LECTION - Prevention of

contact and endogenous

infection
• Dr. Zeltikov Andrey Nikolayevich
• Доцент Желтиков Андрей
Николаевич

1
STERILIISATION of
instruments

Stage1 - preparation of the

instruments

2
Washing solutions for
instruments
• Solution A • Solution B
Perhydrol 20g 2,5% Hydrogen
washing detergennt peroxid 200ml
5g water 975 • washing detergennt
ml 5g water 795
ml

3
preparation of the Injection needels

• In Warm water and 1% sodium

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

4
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/ bag`s

dressing boxes -
• Plastics bag's
Schimmelbusch`s
Sterilliser

6
STAGE 3 - STERILISATION
• In dry heat steriliser • Autoclave
T -180 C
• 2 atmospheres
• time 60 min • T - 132,9 C
• Time 20 min

• Gamma rays • 1,1 Atmospheres

• T - 120 C
• Time 45 min

7
Autoclaving

8
9
Control of sterility

• Direct methods • Indirect methods -

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

10
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

11
 Mechanical and physical
antisepsis
• Debridement of • Ultrasound
wounds • UV
• Laser
• drainage

12
Objectives of drainage

• Outflow wounds secretions

• Control of healing wounds
• Introduction of drugs

• Decompression of hollow organs

13
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

14
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
15
Active Flush drainage

16
Active Flush drainage

17
18
19
20
21
22
23
24
25
Debridement of wounds

26
27
28
29
30
31
32
Complications of drainage

• Microbial contamination through drainage

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

33
dressing changing\ ASEPSIS OF
PATIENT
• Hygienic hand desinfection
• protection medical personal
• preparation of the patient

34
Protective measures

• Preparing hands before dressing

• Using of fresh (disposable) apron, face
mask, covering the hair, eye protection
• Latex, sterile gloves

35
 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 dressing change
36
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/

37
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

39
Concluding tasks

• After dressing change, the patient is

replaced in ward
• The used materials are prepared for final
disposal or for reprocessing

40
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

41
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

42
43