无菌术教育课件

AsepsisAsepsisHistorySignificanceandDefinitionAsepsisofSurgicalinstrumentandDressingPreparationforDr.andPt.KeyPointsHistoryandSignificanceHippocrates(460-377BC)SeparatedmedicinefromphilosophyIrrigatedwoundswithwineorboiledwaterForeshadowingofAsepsisHistory:Pasteur(1862)DiscoveredbacteriumDevelopedPasteurizationprocessHistory:History:

Mikulicz-Radecki(1887)---facemasks

Furbringer(1889)-----------hands-scrubbing

Halsted(1890)---------------surgical-glovesSterilizationfor

SurgicalInstruments190619331947SteamSterilizationHistory:SteamSterilization(1974)EarlytypeofhotairsterilizerMicrowaveOven(1947)AdvancedSterilizerLowtemperaturesystemforendoscopicdevices(1989)Plasmasterilizingsystem(1993)BasicprincipleofSurgeryBasicprincipleofMedicine Significance:DefinitionSterile

freeofalllivingmicroorganismsSterilization

（灭菌）aprocesscapableofdestroyingallformsofmicrobiallifeoninanimatesurfacesAsepsis

（无菌）absenceofmicroorganismsthatcausedisease;freedomofinfectionDisinfection

（消毒）aprocesscapableofdestroyingpathogenicmicroorganismsbut,asordinarilyused,notbacterialsporesAutoclavingDryheatMicrowaveInfraredraysBoilingBurningGasSterilizationEthyleneoxideFormaldehydeSoakinginAntisepticsSterilizationandDisinfectionHighpressure15-20lbf/in2Hightemperature121-126℃TimedependonT&P30min

themostcompletelyreliablesterilizationAutoclaving

(SteamunderPressure)Storagetime 2WeeksAttention 40cm30cm30cm Arrangement 3MIndicateTape FlammableStuff Liquid---degas AutoclavingAvoidbeingspoiledbymoistheatTemperature=160℃Time=1hours(4hoursforgrease)----exposuretocontinuousdryheatDryHeatOnlyifautoclaving,dryheat,gassterilizationisNOTavailable(formetal,glassorrubberstuff)Minimumperiodis20minPeriodcanbedecreasedto10minsafelyinadditionofalkaliNoteffectiveagainstsporeunlessperiod>1hourDripincompletelyTimeCalculationBoilingFormetalinstrumentOnlyinspecialsituation 95%Ethanol Causingdamagetothemetalinstrument Burning2%Glutaraldehyde 30min10%Formaldehyde 20-30min70%Ethanol 30min1：1000BromoGeramine 30min1：1000Chlorhexidinium

30min

Fordelicateinstrument,endoscopeorlaparoscopeSoakCleaninginAntisepticsAttention：CleanBeforeSoakingDripinCompletelyOpenAxesWashbySalinebeforeusingSoakCleaningExcellentsterilizationformostheat-sensitivematerialsDestroybacteria,viruses,fungi,sporesFlammableandtoxicandcausingsevereburnsGasSterilization

Ethyleneoxide&FormaldyhydeMicrowaveTemperature=100℃Time=5-20minInfrared

raysTemperature=160℃Time=60-120minReservationWashingInfectionofP.aeruginosa,Tetanus,Gas-gangreneandHBVpositive Single-useStuff BurntoutAsepsis: OthersPreparationforDr.andPt.

Gown,shoescoverHeadcover,facemaskShortennailGeneralPreparation：Asepsis: PreparationforDr.Washinghands&forearmswithsoapDeliveringantisepticsontowethands,andscrubbing3-5minRinsingthoroughly,drywithasteriletowelAsepsis-HandsScrubbing:Iodophor&IodineMostefficientandbroad-spectrumactivityRarelyskinreactionProlongedactivityNotuseondelicateskinChlorhexidine(Hibitane)Sensitiveareas(perineum,face,genitalia,aroundeyes,infants)AntisepticsDirectionforSterilization

CenterAround AroundCenterDistanceforSterilization 15cmAreaforSterilizationAsepsis: PreparationforPt.

---Toseparatecontaminated

areafromsterilefield

HeadcoverFacemaskShoecoverGloveGownDrapeAsepticMechanicalBarrier

Drape

SterileEnvelope

History:Largeenough(>20*20feet)WithappropriateventilationRemainingclosed&positivepressure

OperatingRoomNOTtouchanynon-sterilizedgoodswithscrubbedhandsNOTpassequipmentthroughthecontaminatedfieldChangepositionfacetofaceorbacktobackNOTliftormovethesteriledrapesCheckbefore/afterOperation

AsepsisinoperativeprocedureStrictaseptictechniqueisessentialtominimizesurgicalinfectionrateItisthemostimportanttokeepasepsisprincipleinmindduringtheanysurgicalprocedureConclusionBloodTransfusionHistoryTypeofTransfusionIndicationTransfusionReactionsAutologoustransfusionComponentTransfusionBloodTransfusionHistoryandSignificanceLower

(1665)FirstbloodtransfusionPhilip(1825)FirsthumanbloodtransfusionLandsteiner

(1900)

DiscoveryofABOtypeHowtostorebloodlonger?WorldwarIIsthereanysuitable

BloodSubstitutesWorldwarIISuccessfulbloodtransfusionisrelativelyrecentCrossmatchingAnticoagulationPlasticstoragecontainerBloodTransfusionTypeofTransfusion：WholeBlood；BloodComponent；

RBCPLTFFPLeukocyteconcentrate

PlasmaSubstitutes；UseofwholebloodisconsideredtobeawasteofresourcesBloodTransfusionSymptomaticanemia(providingoxygen-carryingcapacity)Transfusiontrigger(HCT<30%;HB<10g/dl)1Unitincreases3%HCTor1g/dlShelflife=42d(1-6℃)RedBloodCellsThrombocytopenia(<50,000)PlateletdysfunctionEachunitincrease5,000PLTsafter1HPlateletsProfoundlygranulocytopenia(<500)SeriousinfectionnotresponsivetoantibiotictherapyGranulocytesCoagulationfactordeficiencies1mlincreases1%clottingfactorsBeingusedassoonaspossibleAlbumin,hetastarch,crystalliodsareequallyeffectivevolumeexpanderbutsaferthanFFPAfteruseof5UofRBCs,matching2UofFFPFreshFrozenPlasma(FFP)--VolumeExpanderDextranMostwidelyusedLow/MiddleM.W.(40,000-70,000)MassivetransfusioncouldimpaircoagulationOccasionalALLERGICreactionHydroxyethylStarchFormulation(HES)MorestableContainingessentialelectrolytesNoallergicreactionPlasmaSubstitutesIndication：Acutemassivebloodloss;Anaemiaandhypoalbuminemia;OverwhelmingInfection;DysfunctionofCoagulation;BloodTransfusionTechniqueofTransfusion:ApproachRoute:

PeripheralVein,CenterVeinFiltrationbeforeTransfusion：VelocityofTransfusion：

5-10ml/minBloodTransfusionDoubleCheck:Name,TypeandCrossmatchStorageTime: CitratePhoshateDetrose AcidicCitrateDetrose

21D,35DPre-heat：NoanyotherMedication：Observationduring/afterTransfusion：Attention：BloodTransfusion Incidence：2% Chills,Fever39-40.C Headache,Sweatiness Nausea,Vomiting,Flushing 15min-1hr FebrileReactions：TransfusionReactionsImmuno-reaction：Endo-toxins：ContaminationorHemolysis： Analyzepossiblereasons：StopTransfusion：GeneralSupport： Treatment：FebrileReactions：TransfusionReactions Urticaria Abdominalcramps Dyspnea

Vomiting Diarrhea Anaphylacticreactions：TransfusionReactionsImmuno-reaction： IgEHereditaryImmunoglobulin：IgAReason：AdministerantihistaminesAdministerepinephrine,diphenhydramine,andcorticosteroids：Supportairwayandcirculationasnecessary：Treatment：Anaphylacticreactions： Burningattheintravenous(IV)linesite Fever,Chills,Dyspnea Shock CardiovascularCollapse Hemoglobinuria,Hemoglobinemia RenalFailure DIC HemolytictransfusionreactionsTransfusionReactionsABOincompatibilityRhIncompatibilityNon-immuneHemolysisImmuneHemolysis Reasons：HemolyticTransfusionReactionsStopTransfusionassoonasreactionissuspectedCheckthename,typeandcrossmatchUrineExam RenalProtection (AggressiveFluidResuscitation,Furosemide)DICMonitor Treatment：HemolyticTransfusionReactionsDoubleCheckname,typeandcrossmatchOperatecarefullyandroutinely TemperatureMonitorPrevention：HemolyticTransfusionReactionsMassivetransfusioncomplications: VolumeOverload CongestiveHeartFailure Tachycardia Tachypnea Cyanopathy TransfusionReactionsVolumeOverloadHeartFunctionalFailureLungFunctionalFailure Reasons：StopTransfusionHeartFunctionalSupportDiuresis (Furosemide)Treatment：MassiveTransfusionComplications:Contamination: Fever Shock DIC

BacterialContamination Reasons：TransfusionReactionsStopTransfusionBacterialExamandCultureAntibiotics Treatment：DoubleCheckOperatecarefullyPrevention：Contamination:HepatitisB,HepatitisCHIVCytomegalovirus(CMV)