Antiseptics

History
Pringle in 1750 Ancient India, Palestine and Greece : Doctors hands and everything that comes in contact with the wound must be clean Hippocrates used only boiled water

History 40-s of XIXth century N.I. Pirogov used solutions of carbolic acid, silver nitrate, zinc sulphate, alcohol, iodine tincture in his practice of wound repair

History
The Hungarian doctor I. Zimmelweiss solution of chloride lime for washing hands and treatment of instruments. D. Lister proposed using 2.5 5% solution of carbolic acid

Everything that comes in contact with the wound must be disinfected.

Types of antiseptics
physical chemical mechanical biological

Physical antiseptics
Scalding use of dry heat or steam Boiling Irradiation and creation of conditions for the passage of liquid from the wound into the dressing Burning

Chemical antiseptics and disinfection

Agents for gentle disinfection are used on the skin; Agents for intensive disinfection are used on very dirty objects and materials which have a large amount of organic substances (bedpans, washbasins etc). Agents for disinfection of enclosed premises and objects contained there. Agents for air disinfection.

Chemical antiseptics and disinfection

iodopyrron (iodine compound with polyvinylpyrrolidon) Taurolin (a combination of taurin and formaldehyde)

Chemical antiseptics and disinfection

Instrument desinfection triple solution (2 % formalin, 0.3 % fenol, 15 % sodium bicarbonate) 0.5 % chloramine B solution 3% hydrogen peroxide solution, 0.1 % desozone-1solution, dichlor-1, 0.1 % sulfachlorantine.

Disinfection of surgeons hands

Hygienic and surgical disinfection, Fast disinfection of hands Fast disinfection of skin.

Requirements
Kill off pathogenic flora on the skin surface quickly Kill off microorganisms in the glove liquid quickly and reliably, so that the hands are sterile during the whole surgery procedure

Requirements
Have a cumulative effect: frequent use of one disinfecting agent should reduce the amount of bacteria so that the surgeons hands are bacteria free in the period between disinfection procedures Non-irritant for the skin.

Desinfecting agents
alcohol (70 % ethyl alcohol, 60% propanol, 70% isopropanol), mixed alcohol and iodophor (iodopyrron, iodonate), performic acid or pervomur, 0.5% chlorhexidine solution.

Mechanical disinfection
removal of necrotized unviable tissue, blood clots foreign bodies which can harbor microorganisms, from the wound. initial surgical debridement (2 hours after the injury)

Biological disinfection
antibiotics, sulfanilamides, nitrofuran derivatives, enzyme preparations, vaccines and serums, immunostimulators

Administering antimicrobial therapy

The therapy should be started early enough. A therapy begun too late or at the end of the disease is less effective. One should take into consideration susceptibility of the infecting agent to the preparation. The preparation should be administered in such a way that it contacts the infecting agent directly and creates therapeutic concentration in the focus of infection.

Administering antimicrobial therapy

The therapy should not be interrupted until the infecting agent is destroyed. The duration of therapy should be optimum. One should take into consideration toxicity of the preparation, adverse affects and take measures to prevent or correct them. The drugs administered together with the antibiotic should be chosen well.

Ways of administration
To the wound surface: sponging the walls of the wound or using dressings saturated with disinfecting solution.

Ways of administration
Introducing the drug into body cavities: for prevention and treatment of suppurative processes the drug is introduced into the pleural and abdominal cavity, into the lumen of joints.

Ways of administration
Parenteral, intravenous, intra-arterial and endolymphatic introduction (deep disinfection)

Aseptics
method preventing microbial invasion into surgical wound by using physical factors, chemical agents and measures.

Aseptics
Sterilization Physical methods include thermal and irradiation sterilization Chemical methods include sterilization with ethylene oxide, peracetic acid, and also chemical and thermal treatment.

High temperature sterilization

Heating time Stabilisation time Extermination time Cooling time If sterilization was interrupted in one of its working stages, the whole process has to be repeated.

Sterilization
Steam sterilisation Dry heat sterilising Irradiation sterilisation Chemical sterilisation Ethylene oxide sterilisation Sterilization with peracetic acid

Control of sterilisation
is performed with special indicators high sterility standards special suits and helmets bactericidal ultraviolet lamps are used with short-wave radiation.