Asepsis , antisepsis and Sterilization

Syahbuddin Harahap
Department of Surgery
Adam Malik Hospital



Asepsis and antisepsis
History
1847 - Semmelweis identifies surgeons hands
as route of spread of puerperal infection

1865 - Lister introduces hand and wound
asepsis with the use of carbolic acid

1880 - von Bergmann invents the autoclave
Asepsis is the practice to reduce or eliminate contaminants
such as :
- Bacteria
- Viruses
- Fungi
- Parasites
from entering the operative field in :
- surgery
- medicine
to prevent infection.
Ideally, a field is "sterile" free of contaminants a
situation that is difficult to attain.
However, the goal is elimination of infection, not sterility.
Aseptic Technique in Medical Procedures:
Aseptic technique is the effort taken to keep patients as
free from hospital micro-organisms as possible (Crow
1989).
The founder of the technique is considered to be Joseph
Lister.
It is a method used to prevent contamination of wounds
and other susceptible sites by organisms that could cause
infection.
This can be achieved by ensuring that only sterile
equipment and fluids are used during invasive medical
and nursing procedures.

Ayliffe et al. (2000) suggest that there are two
types of asepsis:
-Medical asepsis
-Surgical asepsis.
Medical or clean asepsis reduces the number of
organisms and prevents their spread.

Surgical or sterile asepsis includes procedures to
eliminate micro-organisms from an area and is
practised by nurses in operating theatres and
treatment areas.
Antiseptics are antimicrobial substances that are applied to
living tissue/skin to reduce the possibility of :
- infection
- sepsis
- putrefaction.
Antibiotics that destroy microorganisms within the body

Disinfectants, which destroy microorganisms found on non-living
objects.
Some antiseptics are :
- bacteriocidal true germicides, capable of destroying
microbes
- bacteriostatic and only prevent or inhibit their growth.
Antibacterials are antiseptics that only act against bacteria
Use in surgery
The widespread introduction of antiseptic surgical methods followed
the publishing of the paper Antiseptic Principle of the Practice of
Surgery in 1867 by Joseph Lister, inspired by Louis Pasteur's (1863)
germ theory of putrefaction.

In this paper he advocated the use of carbolic acid (phenol) as a
method of ensuring that any germs present were killed.

But every antiseptic, however good, is more or less toxic and irritating
to a wounded surface.
Hence it is that the antiseptic method has been replaced in the
surgery of today by the aseptic method, which relies on keeping free
from the invasion of bacteria rather than destroying them when
present.
History
The first step in asepsis is cleanliness, a concept already
espoused by Hippocrates.
The modern concept of asepsis evolved in the 19th century.
Semmelweis showed that washing the hands prior to
delivery reduced puerperal fever.
After the suggestion by Louis Pasteur, Lister introduced the
use of carbolic acid as an antiseptic and reduced surgical
infections rates.
Lawson Tait went from antisepsis to asepsis, introducing
principles and practices that have remained valid to this day.
Ernst von Bergmann introduced the autoclave, a device
used for the sterilisation of surgical instruments.
Methods Asepsis and antisepsis

1. Good hygienic practice.

2. The procedure room is regulations concerning filtering
and airflow, and kept clean between surgical cases.

3. A patient who is brought for the procedure is -
Washed and wears a clean gown

4. The surgical site is washed, possibly shaved, and skin is
exposed to a germicide (i.e., an iodine solution such as
betadine).
5. Members of the surgical team:
- Wash hands and arms with germicidal
solution.
- Operating surgeons and nurses wear
sterile gowns and gloves.
- Hair is covered and a surgical mask is
worn.
6. Instruments are sterilized through autoclaving, or, if disposable,
are used once.

7. Irrigation is used in the surgical site.

8. Suture material have been sterilized beforehand.

9. Dressing material is sterile.

10. Antibiotics are often not necessary in a "clean" case, that is, a
surgical procedure where no infection is apparent; however, when a
case is considered "contaminated," they are usually indicated.

11. Dirty and biologically contaminated material is subject to
regulated disposal.
Larutan cuci tangan
Larutan cuci tangan bedah untuk operasi
Larutan skin preparation
Larutan antiseptik untuk perawatan luka
Paling rentan terhadap
-Bakteri gram + dan gram
-Fungi
-Virus
Spora resisten , hanya mencegah
pertumbuhan spora selanjutnya dan kadang
kadang bisa menghilangkannya dari kulit
Kulit manusia tidak bisa di
sterilkanpengurangan jumlah
mikroorganisme terutama kuman transien
1. Aksi yang luas terhadap mikroorganisme
2. Efektivitas
3. Kecepatan aktivitas awal
4. Efek residu, aksi yang lama setelah pemakaian
untuk meredam pertumbuhan
5. Tidak mengakibatkan iritasi kulit
6. Tidak menyebabkan alergi
7. Efektif sekali pakai, tidak perlu diulang-ulang
8. Dapat diterima secara visual maupun estetik
KELOMPOK AKTIVITAS THDP BAKTERI Aktivitas
Awal
Efek
Residu
DAMPAK
GM
-
Gm+ M.TBC viruses
I.

II

III

IV

V

VI
Alkohol

Chlorhexiden
Gluconate
Hexachlorophene

Iodine / iodophors

Chloroxylenol

Triclosan
Baik

Baik

Baik

Baik

Baik

Baik
Baik

Baik

Buruk

Baik

sedang

Baik

Baik

Sedang

Tidakada

Baik

Sedang

Sedang

Baik

Baik

Buruk

Baik

Sedang

Buruk

Cepat

Sedang

Lambat

Cepat

Baik

Lambat

Buruk

Baik

Baik

Buruk

Baik

Baik



Kulit
kering
Ototoksin
Keratits


Iritasi kulit

Masuk kedalam proses metabolisme sel mikro
organisme shg kemampuan sel untuk bertahan
dan memperbanyak diri terhambat

Merubah struktur protein sel mikro organisme
terjadi koagulasi protein dan penghancuran sel

Meningkatkan permiabilitas membran plasma sel
mikro organisme dan terjadi lisis
Sterilization (or sterilisation) refers to any process that
effectively kills or eliminates transmissible agents such as :
- fungi
- bacteria
- viruses
from a surface, equipment, foods, medications, or
biological culture medium.

Sterilization can be achieved through application of:
1. heat
2. chemicals
3. irradiation
4. filtration
1. STERILISASI UAP PANAS (OTOKLAF)
Menggunakan uap panas dan tekanan tinggi 2 atm
temp.120C waktu 30 menit biasanya digunakan untuk
bahan dari linen dan packing instrumen

2. STERILISASI PANAS (Dry Heat)
Pada suhu 160C diperlukan waktu 4 jam biasanya
digunakan untuk instrumen bedah

3. STERILISASI DENGAN ETILEN OKSIDA
Gas EO mudah menguap dan penetrasinya sangat baik
untuk lumen kateter yang kecil
Kerugian gas ini mudah meledak dan karsinogenik

4. STERILISASI DENGAN SUHU RENDAH
Menggunakan Plasma hydrogen peroksida dan Vapour-
phase hydrogen peroksida
Baik untuk alat-lat yang sensitif terhadap panas dan
kelembaban
serta ramah lingkungan dan tidak meninggalkan residu





Sterilisasi berarti menghilangkan seluruh
mikroorganisme termasuk spora

Desinfeksi adalah menghilangkan Mikroorganisme
sampai jumlah tertentu
Berdasarkan kekuatan desinfektan membunuh kuman
:
1. Desinfeksi tingkat tinggi---- Glutaraldehyde
2 %
2. Desinfeksi tingkat menengah Chlorin bebas
3. Desinfeksi tingkat rendah --- Air panas

Pilihan untuk Sterilisasi dan Desinfeksi
tergantung pada:
1. Tipe bahan instrumen /Alat
2. Waktu yang tersedia
3. Resiko terhadap pasien dan personil rumah sakit

Sterilisasi berarti menghilangkan seluruh mikroorganisme
termasuk spora

Desinfeksi adalah menghilangkan Mikroorganisme sampai
jumlah tertentu

Berdasarkan kekuatan desinfektan membunuh kuman :
1. Desinfeksi tingkat tinggi Glutaraldehyde 2 %
2. Desinfeksi tingkat menengah Chlorin bebas
3. Desinfeksi tingkat rendah Air panas

Pilihan untuk Sterilisasi dan Desinfeksi tergantung pada:

1. Tipe bahan instrumen /Alat
2. Waktu yang tersedia
3. Resiko terhadap pasien dan personil rumah sakit

Di lingkungan rumah sakit,berbagai jenis
instrumen digunakan di tiap bagian

Sudah seharusnya ada dasar panduan yang
membantu tenaga medis menentukan apakah
suatu instrumen sebaiknya
-sterilisasi
-desinfeksi

Berdasarkan Kriteria Instrumen Spaulding
terhadap tubuh pasien


Non Kritikal Kontak dengan kulit
tubuh
Desinfeksi tingkat
rendah/menengah
Membunuh
sebagian besar
mikroorganisme
Semikritikal Kontak dng mukosa
utuh / kulit yang luka
Desinfeksi tingkat
tinggi
Membunuh
semua
mikroorganisme
kecuali beberapa
spora
Kritikal Kontak dengan organ
dibawah
kulit/mukosa
Sterilisasi Membunuh
semua
mikroorganisme
dan spora
1. Dekomtaminasi Tujuan
-mencegah penyebaran potensi infeksi
-melindungi tenaga medis
Caranya merendam dengan larutan desinfektan
yang mengandung Chlorin bebas selama 15
menit virus hepatitis B , Virus HIV
2. Pre-cleaning (Membersihkan peralatan)
-Mekanikal
-Kimiawi enzym protease waktu 5 menit
3. Sterilisasi atau Desinfektan tergantung kebutuhan

PRE-CLEANING
STERILISASI
DESINFEKSI
TINGKAT TINGGI
DESIFEKSI
TINGKAT
MENENGAH
DEKONTAMINASI
Dari foto ini petugas yang mana
yang tidak melakukan tindakan Asepsis ?
Diperlukan tindakan Asepsis , Antisepsis dan
Sterilization