Asepsis , antisepsis and Sterilization

Syahbuddin HarahapDepartment of SurgeryAdam Malik Hospital

Asepsis and antisepsisHistory1847 - Semmelweis identifies surgeons hands as route of spread of puerperal infection 1865 - Lister introduces hand and wound asepsis with the use of carbolic acid

1880 - von Bergmann invents the autoclave

Asepsis is the practice to reduce or eliminate contaminants such as :- Bacteria- Viruses- Fungi- Parasitesfrom entering the operative field in :- surgery - medicine to prevent infection. Ideally, a field is "sterile" free of contaminants a situation that is difficult to attain. However, the goal is elimination of infection, not sterility.

Aseptic Technique in Medical Procedures: Aseptic technique is the effort taken to keep patients as free from hospital micro-organisms as possible (Crow 1989). The founder of the technique is considered to be Joseph Lister. It is a method used to prevent contamination of wounds and other susceptible sites by organisms that could cause infection. This can be achieved by ensuring that only sterile equipment and fluids are used during invasive medical and nursing procedures.

Ayliffe et al. (2000) suggest that there are two types of asepsis: -Medical asepsis -Surgical asepsis.Medical or clean asepsis reduces the number of organisms and prevents their spread.

Surgical or sterile asepsis includes procedures to eliminate micro-organisms from an area and is practised by nurses in operating theatres and treatment areas.

Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of :- infection- sepsis- putrefaction. Antibiotics that destroy microorganisms within the body

Disinfectants, which destroy microorganisms found on non-living objects. Some antiseptics are :- bacteriocidal true germicides, capable of destroying microbes - bacteriostatic and only prevent or inhibit their growth. Antibacterials are antiseptics that only act against bacteria

Use in surgeryThe widespread introduction of antiseptic surgical methods followed the publishing of the paper Antiseptic Principle of the Practice of Surgery in 1867 by Joseph Lister, inspired by Louis Pasteur's (1863) germ theory of putrefaction.

In this paper he advocated the use of carbolic acid (phenol) as a method of ensuring that any germs present were killed.

But every antiseptic, however good, is more or less toxic and irritating to a wounded surface.Hence it is that the antiseptic method has been replaced in the surgery of today by the aseptic method, which relies on keeping free from the invasion of bacteria rather than destroying them when present.

HistoryThe first step in asepsis is cleanliness, a concept already espoused by Hippocrates. The modern concept of asepsis evolved in the 19th century. Semmelweis showed that washing the hands prior to delivery reduced puerperal fever. After the suggestion by Louis Pasteur, Lister introduced the use of carbolic acid as an antiseptic and reduced surgical infections rates. Lawson Tait went from antisepsis to asepsis, introducing principles and practices that have remained valid to this day. Ernst von Bergmann introduced the autoclave, a device used for the sterilisation of surgical instruments.

Methods Asepsis and antisepsis

Good hygienic practice.

The procedure room is regulations concerning filtering and airflow, and kept clean between surgical cases.

A patient who is brought for the procedure is - Washed and wears a clean gown

The surgical site is washed, possibly shaved, and skin is exposed to a germicide (i.e., an iodine solution such as betadine).

5. Members of the surgical team:- Wash hands and arms with germicidal solution. - Operating surgeons and nurses wear sterile gowns and gloves. - Hair is covered and a surgical mask is worn.

6. Instruments are sterilized through autoclaving, or, if disposable, are used once.

7. Irrigation is used in the surgical site.

8. Suture material have been sterilized beforehand.

9. Dressing material is sterile.

10. Antibiotics are often not necessary in a "clean" case, that is, a surgical procedure where no infection is apparent; however, when a case is considered "contaminated," they are usually indicated.

11. Dirty and biologically contaminated material is subject to regulated disposal.

Larutan cuci tanganLarutan cuci tangan bedah untuk operasiLarutan skin preparationLarutan antiseptik untuk perawatan luka

Paling rentan terhadap-Bakteri gram + dan gram -Fungi-VirusSpora resisten , hanya mencegah pertumbuhan spora selanjutnya dan kadang kadang bisa menghilangkannya dari kulitKulit manusia tidak bisa di sterilkanpengurangan jumlah mikroorganisme terutama kuman transien

Aksi yang luas terhadap mikroorganismeEfektivitasKecepatan aktivitas awalEfek residu, aksi yang lama setelah pemakaian untuk meredam pertumbuhanTidak mengakibatkan iritasi kulitTidak menyebabkan alergiEfektif sekali pakai, tidak perlu diulang-ulangDapat diterima secara visual maupun estetik

KELOMPOK AKTIVITAS THDP BAKTERIAktivitasAwalEfekResiduDAMPAKGM -Gm+M.TBCvirusesI.

II

III

IV

V

VIAlkohol

ChlorhexidenGluconateHexachlorophene

Iodine / iodophors

Chloroxylenol

TriclosanBaik

Baik

Baik

Baik

Baik

BaikBaik

Baik

Buruk

Baik

sedang

BaikBaik

Sedang

Tidakada

Baik

Sedang

SedangBaik

Baik

Buruk

Baik

Sedang

BurukCepat

Sedang

Lambat

Cepat

Baik

LambatBuruk

Baik

Baik

Buruk

Baik

Baik

Kulit keringOtotoksinKeratits

Iritasi kulit

Masuk kedalam proses metabolisme sel mikro organisme shg kemampuan sel untuk bertahan dan memperbanyak diri terhambat

Merubah struktur protein sel mikro organisme terjadi koagulasi protein dan penghancuran sel

Meningkatkan permiabilitas membran plasma sel mikro organisme dan terjadi lisis

Sterilization (or sterilisation) refers to any process that effectively kills or eliminates transmissible agents such as :- fungi- bacteria- viruses from a surface, equipment, foods, medications, or biological culture medium.

Sterilization can be achieved through application of:heatchemicalsirradiationfiltration

STERILISASI UAP PANAS (OTOKLAF)Menggunakan uap panas dan tekanan tinggi 2 atm temp.120C waktu 30 menit biasanya digunakan untuk bahan dari linen dan packing instrumen

2.STERILISASI PANAS (Dry Heat)Pada suhu 160C diperlukan waktu 4 jam biasanya digunakan untuk instrumen bedah

3.STERILISASI DENGAN ETILEN OKSIDAGas EO mudah menguap dan penetrasinya sangat baik untuk lumen kateter yang kecilKerugian gas ini mudah meledak dan karsinogenik

4.STERILISASI DENGAN SUHU RENDAHMenggunakan Plasma hydrogen peroksida dan Vapour-phase hydrogen peroksidaBaik untuk alat-lat yang sensitif terhadap panas dan kelembabanserta ramah lingkungan dan tidak meninggalkan residu

Sterilisasi berarti menghilangkan seluruh mikroorganisme termasuk spora

Desinfeksi adalah menghilangkan Mikroorganisme sampai jumlah tertentuBerdasarkan kekuatan desinfektan membunuh kuman :Desinfeksi tingkat tinggi---- Glutaraldehyde 2 %Desinfeksi tingkat menengah Chlorin bebasDesinfeksi tingkat rendah --- Air panas

Pilihan untuk Sterilisasi dan Desinfeksi tergantung pada:Tipe bahan instrumen /AlatWaktu yang tersediaResiko terhadap pasien dan personil rumah sakit

Sterilisasi berarti menghilangkan seluruh mikroorganisme termasuk spora

Desinfeksi adalah menghilangkan Mikroorganisme sampai jumlah tertentu

Berdasarkan kekuatan desinfektan membunuh kuman :Desinfeksi tingkat tinggi Glutaraldehyde 2 %Desinfeksi tingkat menengah Chlorin bebasDesinfeksi tingkat rendah Air panas

Pilihan untuk Sterilisasi dan Desinfeksi tergantung pada:

Tipe bahan instrumen /AlatWaktu yang tersediaResiko terhadap pasien dan personil rumah sakit

Di lingkungan rumah sakit,berbagai jenis instrumen digunakan di tiap bagian

Sudah seharusnya ada dasar panduan yang membantu tenaga medis menentukan apakah suatu instrumen sebaiknya -sterilisasi -desinfeksi

Berdasarkan Kriteria Instrumen Spaulding terhadap tubuh pasien

Non KritikalKontak dengan kulit tubuhDesinfeksi tingkat rendah/menengahMembunuh sebagian besar mikroorganismeSemikritikalKontak dng mukosa utuh / kulit yang lukaDesinfeksi tingkat tinggiMembunuh semua mikroorganisme kecuali beberapa sporaKritikalKontak dengan organ dibawah kulit/mukosaSterilisasiMembunuh semua mikroorganisme dan spora

Dekomtaminasi Tujuan -mencegah penyebaran potensi infeksi-melindungi tenaga medisCaranya merendam dengan larutan desinfektan yang mengandung Chlorin bebas selama 15 menit virus hepatitis B , Virus HIVPre-cleaning (Membersihkan peralatan)-Mekanikal-Kimiawi enzym protease waktu 5 menit3.Sterilisasi atau Desinfektan tergantung kebutuhan

DEKONTAMINASI

Dari foto ini petugas yang mana yang tidak melakukan tindakan Asepsis ?

Diperlukan tindakan Asepsis , Antisepsis dan Sterilization