Asepsis and Antisepsis

Rafael John Rivera

Angela Montero
 History
Prior to the discovery of asepsis, many people died due to
operative (and other) infections.
1847 – Dr. Ignaz Semmelwies
1865 – Joseph Lister
 Drastic reduction in Infection
 1880 – von Bergmann
 Asepsis
The absence of infectious organisms
Is the prevention of access of microorganisms to an
operative wound
Is the purposeful prevention of the transfer of
microbes from one person to another.
Medical Asepsis vs. Surgical Asepsis
Medical Asepsis
Clean technique
The use of practices aimed at destroying and inhibiting
the growth and spread of pathogenic microorganisms
Handwashing
Used in most areas
Surgical Asepsis
Sterile technique
Exclusions of all the microorganisms and there spores
Scrubbing
Used in specialized areas and skills
The basic principles of asepsis include the ff:

 Size of the OR
 Management of air
 Handling of equipment
 Aseptic technique
 Aseptic Technique
 Only sterile items are used within the sterile field.
 The sterile packages/fields are created as close as possible to
the time of use.
 Sterile tables are sterile only at table level.
 Sterile persons touch only sterile items or areas.
 Unsterile persons avoid reaching over sterile field.
 The edges of anything that encloses sterile contents are
considered unsterile.
 Sterile areas are continuously kept in view.
 Sterile persons keep well with the sterile area.
 Sterile persons are gowned and gloved.
 Unsterile persons avoid sterile areas.
 When pouring fluids, the pouring container should not touch the
receiving container
 Destruction of the integrity of microbial barriers result in
contamination.
Always remember…
Sterile + Sterile = Sterile
Sterile + Clean = Contaminated
Sterile + Contaminated = Contaminated
Sterile + Questionable = Contaminated
 Antisepsis
Used of chemical solutions for disinfection
Used of agents or means to remove or destroy
transient microorganisms from the skin and a
reduction of the resident flora
 DEFINITION
•Sterilization
–killing or removal of all microorganisms,
including bacterial spores which are highly
resistant
–Sterilization is usually carried out by autoclaving,
which is the exposure to steam at 121 deg C under a
pressure of 15lbs/in2 for 15 minutes
–Surgical instruments that can be damaged by moist
heat are usually sterilized by exposure to ethylene gas
–Most intravenous solutions are sterilized by filtration
•Disinfection
–is the killing of many but not all
microorganisms
–for adequate disinfection, pathogens must be
killed but some organisms and bacterial
spores may survive
•Antiseptic
–procedures and chemicals used to kill
microorganisms on the surface of skin and
mucous membranes
Antisepsis is achieved through:

1. Skin shaving
2. Skin preparation
3. Surgical handwashing
 Skin shaving
Aesthetic and makes surgery, suture and
dressing removal easier
Wound infection rate lowest when
performed immediately prior to surgery

Skin Preparation
Done circularly from the center outwards.
Solutions used in Skin preparation
70% Isopropyl alcohol
Acts by denaturing proteins
Is bactericidal but short acting
Effective against gram-positive and gram-negative
organisms
Also fungicidal and virucidal
70% Povidone - iodine
Acts by oxidation / substitution of free iodine
Bactericidal and active against spore forming
organisms
Effective against both gram-positive and gram-
negative organisms
Rapidly inactivated by organic material such as
blood
Sensitive to skin
0.5% Chlorhexidine
Acts by disrupting the bacterial cell wall
Bactericidal but does not kill spore forming organisms
It is persistent and has a long duration of action (up to 6
hours)
Effective against gram-positive organisms
 Surgical Handwashing
This uses friction and antiseptic solution to reduce
the transient microflora of the skin
 Two methods of surgical handwashing
1. Numbered stroke method
- a certain number of brush stroke are
designated for each finger, palm, back of hand,
and arm
2. Timed scrub method
-each scrub should last from three to five
minutes, depending on facility protocol
 Five minute scrub procedures:
1. Remove all jewelry on your hands and wrists.
2. Wash hands and arms with antimicrobial soap.
3. Clean under each fingernail with a stick or brush. It is important for
all surgical staff to keep their fingernails short.
4. Start timing. Scrub each side of each finger, between the fingers, and
the back and front of the hand for two minutes.
5. Proceed to scrub the arms, keeping the hand higher than the arm at
all times.
6. Wash each side of the arm to three inches above the elbow for one
minute. Repeat the process on the other hand and arm, keeping hands
above elbows at all times.
7. Rinse each arm separately, fingertips first, holding your hands above
the level of your elbow in one direction only. Let the water drip from
the elbow.
8. Proceed to the operating room suite holding hands above elbows.
9. Using a sterile towel, dry your arms--from fingertips to elbow--using
a different side of the towel on each arm.
10. Once in the operating room suite, keep your hands above the level of
your waist and do not touch anything before putting on sterile
surgical gloves.