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1、Asepsis,Asepsis,History Significance and Definition Asepsis of Surgical instrument and Dressing Preparation for Dr. and Pt. Key Points,History and Significance,Hippocrates (460-377 BC),Separated medicine from philosophy Irrigated wounds with wine or boiled water Foreshadowing of Asepsis,History:,Pas
2、teur (1862) Discovered bacterium Developed Pasteurization process,History:,1906,1933,1947,Steam Sterilization,History:,Steam Sterilization (1974),Early type of hot air sterilizer,Microwave Oven (1947),Advanced Sterilizer,Low temperature system for endoscopic devices (1989),Plasma sterilizing system
3、(1993),Basic principle of Surgery Basic principle of Medicine,Significance :,Definition,Sterile free of all living microorganisms Sterilization （灭菌） a process capable of destroying all forms of microbial life on inanimate surfaces Asepsis （无菌） absence of microorganisms that cause disease; freedom of
4、 infection Disinfection （消毒） a process capable of destroying pathogenic microorganisms but, as ordinarily used, not bacterial spores,Autoclaving Dry heat Microwave Infrared rays Boiling Burning,Gas SterilizationEthylene oxideFormaldehydeSoaking in Antiseptics,Sterilization and Disinfection,High pres
5、sure15-20 lbf/in2 High temperature121-126 Time depend on T & P30 min,the most completely reliable sterilization,Autoclaving (Steam under Pressure),Storage time 2 Weeks Attention 40cm30cm30cmArrangement3M Indicate Tape Flammable Stuff Liquid -degas,Autoclaving,Avoid being spoiled by moist heat Temper
6、ature = 160 Time = 1hours (4 hours for grease),-exposure to continuous dry heat,Dry Heat,Only if autoclaving, dry heat, gas sterilization is NOT available (for metal, glass or rubber stuff) Minimum period is 20 min Period can be decreased to 10 min safely in addition of alkali Not effective against
7、spore unless period 1 hour Drip in completely Time Calculation,Boiling,For metal instrument Only in special situation 95% Ethanol Causing damage to the metal instrument,Burning,2% Glutaraldehyde 30min 10% Formaldehyde 20-30min 70% Ethanol 30min 1：1000 Bromo Geramine 30min 1：1000 Chlorhexidinium 30mi
8、nFor delicate instrument, endoscope or laparoscope,Soak Cleaning in Antiseptics,Attention： Clean Before Soaking Drip in Completely Open Axes Wash by Saline before using,Soak Cleaning,Excellent sterilization for most heat-sensitive materials Destroy bacteria, viruses, fungi, spores Flammable and toxi
9、c and causing severe burns,Gas Sterilization Ethylene oxide & Formaldyhyde,Microwave,Temperature =100 Time = 5-20 min,Infrared rays,Temperature =160 Time = 60-120 min,Reservation Washing Infection of P.aeruginosa, Tetanus, Gas-gangrene and HBV positive Single-use StuffBurnt out,Asepsis: Others,Prepa
10、ration for Dr. and Pt.,Gown, shoes cover Head cover, face mask Shorten nail,General Preparation：,Asepsis: Preparation for Dr.,Washing hands & forearms with soap Delivering antiseptics onto wet hands, and scrubbing 3-5 min Rinsing thoroughly, dry with a sterile towel,Asepsis-Hands Scrubbing:,Iodophor
11、 & Iodine Most efficient and broad-spectrum activity Rarely skin reaction Prolonged activity Not use on delicate skin Chlorhexidine (Hibitane) Sensitive areas (perineum, face, genitalia, around eyes, infants),Antiseptics,Direction for Sterilization CenterAround AroundCenter Distance for Sterilizatio
12、n 15cm Area for Sterilization,Asepsis: Preparation for Pt.,-To separate contaminated area from sterile field,Head cover Face mask Shoe cover Glove Gown Drape,Aseptic Mechanical Barrier,Drape,Sterile Envelope History:,Large enough (20*20 feet) With appropriate ventilation Remaining closed & positive
13、pressure,Operating Room,NOT touch any non-sterilized goods with scrubbed hands NOT pass equipment through the contaminated field Change position face to face or back to back NOT lift or move the sterile drapes Check before /after Operation,Asepsis in operative procedure,Strict aseptic technique is e
14、ssential to minimize surgical infection rate It is the most important to keep asepsis principle in mind during the any surgical procedure,Conclusion,Blood Transfusion,History Type of Transfusion Indication Transfusion Reactions Autologous transfusion Component Transfusion,Blood Transfusion,History a
15、nd Significance,Lower (1665),First blood transfusion,Philip (1825),First human blood transfusion,Landsteiner (1900),Discovery of ABO type,How to store blood longer?,World war I,Is there any suitableBlood Substitutes,World war II,Successful blood transfusion is relatively recent,Crossmatching Anticoa
16、gulation Plastic storage container,Blood Transfusion,Type of Transfusion：,Whole Blood； Blood Component；RBC PLT FFP Leukocyte concentrate Plasma Substitutes；,Use of whole blood is considered to be a waste of resources,Blood Transfusion,Symptomatic anemia (providing oxygen-carrying capacity) Transfusion trigger(HCT30% ; HB10g/dl) 1 Unit increases 3% HCT or 1g/dl Shelf life =42 d (1-6 ),Red Blood Cells,
