PRINCIPLES OF ASEPSIS,

DISINFECTION AND
STERILIZATION IN SURGERY
By
Dr. Yilleng Shem Bulus
Moderator -Dr. Ukwenya

OUTLINE

Introduction/Definitions
Historical Perspective
Sterilisation
Disinfection
Asepsis in Surgery
Conclusion
References

DEFINITION OF
TERMINOLOGIES

oDisinfection: A reduction in load of

pathogenic organism
oSterilization: Complete elimination
of organisms
oAsepsis:Reduction or exclusion of
organisms from surgical sites.
oAntisepsis:The use of chemicals to
reduce or eliminate organisms

HISTORICAL
PERSPECTIVES
Introduction of asepsis-2nd half of
19th century
A major turning point in the history
surgery
Previous erroneous theories of
sepsis overturned against stiff
opposition

EVOLUTION OF ANTISEPSIS AND

ASEPSIS
1840-Jacob Henle-germ theory of
disease
Louis Pasteur - established the
theory
1865-Joseph Lister-adapted germ
theory to antiseptic surgery
1870-German surgeons notably
Nussbaun,Volkmann,Langenbeck
and Thiersch established Listerism

 1882-Gustav Neuber of Kiel : modern

theatre,cap ,gown & pre-operative
skin disinfection.
1886-Ernst Von Bergmann & Curt
Schimmelbusch-steam sterilization
1898-Bloodgood-surgical gloves
Mickulicz Radecki -face masks.
1846-Ignaz Philip Semmelweispuerperal sepsis.
6

METHODS OF
STERILIZATION/DISINFECTATION
(A)PHYSICAL AGENTS
1)Heat
-Dry heat-Hot air oven *Red heat flame
-Moist heat-pasturization *Tyndallization
*Boiling *Autoclave
2)Radiation
*Ultraviolet light*Gamma radiation
3)Membrane filtration

(B)CHEMICAL AGENTS
1)Chlorine compounds
*Sodium hypochloride solution(bleach)*Calcium
hypochloride
*Sodium dichlorocyanurate*Chloramine-T*Chlorine
dioxide
2)Iodine preparation
3)Alcohol
4)Phenolic Compound
5)Chlohexidine
6)Quartenary Ammonium Compounds
7)Hydrogen Peroxide
8)Peracetic Acid
9)Aldehydes(Glutaraldehyde&Formalin)

(C)GASEOUS AGENTS
1)Ethylene Oxide
2)Gaseous Formaldehyde
3)Chlorine Dioxide Gas
4)PeraceticAcid
5)Vapour Phase Hydrogen Peroxide
6)Hydrogen Peroxide Gas Plasma

CLASSIFICATION OF STERILIZATION
Classificati Mech. Of
on
action
Dry Heat Temp. 1601800 for
2hrs

Moist
heat(past
urization,
boiling &
autoclave)

Application
s
Glasswares
metal
instrument
s

Pressurized Metal
steam 121- Instrument
1340 temp- s
sterilization
time

Advantage
s
-Destroys
bact.
endotoxins
- Good
penetrabili
ty

Disadvanta
ges
plastics&ru
bbers

- shortened not
time
sporocidal
- Resistant
bact.
spores

Radiation
(Electrom
agnetic ,
-Particulat
e)

Targets DNA
cause
ionization &
free radical
production

Surgical
gloves,
suture,nee
dle etc

Filtration(
seitz
-sinistered
glass)

Seiving,abs
orption &
trapping
within the
matnx of
the filter
material

Clarify &
sterilize
liquids&
gases for
supply in
aseptic
areas.

-Sterilizes
circulating
air in the
theatre
-Surface
sterilizatio
n of aseptic
work area
-prevents
the
passage of
both viable
& non
viable
particles.

Penetrates
poorly and
affects the
eyes

QUALITIES OF A GOOD
DISINFECTANT

Effective:
Bactericidal, fungicidal and virucidal.
Safe:
People, animals and equipment.
Non corrosive and bio-degradable
Rapid onset of action
Rapid realistic contact time
Stable
Not inactivated by organic matter

 Non-toxic, not irritating and does not

provoke hypersensitivity reactions.
Good cleaning ability
Can remove dust, dirt and soil
Material compatibility
Available for use on all surfaces

CLASSIFICATION OF DISINFECTANTS
Classification

Mech. of
action

Applications

Advantages

Disadvantages

Alcohols(etano -Disrupts
l, methyl
cellular
alcohol)
membranes
- solibilize
lipids
- Denature
protein

-Used pre op
as skin
disinfectant
-To clean
instrument

Effective
against lipid
containing
viruses &
bacteria

-Ineffective
against spore
forming
bacteria
- Evaporates
easily

Quaternary
ammonium
compound(citri
mide,
zephiran)

- Used as skin
disinfectant
- Used for
irrigation of
wounds

-Odourless,col
ourless non
irritant
- Active against
g(+ve) bacteria
- Stable at
higher temp

- Activity is
reduced in the
presence of
soap,
detergent acids
- Ineffective
against viruses,
spors & TB
- Action against
g(-ve) is slow

- Inactivates
energy prod.
Enzymes
- Denatures
essential cell
protein
- disrupts cell
membrane

Chlorine
compound
s(chlorine
dioxide,
hypoclorus
acid,
EUSOL)

Produces
hypoclorus
acid & O2
radical
-Destroys
nucleus

-Disinfects
hosp
environme
nt &
formites
- Used in
water Rx

-Disinfects
clean
surfaces
- broad
spectrum
-cheap
- fast
acting

- quickly
inactivated
-corrodes
metal,
rubbers

Phenolies
(carbonic
acid)
derivatives

- cell
membrane
damage
- protein
denaturati
on

-Skin
disinfectan
t
-Medical
soap

- Effective
against
enveloped
viruses,
ricettiae,
fungi

-Not
sporocidal
-Leaves
residual
films

Classifica
tion
Iodophor
s/iodine(
poridone
iodine,
betadine)

Mech. of
action
Bacterici
dal

Applicati
ons
-Skin
preparati
on
- wound
irrigation
-instrume
nt
disinfecta
tion

Advantag
es
sustained
release of
iodine
-potent
broad
spectrum
-lower
toxicity

Disadvan
tages
-less
effective
by
organic
matter
than
chlorates

Aldehyde Denature -Sterilizes Broad

(foraldeh s protein endoscop spectrum
yde &
es
Does not
glutarald
corrote
ehyde)
metals

Slow
action
Irritates
carcinoge
nic

Biguanid
es(clorhe
xidine)

ineffectiv
e in hard
water
-less
effective
against
most
pathogen
s

-Used as
skin
disinfecta
nt
-Environ
mental
disinfecta
tion

-do not
irritate
tissues
Detergen
t
property

SURGICAL USES OF
ANTISEPTICS

Handwashing : Chlorhexidine ,Cetrimide,

Methylated Spirit.
Pre-operative skin disinfection : Cetrimide,
Povidone-Iodine, Methylated Spirit
Mucous membrane disinfection : Antiseptic
irrigations may be instilled into the bladder
Wound Debridement :- EUSOL , H2O2
Sterilisation of Endoscopes :-Glutaraldehyde

 Preventing and treating infected

wounds and burns : Iodophors,
Cetrimide, H2O2
Treating mouth and throat infections :
Dequalinium chloride
Surgical Ward Disinfection :- Phenolics,
Formalin, Glutaraldehyde

ASEPSIS:
SOURCES OF SURGICAL SITE
CONTAMINATION

Patient(autoinfection)
Theatre air
Instruments and other supplies
Operating room(OR) personnel

PRE-OPERATIVE
oModality of admission.
o Septic foci.
o Antibacterial bath.
oPatient to wear a clean gown.
oShaving on surgery day

21

THEATRE DESIGN
Location
Compartments
Walls&fittings
Floor
Separate sterilization unit(CSSD)
Temp = 20-22C&60%humidity
Strict control of human traffic

22

VENTILATION
-Should be free of pathogens

20-25 air changes/hr

HighEfficiency Particulate Air
(HEPA) Filter.
All OR doors should remain closed
Positive air pressure in the OR to
prevent air entry.
23

OPERATING PERSONNEL

Scrub hands&arms-(23min)attension to the nails

oSterile gowns,Caps,Face masks
o Surgical gloves(usually water
proof)
oTheatre booths
oRings should be removed
o Use of reinforced gowns
o Move(back-to-back )
o

SPECTATORS

Gowned
Properly shod
Caps
Mask
Limited movement& No of
spectators
Closed circuit camera

THE PATIENT
Skin preparation
Draping
Chemoprophylaxis

26

SURGICAL EQUIPMENTS
o Should be limited in theatre
o Sterile pack doubly wrapped and kept
dry
o All equipments coming in contact with
incision should be disinfected or
sterilized

SURGICAL WARD

Isolation policy
Dressing technique
-Dressers properly
clothed&masked
-Non touch technique
-should be in a separate
room(well ventilated)

 Disposition of contaminated articles

General cleaning & disinfectation
-Bed sheets-2dly
-Bed covers-wkly
-Blankets-2wkly
-Screens-mthly
-Curtains-3mthly
-walls&ceilings-yrly

ASEPTIC REGULATORY
MEASURES
Aseptic discipline
Autoclaving validity
Sedimentation rate and
fumigation
Infection control and
surveillance committee

CHALLENGES TO ASEPSIS
Antibiotics
Advances in surgery
-complexity and duration
-minimally invasive surgery
-implants and other technologies
-transplant surgeries
HIV and Hepatitis cross infection

CONCLUSION
The practice of human medicine,
emergence of newer pathogens and
devices is a continuous process. Hence a
need for regular review of techniques
and practice of disinfection and
sterilization would be most appropriate
for asepsis