Chair of the general surgery, children's surgery of medical faculty and surgical illnesses of mediko-preventive faculty

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Chair of the general surgery, children's surgery of medical faculty and surgical illnesses of mediko-preventive faculty

The Tashkent Medical Academy

Lecture for students of a 3-course mediko - preventive faculty a theme: «Antiseptics and асептика»

The lecturer: д.м.н., professor Ergashev U.J.

Composers: д.м.н., professor Ergashev U.J.


The lecture Purpose:

1. To Give concepts to students about antiseptics and асептике

2. Will acquaint students principal views of antiseptics and асептики

3. Will explain to students main principles of antiseptics and асептики
The complex of actions directed on destructions of microbes in a wound and round it, in the pathological centre or an organism as a whole, reduction вирулентности microbes and restriction of their distribution is called as antiseptics.

Prior to the beginning of a bacteriological era (1878) almost half of the patients who have transferred operative intervention, perished from an erysipelatous inflammation, пиемии, a gas gangrene and a diphtheria of wounds. A suppuration of wounds considered as something immutable, as almost inevitable phenomenon because among various forms раневой infections гноеродная looked the most harmless.

The concept "antiseptics" was entered by English military surgeon Dzh. Прингл (1750) on the basis of supervision for противоглистным effect of the mineral acids used at that time for disinfecting of a sewage. However methods of struggle against infection, a suppuration of wounds and putrefactive process were rather primitive.

In the early forties of the nineteenth century N.I.Pirogov applied in practice of treatment of wounds solutions карболовой acids. Гиппократ at bandaging and washing of wounds used only кипяченную water, pure плотняные, bandages well soaking up separated wound, impregnated with their wine for strengthening of disinfecting action.

The Hungarian accoucheur-gynecologist I.Zemmelvejs has intuitively found out the big danger which hands of the surgeon for a maternity fever at lying-in women and healing of wounds can represent. It has most close approached to creation of a method of antiseptics, began to apply regularly to disinfection of hands, patrimonial ways, tools and everything that use at obstetric aid, chloric water.

I.Zemmelvejs has experimentally proved presence in a secret of a uterus of the infectious beginning which can be transferred through dirty hands of the personnel and tools from one patient to another. Introduction of obligatory washing of hands by a solution chloric to exhaust before research of lying-in women has yielded amazing result: death rate from a patrimonial sepsis has decreased almost on 10 times. It is I.Zemmelvejsa's big merit before mankind

English druggist Lemer has proved that карболовая acid detains fermentation, and for the first time has suggested to use for treatment of wounds as an antiseptic of 5 % a water solution карболовой acids.

Teacher Listera of J. Эриксен in 1874г. Has declared that the belly both chest cavity and a skull cavity for ever remain inaccessible to the surgeon for surgery. The French scientist Lui Pasteur has brought the big treasure in antiseptics development by the numerous experiences. It has convincingly proved that development of live organisms in обеспложенном a material depends on penetration of microorganisms from the outside.

Under the influence of L.Pasteur's works about the reasons of rotting and fermentation of J. Листер has offered the antiseptic way of struggle against an infection with the help карболовой acids. I use 2-5 % a solution карболовой acids as to the wound, and on all subjects adjoining to it, without excluding hands of the surgeon, it has considerably improved results and has achieved full treatment of 10 patients with open crises. A wound it closed a special 10-layer bandage from oil solutions карболовой acids.
1. Dispersion карболовой acid air of the operational.

2. Processing of tools, шовного and dressing materials of 2-3 % карболовой acid.

3. Washing of hands of the surgeon of 2-3 % карболовой acid.

4. Processing of an operational field of 3 % карболовой acid

5. A special bandage of Listera on a wound.

1. The Silk impregnated of 5 % карболовой with acid.

2. The eight-layer gauze impregnated of 5 % карболовой with acid with a mix канифоля and paraffin.

3. Прорезинованная a paper fabric or кленка.

4. Strengthening of a bandage by bandage the impregnated 5 % карболовой acid

Antiseptic method of J. Листера dominated in surgery of 15 years. But in 1871 Lister was convinced that карболовая acid is not indifferent for organism fabrics, and search of other, less harmful antiseptic substances since then has begun.

In the end of XIX century working out of methods of sterilisation of a surgical material and tools has begun. The base of a new direction - асептики in the surgery providing безмикробные conditions of surgical activity has been put.

In 1878 E.Buhner has suggested to sterilise surgical tools кипячением, and Z.Terillon - dry steam.

In 1882 F.Trendelenburg in Bonn has designed the device for sterilisation of a surgical material and tools water steam.

In 1890 in hospital of J. Gopkisa Bladgud conducted rubber gloves for protection of wounds against hands of the surgeon.

In 1886 E.Bergman and K.Shimmelbushem have designed a sterilizer for кипячение tools, have created metal биксы, have improved an autoclave.

On X international congress of surgeons in Berlin (1890) for merits on внедрекнию and propagation асептики professor E.Bergman is named by the father асептики.

Systematically spent асептика along with anaesthesia became the major principles of modern surgery. Асептика has included actions for creation of sterile working conditions and together with antiseptics, supplementing each other, provides realisation of surgical activity.
Antiseptics kinds

- Physical antiseptics

- Mechanical antiseptics

- Chemical antiseptics

- Biological antiseptics

- The Mixed antiseptics

Physical antiseptics:

1. Дренирование cavities.

2. Application of gauze tampons.

3. Uses of beams.

Mechanical antiseptics:

1. Иссечение and a section of wounds.

2. Removal of foreign matters.

3. Washing of purulent wounds, etc.

Chemical antiseptics:

Local application of antiseptic solutions:

1. Skin and wound processing.

2. A body premise in a bath with solutions of antiseptic tanks.

3. Conducting through a drainage of antiseptic tanks in a cavity or a wound.

4. Инфильтрация a solution of antibiotics of fabrics round a wound).

Biological antiseptics:

1. Local (засыпание wounds, introduction of tampons with solutions of antibiotics in a wound or cavities);

2. Intramuscular, intravenous, intraarterial, intrabone introduction of antibiotics.

3. Local, intramuscular, внутриполостное, intravenous, intrabone application of enzymes.

4. Intramuscular, intravenous, introduction antistaphylococcal, антигангренозных, противостолбнячных preparations.
Ways of introduction of antiseptic tanks to an organism

1. Through a mouth.

2. In blood.

3. In a marrow.

4. Hypodermically.

5. By means of inhalations.

6. In a cavity.

7. In a wound.

8. In the closed abscesses.

9. By means of baths.

10. In a rectum

- Components of PHYSICAL ANTISEPTICS (M.J.Preobrazhensky 1894)

1. Tampons from a gauze, drainages from rubber and other materials.

2. Ultrasound <20 кГц:

l Physical effect - кавитация and a shock wave

l Chemical effect - clearing Н + and It -

3. The laser: (high and low energy)

l Temperature, a shock wave, electric weeding

4. Diadinamichesky currents (Bernard)

5. Электрофорез

- COMPONENTS of MECHANICAL ANTISEPTICS (ПХО wounds. A.Charukovsky 1836, Fridrih of 1898)
Toilet round a wound (an aether, gasoline, фурациллином, oil and т.д).

2. To cut hair round a wound.

3. To process spirit and iodine operational weeding.

4. Local anaesthesia of 0,5 % by a solution новокаина.

5. Washing of the wound by hydrogen peroxide, фурациллином.

6. Иссечение a scalpel of edges, walls and a wound bottom, and also the become lifeless, impractical rags.

7. A hemostasis.

8. Approach of edges of a wound by imposing of level-by-level seams.

9. Processing by iodine.

10. Imposing of an aseptic bandage.


- I. An inorganic number

- 1. Haloids.

- 2. Oxidizers

- 3. Salts of heavy metals

- 4. Dyes

- 5. Acids and alkalis

- II. An organic number

- Aldehydes

- Phenols

- Spirits.

- Sulfanilamidy

- 5. Derivatives нитрофурана

- Inorganic chemical substances.

- A.Gruppa of haloids.

- 1. Хлорамин (0,5 %-2 %)

- исп.: Treatment инфиц. Wounds (1-2 % р-р)

- Disinfection of hands (0,5 % р-р)

- Disinfection of premises (2 % р-р)

- 2. Йодинол.

- исп.: Washing гнойн. Cavities, трофич. Ulcers

- Uses in the form of lotions and compresses.

- Jodanat (1 %), (a substitute spirit a solution)

- исп.: For disinfecting of a skin of an operational field.

- Jodopiron.

- исп.: Disinfection of a skin of an operational field.

- Primary surgical processing of wounds.

- Jodofor (исп. As йодопирон).

- Jodofom.

- Isp.: Treatment инфиц. Wounds and ulcers.

l B.Okisliteli.

1. 1. Р-р перикиси hydrogen (3-6 %), (Ochishenie of wounds).

2. 2. Potassium permanganate.

0,1 - 0,05 % водн. р-р - washing of wounds.

0,01 - 0,1 % oral cavity and throat rinsing.

0,02 - 0,1 % - for syringing.

2 - 5 % смзыв. Ulcers and burns, поверн.

l V.Soli of heavy metals.

l 1. Silver nitrate. 1-2 %; 5 10 %

l R-R - having washed out. Purulent wounds and мочев. A bubble.

l 2. Протаргол.

l 1-3 % р-р for дезинф. A bladder and верхн. дых. Ways.

l 3. Колларгол.

l 0,2-1 % р-р - having washed out гнойн. Wounds.

l 1-2 % - мочев. A bubble.

l 2-5 % - eye drops.

l 4. Mercury оксицианид.

l 1; 5000 for washing of wounds, a bladder.

l 1 % р-р - стерил. Tools.

l 5. Zinc sulphate.

l 0,1-0,5 % р-р - at коньюктивитах.

l 0,25-0,5 % - at восп. Processes top дыхатель. Ways.

l G.Krasiteli.

l 1. Метиленовый dark blue (1-3 %) - for washing uric

l A bubble and wounds.

l 2. Diamond zelenij.0,1-2 % spirit. р-р for processing

l Small wounds.

l D.Kisloty and alkalis.

l 1. Acid salicylic.

l 2-5 % - powders \

l 1-10 % - ointment - - treatment of wounds with некрозом fabrics.

l 1-2 % - спиртовый р-р - treatment гиперкератоза.

l 2. Acid boric.

l Powders, 5-10 % of ointment - at skin disease

l 2-4 % - water r-ry - washing of wounds.

l 3. Sodium тетраборат.

l 4 % - р-р for syringing and washing of wounds.

Organic chemical substances.

l E.Aldegidy.

l 1. Formalin or formaldehyde

l Disinfection of hands, gloves, drainage tubes, tools.

l 2. Сайдекс.

l 2 % - р-р глутар. диальдегида

l Disinfection катетеров, инструм., the equipment.

l Geksametilen - тетраамин.

l Inside and in a vein at инфекц. Processes

l Mochevyvodjashih of ways.


l 1. Phenol or карболовая acid - 3-5 % р-р - for дезинф. Subjects, linen, выделений the patient.

l Tar birch.

l Naruzhno - 10-30%мазь at забол. Skin.


l Spirit ethyl. 70-96 %

l Disinfection of hands of the surgeon, tools, шовного a material, processing of a skin of an operational field.

And. Sulfanilamidnye preparations.

l Streptocide, норсульфазол, сульфазин, сульфадимезин, сульфадиметоксин is often used.

K.Proizvodnye нитрофурана

l 1. Фурацилин (1:5000) - for washing of wounds, cavities of a pleura, joints, брюшины.

l 2. Фурагин - 0,1 % р-р it is applied местно, it is applied at ьтяжелых infection forms.

l 3. Фурадонин

l 4. Фуразолидон

- Enzimoterapija (enzymes)

- Animal - трипсин, химотрипсин, химопсин

- Bakterialnyj - террилитин, стрептокиназа, коллагеназа, аспераза, ируксол

- Vegetative - бромелаин, папаин.

- Operating on immune system: whey, анатоксины, vaccines, бактериофаги.


v Local application

v By means of inhalation

v Parenteralnoe introduction

Activization of protective forces of an organism:

- Transfusion свежеконцентрированной Blood and эритроцитарной weights

- Active immunization: applications анатоксина, special vaccines

- Passive immunization: applications Staphylococcal antitoxin, Antistaphylococcal plasma or scale- The globulin specific бактериофага

Groups of antibiotics:

1) 1). Penicillin group: бензилпенициллина натриевая, калиевая, новокаиновая salts, bitsillin-1, bitsillin-3, bitsillin-5, метициллина натриевая salts, оксациллина натриевая salts, ampicillin, etc.

2) 2). Streptomycin group: streptomycin sulphate, streptomycin хлоркальцевый a complex.

3) 3). Group тетрациклинов: тетрациклин, тетрациклин a hydrochloride, окситетрациклина дигидрат, морфоциклин.

4) 4). Group левомицетина: левомицетин, синтомицин.

5) 5). Group of antibiotics - macroleads: erythromycin, олеандомицин, phosphate, олететрин, олеморфоциклин.

6) 6). Group of antibiotics - аминогликозидов: неомицина sulphate, мономицин, канамицин.

7) 7). противогрибковые: nystatin, леворин, амфотерицин In, etc.,

Application of antibiotics:

ü Local application of antibiotics

ü Intrabone introduction

ü Intravenous introduction

ü Intraarterial introduction

ü Vnutriaortalnoe introduction

ü Intratrahealnoe introduction

ü The Combination выщеукзаннных ways

At use of antibiotics possible errors:

l Use without indications.

l Appointment of small or big doses

l Appointment of the same group

l Appointment without sensitivity definition

l The insufficient account синергизма or antagonism

l Does not consider collateral action

Complex - actions including the prevention hit of microbes in an operational wound as a result of carrying out of organizational actions, by use of physical factors, chemical means and biological methods.

Now асептика remains to one of bases against which the surgery leans.

Sources from which pathogenic bacteria nestle close in a wound, happen экзогенными and эндогенными.

I. Ekzogennye

l 1. Air-drop.

l 2. Contact.

l 3. Имплантационный.

II. Endogennye.

l Limfogenno or a blood way of penetration of an infection through the pathological centres in the organism (a skin, жкт, дых. Ways and др).


– Ekzogennaja an infection

l А air-drop

l The Open window during operation

l Cleaning of a hall during operation

l Sharp movement during operation

l Conversations during operation

l 1. Unsterile hands

l 2. The unsterile tool

l 3. Unsterile linen

l 4. A raw operational table

l 1. Unsterile means for металлоостеосинтеза

l 2. Unsterile artificial limbs of bodies

l 3. Unsterile шовный a material

l 4. Unsterile drainages
– Endogennaja an infection

l The Dozing infection (a cicatricial fabric)

l Contact (abscess opening, opening of a gleam of a gut)

l Gematogennaja and лимфогенная (a chronic tonsillitis, caries of teeth)


l The Organization surgical branch and a lay-out.

l Furnish and the equipment of the operational block.

l The Maintenance operational and care of them.


I. Mechanical clearing, disinfection, дубление:

l 1. A method Spasokukotsky - Kochergin. (0,5 % нашатыр. Spirit)

l 2. A method of Alfelda. (96 % spirit + 5 % iodine)

l 3. A method of Fjurbringera. (70 % spirit + 0,5 % р-р corrosive sublimate)

II. Only дубление skin:

l 1. A way Bruno. (96 % spirit - 10 minutes)

l 2. A way Zabludovsky.



l The Chink - a method of Kohera. (сулема+спирт)

l Ketgut - Klaudiusa (damp) and Sitkovsky (dry pair of iodine).

l Kapron - кипячение 20 minutes.

l Hair - in stomatology. (96 % spirit + 7 days - 2 times)

l Tantalic paper clips - also as well as tools.

(Branch of the central sterilisation).

And. In autoclaves:

l 1. Nerezhashchie tools (wrapped in bed-sheets).

l 2. The Dressing (in биксах).

l 3. Operational linen (in биксах).

B. In сухожаровом to a case (180 гр. - 45мин).

l 1. Syringes and a needle.


I. Control crops.

II.В Autoclaves:

l 1. Sulphur.

l 2. Benzojnaja acid.

l 3. Антипирин.

l 4. A method of Mikulicha.

III.В сухожаровом to a case:

l Sucrose.

l Urea.

l 1. Sterilisation of means for


l 2. Sterilisation artificial limbs of bodies

l 3. Sterilisation шовный a material

l 4. Sterilisation drainages

l Preparation operational weeding

l Liquidation of a source of an infection in an organism.

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