Asepsis

1. Asepsis Dr.Weiguo Hu 胡伟国 Dr.Weihua Qiu 邱伟华 Surgical Department Shanghai Rui-Jin Hospital Shanghai Second Medical University

2. Asepsis: • History • Significance and Definition • Asepsis of Surgical instrument and Dressing • Preparation for Dr. and Pt. • Key Points

3. Historyand Significance

4. History: Hippocrates (460-377 BC) • Separated medicine from philosophy • Irrigated wounds with wine or boiled water • Foreshadowing of Asepsis

5. Pasteur (1862) History: • Discovered bacterium • Developed Pasteurization process

6. Mikulicz-Radecki(1887)---face masksFurbringer(1889)-----------hands-scrubbingHalsted (1890)---------------surgical-gloves History:

7. Sterilization for Surgical Instruments

8. 1933 Steam Sterilization 1947 History: 1906

9. Steam Sterilization (1974)

10. Microwave Oven (1947) Early type of hot air sterilizer

11. Advanced Sterilizer Plasma sterilizing system (1993) Low temperature system for endoscopic devices (1989)

12. Significance : • Basic principle of Surgery • Basic principle of Medicine

13. Definition Sterile • free of all living microorganisms Sterilization • a process capable of destroying all forms of microbial life on inanimate surfaces Asepsis • absence of microorganisms that cause disease; freedom of infection Disinfection（消毒） • a process capable of destroying pathogenic microorganisms but, as ordinarily used, not bacterial spores

14. Sterilization and Disinfection • Autoclaving • Dry heat • Microwave • Infrared rays • Boiling • Burning • Gas Sterilization Ethylene oxide Formaldehyde • Soaking in Antiseptics 高压蒸气法 蒸气熏蒸法 煮沸法 火烧法 药液浸泡法

15. Autoclaving (Steam under Pressure) the most completely reliable sterilization • High pressure 15-20 lbf/in2 • High temperature 121-126℃ • Time depend on T & P 30 min

16. Autoclaving • Storage time 2 Weeks • Attention 40cm30cm30cm • Arrangement • 3M Indicate Tape • Flammable Stuff • Liquid ---degas

17. Dry Heat ----exposure to continuous dry heat • Avoid being spoiled by moist heat • Temperature = 160℃ • Time = 1hours (4 hours for grease)

18. Boiling • Only if autoclaving, dry heat, gas sterilization is NOT available (for metal, glass or rubber stuff) • Minimum period is 20 min • Period can be decreased to 10 min safely in addition of alkali • Not effective against spore unless period >1 hour • Drip in completely • Time Calculation

19. Burning For metal instrument Only in special situation 95% Ethanol Causing damage to the metal instrument

20. Soak Cleaning in Antiseptics • 2% Glutaraldehyde 30min • 10% Formaldehyde 20-30min • 70% Ethanol 30min • 1：1000 Bromo Geramine 30min • 1：1000 Chlorhexidinium 30min For delicate instrument, endoscope or laparoscope 戊二醛 新洁尔灭 洗必泰

21. Soak Cleaning Attention： • Clean Before Soaking • Drip in Completely • Open Axes • Wash by Saline before using

22. Gas SterilizationEthylene oxide & Formaldyhyde • Excellent sterilization for most heat-sensitive materials • Destroy bacteria, viruses, fungi, spores • Flammable and toxic and causing severe burns

23. Microwave Temperature =100℃ Time = 5-20 min

24. Infrared rays • Temperature =160℃ • Time = 60-120 min

25. Asepsis: Others • Reservation • Washing • Infection of P.aeruginosa, Tetanus, Gas-gangrene and HBV positive Single-use Stuff Burnt out

26. Preparation for Dr. and Pt.

27. Asepsis: Preparation for Dr. General Preparation： • Gown, shoes cover • Head cover, face mask • Shorten nail

28. Asepsis: Hands Scrubbing: • Washing hands & forearms with soap • Delivering antiseptics onto wet hands, and scrubbing 3-5 min • Rinsing thoroughly, dry with a sterile towel

29. Antiseptics Iodophor & Iodine • Most efficient and broad-spectrum activity • Rarely skin reaction • Prolonged activity • Not use on delicate skin Chlorhexidine (Hibitane) • Sensitive areas (perineum, face, genitalia, around eyes, infants) 碘伏 洗必泰

30. Asepsis: Preparation for Pt. • Direction for Sterilization CenterAround AroundCenter • Distance for Sterilization 15cm • Area for Sterilization

31. Aseptic Mechanical Barrier ---To separate contaminated area from sterile field • Head cover • Face mask • Shoe cover • Glove • Gown • Drape

32. Drape

33. Sterile Envelope

34. Operating Room • Large enough (>20*20 feet) • With appropriate ventilation • Remaining closed & positive pressure

35. Asepsis in operative procedure • NOT touch any non-sterilized goods with scrubbed hands • NOT pass equipment through the contaminated field • Change position face to face or back to back • NOT lift or move the sterile drapes • Check before /after Operation

36. Conclusion • Strict aseptic technique is essential to minimize surgical infection rate • It is the most important to keep asepsis principle in mind during the any surgical procedure

38. Blood Transfusion

39. Blood Transfusion • History • Type of Transfusion • Indication • Transfusion Reactions • Autologous transfusion • Component Transfusion

40. Historyand Significance

41. First blood transfusion Lower (1665)

42. First human blood transfusion Philip (1825)

43. Discovery of ABO type Landsteiner (1900)

44. World war I How to store blood longer?

45. World war II Is there any suitable Blood Substitutes

46. Blood Transfusion Successful blood transfusion is relatively recent • Crossmatching • Anticoagulation • Plastic storage container

47. Blood Transfusion Type of Transfusion： • Whole Blood； • Blood Component； RBC PLT FFP Leukocyte concentrate • Plasma Substitutes； Use of whole blood is considered to be a waste of resources

48. Red Blood Cells • Symptomatic anemia (providing oxygen-carrying capacity) • Transfusion trigger (HCT<30% ; HB<10g/dl) • 1 Unit increases 3% HCT or 1g/dl • Shelf life =42 d (1-6 ℃)

49. Platelets • Thrombocytopenia (< 50,000) • Platelet dysfunction • Each unit increase 5,000 PLTs after 1 H

50. Granulocytes • Profoundly granulocytopenia (<500) • Serious infection not responsive to antibiotic therapy