DEFINITION

The asepsis is a complex of actions

aimed to prevent the contamination of
wound, tissues, organs and organism
as a whole. Unlike of antisepsis, that
destroy microorganisms already fallen
into the wound, asepsis preclude its
penetration in the patients organism.

PURPOSE
The purpose of surgical asepsis
is to prevent the contamination of
the open surgical wound by
isolating the operative site from the
surrounding nonsterile
environment.

The main rule of

asepsis is
One and all that get
into the contact with
wound obligate to be
sterile.

Source of infection:
Caries as a nidus
of infection

Exogenous
Exo
source of
infection

Wound

Endogenous
Endo
source of
infection

WAYS:
There are three ways of
exogenous contamination :
1.Airborne spread;
2.Contact spread;
3.Contamination by implantation
of infected materials
(implantation infection).

Airborne way of contamination

Infection from respiratory
tract of patients and
health-care workers
Infected bandages and
infected wound discharge

INFECTED AIR IN
OPERATING
ROOM

Infected dust in the

operating room
Pathogenic germs from
clothes and skin of
workers and patients

INFECTED
WOOND

Prevention of airborne infection.

Separation of patients.
SEPTIC
SURGICAL
DEPARTMENT

ASEPTIC
SURGICAL
DEPARTMENT

Prevention of airborne infection.

Consecution of operations .
Absolutely clean interventions
(vascular surgery, hernia repair )
Relatively clean interventions
(cholecystectomy, gastric rezection )
Infected interventions
(colon surgery, purulent surgery )

Prevention of
airborne infection
Restricted access of
unauthorized persons into
department and operating room
especially.

Four zones of operating

room:
1.zone of general regime
2.zone of restricted regime
3.relative sterile zone
4.absolute sterile zone

Persons working in absolute

sterile zone :
STERILE
(SCRUBBED)
MEMBERS:
surgeon
surgeons
assistants
scrub nurse

NONSTERILE
PERSONNEL:
anaesthetist
nurses
students, medical
rezidents

The second and third zones are divided

by marked red line painted on the
floor.

III

II

Medical clothes.
Sterile zone

Zone of general
regime

Medical clothes.

Sterile
surgical
gloves

Sterile
surgical
gown

Scrubbed persons in sterile zone

Test for carrier of

Staphylococcus.

Cleaning in the operation

room.
cleaning prior to start operations
current cleaning
cleaning after each finished
operation
cleaning after termination of
working day

The complete cleaning, with

profound and prolonged
disinfection of all accessible
surfaces and facilities in
operating room should be
performed weekly and that day
is considered operation-free.

CLOSED CIRCUIT OF AIR IN

OPERATING ROOM.

High-performance bacterial filters

OPERATING
ROOM

Prophylaxis of
contact infection
One and all that get
into the contact with
wound obligate to be
sterile.

What enter into direct contact

with a wound ?
surgeons hands with gloves
surgical gown
drapes and bandages
surgical instruments
operating field (patients skin)

Surgeons hands.

1
Washing with soap and brush in
running water.

Surgeons hands.

2
After thrice-repeated washing, hands
should be dried with sterile towel.

Surgeons hands.

3
Decontamination with antiseptic:
Pervomur, Degmin, Tserigel, Eurosept.

Surgeons hands.

In our clinic we use for

this purpose the

0.5 spirituous
solution of
chlorhexidine.

Surgeons hands.

4
After decontamination - sterile surgical
gown and sterile surgical gloves.

Sterilization of textile products.

Sheemelbushs
container

130C

Variants of sterilization in
autoclave :
one hour under pressure of steam
equal to 1.1 atm
45 minutes under pressure of steam
equal to 1.5 atm
30 minutes under pressure of steam
equal to 2 atm

Processing of surgical
instruments :
rinsing
disinfecting
cleaning
drying
sterilization

Sterilization of
surgical instruments.

1-st step:
Rinsing of instruments
under warm running water
for removing of blood and
organic tissue.

Sterilization of surgical
instruments.

Instruments immersed in 6% solution

of hydrogen peroxide during 90
minutes

Sterilization of
surgical instruments.
Cleaning of instruments by means of
soaking in the detergent with
temperature of 50 60 C for 20
minutes. After that, instruments should
be washed in this solution with brush
and rinsed with running water.

Sterilization of surgical
instruments.

30 - 80

Drying of instruments in the special

electric oven.

Sterilization of surgical
instruments.

60 - 180

Door closed and sterilization

performed .

Quality control of thermal

sterilization :
DIRECT METHOD
Culture of tested
material in
bacteriological
laboratory (weekly)

INDIRECT
METHOD
Melting of special
substances

Rezorcin,
Antipirin 110120C

Ascorbic &
siccine acid
180-190C

Quality of sterilization.

Unmelt substantion

Melt substantion

Decontamination of operation
field:
The skin must be cleaned more widely
than area of planned intervention;
Cleaning must be performed from the
center to periphery;
The more contaminated areas are cleans
in the latter time.

Decontamination of operation field.

Three times before
limitation of operation
field with surgical drapes

Prior to
incision
Before and after insertion
of wound suture

Implantation of infected material in

the human body inevitably results
in development of septicpurulent
process. This kind of suppuration is
very resistant to antibacterial
treatment and removing of infected
item is required as usual.

Surgical sutures.
NATURAL:

SYNTHETIC:

Silk

Kapron Polipropilen

Catgut

Lavsan

Dacron

ABSORBABLE:

UNABSORBABLE:

Catgut
Vicril
Dexon

Silk
Lavsan
Polipropilen
Kapron

Surgical sutures.

Implantable surgical objects.

Sutures
Artificial heart
valves
Orthopedic devices
Synthetic meshes
for hernia repair
Vascular grafts

Sterilization of implantable
surgical objects.
The methods of
suture sterilization:
Claudis

GOING DOWN IN
HISTORY

Sitkovsky
Koher
Gubarev
Kapron boiling + immersion in to 96% ethyl
alcohol

Sterilization of implantable
surgical objects.
METALLIC
ORTHOPEDIC DEVICES

ATRAUMATIC SUTURES
GRAFTS
MESHES

Thermal
sterilization
(electric oven)

Ionizing
radiation

Principal rules of behavior into

operating room:
1.Only sterile persons function within a
sterile field.
2.Sterile drapes are used to create a sterile
field.
3.All items used within a sterile field must
be sterile.
4.A sterile field should be maintained and
monitored constantly.

Principal rules of behavior into

operating room:
5.If there is doubt regarding an item's
sterility, consider it not sterile.
6.Nonsterile personnel should always
remain in nonsterile areas and contact
only nonsterile items.
7.Nonsterile personnel must always
maintain a "margin of safety" when
approaching sterile fields and personnel.

Endogenous infection.
Chronic
inflammatory
diseases:
chronic
pyelonephritis,
chronic
bronchitis,
chronic
tonsillitis,
caries

Hematogenous
and
lymphogenous
ways

Surgical
site
infection

Nosocomial infection.
Nosokomeion (greek) - hospital

Nosocomial infections are defined as

infections acquired during or as a result
of hospitalization. A patient may develop
a nosocomial infection during
hospitalization or after being discharged
from the hospital.

Nosocomial infection.
The most common nosocomial
infections are - urinary tract infections,
pneumonia and surgical-site infections.
In most cases, the nosocomial infection
has been caused by antimicrobialresistant pathogens.

INFECTION
ASEPSIS

WOUND