Surgery Lecture - 02 Sterilisation

8/14/2019 Surgery Lecture - 02 Sterilisation

1/43

11

LECTION - Prevention ofLECTION - Prevention ofcontactcontact and endogenousand endogenous

infectioninfection Dr. Zeltikov AndreyDr. Zeltikov Andrey NikolayevichNikolayevich


2/43

22

STERILIISATION ofSTERILIISATION of

instrumentsinstrumentsStage1 - preparation of theStage1 - preparation of the

instrumentsinstruments


3/43

33

Washing solutions forWashing solutions for

instrumentsinstruments Solution ASolution A

Perhydrol 20gPerhydrol 20g

washingwashingdetergennt 5gdetergennt 5gwater 975water 975mlml

Solution BSolution B2,5% Hydrogen2,5% Hydrogen

peroxid 200mlperoxid 200ml washingwashingdetergennt 5gdetergennt 5gwater 795 mlwater 795 ml


4/43

44

preparation of the Injectionpreparation of the Injection

needelsneedels

InIn Warm water and 1% sodiumWarm water and 1% sodiumhydrocarbonatehydrocarbonate

Canal - with 0,5% ammmoiumCanal - with 0,5% ammmoium Boiling in 2% sodium bicarbonateBoiling in 2% sodium bicarbonate


5/43

55

STAGE 2 - package andSTAGE 2 - package andpreparation of materials forpreparation of materials for

sterilisationsterilisation

Universal package - box contains aUniversal package - box contains a

set of material for typical operatiosset of material for typical operatios/ appenndectomy,/ appenndectomy,

phlebectommy /phlebectommy /

Specific package - box contains aSpecific package - box contains aset of material for specificset of material for specificoperatios /Stomach resection,operatios /Stomach resection,

pneumonectomypneumonectomy


6/43

66

STAGE 2 - packageSTAGE 2 - package

MetalMetal Containers -Containers -dressing boxes -dressing boxes -

Schimmelbusch`sSchimmelbusch`sSterilliserSterilliser

Cotton / lien/Cotton / lien/bag`sbag`s

Plastics bag'sPlastics bag's


7/4377

STAGE 3STAGE 3 -- STERILISATIONSTERILISATION

In dry heatIn dry heatsteriliser T -180 Csteriliser T -180 C

time 60 mintime 60 min

Gamma raysGamma rays

AutoclaveAutoclave 2 atmospheres2 atmospheres

T - 132,9 CT - 132,9 C Time 20 minTime 20 min

1,1 Atmospheres1,1 Atmospheres T - 120 C T - 120 CTime 45 minTime 45 min


8/43

88

AutoclavingAutoclaving


9/43

99


10/43

1010

Control of sterilityControl of sterility

Direct methodsDirect methods BacteriologicalBacteriological

Indirect methods -Indirect methods -compounds withcompounds with

known meltingknown meltingpoinds: Benzoicpoinds: Benzoicacid - 120;acid - 120;resorciol - 119;resorciol - 119;

antipyrin - 110antipyrin - 110 IndicatorsIndicators


11/43

1111

STAGE 4 - Keeping theSTAGE 4 - Keeping the

sterilised materialssterilised materials In box can stay sterile for 3 daysIn box can stay sterile for 3 days InIn cottoncotton bag - 24 hoursbag - 24 hours

In Plastics bag's - 1 \ 50 monthsIn Plastics bag's - 1 \ 50 months


12/43

1212

Mechanical and physicalMechanical and physical

antisepsisantisepsis Debridement ofDebridement of

woundswounds UltrasoundUltrasound UVUV

LaserLaser drainagedrainage


13/43

1313

Objectives of drainageObjectives of drainage

Outflow wounds secretionsOutflow wounds secretions Control of healing woundsControl of healing wounds Introduction of drugsIntroduction of drugs

Decompression of hollow organsDecompression of hollow organs


14/43

1414

Types of drainageTypes of drainage

PassivePassive with strip of latexwith strip of latex with different tubes with different tubes

Active with vacuum aspirationActive with vacuum aspirationthrough a drainage tubethrough a drainage tube

Flush - ink-jet flushingFlush - ink-jet flushing

- drip flushing- drip flushing


15/43

1515

Principles of drainagePrinciples of drainage

The insertion of drain trough alternativeThe insertion of drain trough alternativeincisionincision

Placement in dependent areas of thePlacement in dependent areas of thedrained cavitydrained cavity

Fixation of drainageFixation of drainage

maintenance of air-tightnessmaintenance of air-tightness It not be in contact with vessels, nervesIt not be in contact with vessels, nerves


16/43

1616

Active Flush drainageActive Flush drainage


17/43

1717

Active Flush drainageActive Flush drainage


18/43

1818


19/43

1919


20/43

2020


21/43

2121


22/43

2222


23/43

2323


24/43

2424


25/43

2525


26/43

2626

Debridement of woundsDebridement of wounds


27/43

2727


28/43

2828


29/43

2929


30/43

3030


31/43

3131


32/43

3232


33/43

3333

Complications of drainageComplications of drainage

Microbial contamination throughMicrobial contamination throughdrainage tubesdrainage tubes

Compression and damage of theCompression and damage of theorgans and tissuesorgans and tissues

Blockage, falling out of the drainageBlockage, falling out of the drainage


34/43

3434

dressing changdressing changing\ing\ ASEPSISASEPSIS

OF PATIENTOF PATIENT

Hygienic hand desinfectionHygienic hand desinfection protection medical personalprotection medical personal

preparpreparaation of the patienttion of the patient


35/43

3535

Protective measuresProtective measures

Preparing hands before dressingPreparing hands before dressing Using of fresh (disposable) apron,Using of fresh (disposable) apron,

face mask, covering the hair, eyeface mask, covering the hair, eyeprotectionprotection

Latex, sterile glovesLatex, sterile gloves


36/43


37/43

3737

Wound inspectionWound inspection Wound size, depthWound size, depth

degree and nature of deposits and necrotic tissue/degree and nature of deposits and necrotic tissue/black, lathery, scab, sloghy/black, lathery, scab, sloghy/

nature of exudate /serous, bloody/ and degree ofnature of exudate /serous, bloody/ and degree ofsecretion / highly secreting, wounsecretion / highly secreting, woundd becamingbecaming

desiccated/desiccated/ Presence and nature of granulation/ noPresence and nature of granulation/ no

granulation, tissue present, pale,spongy/granulation, tissue present, pale,spongy/


38/43

3838

Wound inspectionWound inspection Extent of epithelial formationExtent of epithelial formation

degree of bleeding tendencydegree of bleeding tendency painfulness of woundpainfulness of wound sings of infectionsings of infection

LocalisationLocalisation Age of woundAge of wound


39/43

3939

Functions of the dressingFunctions of the dressing

Protection against mechanical influences,Protection against mechanical influences,contamination, chemical irritationcontamination, chemical irritation

Protection against secondary infectionsProtection against secondary infections

Protection against drying and loss electrolyteProtection against drying and loss electrolyte

Protection against loss of heatProtection against loss of heat


40/43

4040

Concluding tasksConcluding tasks

After dressing change, the patient isAfter dressing change, the patient isreplaced in wardreplaced in ward

The used materials are prepared forThe used materials are prepared forfinal disposal or for reprocessingfinal disposal or for reprocessing


41/43

4141

Frequency of dressingFrequency of dressing

changechange

Depends on the condition of the woundDepends on the condition of the woundand the characteristics of dressingsand the characteristics of dressings

materialmaterialThe dressing should be inspected and,The dressing should be inspected and,if necessary, removed promptly:if necessary, removed promptly:

If the patient complains of painIf the patient complains of pain

If the dressing is pollutedIf the dressing is polluted

If the bleeding is continuedIf the bleeding is continued


42/43

4242

Documentation of dressingDocumentation of dressing

Is necessary:Is necessary: - to document progress, stagnation- to document progress, stagnation

or reversal of wound healingor reversal of wound healing - to adjust to the treatment plan- to adjust to the treatment plan - to transfer information between- to transfer information between

doctors and nursing staffdoctors and nursing staff


43/43

Surgery Lecture - 02 Sterilisation

Documents

Transcript of Surgery Lecture - 02 Sterilisation