aggressive antiseptic, no mitigating components in alcohol-containing antiseptics), contribute to the formation of dysbiosis of the skin. A characteristic indicator is the prevalence of constant strain of gram-negative conditionally pathogenic microflora, including hospital strains, which are resistant to the antibacterial, antiseptic drugs and disinfectants. Thus, the hands of healthcare workers may become a factor in the transmission of infection, and their source.
If transient flora can be removed by mechanical means (hand washing and use of antiseptic agents), the permanent population of almost not be destroyed in this way. Sterilization of the skin is impossible and undesirable, because the preservation of the stratum corneum and permanent population of microorganisms prevents the settlement of more dangerous microbes.
Modern methods of processing the hands of the surgeon
In connection with the above-described physiology, the countries of Western Europe have undergone change and improvement of the basic ways of processing of hands of the surgeon (Alfeld-Fuerbringer, Spasokukotskogo-Kochergina).
From a large number used at the present stage of the methods of disinfection of the skin of hands, only one is held by Europe standard, and recorded in the manner prescribed by law as the “European norm 1500” (EN 1500). This rule use two thirds of the countries of the European continent: Belgium, Ireland, Germany, Netherlands, France, Greece, Iceland, Finland, Luxembourg, Netherlands, Norway, Portugal, Austria, Italy, Sweden, Spain, Switzerland, Czech Republic, England.
Hygienic treatment of hands
Indications for this treatment are the following:
- communication with patients with infectious diseases with accurate or probable cause
- the contact with body secretions of the patients (pus, blood, excrement, etc.).
- manual and instrumental studies and actions
- after visiting the infectious diseases hospital Boxing
- after visiting the toilet room
- at the end of the work shift.
Specific requirements for the treatment of hands:
- antiseptic is applied exclusively to dry skin
- the use of the elbow dispensers in order to avoid excess antiseptic
- do not use accessory items for applying antiseptic
- mandatory alternation of antiseptics, which contain active substances with different mechanisms of antibacterial action
- compliance with the prescribed sequence of action, dose and exposure when performing each stage of processing.
The stages of the hygienic treatment of hands
1. Antiseptic applied to the skin in an amount of 3 ml and rubbed thoroughly for 30-60 seconds to dry completely. Further, it is necessary to carry out the following manipulation:
- RUB the Palmar surfaces together
- rubbing the palm of his right hand on the back plane of the left hand and in reverse order
- rub palmar surfaces, crossing and spreading fingers;
- rubbing the back surface of the bent fingers on the palm of the other brushes
- circular steps to scrub large fingers
- circular steps alternately to RUB the Palmar surface of the fingertips and in the reverse order.
2. Contamination of biological materials is removed with a sterile cotton swab or cloth moistened with an antiseptic solution. Then on the surface of the brush applied to 3 ml of antiseptic and rubbed into the skin until dry, paying special attention to interdigital, Palmar and back surfaces is not less than ½ minute and washed with running water followed by washing.
Surgical treatment of hands and its stages
Surgical treatment of hand — the method of preparing the limb for surgical operations, bandages and other surgical procedures with the purpose of disinfection of the skin and prevent the entry of microbes into sterile items and on the wound surface.
Surgical treatment hands are in contact (direct or indirect) with the sterile formations of the body (catheterization of blood vessels, puncture, etc.).
Stages of surgical processing:
- Two-minute washing of hands and forearms without the use of additional funds with warm running water, soap with a neutral pH.
- Drying with a sterile towel.
- A 5-minute rubbing antiseptic into the skin surface of the hands and forearms in a standard way.
- Dry skin air.
- Putting on sterile gloves.
- After the end of manipulations for surgical purposes, remove gloves and rinse in warm water with liquid soap for two minutes. Then - lubrication with a nutritious cream.
Types of antiseptics
The types of asepsis depend on the method of using antiseptic agents. Distinguish local and General antiseptic. The first is subdivided into a superficial (ointments, washing of wounds and cavities, etc.) and deep (the introduction of the drug into the wound or inflammatory focus).
Total asepsis is the saturation of the whole organism antiseptic preparations (antibacterial agent, sulfonamides), who later gets into an infectious nidus or acts on the blood contained in the blood microorganisms.
Using one or another form of reimbursement, it is necessary to remember about its probable side effects: intoxication (use of chemical antiseptic agents), damage to important anatomical structures (mechanical), photodermatitis (physical), allergies, disbacterial reaction, the accession fungal (biological) and so on.
Requirements antiseptic means
Preparations that are used for antiseptic treatment must meet the following requirements:
- a wide range of activities;
- quickness of action;
- complete disinfection (asepsis) transient microorganisms
- reduction of contamination of resident microflora to a normal level;
- long-term action after treatment (at least 3 hours);
- absence of skin irritant, allergenic, carcinogenic, mutagenic and other side effects;
- slow development of resistance microflora
In conclusion, we can say that the complex of measures aimed at preventing the penetration of microorganisms into the wound, called the “asepsis”. This can be achieved complete disinfection of all used items that come in contact with the wound surface.
Asepsis and antisepsis – what is it? This issue remains one of the topical issues in the medical field.