“Ovidius” University, Constanta

General Medicine
3rd year

THE ASEPSIS AND

ANTISEPSIS

Ş.L. Dr. COSTEA DANIEL-OVIDIU

 DEFINITION

• 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” technique (Ie: surgical gloves need to be
sterilised = be aseptic)
• Asepsia or aseptic = total absence of germs on a surface,
objects, liquid or in a wound.
 THE ASEPSIA

• The goal of asepsis is to prevent contamination.

• Our 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 major
defense against organism (= the skin) is broken > inner surface
of the body are exposed to the environment.

• When we must operate it is vital to desinfect the skin before the

operation using betadine for ex before to proceed the incision.
 STERILISATION
• 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
 Mechanical method
 Chemical method
 PHYSICAL METHODS

MECHANICAL
STERILISATION METHODS

CHEMICAL METHODS
 PHYSICAL METHODS OF
STERILISATION
• Boiling water

• Steam at high temperature (autoclaves)

• Dry heat

• Open flame of propane

• Radiation – UV or gamma
 BOILING WATER AND DRY HEAT

• BOILING WATER - 100°C

• + 30minutes/1hour
• not efficient on endospore meaning that must be used in
extreme conditions when no other possibilities are availables.

• DRY HEAT – 160-180°C

• 2 and respectively 1 hours.
STEAM AT HIGH TEMPERATURE

• Uses AUTOCLAVES = Self-locking machine that sterilize with

steam under pressure
• The most used method for surgical instruments
• 1 atm. – 120°C
• 2 atm. – 136°C 30 min.
• 3 atm. – 144°C

• Disadvantage = unsuitable for heat sensitive objects.

 OPEN FLAME OF PROPANE -
FLAMING
• Common type of heat sterilization consisting to „burn”
microorganisms by exposing them to an open flame of propane.

• Process also known as „incineration”: ie: flaming of inoculating

needles and the tops of laboratory glassware before and after
sampling are examples 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 off
and clean with ETOH).
 RADIATION – UV OR GAMMA

• Used to sterilise the needles, the

drainage tubes or even the surgicals
gloves.

• Disadvantage: it is forbiden to combine

it with another method because it
generates toxic substances
 CHEMICAL METHODS

• By vapours and gaz using

- formaline – low temperature and subatmospheric
pressure,
- ethylene oxide – highly penetrative and active against
bacteria + spores + viruses
• By immersion using mercasept, mercurybrom or
glutaraldehyde
 EXAMPLES
• Air + rooms = use ultraviolet radiation + bacterial filter or formalin vapors
• Instruments + other objects resistant to temperature (glass or metal made)=use
dry heat at 160-180°C for 30-40 minutes or immersion in special solution.
• Soft materials meaning most common tissues:We are using sterilisation by stream
(autoclaves) at 140°C and 1,5 atm.
• Cotton wool
• Cotton swabs
• Dressing
• Compresses
• Rubber or plastic materials which are not resistant to normal heat sterilization we
use method as: Ethylene oxide vapors in special device at temperature of 40-55°c
for 90 to 360 minutes depending on pressure or previous sterilization by gamma
radiation obtained from cobalt 60 or Celsium 137 in industrial environment.
 PREPARATION OF THE
OPERATING FIELD

• The operating field is the future skin area were the incision will
be made
• Security zone ≥ 20 cm around the future incision
• 1st step:
• The day before surgery – washing the area with soap and water
• The day of the surgery – removing the hair in the area (if necessary)

• 2nd step:
• Applying betadine on the security zone
• Sterile surgical fields – for one use
 SURGICAL HAND ANTISEPSIS

• 4 factors affecting the effectiveness of surgical hand antisepsis:

- The preparation before cleaning (hygienic handwash)

- The choice of antiseptic solution
- The cleansing method
- The duration of hand cleansing
 SCRUBBING FOR SURGERY

• Hygienic handwash
• Soap washing + antiseptic solutions (30 sec.-1 min.)
• Manorapid, Sterilium

• Surgical hand preparation

• Should reduce the release of skin bacteria from the hands of the surgical
team
• Must eliminate the transient and reduce the resident flora
• Betadine soap – 3-5 min.

• Sterile gloves
 ANTISEPSIS

• Gr. anti = against, sepsis = putrefaction

• Definition = The process of reducing to a significant degree
the microbial flora of skin and mucous membranes
• Antiseptics = antimicrobial substances that are applied to
living tissue/skin to reduce the possibility of infection, sepsis or
putrefaction
• Disinfectants = strong substances which destroy
microorganisms found on non-living objects, but which can
affect the skin or mucous membranes
 ANTISEPSIS

• The actions of antiseptics is different, based on various factors:

• Concentration, action, temperature, pH,

density of the medium in which they
have action

• From the biological point of view, they can be:

• Bacteriocidal
• Bacteriostatics
• Microbicides – that destroy virus particles
 ANTISEPTICS

• A GOOD ANTISEPTIC MUST HAVE SOME PROPERTIES:

• Large spectrum (bacterii, fungi, viruşi, protozoare)
• Bacteriocidal
• Fast action
• Non-toxic for tissues
• Stability in time
• Soluble in water or organic substances
• Non-corrosive
• To be active in the presence of body’s fluids (blood, plasma)
 ALCOHOLS

• Although several alcohols have been shown to be effective

antimicrobials, ethyl alcohol (ethanol), isopropyl alcohol
(isopropanolol) are most widely used
• Alcohol exhibit rapid broad-spectrum antimicrobial activity
against vegetative bacteria, virusis and fungi but are not
sporicidal
• Inhibit sporulation and spore germination
• Not used in wounds – precipitates proteins
 IODINE SUBSTANCES

• Large spectrum – killing all principal pathogens

• Better tolerated by skin and tissues
• Do not negatively affect wound healing
• Leave a deposit of active iodine – persistent effect
• It may induce scar tissue formation and increase healing time
of the wound
• Tincture of iodine / Lugol’s iodine
 IODINE SUBSTANCES

BETADINE – Povidone-iodine solution, with a concentration of

10% (1% available iodine)

Purpose – first aid antiseptic

Uses – first aid to help prevent infection in minor cuts, scrapes or

burns, surgical handwash
OXYGEN-RELEASING SUBSTANCES

• Antiseptic and disinfectant effect

• HYDROGEN PEROXIDE – Widely used biocide for disinfection,
sterilization and antisepsis
- It is a clear, colorless liquid that is commercially available in a variety of
concentrations ranging from 3 – 90%.
- It has a broad-spectrum efficacy against viruses, bacteria and bacterial
spores.
- It has greater activity against gram-positive than gram-negative bacteria
• Peracetic acid – considered a more potent biocide than hydrogen
peroxide, being sporicidal, bactericidal, virucidal and fungicidal at low
concentrations ( <0.3% )
 CHLORINE BASED SUBSTANCES

• Active chlorine from these substances have bactericidal action,

but it doesn’t affect viruses or other microorganisms
• Cloramins are organic compounds of chlorine
• Cloramin B the most used substance, soluble in water, it releases
chlorine slow, and it is efficient on gram-negatives bacterias and
Koch bacteria.
• They can be used in different concentrations:
• 0,2-1% for open wounds,
• 1-2% skin and mucosa disinfection,
• 5% floor disinfection.
 SILVER COMPOUNDS

• In one form or another, silver and its compounds have long

been used as antimicrobial agents
• The most used silver compound currently in use is silver
sulfazidine.
• Silver nitrate (cristals used to cauterize tissues, or solution
used to bladder lavage in urology); in contact with tissues,
precipitates albumines, and makes healing faster
 CONCLUSIONS

• In conclusion, a great deal remains to be learned about the

mode of action of antiseptics and disinfectans.

• Although significant progress has been made with bacterial

investigations, a greater understanding of these mechanisms is
clearly lacking for other infectious agents.