手术学总论及无菌术(英文)课件

1、 General Operative SurgerySurgerySurgery is medical treatment in which someones body is cut open so that a doctor can repair, remove, or replace a diseased or damaged part.Classification of surgery（1）based on the condition emergency selective operation（ benign tumour ）limited operation （ therioma）em

2、ergency operation （ rupture of spleen 、 trauma）（3） based on the lesionproperties and difficulty one-stage operation two-stage operationMulti periodoperationAppearancewound dressing, skin closure, and youCleanNo religiousNo political buttons Opetating Room-OR75% questions about anatomyNever argue wit

3、h the scrub nurseDo not touch anythingKeep quiet, never runFeel faintFeel swell ASEPSISASEPSISHistoryBasic ConceptionMethodsTechniqueThe OriginHippocrates (460-377 BC)The Oath of Medicinewounds must be cleaned with wine, boiled water or clean rain waterKoch (1881)GermanHot steam Beginning of sterili

4、zationHalsted (18521922)The first surgeon professor in Johns HopkinsGlovesThe father of American SurgeryBASIC CONCEPTIONAseptic technique Aseptic technique is the technique aiming to prevent all kinds of microorganisms from invading the body in the process of medical treatment and nursing care and i

5、t also means the technique that prevent germ free articles and environment from contaminated. BASIC CONCEPTION Sterilization use of physical procedures or chemical agents to destroy all microbial forms, including bacterial sporesDisinfection use of physical procedures or chemical agents to destroy m

6、ost microbial forms; bacterial spores and other relatively resistant organisms may remain viableSterilizationTotal destruction of all microbes, includingBacterial sporesMycobacteria, TBNonenveloped (nonlipid) virusesFungiDisinfectionDestroying most of the microbial formsBacterial spores and relative

7、ly resistant organisms remain viableDisinfectants are subdivided into high-, intermediate-, low- level agentsSterilizationPhysical methodsChemical methodsSterilizationPhysical methods:HeatFiltrationRadiationSterilization by heatMoist heatDry heatDry heat171C 1h160C 2hSpecial chambersGlasswareMoist h

8、eat: Boiling100C5-6min disinfectioinMoist heat: AutoclavingSteam under pressureThe most reliable sterilizationAny heat and moist resistant materialsdownward displacementPressure =104.0137.3 kPaTemperature =121126Time = 30minpre-vacuum autoclave Pressure =170 kPaTemperature =133Time = 46minMoist heat

9、: AutoclavingMilkBeer63C 30min72C 15 minMoist heat: Pasteurization Moist heat Dry heatPenetrating potency higherlowerTemp for protein clotting lowerhigher Time short longSterilizing potency: Moist heat Dry heatRemoves bacteria and fungiFrom air and solutionsThey can not remove viruses and smaller ba

10、cteriaSterilization by filtrationUltraviolet (limitation: direct exposure)Lonizing radiation (microwave or gamma rays)Sterilization by radiationEthylene oxide ( Strict regulations: extremely toxic)Formaldehyde gasHydrogen peroxide vaporsSterilization-chemical methods: Gas vapor sterilantsPeracetic a

11、cid 0.2% An oxidizing agent Excellent activity Non-toxic end produtsGluteraldehyde 2% Toxic: care must be used when handing this chemicalSterilization-chenmical methods: Liquid chemical sterilantsDisinfectionDestroying most of the microbial formsBacterial spores and relatively resistant organisms re

12、main viableDisinfectants are subdivided into high-, intermediate-, low- level agentsDisinfection-Chemical Methods：HighKilling all microbes including endospores and TBglutaric dialdehydeformaldehyde peroxyacetic acidepoxy ethaneMediumKilling all non-spore microbes including TBalcoholchlorinesiodophor

13、sLow Killing vegetative bacteria and lipophilic viruses, but resisted by endospores, TB and hydrophilic (non-enveloped) viruseschlorhexidinebromogeramineExcellent activity against all groups of organismsExcept sporesNon-toxicInactivated by organic materialAlcoholsExcellent activity ( skin antiseptic

14、s)Slightly more toxicInactivated by organic materialFrequently used with alcoholsIodophorsPrinciple of Aseptic TechniquePrinciple of Aseptic Technique-11. The surroundings should be clean, roomy.The surroundingsThe operating-table30 minutes, stop cleaning and minimize movingPrinciple of Aseptic Tech

15、nique-22. The hospital personnels appearance should conform to the standard.cap and masktrim fingernails wash handsPrinciple of Aseptic Technique-33. Knowing the basic concept.Aseptic area Non-aseptic area Aseptic supplyPrinciple of Aseptic Technique-44. The articles should be placed orderly and lab

16、eled clearly.Keep aseptic articles in sterile containers or sterile packagesthe label on the packageonly used oncePrinciple of Aseptic Technique-55. Sense of aseptic in the procedure.Keep away from the asepticface to the aseptic areaDo not reach across sterile fieldKeep the non-aseptic articles far awayAvoid talking, coughing and sneezingNo doubtAny surgical procedure needSterile surgical instrumentsClean patientLarge