Asepsis, Antisepsis, Principles of

antimicrobial therapy and Chemoprophylaxs

Dr. C. O. Udemezue
MBBS; FWACS-Ortho
Consultant Orthopaedic Surgeon
 Outline
• Introduction
• Historical perspective
• Sources of contamination
• Methods of sterilization
• Chemo-prophylaxis
• Uses of antibiotics
• Abuse of antibiotics
• Conclusion
 Introduction: Definition of terms
• Cleaning: Removal of foreign (especially
organic or soil) materials from objects usually
accomplished with water and/or detergent
and must precede procedures to sterilize or
disinfect devices.
• Disinfection: Elimination of all vegetative
micro-organisms but not spores from an
inanimate object.
• Sterilization: Destruction or elimination of all
forms (both vegetative and spores) of life by a
physical or chemical process from an
inanimate object.
• Decontamination: This is a more broader term
than disinfection, it is used mostly for
radioactive and infective waste
• Antiseptic: A substance applied to the skin or
living tissue that prevents or arrests the
growth and action of micro-organism either by
inhibiting there activity or by destroying them
• Germicides: They are chemical agents that kill
organisms or prevent their growth. They could
be Bacteriostatic or Bactericidal
• Sanitizer (Disinfectant): A substance applied to
inanimate objects to reduce the number of
bacteria to a level judged safe by the public
health department.
• Asepsis: Technique employed to present
contamination of wounds ensuring that only
sterile materials make contact.
• Antisepsis: The use of anti-microbial agents on
human tissue`
 Historical Perspective
• Semmelweis of Vienna (1847): Used chlorinated
water to wash his hands before any surgery, He
was known as the Father of asepsis
• Loius Pasteur (1861): Germ theory
• Joseph Lister (1865): Discovered the use of
carbolic acid which reduced mortality when used
in wound dressing
• Ernest Von Bergmann of Berlin (1886): Steam
sterilization.
 Sources of contamination
• Surgical personnel
• Patient
• Operating theatre
• Surgical equipment
 Methods of sterilization
• Moist heat: Autoclaving, Boiling,
Pasteurization and Tyndallization
• Dry heat: Radiation and membrane filtration’
• Chemical sterilization: Liquids or Gaseous
methods
 Autoclaving
• Use of steam under pressure for sterilization
• Pressure of 105 Kpa with temperature of 121’C will
sterilize instruments in 15 minutes.
• Stages of autoclaving: Heating, sterilization and
cooling.
• Types of autoclave:
• 1. Downward displacement autoclave (for sterilization
of unwrapped or lightly wrapped materials.
• 2. Pre-vacuumed high temperature autoclave
 Boiling
• Boiling water at ambient pressure (100’C) for
10 to 30 minutes.
• It destroys viruses
• It is easy and cheap
• However, it is also cumbersome and not
practical for everyday use
• It is also not reliably sporicidal
 Pasteurization
• Heating to below boiling point (usually 77’C)
for up to 30 minutes
• It is used for heat-sensitive liquids (milk and
dairy products)
• Respiratory therapy breathing circuits and
instruments are sterilized via this means
• It is not reliably sporicidal
 Tyndallization
• Heating at 80 to 100’C for 30 minutes on 3
successive days.
• After each day, the material is stored at room
temperature for the heating the next day
allowing spores to germinate.
• It is used for heat-sensitive materials
• It is time consuming and not reliably
sporicidal.
 Dry Heat
• Heating at 200’C
• It inactivates micro-organism by oxidative
destruction.
• Red heat flames are used for wire loops and
needles.
• Incineration is used for waste items
• Infra red radiation is also a method of dry heat
sterilization
 Hot Air Oven
• Temperature of 160’C for 1 hour.
• Fans are needed to circulate the hot air
throughout the chamber
• Not efficient as sterilizing agent as it is a poor
conductor of heat and does not penetrate
material very well.
• Used for glass ware (syringes), oily fluids,
powders, sharps
• Temperature is too hot for fabrics and rubber
 Chemical Agents of Decontamination

Inorganic Organic
• Chlorine • Alcohols
• iodophors • Aldehydes
• Phenols
• Cationic surface active
agents
• Peracetic acid
• Hydrogen peroxide
 Chemo-prophylaxis
• Antibiotics are chemical agents which destroy
micro-organisms or inhibit their growth.
• They are not used as replacement for asepsis
and good surgical technique.
• They have side effects
 Uses of antibiotics
• Prophylactic
• Therapeutic (Presumptive, Empirical and
Definitive)
 Antibiotic Prophylaxis
• Use of antibiotics at induction of anaesthesia
(30 to 60 minutes before knife on skin) and
not repeated after skin closure.
• Indications of Prophylaxis
• Prevent surgical site infection (SSI)
• Prevent other HeathCare Associated Infections
(HCAIs).
• Prevent specific infections e.g UTI
 Surgical Site Infection (SSI)
• SSI is infection related to operative procedure
occurring at or near the surgical incision within
30 days of surgery or 90 days (or 1 year) if
implants are used
• It is classified into.
• 1. Superficial SSI: skin and subcut
• 2. Deep SSI: Below or exposing the deep fascia
• 3. Organ-space SSI: at the organ entered during
surgery e.g abdomen, chest etc
 Surgical wounds and expected risk of SSI

• 1. Clean wound: <2%. Surgically created wound under

strict asepsis, done as elective surgery, no
inflammation along the site before surgery and wound
was closed primary. E.g herniorrhaphy, thyroidectomy
• Here, no prophylactic antibiotic use is required.
• 2. Clean-contaminated wound: 4-10%. There is
controlled entry into respiratory, alimentary or urinary
tract, no unusual spillage and no major break in
asepsis. E.g appendicectomy in acute and
uncomplicated appendicitis.
• Prophylactic antibiotics in used in clean-
contaminated wounds.
• 3. Contaminated wound: >20%. Open fresh
accidental wound, gross spillage in the
respiratory/alimentary/urinary tract, acute
purulent inflammation. E.g ruptured
appendicitis.
• Prophylactic antibiotics is used here
• 4. Dirty wound: >40%. Old traumatic wounds
discharging pus. E.g Chronic osteomyelitis.
• Therapeutic antibiotics is used
 Antibiotics abuse
• Under dose
• Overdose
• Skipping of doses
• Short duration
• Protracted use
• Unguided change of antibiotics
• Unguided combination of antibiotics
 Conclusion
• Introduction of asepsis made great
improvement in surgical practice.
• Anti-microbial use is not a substitute to good
surgical technique.
• The use of anti-microbial agents should be
guided to prevent resistance