Surgery Lecture - 02 Sterilisation

LECTION - Prevention of contact and endogenous infection • Dr. Zeltikov Andrey Nikolayevich • Доцент Желтиков Андрей Николаевич

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STERILIISATION of instruments Stage1 - preparation of the instruments

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Washing solutions for instruments • Solution A

Perhydrol 20g washing detergennt 5g water 975 ml

• Solution B

2,5% Hydrogen peroxid 200ml • washing detergennt 5g water 795 ml

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preparation of the Injection needels • In Warm water and 1% sodium

hydrocarbonate • Canal - with 0,5% ammmoium • Boiling in 2% sodium bicarbonate

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STAGE 2 - package and preparation of materials for sterilisation • Universal package - box contains a

set of material for typical operatios / appenndectomy, phlebectommy / • Specific package - box contains a set of material for specific operatios /Stomach resection, pneumonectomy 5

STAGE 2 - package • Metal Containers - • Cotton / lien/ dressing boxes Schimmelbusch`s Sterilliser

bag`s • Plastics bag's

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STAGE 3 - STERILISATION • In dry heat

• Autoclave • 2 atmospheres • T - 132,9 C • Time 20 min

• Gamma rays

• 1,1 Atmospheres • T - 120 C • Time 45 min

steriliser T -180 C • time 60 min

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Autoclaving

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Control of sterility • Direct methods • Bacteriological

• Indirect methods compounds with known melting poinds: Benzoic acid - 120; resorciol - 119; antipyrin - 110 • Indicators

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STAGE 4 - Keeping the sterilised materials • In box can stay sterile for 3 days • In cotton bag - 24 hours • In Plastics bag's - 1 \ 50 months

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Mechanical and physical antisepsis • Debridement of wounds

• Ultrasound • UV • Laser • drainage

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Objectives of drainage • Outflow wounds secretions • Control of healing wounds • Introduction of drugs • Decompression of hollow organs

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Types of drainage • Passive – with strip of latex

– with different tubes • Active – with vacuum aspiration through a drainage tube • Flush - ink-jet flushing - drip flushing

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Principles of drainage • The insertion of drain trough alternative incision • Placement in dependent areas of the drained cavity • Fixation of drainage • maintenance of air-tightness • It not be in contact with vessels, nerves

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Active Flush drainage

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Active Flush drainage

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Debridement of wounds

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Complications of drainage • Microbial contamination through

drainage tubes • Compression and damage of the organs and tissues • Blockage, falling out of the drainage

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dressing changing\ ASEPSIS OF PATIENT • Hygienic hand desinfection • protection medical personal • preparation of the patient

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Protective measures • Preparing hands before dressing • Using of fresh (disposable) apron, face mask, covering the hair, eye protection • Latex, sterile gloves

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Preparation of the patient • The patient should be informed about the

change of dressing • The patient should be given pain-reliving medication • The patient should be positioned so that he is lying comfotably • During the dressing the room should not be entered by other persons • Cut flowers or other obvious reservoirs of organisms should be removed from the area of 36 dressing change

Wound inspection

• Wound size, depth • degree and nature of deposits and necrotic tissue/ black, lathery, scab, sloghy/ • nature of exudate /serous, bloody/ and degree of secretion / highly secreting, wound becaming desiccated/ • Presence and nature of granulation/ no granulation, tissue present, pale,spongy/

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Wound inspection • Extent of epithelial formation • degree of bleeding tendency • painfulness of wound • sings of infection • Localisation • Age of wound 38

Functions of the dressing • Protection against mechanical influences,

contamination, chemical irritation • Protection against secondary infections • Protection against drying and loss electrolyte • Protection against loss of heat

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Concluding tasks • After dressing change, the patient is replaced in ward • The used materials are prepared for final disposal or for reprocessing

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Frequency of dressing change • Depends on the condition of the wound and the characteristics of dressings material • The dressing should be inspected and, if necessary, removed promptly: • If the patient complains of pain • If the dressing is polluted • If the bleeding is continued

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Documentation of dressing • Is necessary: • - to document progress, stagnation or reversal of wound healing • - to adjust to the treatment plan • - to transfer information between doctors and nursing staff

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