Treatment of chronic prostatitis in men with folk remedies. Treatment of prostatitis with folk remedies

History of the development of the method

The concept of asepsis

Asepsis- system preventive measures, aimed at preventing the entry of microbes into wounds, tissues, organs, body cavities of the patient (wounded) during surgical operations, dressings, endoscopy and other therapeutic and diagnostic procedures.

Asepsis includes:

■ sterilization of instruments, materials, surgical linen, devices;

■ treatment of the surgeon’s hands;

■ compliance special rules and methods of work during operations, research, etc.;

■ implementation of special sanitary, hygienic and organizational measures in a medical institution.

The asepsis method is further development antiseptic method and is closely related to it.

Founders of asepsis- German surgeons E. Berdmann and S. Schimmelbusch, and in Russia - M. S. Subbotin and P. I. Dyakonov.

In 1890, at the X International Congress of Physicians in Berlin, Bergmann proclaimed the fundamental law of asepsis: everything that comes into contact with the wound must be free of bacteria.

With further development of aseptic issues, it turned out that it is not possible to ensure the prevention of wound suppuration using one aseptic method - it is necessary complex application aseptics and antiseptics.

To ensure asepsis in last years began to use such physical factors like radioactive radiation, ultra-violet rays, ultrasound and electric current different frequencies and etc.

There are two sources of surgical infection: exogenous And endogenous. Exogenous the source is in the patient’s habitat, that is, in the external environment, endogenous- in the patient's body.

Prevention of implantation infection involves thorough sterilization of devices, suture material, drainages, endoprostheses, etc. This infection can be dozing and manifest themselves after a long period of time, when weakening protective forces human body.

Special meaning prevention is important when transplanting organs and tissues, since this weakens the body’s defenses. Asepsis is the law of surgery. It is achieved by using physical factors And chemical substances.

Heat, causing denaturation of microbial cell proteins, was most often used in the past.

The sensitivity of microbes to high temperature depends on their type, strain and state of the microbial cell (dividing and young bacteria are more sensitive, spores are more resistant to high temperature). In alkaline and acidic environments, the susceptibility of microbial cells is high. Cold inhibits the proliferation of microbial cells without having a pronounced bactericidal effect.

Ultra-violet rays capable of infecting microbes in the air, on the skin, human tissues, on the walls and floors of premises. Gamma rays are radioactive isotopes 60 CO and 137 Cs. Sterilization is carried out in special chambers in a dose of 1.5-2.0 million rubles. Underwear, suture material, blood transfusion systems, etc. are sterilized. Specially trained people, equipped with powerful protective equipment, work. Radiation sterilization of plastic items that cannot withstand high temperatures and steam under pressure is especially useful.

Thermal sterilization, that is, high temperature, is the main method of disinfection used in medical practice. The upper limit of vegetative microorganisms is 50 °C, and tetanus bacillus spores - in boiling water (up to 60 minutes). Most effective look Sterilization of any form of bacteria is exposure to iodine steam pressure. After 25 minutes, any infection dies, and the most common one - after 1-2 minutes (132 ° C). Burning used only in laboratory practice for the sterilization of plastic needles and loops used in bacteriological laboratories and in emergency situations- when the patient’s life is at risk.

Sterilization dry heat carried out in dry heat sterilizers at a temperature of 180-200 °C. Instruments, utensils, etc. are sterilized. This type of sterilization wide use found in dental practice.

Boiling produced in boilers: portable and stationary. Use boiled distilled water with the addition of sodium bicarbonate at the rate of 2.0 g per 100.0 g of water. A 2% solution is obtained, and the boiling point of water increases by 1-2 °C.

Sterilization ferry carried out under pressure autoclaves. They can be stationary or traveling. Depending on the steam pressure (kgf/cm2), the temperature rises to strictly defined figures, for example, at a steam pressure of 1.1 kgf/cm2, the temperature in the autoclave rises to 121.2 °C; at 2 kgf/cm 2 - up to 132.9 °C, etc. Hence the sterilization exposure is from 60 minutes to 15 minutes.

Held sterility control. It can be bacteriological, technical and thermal. The bacteriological method is the most accurate, but the result is given too late. Samples of sterilized material are taken and sown on nutrient media. Technical methods are used when installing a new autoclave. Thermal methods are used every day. They are based either on a change in the color of a substance or on the melting of a substance.

Mikulich's test: written on white filter paper with a simple pencil“sterile” and lubricate the surface of the paper with a 10% starch solution. When the paper dries, it is treated with Lugol's solution. The paper darkens, the word “sterile” is not visible. It is placed in the thickness of the material to be sterilized in an autoclave. At 100 °C, starch combines with iodine and the word “sterile” becomes visible again. The exposure must be at least 60 minutes.

More effective are tests with powdered substances that melt at a certain temperature: sulfur - at 111-120 °C, resorcinol - 110-119 °C; benzoic acid - 121 °C, urea - 132 °C; phenacetin - 134-135 C.

To control dry heat sterilization: thiourea - 180 °C; succinic acid ----180-184 °C; ascorbic acid - 187-192 °C; barbital - 190-191 °C; pilocarpine hydrochloride - 200 °C.

Lecture 7. Asepsis: sterilization with chemicals

1. Concept and types of chemical sterilization

Chemical substances, used for sterilization must be bactericidal and not spoil the instruments and materials with which they come into contact.

IN Lately sterilization has become increasingly used cold method, using antiseptic substances. The reason for this is the fact that in medical practice objects made of plastics are used. They cannot be sterilized using thermal methods. These include devices cardiopulmonary bypass(AIK), devices for anesthesia, artificial ventilation of the lungs, etc. It is difficult and difficult to disassemble such devices, and it is not possible medical workers. Therefore, methods are needed that make it possible to sterilize the device either as a whole or disassembled into large units.

Chemical sterilization can be carried out using both solutions, including aerosols (solutions of mercury, chlorine, etc.), and gases (formalin vapor, OB mixture).

Asepsis is a set of preventive surgical measures aimed at preventing infection from entering the wound.

Aseptic technique was proposed by the German surgeon Bergman ( physical techniques disinfection - boiling, burning, autoclaving). A definition of asepsis has been proposed.

Asepsis is a method of surgical work that prevents microbes from entering or developing in the operating room. That's why debridement requires compliance with the basic law of asepsis, which is formulated as follows:
everything that comes into contact with the wound must be free of bacteria, i.e. .

It can be an exogenous infection or endogenous (depending on the source of infection).

Routes of penetration of endogenous infection:
- lymphogenous pathway,
- hematogenous route,
- path through intercellular spaces, especially loose tissue,
- contact path(for example, with a surgical instrument)!

For surgeons, endogenous infection does not pose a particular problem, unlike exogenous infection.

Depending on the route of entry into the body exogenous infection subdivided:
- for airborne infection,
- contact infection,
- implantation infection.

Airborne infection: If there are few microbes in the air, the likelihood of airborne infection is not high. Dust increases the likelihood of airborne contamination. Basically, measures to combat airborne infections come down to dust control and include ventilation and ultraviolet irradiation. Cleaning is used to combat dust. There are 4 types of cleaning:
- pre-cleaning means that in the morning, before the start trading day, wipe all horizontal surfaces with a cloth moistened with a 0.5% chloramine solution;
- routine cleaning is carried out during the operation and consists in the fact that everything that falls on the floor is immediately removed;
- final cleaning (after the operating day) consists of washing the floors and all equipment with a 0.5% chloramine solution and turning off ultraviolet lamps. It is impossible to sterilize the air with the help of such lamps, but they are used in the place of the greatest sources of infection.
- ventilation is a very effective method - after it, microbial contamination drops by 70-80%.

For a very long time it was believed that airborne infection was not dangerous during operations, but with the development of transplantation with the use of immunosuppressants, operating rooms began to be divided into 3 classes:
- first class - no more than 300 microbial cells per 1 cubic meter air.
- second class - up to 120 microbial cells - this class is intended for cardiovascular operations;
- third class - absolute asepsis class - no more than 5 microbial cells per cubic meter of air.

This can be achieved in a sealed operating room, with ventilation and air sterilization, with the creation of an operating area inside high blood pressure(so that air flows out of the operating rooms), and special airlock doors are installed.

Droplet infections are those bacteria that can be released into the air from respiratory tract all those (patients, staff) who are in the operating room. Microbes are released from the respiratory tract with water vapor. Water vapor condenses and, along with these droplets, microbes can enter the wound.

To reduce the risk of spreading droplet infection, there should be no unnecessary talk in the operating room. Surgeons use four-layer masks, which reduce the likelihood of contracting a droplet infection by 95%.

These are all microbes that are capable of penetrating into a wound with any instrumentation, with all that. that comes into contact with the wound. Dressing material - gauze, cotton wool, threads - is subjected to high temperature treatment (at least 120 degrees for an hour).

An implantation infection is an infection that enters the body along with implanted materials, prostheses, organs, during their transplantation.

Before the introduction of aseptic and antiseptic methods, postoperative mortality reached 80%: patients died from purulent, putrefactive and gangrenous processes. The nature of rotting and fermentation, discovered in 1863 by Louis Pasteur, became a stimulus for the development of microbiology and practical surgery, making it possible to assert that the cause of many wound complications are also microorganisms.

This abstract will discuss disinfection methods such as asepsis and antiseptics.

These concepts should be considered in a complex of measures that complement each other; one without the other will not have the best result.

Asepsis is a method of surgical work that prevents microbes from entering or developing in the surgical wound. On all objects surrounding a person, in the air, in water, on the surface of his body, in the contents internal organs etc. there are bacteria. Therefore, surgical work requires compliance with the basic law of asepsis, which is formulated as follows: everything that comes into contact with the wound must be free from bacteria, i.e. sterile.

ANTISEPTICS

Antiseptics implies a set of measures aimed at destroying microbes on the skin, in a wound, in a pathological formation or in the body as a whole. There are physical, mechanical, chemical and biological antiseptics.

With physical antiseptics, they ensure the outflow of infected contents from the wound and thereby cleanse it of microbes, toxins and tissue decay products. This is achieved by using gauze tampons, drains made of rubber, glass, and plastic. The hygroscopic properties of gauze are significantly enhanced when it is wetted with hypertonic solutions (5-10% sodium chloride solution, 20-40% sugar solution, etc.).

Open wound treatment methods are used without applying a bandage, which leads to drying of the wound with air and thus creating unfavorable conditions for the development of microbes. Physical antiseptics also include the use of ultrasound, laser beams, and physiotherapeutic procedures.

Mechanical antiseptics are techniques for removing infected and non-viable tissues from a wound, which serve as the main breeding ground for microorganisms. These are operations called active surgical debridement, as well as wound care. Have great importance to prevent the development of wound infection.

Chemical antiseptics include substances with a bactericidal or bacteriostatic effect (for example, sulfonamide drugs) that have a detrimental effect on the microflora.

Biological antiseptics constitute a large group of drugs and techniques, the action of which is directed directly against the microbial cell and its toxins, and a group of substances that act indirectly through the human body. Thus, the following mainly affect the microbe or its toxins: 1) antibiotics - substances with pronounced bacteriostatic or bactericidal properties; 2) bacteriophages; 3) antitoxins, administered, as a rule, in the form of serums (antitetanus, antidiphtheria, etc.).

Vaccines, toxoids, blood and plasma transfusions, administration of immune globulins, methylthiouracil preparations, etc. act indirectly through the body, increasing its immunity and thereby enhancing protective properties.

Proteolytic enzymes lyse dead and non-viable tissue, promote rapid wound cleansing and deplete microbial cells nutrients. According to observations, these enzymes, by changing the habitat of microbes and destroying their shell, can make the microbial cell more sensitive to antibiotics.

Biological antiseptics involves the use of biological agents, as well as the influence on the immune system of the macroorganism. We have a suppressive effect on microbes and a stimulating effect on the immune system. The largest group of drugs of biological origin are antibiotics, which are usually products of the vital activity of fungi. various types. Some of them are used unchanged, some are subject to additional chemical treatment (semi-synthetic drugs), and there are also synthetic antibiotics. Antibiotics are divided into various groups, the pencillin group, proposed back in the 30s by Fleming, is especially widely used, and in our country this drug was synthesized by the group of Academician Ermolyeva. Introduction of penicillin into medical practice caused a revolution in medicine. That is, diseases that were fatal to humans, say pneumonia, from which millions of people around the world died began to succumb successful treatment. Purulent complications have become much less common in surgery. However, the misuse of penicillin for 20 years led to the fact that already in the 50s the doctors themselves completely compromised it. This happened because the strict indications for the use of penicillin were not taken into account; penicillin was prescribed for influenza to avoid complications - pneumonia caused by staphylococci or pneumococci. Or surgeons, when performing an operation for an inguinal hernia, prescribed antibiotics to avoid purulent complications. Currently, antibiotics cannot be used prophylactically, except in cases of emergency prophylaxis. The second circumstance is that it was prescribed in low doses. As a result, not all microbes were exposed to penicillin, and the microbes that survived the use of penicillin began to develop protective mechanisms. Most famous defense mechanism- this is the production of penicillinase - enzymes that destroy penicillin. This property is characteristic of staphylococci. Microbes began to include tetracycline antibiotics in their metabolic cycle. Strains have evolved that can only live in the presence of these antibiotics. Some microbes have rearranged their cell membrane receptors so as not to perceive antibiotic molecules.

In the 60s it appeared a new group antibiotics - antifungal antibiotics. The fact is that as a result of the large-scale use of antibiotics, people began to experience suppression of their own microflora of the colon, E. coli is suppressed, and it is vital for humans, for example, for the absorption of vitamins (K, B12). Recently, another mechanism of interaction between the human body and E. coli was discovered: E. coli is absorbed into the vessels of the intestinal villi and enters the mesenteric veins portal vein, and then to the liver and there they are killed by Kupffer cells. Such bacteremia in the blood of the portal vein is important for maintaining constant tone immune system. So when suppressed coli these mechanisms are disrupted. Thus, antibiotics reduce the activity of the immune system.

As a result of the fact that normal microflora, is suppressed by antibiotics, completely unusual for healthy person microflora. Among this microflora, fungi of the genus Candida are in first place. The development of fungal microflora leads to the occurrence of candidiasis. In our city, 10-15 cases of sepsis caused by canidomycosis are reported annually. That is why a group of antifungal antibiotics has appeared, which are recommended for use against dysbacteriosis. These antibiotics include levorin, nystatin, metragil, etc.

ASEPSIS

A method of surgical work that prevents microbes from entering or developing in the surgical wound. On all objects surrounding a person, in the air, in water, on the surface of his body, in the contents of internal organs, etc. there are bacteria. Therefore, surgical work requires compliance with the basic law of asepsis, which is formulated as follows: everything that comes into contact with the wound must be free from bacteria, i.e. sterile.

ASEPTICA is a set of preventive surgical measures aimed at preventing infection from entering the wound. This can be achieved by sterilizing everything that comes into contact with it. Aseptic technique was proposed by the German surgeon Bergman. This happened at the 9th Congress of Surgeons in Berlin. Bergman proposed physical methods of disinfection - boiling, burning, autoclaving.

Asepsis and antiseptics represent a single set of measures; they cannot be separated.

According to the source of infection, they are divided into exogenous and endogenous. Paths of penetration of endogenous infection: lymphogenous, hematogenous, through intercellular spaces, especially loose tissue, contact (for example, with a surgical instrument). For surgeons, endogenous infection does not pose a particular problem, unlike exogenous one. Depending on the route of penetration, exogenous infection is divided into airborne droplet, contact and implantation. Airborne infection: since there are not many microbes in the air, the likelihood of airborne infection is not high. Dust increases the likelihood of airborne contamination. Basically, measures to combat airborne infections come down to dust control and include ventilation and ultraviolet irradiation. Cleaning is used to combat dust. There are 4 types of cleaning:

1. preliminary is that in the morning before the start of the operating day, all horizontal surfaces are wiped with a cloth moistened with a 0.5% chloramine solution.

2. routine cleaning is carried out during the operation and means that everything that falls on the floor is immediately removed

3. final cleaning - after the operating day and it consists of washing the floors and all equipment with a 0.5% chloramine solution and turning on ultraviolet lamps. It is impossible to sterilize the air with the help of such lamps, but they are used in the place of the greatest sources of infection.

4. Ventilation is a very effective method - after it, microbial contamination drops by 70-80%.

1. first class - no more than 300 microbial cells in 1 cubic meter of air.

2. Second class - up to 120 microbial cells - this class is intended for cardiovascular operations.

3. The third class is the class of absolute asepsis - no more than 5 microbial cells per cubic meter of air. This can be achieved in a sealed operating room, with ventilation and sterilization of air, with the creation of a high-pressure zone inside the operating room (so that the air flows out of the operating rooms). Special lock doors are also installed.

Droplet infection is those bacteria that can be released into the air from the respiratory tract of everyone in the operating room. Microbes are released from the respiratory tract with water vapor, the water vapor condenses and, along with these droplets, microbes can enter the wound. To reduce the risk of the spread of droplet infection in the operating room, there should be no unnecessary talk. Surgeons must use 4-layer masks, which reduce the likelihood of infection by droplet infection by 95%.

Contact infection is all microbes that are able to penetrate the wound with any instrument, with everything that comes into contact with the wound. Dressing material: gauze, cotton wool, threads high temperature, therefore should not be less than 120 degrees, exposure should be 60 minutes.

Sterility control. There are 3 groups of control methods:

1. Physical: take a test tube into which is poured some substance that melts at a temperature of about 120 degrees - sulfur, benzoic acid. The disadvantage of this control method is that we see that the powder has melted and that the required temperature has been reached, but we cannot be sure that it was like this throughout the entire exposure time.

2. Chemical control: take filter paper, place it in a starch solution, and then immerse it in Lugol's solution. It acquires a dark brown color. After exposure in an autoclave, starch is destroyed at temperatures above 120 degrees, and the paper becomes discolored. The method has the same drawback as the physical one.

3. Biological control: this method is the most reliable. Samples of the sterilized material are taken and sown on Nutrient Media, no microbes were found - that means everything is in order. If microbes are found, it means it is necessary to re-sterilize. The disadvantage of the method is that we receive an answer only after 48 hours, and the material is considered sterile after autoclaving in a jar for 48 hours. This means that the material is used even before receiving a response from the bacteriological laboratory.

In recent years, mainly chemical methods of hand treatment have begun to be used: hand treatment with pervomur is widespread. This method is extremely reliable: glove juice formed within 12 hours after putting on gloves (in the experiment) remained sterile.

BASIC PRINCIPLES OF RATIONAL ANTIBIOTIC THERAPY

1. Purposeful use of antibiotics: according to strict indications, in no case for prophylactic purposes

2. Knowledge of the pathogen. results bacteriological research appear only after 12 hours, and the person must be treated immediately. Every third case of surgical infection is caused not by a monoculture, but by many pathogens at once. There can be 3-8 or more. In this association, one of the microbes is the leader and the most pathogenic, and the rest can be fellow travelers. All this makes it difficult to identify the pathogen, so it is necessary to put the cause of the disease at the forefront. If a person is in danger severe complication or death, then it is necessary to use reserve antibiotics - cephalosporins.

3. Right choice dosage and frequency of antibiotic administration based on maintaining the required level of antibiotic concentration in the blood.

4. Prevention of possible side effects and complications. Most common side effect- allergies. Before using an antibiotic, a diagnosis must be made skin test for antibiotic sensitivity. To reduce the risk of toxicity between antibiotics. There are antibiotics that enhance the adverse effects of each other. There are antibiotics that weaken it. To select antibiotics, there are antibiotic compatibility tables.

5. Before starting antibiotic therapy, it is necessary to find out the condition of the patient’s liver, kidneys, and heart (especially when using toxic drugs).

6. Development of an antibacterial strategy: it is necessary to use a/b in various combinations. The same combination should be used for no more than 5-7 days; during treatment, if there is no effect, it is necessary to change the antibiotic to another.

7. When a person becomes ill of an infectious etiology, it is necessary to monitor the state of the immune system. It is necessary to use our existing methods for studying humoral and cellular immunity in order to promptly identify a defect in the immune system.

There are three ways to influence immunity:

· active immunization, when antigens are introduced, in surgery these are vaccines, toxoids.

· Passive immunization with serums, gamma globulin.

Antitetanus, antistaphylococcal gamma globulins, and immunomodulation are widely used in surgery. The use of various immune stimulants: aloe extract, autohemotherapy and other methods, but the lack of stimulating effect is that we act blindly, not on any specific immune mechanism. Along with normal ones, there are also pathological immune reactions- autoimmune aggression. Therefore, what is happening now is not immunostimulation, but immunomodulation, that is, an effect only on the defective part of the immune system. Nowadays, various lymphokines, interleukins, interferons, and drugs obtained from the thymus gland that affect the T-population of lymphocytes are used as immunomodulators. Various extracorporeal immunomodulation techniques can also be used: ultraviolet blood transillumination, hemosorption, hyperbaric oxygenation, etc.

BIBLIOGRAPHY

1. Borodin F.R. Selected lectures. M.: Medicine, 1961.

2. Zabludovsky P.E. History of Russian medicine. M., 1981.

3. Zelenin S.F. A short course in the history of medicine. Tomsk, 1994.

4. Stochnik A.M. Selected lectures on the course of history of medicine and cultural studies. – M., 1994.

5. Sorokina T.S. History of medicine. –M., 1994.

Asepsis (Greek a - without + sëptikos - causing suppuration, putrefactive) is a set of measures aimed at preventing the penetration of microorganisms into the wound and into the body as a whole. Asepsis has the main goal: protecting the patient’s body and especially the wound from contact with an external bacterially contaminated environment, destroying microorganisms using physical, chemical, biological and mechanical methods on everything that can come into contact with the patient’s wound, as well as on objects that can be a source of spread nosocomial infection. The basic law of asepsis: “Everything that comes into contact with the wound must be free of bacteria.”

The aseptic method is a further development of the antiseptic method and is closely related to it (see). The founders of A. are German surgeons E. Bergmann and S. Schimmelbush, Russians - M.S. Subbotin, P.I. Dyakonov. Modern A. provides for the destruction of microbes by in different ways transmission of infection: airborne, droplet, contact and implantation. Source airborne infection are microbial cells found in the air. The basis for the prevention of airborne infection is the fight against dust in the air in the hospital premises, dressing rooms, and operating rooms.

The main measures aimed at reducing airborne infection come down to: 1) optimal ventilation of operating rooms and dressing rooms (including air conditioning) 2) limiting visits to operating rooms and reducing the movement of personnel through them, 3) protection from static electricity, which causes dissipation dust, 4) wet cleaning of premises, regular ventilation and irradiation of the operating room with UV light, 5) reducing contact time open wound with air.

Droplet infection is a type of airborne infection when the source of infection is air contaminated with droplets of saliva from the mouth and respiratory tract of the patient and staff or small drops of other infected liquids. The main measures aimed at combating droplet infection are a ban on talking in the operating room, mandatory wearing of masks to cover the mouth and nose of medical staff, as well as timely routine cleaning of operating rooms. Contact infection - infection of a wound with unsterile instruments, contaminated hands, materials, etc.

Prevention of contact infection consists of sterilizing everything that comes into contact with the wound, is introduced into the human body during operations, dressings, injections, etc. Sterilization is carried out by physical and chemical methods. TO physical methods includes heat sterilization: pasteurization, boiling, steam sterilization under pressure, dry heat; Ultrasound and radiation sterilization. TO chemical methods Sterilization includes the use of chemicals: formalin vapor, iodine solutions, chlorhexidine bigluconate, etc. Implant infection is an infection that is introduced into a wound with suture material, tampons, drains, prostheses, etc.

Prevention of such an infection consists of their thorough sterilization. To ensure asepsis measures are extremely important organizational events (proper planning surgical departments and operating units, the use of monitoring systems to monitor patients) and personnel sanitation. Knowledge and strict adherence to the rules of A. by all employees is the law of work in surgical practice.

In pharmacy, creating aseptic conditions for the technological process of drug production has its own specifics. Thus, it is necessary to prevent contamination of equipment, premises, raw materials, materials, intermediate products with viable microorganisms and mechanical particles in order to ensure the sterility of the finished product.

The production of medicines under aseptic conditions in pharmacies and medical centers is carried out in special “clean” rooms, where air purity is standardized based on the content of microbial bodies and mechanical particles. Access to such premises by personnel and entry of raw materials, materials, intermediate products and equipment is permitted only through airlocks. Clean areas must be maintained to an appropriate degree of cleanliness, and ventilation air entering such areas must be treated using filters of appropriate efficiency.

For the production of sterile products under aseptic conditions in pharmaceutical production, four classes of cleanliness zones are distinguished: class A (filling, capping, mixing under aseptic conditions, etc.). Requires minimal risk contamination with laminar air flow; class B - environment for class A zone; classes C and D - clean areas for other, less critical technological operations.

To produce sterile medicines in pharmacies, it is necessary to have an aseptic unit, which must have at least 3 rooms: a transfer room (gateway), an aseptic room and a hardware room. Aseptic conditions for the manufacture of drugs in the relevant production premises of pharmacies and pharmacies are ensured through technological and sanitary measures: installation of sterile supply ventilation and recirculation air purifiers, increasing the air exchange rate, using bactericidal emitters, special training premises and personnel sanitation.

Asepsis- a set of measures aimed at preventing the entry of microorganisms into the wound.

Asepsis has undoubted advantages over antiseptics in terms of treatment results, and also because with the aseptic method of treating wounds there is no poisoning, which is possible when using some antiseptics.

The basic rule of asepsis is that everything that comes into contact with the wound is sterile, that is, reliably disinfected, free of viable bacteria.

Sterilization is the release of objects external environment from various microorganisms using physical and chemical methods(disinfection, sterility). Sterilization technology includes the following stages: disinfection, cleaning the material, placing it in containers and sterilizers, sterilization itself, evaluating its effectiveness and storing sterile material. There are steam sterilization (water vapor pressure), air (hot air) and gas (sterilizing gas), chemical, radiation (ionizing radiation, ultraviolet rays).

Steam method:

for sterilization of dressings, linen, instruments:

2.1 ATM (steam temperature - 132.9 ° C) - 20 minutes. 1.1 ATM (steam temperature - 120° C) - 45 minutes (reusable syringes, glass).

for sterilization of rubber products: 1.1 ATM (steam temperature - 120° C) - 45 minutes (purge every 5 minutes).

Air method:

For sterilization of glass and instruments Dry-heat oven (air temperature - 180° C) - 60 min. Dry-heat oven (air temperature - 160° C) - 150 min.

Solutions of chemical compounds(instruments, endoscopes): 6% hydrogen peroxide - 6 hours; lysoformin 3000 8% - 1 hour;

Sidex 2% - 10 hours; glutaraldehyde 2.5% - 6 hours.

Gas method ( dental, surgical instruments, reflexology needles, etc.): ethylene oxide; formaldehyde

Operating linen and material(wipes, bandages, gloves, suture material, etc.) are sterilized and stored in special drum boxes (Schimmelbusch boxes). Large boxes come in two types: without a filter (with side holes covered by a metal belt with a tension lock) and with a filter (with holes in the bottom and lid of the box covered with textile filters - madepolam, flannel, etc.).

TO dressing material include napkins, gauze balls, tampons, turundas, bixes; for operating linen - gowns, sheets, towels, masks, caps, shoe covers.

After preparation, the dressing material and surgical linen are placed in bags or linen bags. After sterilization, the shelf life of dressings and linen in bags is 48 hours, in bags - 24 hours (if they have not been opened).

Uninfected instruments wash with running water for 5 minutes and soak in warm (up to 50 ° C) washing solutions for 15-20 minutes. Approximate compositions of washing solutions: perhydrol 20 g, washing powder 5 g, water - 975 ml; 2.5% hydrogen peroxide solution - 200 ml, washing powder 5 g, water - 775 ml. Tools are washed in this solution with a brush and brushes, rinsed warm water 5 min and distilled - 1 min. Then they are dried in a dry air sterilizer at a temperature of 85 ° C.

Instruments contaminated with pus or intestinal contents are placed in enamel containers with a 0.1% diocide solution or a 5% Lysol solution for 30 minutes. Then they wash in the same solution with brushes, rinse with running water and then follow the procedure described for uninfected instruments. Instruments in contact with anaerobic infection(soak for 1 hour in a 6% solution of hydrogen peroxide with a 0.5% solution detergent, washing and boiling for 90 minutes, then according to the above method.

Sterilization suture material can be carried out in factory conditions with gamma radiation.

Ampuled skeins of catgut, silk, nylon and other threads are stored at room temperature and used if necessary.

Linen and cotton threads, lavsan, nylon are sterilized in an autoclave. Silk, nylon, lavsan, cotton are also sterilized using the Kocher method.

Catgut is sterilized after degreasing (soaking in ether for 24 hours) according to the methods of Claudius (using Lugol's solution and 96% alcohol solution), Gubarev (Lugol's solution), Sitkovsky (in a 2% solution of potassium iodide), etc.

Sterility control medical products carried out bacteriological laboratories medical and preventive institutions and sanitary and epidemiological services.

Classification of surgical instruments. Storage of tools. Preparing tools for work. Technique for covering the dressing table in the dressing room. Monitoring the sterility of instruments.

Surgical instruments can be divided into general purpose tools and special purpose tools.

1. To separate tissues: scalpels, knives, scissors, saws, chisels, osteotomes, nippers, etc. Cutting instruments also include resection knives used to cut dense tendon tissue near joints, and amputation knives.

2. Auxiliary Tools(expanding, fixing, etc.: anatomical and surgical tweezers; blunt and sharp hooks; probes; large wound dilators (mirrors); forceps, Mikulicz clamps, etc.

3. Hemostatic: clamps (such as Kocher, Billroth, Halstead, Mosquito, etc.) and Deschamps ligature needles.

4. Tools for joining fabrics: needle holders different systems with piercing and cutting needles.

Used in manipulations surgical instruments must be sterile.

Surgical instruments passed from hand to hand with blunt ends towards the recipient so that the cutting and piercing parts do not injure the hands. In this case, the transmitter must hold the instrument by the middle.

Majority surgical instruments made of chrome-plated stainless steel.

Tool processing

Stage I - pre-sterilization preparation.* Wash in running water for 5 minutes. * Soak in a special washing solution at a temperature of 50? C for 15 - 20 minutes. Washing solution: 0.5% powder, 1 liter of water, 3% peroxide.* Wash in the same solution with a brush. * Rinse for 5 minutes with warm water. *Rinse in distilled water for 1 minute.* Powder test - phenolphthalein. * Blood test - benzidine.

Stage II - laying and preparation for sterilization. In a dry-heat oven: Place in metal boxes, stacked vertically in one layer. The lids of the boxes are sterilized nearby. In autoclaves: Wrap in a waffle towel in the form of a package and place on a metal tray or mesh.

Stage III - sterilization. Instruments and glassware are sterilized in a dry-heat oven: * Placed on shelves. * Heating is turned on. * Bring to 80 – 85?C with the door open. *Dry for 30 minutes. * Close the door. * Bring to 180 0 C. * Sterilize for 1 hour. * After the temperature drops to 70 - 75 0 C, open the door. * Use a sterile instrument to close the metal boxes with instruments with a lid. * After 15 – 20 minutes the chamber is unloaded.

Instruments, systems, and gloves are sterilized in an autoclave. Instruments: at 2 atm. - 20 minutes, 132 €.

Stage IV - storage of sterile material. Stored in a separate room. Sterility in containers is 48 hours. If instruments wrapped in material were sterilized in containers - 3 days.

The dressing nurse receives a list of all dressings for the day and sets their order. First of all, patients with a smooth postoperative course (removal of sutures) are bandaged, then those with granulating wounds. Having made sure that the dressing room is ready, the nurse begins to treat her hands.
First, she puts on a surgical uniform, carefully hides her hair under a headscarf or cap, trims her nails short, and puts on a mask. After cleaning her hands, the sister gets dressed. She takes a robe from the bix without touching the edges of the bix. Carefully unfolding it on outstretched arms, she puts it on, ties the sleeves of the robe with ribbons and hides the ribbons under the sleeve. The dressing room nurse opens the bix and ties the ribbons of the dressing gown at the back. After this, the nurse puts on sterile gloves and covers the instrument table. To do this, she takes out a sterile sheet from the box and lays it, folded in half, on the instrument table. The nurse opens the sterilizer, uses hooks to remove the nets with instruments from the sterilizers, allowing the water to drain, and carefully places the nets on the corner of the instrument table covered with a sheet. When air sterilizing in kraft paper, the nurse should first find out the sterilization date. Products sterilized in kraft paper can be stored for no more than 3 days.
The instruments should be laid out in a certain order, which the dressing nurse chooses herself. Usually the instruments are laid out on the left side of the table, the dressing material is on right side, special instruments and drainage tubes are placed in the middle. Here the sister puts sterile jars for novocaine, hydrogen peroxide, furatsilin. The nurse leaves the right corner free for preparing stickers and bandages during dressing. The sister covers the instrument table with a sheet folded in half. Preparatory work must be completed by 10 o'clock