Medical asepsis1/2/2024 ![]() Sterilization of operating room linen-smocks, caps, gauze masks, towels, sheets, gloves, and so forth-and also of the dressings is achieved by autoclaving in a biks, in which the material is kept sterile for several days. The operating area-the place where the incision is made-is shaved, treated with an alcohol solution of iodine, and isolated from the other portions of the body with sterile sheets. The personnel perform the operation wearing sterile smocks and rubber gloves. Surgeons and surgical nurses begin the operation after washing their hands with sterile brushes according to a special method and after treating them with agents that kill microbes on the surface of the skin and prevent the spread of microbes from the sudoriferous and sebaceous glands (tanning agents). Operating room personnel who have been exposed to festering diseases or who are carriers of infection are not permitted to work in the operating room. Access to operating rooms is permitted only to a small number of people who wear special clothes, shoes, and masks made from gauze. The disinfection of the air in operating rooms is achieved by means of ultraviolet radiation from bactericidal lamps. To maintain asepsis, all surgical operations are carried out only in special operating rooms under conditions that eliminate infectious microbes-that is, smooth, easily washed walls and the absence of unnecessary objects and furniture. In contemporary surgical practice, disinfection (sterilization) is achieved mainly by physical methods-that is, high temperature (boiling, heating), high temperature in combination with increased pressure (autoclaving), and ultraviolet rays. In Russia asepsis became widespread in the 1890’s (V. Schimmelbusch greatly contributed to the progress of asepsis in the 1880’s and may rightly be considered the founders of asepsis. Researchers established the fact that microorganisms are killed by high temperatures (boiling, hot air, and so forth) this discovery laid the foundation for the development of the aseptic method (physical antisepsis). The search was undertaken for new methods of neutralizing microbes, methods that would not have a negative effect on the patient’s organism. Later it was found that carbolic acid is not entirely safe for either patients or surgeons poisoning and complications during the healing of the wound, including necrosis-mortification of tissues-were observed. Lister proposed the use of carbolic acid in the battle against infection. The totality of measures taken to prevent infection of a wound by microbes, including the sterilization of everything that comes in contact with the wound and is either temporarily or permanently introduced into the organism during an operation. Sterilization is the chief means of achieving asepsis. Modern surgical techniques for avoiding infection are founded on asepsis, the absence of pathogenic organisms. Joseph Lister was the first to employ the antiseptic phenol, or carbolic acid, in surgery, following the discovery by Louis Pasteur that microorganisms are the cause of infections. The bacteriostatic action of an antiseptic compared to that of phenol (under the same conditions and against the same microorganism) is known as its phenol coefficient. Since so much variability exists, systems have been devised for measuring the action of an antiseptic against certain standards. Other antiseptics have slower, more residual action. Iodine, one of the fastest-working antiseptics, kills bacteria within 30 sec. There is also a great difference in the time required for different antiseptics to work. In contrast, silver nitrate kills fewer germs but can be used on the delicate tissues of the eyes and throat. For example, mercuric chloride is a powerful antiseptic, but it irritates delicate tissue. There is great variation in the ability of antiseptics to destroy microorganisms and in their effect on living tissue. Some common antiseptics are alcohol, iodine, hydrogen peroxide, and boric acid. Germicides include only those antiseptics that kill microorganisms. Antiseptics should generally be distinguished from drugs such as antibiotics that destroy microorganisms internally, and from disinfectants, which destroy microorganisms found on nonliving objects. Antiseptic, agent that kills or inhibits the growth of microorganisms on the external surfaces of the body.
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