Antisepsis



Antiseptic - a complex of therapeutic and preventive measures aimed at the destruction of microbes in the wound or in the human body.

Many ancient physicians independently came to the conclusion that disinfecting wounds. Later came to the conclusion that all the random wound initially produced with a hot iron, burnt vinegar, lime, imposed on the wound ointments and balsamic t. D.

It was only in 1843 Holmes (O. W. Holmes), and in 1847 Semmelweis (J. Semmelweis) offered for disinfecting hands Obstetricians bleach solution. NI Pirogov for disinfecting wounds in their treatment applied tincture of iodine, a solution of silver nitrate in the wine and other alcohol.

The term "antiseptic" put into daily practice Frenchman Louis Pasteur. His work formed the basis for solving the problem about the causes festering wounds and infection control measures. He proved that the processes of fermentation and putrefaction in the wound are caused by germs and their livelihoods.

English surgeon D. Lister, based on the work of Louis Pasteur on the role of microorganisms in the development of festering wounds, came to the conclusion that they fall into the wound from the air. For the prevention of festering wounds Lister proposed processing operating air spray carbolic acid. Later, the surgeon's hands before surgery and the surgical field and irrigated with carbolic acid, as well as the wound after surgery, and then covered with gauze soaked in a solution of carbolic acid.

Antiseptic surgery method allowed to penetrate all organs of the body. However, the antiseptic method of Lister had a number of significant drawbacks. Started new research that led to the aseptic method of treatment of wounds.

Method Lister had weaknesses such as:

carbolic acid causes necrosis of tissue at the wound site;
after hand washing with a solution of carbolic acid surgeon appeared dermatitis;
inhalation of carbolic acid led to the poisoning of patients and surgeons.
Applied and other antiseptics - solution of mercuric chloride 1: 1000, 1: 2000, zinc chloride, salicylic acid, boric acid, potassium permanganate and others. But they, killing bacteria, killed and tissue cells. Phagocytosis in its application decreases or ceases altogether.

Types of antiseptics

Currently antiseptic is an integral part of surgical science and includes the following types: mechanical, physical, chemical, biological and mixed antiseptics.

Mechanical antiseptic - is the mechanical removal of infected and non-viable tissue. Essentially - primary debridement. Timely made, it turns infected wound in aseptic surgical wound heal by primary intention.

Mechanical antiseptic used as a surgical wound toilet, which removes foreign bodies, necrotic and non-viable tissue, performed the autopsy streaks and pockets, wash wounds and other manipulations aimed at cleansing the infected wound.

Physical antiseptic - prevention and treatment of wound infections by applying physical factors ensuring destruction of microbes or a significant reduction in their number, as well as the destruction of their toxins.

By physical antisepsis are hygroscopic bandages, wound suction secret mass of bacteria and their toxins; the use of hypertonic solutions, pulling out its contents into the wound dressing. However, be aware that hypertonic solutions have chemical and biological effects on wound and on microorganisms. It also includes a physical antiseptic action of light, dry heat, ultrasound, UV microbes. Their mechanism of action is not only physical, but also the physico-chemical and biological.

Chemical antiseptics - effects on microorganisms chemicals have a bactericidal or bacteriostatic effect. It is better if these substances adversely affect the microflora and do not have a negative effect on the cells and tissues of the human body.

Biological antiseptic - application of biological preparations acting directly on microorganisms and their toxins, as well as working through macro-organism.


These drugs include:

1. antibiotics have bactericidal or bacteriostatic effect;

2. bacteriophages - bacteria eaters;

3. antitoxins - specific antibodies in the human body under the influence of serum. Antitoxins are one of the factors of immunity of tetanus, diphtheria, botulism, gas gangrene and other diseases.

Mixed antiseptic - the influence on the microbial cell, as well as on the human body, several types of antiseptics. Often their action complex. For example, primary debridement (mechanical and chemical antiseptic) supplemented biological antiseptics (the introduction of tetanus toxoid, antibiotics) and the appointment of physiotherapy (physical antiseptic).

Depending on the method of application of antiseptic agents are distinguished local and general antiseptics; spot, in turn, is divided into the superficial and deep. When the surface antiseptic drug is used in the form of powders, ointments, applications for washing wounds and cavities, and in the deep - the drug is injected into the tissue of the wound inflammatory focus (chipping, penicillin-novocaine blockade, and so on. D.).

Under the general antiseptics imply saturation of the body antiseptic (antibiotics, sulfonamides, and others.). At the site of infection, they entered the bloodstream or lymphatic system and thus affect the microflora.

In the appointment of antiseptics should always keep in mind the maximum permissible doses of drug interactions, possible side effects and allergic reactions in patients.

There are several ways antiseptic:

1. Ultrasonic antiseptic

2. sorbent antiseptic

3. Laser antiseptic

4. Rengenoterapicheskaya antiseptic

1. Ultrasound is used in the treatment of purulent wounds. In the wound poured antiseptic solution and insert the tip of the device with low-frequency ultrasonic vibrations. The method is called "Ultrasonic Cavitation wounds" Fluctuations fluid contribute to improving the microcirculation in the walls of the wound rapidly rejected necrotic tissue, moreover, water is ionized, and ions of hydrogen and hydroxyl ions violate the redox processes in the microbial cells.


2. In recent years, increasingly used method of treating wounds sorption when the wound is administered substances which adsorb on themselves toxins and microorganisms. Typically carbonaceous materials is in the form of powder or fibers. The most commonly used Polyphepanum and various coals intended for hemosorption and hemodialysis, for example Smoothie-1.


3. The laser radiation of low power (usually carbon gas laser) is actively used in contaminated surgery. Bactericidal activity against a wall wound ensures the success of operations in cases where usually develops purulent process.
  Recently, laser and ultraviolet radiation is used for irradiating the extracorporeal blood as well as in the vessels. For this purpose special machines are created, however, these methods are more appropriate to refer to biological antiseptic, as it is important not bactericidal action and stimulation of the body's defenses of the patient.


4. X-rays are used to suppress infection in small, deep-seated foci. So it is possible to treat osteomyelitis and bone felon, inflammation after surgery in the abdominal cavity, and others.

Antiseptic preparations:

Chloramine B - a white or yellowish crystalline powder comprising 25-29% of active chlorine. Antiseptic and disinfectant action. In surgery used 0.5-3% solution for washing wounds, hand disinfection, non-metallic tools.

Yodonat, yodopiron, yodolan - aqueous solution of a mixture of alkyl sulfates, sodium and iodine. The drug is used instead of iodine tincture for processing the surgical field as a 1% solution.

An alcohol solution of iodine. Widely used for skin disinfection of the operative field, the edges of the wound, and the surgeon's finger, etc. except bactericidal and bacteriological action has cauterizing and tanning effect.


Hydrogen peroxide solution. Is a colorless solution of 3% H2O2 in water. With its decomposition releases oxygen, which at the time of selection has a strong oxidizing action, creating an unfavorable environment for the development of anaerobic and putrid wounds. Apply with a wound dressing.

Potassium permanganate. Dark or red-violet crystals are soluble in water. Is a powerful deodorizer. Aqueous solutions for washing of wounds, rinsing the mouth and throat, douching. Has tanning properties.

Mercury oksitsianid - strong disinfectants that in the breeding of 1:10 000 1:50 000 is used for bladder irrigation, disinfection cystoscopy.

Lapis (silver nitrate) is used as a disinfectant for washing festering wounds (1-2% solution), to cauterize wounds granulations with excess (10-20% solution). Strong antistatic.

Ethyl alcohol or wine. Applied as a 70-96% solution of the pure and denatured alcohol. Widely used for tanning leather and dizenfektsii surgeon's hands, preparation and storage of sterile silk, disinfection tools.

Penicillins - the most common group of antibiotics. Apply with stafilakokovoy, streptakokovoy, meningococcal disease, such as erysipelas, wound infection when, etc.

Streptomycin - is particularly effective in diseases caused by Gram-positive bacteria, has a suppressive effect on TB wand.

Tetracycline, doxycycline, methacycline hydrochloride - acts on coca, diphtheria bacillus, mycoplasma, chlamydia, etc.

Levomitetsin - broad-spectrum antibiotic, acts as a Gram-positive and Gram-negative bacteria, Pseudomonas aeruginosa, chlamydia, mycoplasma.

Eritrometsin, oletetrin etc. - Effective for diseases caused by Gram-positive cooks

Streptocide norsulfazol, sulfadimetoksin - they violate the metabolic processes in the bacterial cell and cause a bacteriostatic effect.

Furatsilin - has high antibacterial properties, acts on staphylococci, anaerobic bacteria, E. coli. Used in a 1: 5000 topically for washing wounds, pleural cavities, joints, peritoneum.

Okteniman-Oktenidingidrohlorid, propanol-1, 2-propanol is used to sanitize the hands of surgeons and nurses, hepatitis B prevention, hand care and protection. Bactericidal effect begins 30 seconds and stored for 6 hours.

                Dekosept Plus-2-propanol, 44, 7 g, 1-propanol, 21, of 9, benzalkonium chloride, 0.2 g -Use with hygienic and surgical treatment of hands. Active against gram-positive and gram-negative (in Vol. H. Tuberculosis) bacteria and viruses.

                   Lizanin-ethyl alcohol, HR -antiseptik for hygienic and surgical hand. Has antimicrobial activity against Gram-positive and Gram-negative bacteria, including pathogens of nosocomial infections, Mycobacterium tuberculosis, fungi.

                   Biotenzid-2-propanol, 1-propanol, ethanol, chlorhexidine digluconate. Has antimicrobial activity against Gram-positive and Gram-negative bacteria, mycobacterium tuberculosis, pathogenic fungi and viruses. Designed for hygienic hand washing and processing of medical staff hand surgeons.

                   Ezemtan-Disinfectant - lotion for hand washing surgeons.

                  Vase-Soft - antibacterial liquid detergent for cleaning the skin. It is recommended in cases where frequent hand washing is necessary - before surgical and hygienic hand disinfection.

                 Okteniderm- Oktenidindigidrohlorid, 1-propanol, 2-propanol. It is used to disinfect the skin before surgery, punctures, and others. Such manipulation. Also used for hygienic and surgical hand disinfection: formed after drying the film lasts a long time.


The main classes of antiseptics and disinfectants
Alcohols
 Alcohols lead to denaturation of enzyme protein structure and microbial cells, fungi and viruses. The disadvantages of alcohols are: lack of sporicidal effect, the ability to fix organic pollution, rapid decrease in concentration due to evaporation. These deficiencies are deprived of modern means of combined alcohol-based - Sterillium, okteniderm, oktenisept, sagrosept.

Aldehydes
Aldehydes - highly active compounds, strong reducing agents, irreversibly bind proteins and nucleic acids. Disinfectants containing aldehydes: gigasept FF FF 50 dekoneks, dezoform, lizoformin 3000 septodor fort CIDEX - are widely used for various types of disinfection and sterilization of medical equipment.

Acids and their derivatives
Disinfectants - pervomur, dezokson-O odokson, divozan forte - contain formic and acetic acid. Have strong bactericidal (including sporicidal), fungicidal and virucidal effect. These disadvantages include a strong smell, the need to work in respirators and corrosive properties.

Group halogens and halogen compounds of chlorine, bromine and iodine
Modern chlorine disinfectants - klorsept, sterol, neohlor, Chlorantoin and so on. N. - Do not have a strong irritating odor and effect on the skin, are highly effective and are used for different types of disinfection. Dezam (containing 50% chloramine B and 5% of oxalic acid) used for the current and final disinfection.

Oxidants
In practice, the complex preparations are widely used for hydrogen peroxide-based:

Pervomur (mixture of peroxide and performic acid) is used to process the operating field, the surgeon's hands for the sterilization of articles made of polymers, glass, optical instruments;

Persteril (10% solution of peroxide, 40% solution of performic acid and 1% solution of sulfuric acid) is used for the disinfection of different types. In 1% p-re persterila killed all naturally occurring microorganisms and their spores;

Dezokson-1 (10% solution of peroxide, 15% solution of acetic acid + stabilizers) are also used for most types of disinfection.





Surfactants (detergents)
This group includes the quaternary ammonium compound (QAC), guanidine derivatives, amine salts, iodophors soap. These include:

Decamethoxin and drugs based on it: amosept (0.5% alcohol solution for disinfection of surgical gloves) dekasan (antiseptic generalist);

Degmin and degmitsid - used to treat the surgeon's hands.


Asepsis

Asepsis - prevention method (sterilization instruments et al.), Directed against the penetration of bacteria into the wound, or tissue in the body cavity operations, etc.

Distinguish 2 source of surgical infection: exogenous and endogenous. Exogenous source is in the patient environment, ie in an environment, the endogenous - a patient's body.

Prevention of infection is to implant a thorough sterilization of instruments, sutures, drains, and so on implants. N. This infection can be dormant and manifest themselves through a long period of time, with the weakening of the protective forces of the human body.

Of particular importance is the prevention of transplantation of organs and tissues, as applied methods to reduce the body's defenses. Asepsis - law surgery. It is achieved using physical factors and chemicals.

High temperature causes denaturation of proteins of microbial cells, the most commonly used in the old days.

The sensitivity of microbes to high temperature is dependent on the species or strain state and microbial cells (dividing young and more sensitive bacteria, spores are more resistant to high temperature). In alkaline or acidic medium high susceptibility of microbial cells. Cold retards multiplication of microbial cells without causing a pronounced bactericidal effect.

Ultraviolet rays can attack germs in the air, on the skin, human tissues, on the walls and floor space. Gamma rays - a radioactive isotopes 60 CO and 137 Cs. Sterilization is carried out in special cells in a dose of 1.5-2.0 million rubles. Sterilized linen, suture system for blood transfusions and others. They work by specially trained people, providing powerful protective devices. Especially useful radiation sterilization of plastic, can not withstand high temperature and pressure steam.

Heat sterilization, that is, high temperature, is the primary method of disinfection used in medical practice. The upper limit of vegetative microorganisms 50 C, and tetanus bacillus spores - in boiling water (up to 60 min.) The most effective kind of sterilization of any form of bacteria is the impact of pressurized steam. After 25 min, killed any infection, but the most common - 1-2 min (132 C). Roasting is used only in laboratory practice to sterilize needles and plastic loops used in bacteriological laboratories and in emergency situations - with the threat of life of the patient.

Sterilisation with dry heat is conducted in a heat sterilizer at a temperature of 180-200 C. Sterilized tools, utensils and others. This kind of sterilization widely found in dental practice.

Boiling is produced in the boiler: portable and stationary. Use boiled distilled water with the addition of sodium hydrogencarbonate based on 2.0 g water 100.0 g. Obtain a 2% solution, and the boiling temperature of the water increases by 1-2 C.

Steam sterilization is carried out under pressure in an autoclave. They can be fixed and hiking. Depending on the steam pressure (kgf / cm2), the temperature rises to a well-defined numbers, such as at a steam pressure of 1.1 kgf / cm2, the temperature of the autoclave was raised to 121,2 C; at 2 kgf / cm2 - up to 132,9 C and t. d. Hence sterilization exposure of 60 minutes to 15 minutes. Held control of sterility. It can be bacteriological, Technical and thermal. Bacteriological method is the most accurate, but the result is given too late. Take samples of sterilized material and sow on nutrient media. Technical methods are used when installing a new autoclave. Thermal methods are used on a daily basis. They are based either on the change of the color substance, or a substance melting.

Sample Mikulic: a white filter paper written in pencil "sterile" and lubricates the surface of paper 10% solution of starch. When a piece of paper dries, it lubricate Lugol's iodine solution. The paper darkens, the word "sterile" is not visible. It lay in the thickness of the material to be sterilized in an autoclave. At 100 C the starch binds with iodine and the word "sterile" becomes visible again. Exposure must be at least 60 minutes.

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