ASEPSIS

ASEPSIS
A whole set of measures which will eliminate
germs from surfaces that will come in contact
with a woud:
Sterilization of materials;
Surgeons hands disinfection
Disinfection of skin in an operative field

GERM FREE
=PREVENTION/ REDUCING the infection
incidence
 ASEPSIS
Sterilization
Complete destruction or removal of all
microorganisms in all forms of existence, from
an object or from the medium;
Chemical or physical methods.
 Physical methods:
ASEPSIS
Dry heat sporulated
microorganisms are destroyed
in dry heat at 180o C
Flame exposure: passing an
instrument through a flame:
3-4 minutes are requested;
Microscopy slides;
Tip of pipetting devices ;
Neck of tubes used for
microbiological cultures.
 ASEPSIA

Heating to red
Quick and very secure;
Destroys instruments;
Tip of pipettes
Metallic loops used for
seeding microbiological
smears
 ASEPSIS
Hot air:
Poupinel oven
double walled isolated
with asbestos;
Metallic and glass
objects;
180o C, 60 de minute
(after the temperature is
stable at 180);
Not very quick
cooling down take
about 1 hour
 ASEPSIS
incineration used contaminated materials
Destroy all materials
Destroy all germs

Can only be used for materials that are not to be

recovered
 ASEPSIS
Moist heat
boiling: NOT ANY MORE!!!!!
Metallic boxes that are well covered
30 minutes from the boiling moment;
Metallic instruments ad some rubber.
NOT safe, completely abandoned
 ASEPSIS
The classic autoclave:
Steam under pressure;
Soft tissue
Metals, glass
1 atm 120oC - 20 min;
2 atm 134-136oC 30
min;
3 atm 143-144o C;
2,5 atm 140o C 30
min
Special boxes that can be
closed or be steam
permeable
Indicators-seals for time
of sterilization
 ASEPSIS
Fully automated autoclaves
Autoclave the principle
 ASEPSIS
Control of sterilization efficacy:
Control the temperature inside the instrument boxes using
powders that melt at certain temperatures
Control of temperature achieved using special paper
stripes that change colours
Control temperatures by permanent monitoring of the
temperature inside the container
Samples of cultures of highly resistant germs
 ASEPSIS
UV light:
Interferes synthesis of nucleic acids and create free
radicals with high toxicity;
Direct action on bacteria and viruses
Used in OR, patients wards, water (industrial)
BUT is effective only on surfaces (thin layer)
surfaces need to be cleaned in advance;
 ASEPSIS
Ethilene oxide (ETO)
Heated autoclave reduces the time needed for exposure
Destroys bacteria in vegetative and sporulated form;
Non colored gas with high permeability: can be used
through paper or plastic wrapping! Does not destroy plastic
or rubber (not high temperature)
time = 1-5 hours;
Toxic vapors: toxic to environment and personal, requires
good ventilation after the procedure
 ASEPSIS
Peroxide plasma
Combination of plasma
on surface + oxidisation

Very good for thermal

sensitive materials and
tubes
 ASEPSIS
Ionising radiation (X, gamma and beta) :
Penetration is very good in all tissue;
Sterilization can be done in pre-packed conditions
Ultrasounds mechanic effect :
Only in dentistry;
Breaks cell membrane cell death
 ASEPSIS
Chemical methods
Formaldehide:
Urologic materials (not any more single use)
Jannet boxes with tablets of formaline;

24 hours at room temperature

Not accepted any more in Europe

Completely replaced by single used instruments
 ANTISEPSIS
CHEMICAL AGENTS ON ANIMATE SURFACES

- Surgeon hands
- Patient s skin
- Sterile field

!!!! GOWNING AND GLOVING

 ANTISEPSIS
Desinfection of surgeons
hands
Different commerciality
available combinations of
alcohols (etanolic,
isopropilic) + protectors
for skin
Bactericid, fungicid
Activ on main viruses HIV,
Herpes, Rotavirus, Hepatitis B,
Poliovirus
H1N1 i H5N1
3 ml - 30 sec
 ANTISEPSIS
Clorhexidine
Sol. 4%
Similar with alcohols as
efficacy
Hydrex, Hibiscrub
often combined with a
detergent for a better
action on skin surface
1min + 2min
 ANTISEPSIS
Betadine
Povidon iodine 7,5%
Destroys most bactera,
fungi, viruses and protozoa
Contact 5-7 min
Diversity of formulations
Scrub soap
Body shampoo
Mouth wash
Solution for irrigations
 ANTISEPSIS
Pure alcohol
70% -90% etanol
Very effective in
denaturizing protein
Good penetration
(lypophilic)
 ANTISEPSIS
Preparing the operating
field
Wash with water and soap
hair removal painting the
skin with a combination of
ether and alcohol;
Painting the skin with
betadine 10%, alcoholic
solution of iodine or
clorhexidine allows for 1,5
ore of germ free skin
preparation.
ANTISEPSIS
 ANTISEPSIS
Complete removal or destruction of germs from
living tissue or hospital environment
Complementary to asepsis;
Uses disinfectants and antiseptivc substances
antiseptics - chemical substances with bacteriostatic
effects or bactericidal effects against germs that inhabit
skin, mucosa and living tissue;
disinfectants chemical substances that destroy or
remove germs from inanimate objects, instruments and
pathological material.
 ANTISEPSIS
The ideal antiseptic agent
Very toxic against microorganisms at very low concentrations
Very low toxicity for human tissue
High penetration through bacteria membrane
As high as possible therapeutic index (50% lethal dose/50%
efficient dose)
Stable and easy to handle
Rapid and long lasting action
Nice smell and either non-color or easy to remove
 ANTISEPSIS
Clasification:
Substances that change the superficial tension properties
Change the permeability of bacteria wall and cytoplasmatic membranes;
phenols, detergents, soaps.
Substances that denaturize proteins:
Coagulate and precipitae proteins;
acids, alkali, alcohol, organic sovents.
Substances that interfere with functional active groups of
enzymes essential for metabolic activity of the mirobes. :
formaldehide, heavy metal salts, oxidising agents, detergents,
metallic ions.
 ANTISEPTICS
Based on chemical structure
Halogens and halogenated compounds
Cloramine Cloramine B:
0,5 gr/tablete
Sodium hypochlorite the active compund
Contaminated clothes and instruments 2-5%;
Bactericidal but soft on living tissue;
Gram +, Gram -, TB.
Chloride water:
0,02-0,06%;
Disinfection of well water;
Bactericidal and sporicidal
Potassium hypochlorite:
Complex wounds;
Bacteriostatic and tissue safe
Produces chloride in atomic form removes debris
Sodium hypochlorite:
5% DaKin.
 ANTISEPTICS
Iodine:
Alcoholic solution
bactericidal, fungicidal;
Corosive for mucosal membranes;
Good for preparing the operating field (advantages and disadvanteges)
Problems:
Old iodhidric acid;
Water over solution in dressings iodhidric acid.
Can easily burn
Very expensive

Iodoform;
Yellow grains
Facilitates wound healing
Deodorant
Betadine.
Antiseptic + combined with detergents increases activity.
Non toxic, non iritant
Large spectrum of usage (wounds, surgeons hands, asepsis, etc)
 ANTISEPTICS
Oxidizing antiseptics
Peroxide:
aciune oxidant, citofilactic, hemostatic;
Atomic oxygen released in contact with tissue foam
debris and devitalized tissue are brought to the
surface;
Hemostatic effect
Potassium permanganate
1-4 %;
Wounds irrigation, vaginal irrigations, urinary tract
Completely abandoned from clinical usage
 ANTISEPTICS
Glutaraldehide
2%
Surgical and endoscopic
materials which are
destroyed by heta
Highly toxic
Bactericidal, fungicidal,
sporicidal, virucidal
HIV, Hepatita B,
Herpes, Rotavirus
 ANTISEPTICS
DETERGENTS
Tensio-active substances
anionic
cationic
First stage of disinfection of
surgical materials and
endoscopic instruments
Bactericidal
BK, Candida albicans, HIV,
Hepatita B
 ANTISEPTICS
Alcohol and phenol
Ethanol
Good for surfaces ;
70%;
Very good penetration in the epidermis and sebaceous glands;
Skin, but not in wounds precipitates proteins pseudomebrane
on which germs can grow.
Hexaclorophen:
Bactericidal antiseptic
Alcoholic solution;
Cream and ointments.
Surgeons hands wash;
Non iritant;
Good penetration.
 ANTISEPTICS
Metallic compounds and heavy metals
Silver nitrate
1-2;
Good indication for :
wounds;
burns;
Conjunctiva and urinary irrigation;

2-10% - cauterization.
Mercury oxicianide (Tiomersal)
1:4000 ddisinfectant for urinary mucosa;
1:1000 solution for instrument storage
Not used anymore