THE ASEPSIS AND ANTISEPSIS

Asepsis and antisepsis are 2 fundamental notions in order to become a doctor.

I) The asepsis
= the state of germ- free or without infections (without microorganisms =
bacteria, virus, parasite or even fungus).
The asepsis (primary prevention) covers all those procedures designed to reduce the
risk of bacterial fungal viral contamination through the use of sterile
instruments and the gloved !no touch" techni#ue ($e% surgical gloves need to be
sterilised = be aseptic)
Asepsia or aseptic = total absence of germs on a surface, ob&ects, li#uid or in a
wound.
They include all of those prophylactic methods, working processes and behavioral
forms by which microorganisms (bactera, fungi or viruses) can be kept away from
the patient's organism and the surgical wound.
The goal of asepsis is to prevent contamination.
()amples%
*ur internal medium is aseptic meaning germ+free normally. Also the instruments
used for intervention or any surgical procedure must be aseptic because during
surgery the body's ma&or defense against organism (= the skin) is broken , inner
surface of the body are e)posed to the environment.
-hen we must operate it is vital to desinfect the skin before the operation using
betadine for e) before to proceed the incision.
The major method generating the aseptia is the sterilisation.
Sterilisation = method destroying completely all kind of pathogenic or apathogenic
organisms including viruses, bacteria and latent or resting forms such as spores.
This is achived by%
Physical method
echanical method
!hemical method
Sterility " microbiologically germ+free state of materials items.
#$ Physical methods
.oiling water (/0012 30minutes4/hour) = not e5cient on endospore
meaning that must be used in
e)treme conditions when no other
possibilities are availables.
6team at high temperature = A%toclaves% self locking machine that
sterili7es with steam under pressure%
the time needed for sterili7ation at /2/12 is
20 minutes and at /3812 is /0 minutes.
Disadvantage = unsuitable for heat sensitive ob&ects.
9ry heat at /:0+/;01c for respectively 2 and / hours.
*pen <ame of propane = !&laming'% common type of heat sterili7ation
consisting to !burn" microorganisms by
e)posing them to an open <ame of propane.
=rocess also known as !incineration"% ie% <aming of inoculating
needles and the tops of laboratory glassware before and
after sampling are e)amples of incineration.
Disadvantage = some say
that this method , creation of a thin bed
ofg carbon which is a focus for infection (must wipe the
carbon o> and clean with (T*?).
@adiation = AB or gamma% use for sterilise the needles, the drainage
tubes or even the surgicals gloves.
9isadvantage% it is forbiden to
combine it with another method because it generates
to)ic substances% ie% using ethylene o)ide after a gamma radiation ,
formation of ethylene chlorohydrin (cytoto)ic e)tremely irritating on
wound, less on skin inhibit cell growth).
($ !hemical methods
.y vapo%rs and ga), using%
+ &ormaline% 80C a#ueous solution of formaldehyde (2h2o) =
colorless, neutral and volatile li#uid with a pungent odor and
slightly irritating taste. Dormalin is e#ual in germicidal power
to corrosive sublimate and in large room a 2,E volume C of
formalin in the air destroyed all microorganisms in a #uarter
of hour.
?owF, when allowed to evaporate in the presence of wool,
gau7e+bandages or other dressing material, the vapors of
formalin condensed upon the fabrics in solid form
(paraformalin) and so desinfected them.and ethyleno)ide.
?ence dressing material impregnated with formalin become
perfectly sterile and can immediatly be used as antiseptic
dressing.Also the vapors from the spray by a steam atomi7er
above the patient's head has proven e5cient in whooping+
cough and chronic bronchitis.
+ Ethylene o*ide " ga) sterilisation% highly penetrative and
active against bacteria spores viruses.9isadvantage% it is
<ammable to)ic e)pensive leaves to)ic residues on
sterili7ed items (see above).
.y immersion, using%
+ ercasept% a#ueous solution of phenylmercuric borate
(topical antiseptic and desinfectant that is soluble in water
ethanol glycerol) with a concentration of 2C1.Ased in
surgery
+ erc%ry+rom% very e5cient desinfectant for the burns
+ ,l%taraldehyde (ie% 2$9(G )= very corosive for the
instrument , destruction of the metal instruments with time
but it is very usefull for surgery = 30 minutes to /hour of
immersion is necessary to destroy all germs e*ept hepatic
vir%ses " - and ! . to destroy these vir%ses an
immersion of (/h at least is necessary. .efore any
invasive operation we must ask the patient if he has hepatitis
. or 2 and if it is the case , sterilise again the instruments
after operation.
0$ echanical methods
+ .acterial Hlters for air sterilisation is used.
8. E*amples.
Dor%
+ Air 1 rooms = use %ltraviolet radiation +acterial 2lter or formalin
vapors
+ Instr%ments 1 other o+jects resistant to temperat%re (glass or metal
made)=use dry heat at /:0+/;012 for 30+80 minutes or immersion in
special solution.
+ Soft materials meaning most common tissues%
!otton 3ool
!otton s3a+s
Dressing
!ompresses
-e are using sterilisation by stream 4a%toclaves) at /8012 and /,E atm.
+ 5%++er or plastic materials which are not resistant to normal heat
sterili7ation we use method as%
Ethylene o*ide vapors in special device at temperature of
80+EE1c for I0 to 3:0 minutes depending on pressure or
previous sterili7ation by gamma radiation obtained from cobalt
:0 or 2elsium /3J in industrial environment.
II) Antisepsis
Kethod of destroying germs on biological structure such%
S6in
7o%nds
-ody cavities
-o3el
Asing the methods seen before for asepsia.
$n fact antisepsis relate to the momentarily removal of transient microorganisms
from living tissues reduction in the resident <ora by using antiseptic products.
$n a wider sense, antisepsis includes all those prophylactic procedures designed to
ensure surgical asepsis.
Kethods of antisepia are%
!hemical s%+tances = antiseptics with e)ternal application on either the
skin or mucous membranes.
Dor academic purpose they can be classiHed as%
7ea6 antiseptic%
/. Soap detergent (most common one) = wash hands E
minutes at least with water but today with the new special
solution it takes only 2 to 3 minute to desinfect.
S%rface antiseptics%
+ Alcool 89: concentration = germicid by coagulation of
germ's proteins
+ Iodine.
o In alcoolic sol%tion " tinct%re of iodine. is a
very good anti+bacterial4 fungal 4 viruses agent$
Iodine alcoolic sol%tion is
used for mycosis and is able to destroy fungus.
o In non alcoolic sol%tion where it is associated
with polyvinil pyrolidone = +etadine (here there is
no coagulation of the germ's proteins).
-etadine 4or non alcoolic iodine sol%tion) is
used for hands skin or wounds (the alcoolic one
cannot be used for wounds)% clean the hands with
betadine during 3 minutes at least.

!hlor eliminating s%+stance.
+ Sodi%m hypochrorite (DA;IN solution) is indicated
freasly diluted by continuous or simple irrigation of
wounds (post operative) = %sed in %rology
+ !hloramine sol%tion. 9<(-=> concentration is used
for pavement, material and glass ob&ects (it is a too high
concentration to be used on the wounds , chemical
burns) 1 9<# to 9<0> for 3o%nds
?*ygen eliminating s%+tance.
H(?(. sol%tion p%t on a 3o%nd, generate a e>ervescence and
remove the necrotic tissue remove the pus clean the area by
destroying even anaerobical germs 4e*. gangren or tetanos)
+ -oric acid. it is a white cristal with similar e>ect than
?2*2 (but no e>ervescence).
Heavy metal compo%nds%
+ erc%ry
+ Silver
A)oic dyes.
+ 5ivanol 4 ethacridine lactate or ethacridine monolactate
monohydrate)% yellow powder largely used in surgery for treating infective
wounds (similar fre#uency of use than betadine or ?2*2 in surgery).
+ ;n?/ (kalium permanganic acid)= violet cristalL solution /+8C
concentration used in surgery for cleaning mucous membrane (in case of an
infective wound in the buccal cavity in case of hemorroids or anal Hssure =
local bath).
+ Panestrine = green color powder used in surgery before (20+30 years ago)
to clean wounds as an alternative to betadine...it is not use anymore.
Phenol or phenol compo%nds%
Ased in dentistry as spray to desinfect the instruments because it is e)tremly
corrosive.
Detergents% can be anionic or cationic
Anti+iotics%
-ith internal adimistration (intraveinous intramuscular) or oral
administration
They can be applied locally or systematically$
9i>erent categories of antibiotic e)ist related to the area (like the stomach or the
lung ect...) the germ concerned but there is also more general one.
-e reali7e an antibiogram to know.
Example of questions for the exam:
En%marating the chemical antiseptic
Descri+e s%rface antiseptic