Asepsis

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Hand scrubbing procedure for surgery A day in the life of an OR technician 160920-F-AE629-070.jpg
Hand scrubbing procedure for surgery

Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). [1] There are two categories of asepsis: medical and surgical. [1] The modern day notion of asepsis is derived from the older antiseptic techniques, a shift initiated by different individuals in the 19th century who introduced practices such as the sterilizing of surgical tools and the wearing of surgical gloves during operations. [2] The goal of asepsis is to eliminate infection, not to achieve sterility. [1] Ideally, a surgical field is sterile, meaning it is free of all biological contaminants (e.g. fungi, bacteria, viruses), not just those that can cause disease, putrefaction, or fermentation. [1] Even in an aseptic state, a condition of sterile inflammation may develop. The term often refers to those practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection. [3]

Contents

History

The modern concept of asepsis evolved in the 19th century through multiple individuals. Ignaz Semmelweis showed that hand washing prior to delivery reduced puerperal fever. Despite this, many hospitals continued to practice surgery in unsanitary conditions, with some surgeons taking pride in their bloodstained operating gowns. [4] It was not until after reading of the findings by Louis Pasteur that Joseph Lister introduced the use of carbolic acid as an antiseptic, and in doing so, reduced surgical infection rates. [5] Lawson Tait shifted the movement then from antisepsis to asepsis, instilling practices such as a strict no-talking policy within his operating room and drastically limiting the number of people to come in contact with a patient's wound. [6] Ernst von Bergmann also introduced the autoclave, a device used for the practice of the sterilization of surgical instruments. [7]

Image of William Stewart Halsted William Stewart Halsted.jpg
Image of William Stewart Halsted

But, everything from operating room uniforms to gloves was pioneered by William Halsted. Preceding modern-day scrubs attire, Halsted implemented a no street clothes policy in his operating room, opting to wear a completely white, sterile uniform consisting of a duck suit, tennis shoes, and skullcap. [2] This helped to prevent the introduction of infections into open wounds. [2] Additionally, Halsted would sterilize the operation site with alcohol, iodine and other disinfectants and use drapes to cover all areas except for the site. [2] In his department at Johns Hopkins Hospital, he enforced an extreme hand washing ritual consisting of soaking in harmfully strong chemicals like permanganate and mercury bichloride solution as well as scrubbing with stiff brushes. [2] The damage to a surgical nurse's hands compelled him to create the earliest form of the surgical gloves with the Goodyear Rubber Company. [2] These gloves became a part of the aseptic surgery standard when Dr. Joseph Colt Bloodgood and several others began wearing them for that particular purpose. [8]

Antisepsis vs. Asepsis

The line between antisepsis and asepsis is interpreted differently, depending on context and time. [5] In the past, antiseptic operations occurred in people's homes or in operating theaters before a large crowd. [5] Procedures for implementing antisepsis varied among physicians and experienced constant changes. [5] Until the late 19th century, physicians rejected the connection between Louis Pasteur's germ theory that bacteria caused diseases and antiseptic techniques. [9] At the end of the 19th century, Joseph Lister and his followers expanded the term "antisepsis" and coined "asepsis," with the justification that Lister had initially "suggested excluding septic agents from the wound from the start." [5] Generally, however, asepsis is seen as a continuation of antisepsis since many of the values are the same, such as a "germ-free environment around the wound or patient," and techniques pioneered under both names are used in conjunction today. [5]

Method

Asepsis refers to any procedure that is performed under sterile conditions. This includes medical and laboratory techniques (such as with bacterial cultures). There are two types of asepsis — medical and surgical. [1] 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 practiced by surgical technologists and nurses. [1] Ultimately, though, successful usage of aseptic operations depends on a combination of preparatory actions. [10] For example, sterile equipment and fluids are used during invasive medical and nursing procedures. [10] The largest manifestation of such aseptic techniques is in hospital operating theaters, where the aim is to keep patients free from hospital micro-organisms. [11]

Packaged, sterilized surgical instruments Scalpel blade 01.JPG
Packaged, sterilized surgical instruments

While all members of the surgical team should demonstrate good aseptic technique, it is the role of the scrub nurse or surgical technologist to set up and maintain the sterile field. [12] [13] To prevent cross-contamination of patients, instruments are sterilized through autoclaving or by using disposable equipment; suture material or xenografts also need to be sterilized beforehand. [14] Basic aseptic procedures includes hand washing, donning protective gloves, masks and gowns, and sterilizing equipment and linens. [11] Medical aseptic techniques also includes curbing the spread of infectious diseases through quarantine, specifically isolation procedures based on the mode of disease transmission. [11] Within contact, droplet and airborne isolation methods, two different procedures emerge: strict isolation vs. reverse isolation. [11] Strict isolation quarantines patients to prevent them from infecting others, while reverse isolation prevents vulnerable patients from becoming infected. [11]

In aseptic conditions, a "chronic low-level inflammation" known as sterile inflammation may develop as a result of trauma, stress, or environmental factors. [15] As in infections caused by pathogens or microbes, the immune response is regulated by host receptors. [3] Tissue damage resulting from non-infectious means are caused by DAMPs molecules released after injury or cell death has occurred, which are able to stimulate inflammation response. [3] Diseases associated with sterile inflammation include Alzheimer's disease, atherosclerosis, as well as cancer tumor growth due to "immune cell infiltration." [3] Additionally, aseptic tissue damage may arise from corticosteroid injections, which are drugs used to treat musculoskeletal conditions such as carpal tunnel and osteoarthritis, though this tends to result from improper aseptic technique. [16] [17]

Medical illustration of Staphylococcus Staphylococcus Bacteria.jpg
Medical illustration of Staphylococcus

Despite efforts to preserve asepsis during surgery, there still persists a 1-3% chance of a surgical site infection (SSI). [18] Infections are categorized as superficial incisional, deep incisional, or organ; the first type are confined to the skin, the second to muscles and nearby tissues, and the third to organs not anatomically close to the operation site. [18] [19] The exact modes of infection depend on the types of surgery, but the most common bacteria that are responsible for SSIs are Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, and Enterococcus spp. [20] The CDC emphasizes the importance of both antiseptic and aseptic approaches in avoiding SSIs, especially since Staphylococcus aureus, among other bacteria, are able to evolve drug-resistant strains that can be difficult to treat. [21] In 2017, nearly 20,000 patients in the United States died from Staphylococcus aureus in comparison to the 16,350 from diagnosed HIV. [22] [23]

See also

Related Research Articles

<span class="mw-page-title-main">Surgery</span> Medical procedures that involve incisive or invasive instruments into body cavities

Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or improve aesthetics and appearance, or to remove unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.

<i>Staphylococcus aureus</i> Species of Gram-positive bacterium

Staphylococcus aureus is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive for catalase and nitrate reduction and is a facultative anaerobe that can grow without the need for oxygen. Although S. aureus usually acts as a commensal of the human microbiota, it can also become an opportunistic pathogen, being a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning. Pathogenic strains often promote infections by producing virulence factors such as potent protein toxins, and the expression of a cell-surface protein that binds and inactivates antibodies. S. aureus is one of the leading pathogens for deaths associated with antimicrobial resistance and the emergence of antibiotic-resistant strains, such as methicillin-resistant S. aureus (MRSA), is a worldwide problem in clinical medicine. Despite much research and development, no vaccine for S. aureus has been approved.

Methicillin-resistant <i>Staphylococcus aureus</i> Bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) is a group of gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019.

<span class="mw-page-title-main">Operating theater</span> A room in a hospital in which surgeries are performed

An operating theater is a facility within a hospital where surgical operations are carried out in an aseptic environment.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in a hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number of dynamic processes can bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Healthcare staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection tends to lack evidence that it was present when the patient entered the healthcare setting, thus meaning it was acquired post-admission.

<span class="mw-page-title-main">Medical glove</span> Single-use glove worn during medical examinations and procedures

Medical gloves are disposable gloves used during medical examinations and procedures to help prevent cross-contamination between caregivers and patients. Medical gloves are made of different polymers including latex, nitrile rubber, polyvinyl chloride and neoprene; they come unpowdered, or powdered with corn starch to lubricate the gloves, making them easier to put on the hands.

<span class="mw-page-title-main">Parotitis</span> Medical condition

Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.

<span class="mw-page-title-main">William Stewart Halsted</span> American surgeon (1852–1922)

William Stewart Halsted, M.D. was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer. Along with William Osler, Howard Atwood Kelly and William H. Welch, Halsted was one of the "Big Four" founding professors at the Johns Hopkins Hospital. His operating room at Johns Hopkins Hospital is in Ward G, and was described as a small room where medical discoveries and miracles took place. According to an intern who once worked in Halsted's operating room, Halsted had unique techniques, operated on the patients with great confidence and often had perfect results which astonished the interns.

Infection prevention and control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection". It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

<span class="mw-page-title-main">Orbital cellulitis</span> Inflammation of eye tissues

Orbital cellulitis is inflammation of eye tissues behind the orbital septum. It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. It may also occur after trauma. When it affects the rear of the eye, it is known as retro-orbital cellulitis.

<span class="mw-page-title-main">Isolation (health care)</span> Measure taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

<span class="mw-page-title-main">Scrubs (clothing)</span> Lightweight, washable clothing worn by hospital staff or other medical personnel

Scrubs, or sometimes Surgical Scrubs, or Nursing Scrubs, are the sanitary clothing worn by physicians, nurses, dentists and other workers involved in patient care. Originally designed for use by surgeons and other operating room personnel, who would put them on when sterilizing themselves, or "scrubbing in", before surgery, they are now worn by many hospital personnel.

Octenidine dihydrochloride is a cationic surfactant, with a gemini-surfactant structure, derived from pyridine. It is active against Gram-positive and Gram-negative bacteria. Since 1987, it has been used primarily in Europe as an antiseptic prior to medical procedures, including on neonates.

<span class="mw-page-title-main">Sophoraflavanone G</span> Chemical compound

Sophoraflavanone G is a volatile phytoncide, released into the atmosphere, soil and ground water, by members of the Sophora genus. Sophora pachycarpa, and Sophora exigua; all found to grow within the United States in a variety of soil types, within temperate conditions, no lower than 0 °F. Sophoraflavanone G is released in order to protect the plant against harmful protozoa, bacteria, and fungi. Sophoraflavanone G, also called kushenin, is a flavonoid compound.

Vertebral osteomyelitis is a type of osteomyelitis that affects the vertebrae. It is a rare bone infection concentrated in the vertebral column. Cases of vertebral osteomyelitis are so rare that they constitute only 2%-4% of all bone infections. The infection can be classified as acute or chronic depending on the severity of the onset of the case, where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease. Although vertebral osteomyelitis is found in patients across a wide range of ages, the infection is commonly reported in young children and older adults. Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae. The prognosis for the disease is dependent on where the infection is concentrated in the spine, the time between initial onset and treatment, and what approach is used to treat the disease.

<span class="mw-page-title-main">Paul Berger</span> French physician and surgeon

Paul Berger was a French physician and surgeon who practised in Paris at the Hôpital Tenon and was Professor of Clinical Surgery and Pathology at the Faculté de médecine de Paris. He is noted for Berger's operation, a method of interscapulothoracic amputation, and for improvements in hernia/intestinal suturing.

Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

Decolonization, also bacterial decolonization, is a medical intervention that attempts to rid a patient of an antimicrobial resistant pathogen, such as methicillin-resistant Staphylococcus aureus (MRSA) or antifungal-resistant Candida.

<span class="mw-page-title-main">Intravitreal injection</span> Method of administration of drugs into the eye by injection with a fine needle

Intravitreal injection is the method of administration of drugs into the eye by injection with a fine needle. The medication will be directly applied into the vitreous humor. It is used to treat various eye diseases, such as age-related macular degeneration (AMD), diabetic retinopathy, and infections inside the eye such as endophthalmitis. As compared to topical administration, this method is beneficial for a more localized delivery of medications to the targeted site, as the needle can directly pass through the anatomical eye barrier and dynamic barrier. It could also minimize adverse drug effects on other body tissues via the systemic circulation, which could be a possible risk for intravenous injection of medications. Although there are risks of infections or other complications, with suitable precautions throughout the injection process, chances for these complications could be lowered.

<span class="mw-page-title-main">Surgical drape</span>

A surgical drape is a sterile sheet used to create a sterile field during surgical procedures with the purpose of preventing the spread of infection from non-sterile to sterile areas and protecting the patient from contamination.

References

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  2. 1 2 3 4 5 6 Markel, Howard. An anatomy of addiction. New York: Pantheon Books.
  3. 1 2 3 4 Chen, Grace Y.; Nuñez, Gabriel (19 November 2010). "Sterile inflammation: sensing and reacting to damage". Nature Reviews. Immunology. 10 (12): 826–837. doi:10.1038/nri2873. ISSN   1474-1733. PMC   3114424 . PMID   21088683.
  4. ↑ Millard, Candice (2011). Destiny of the republic: a tale of madness, medicine and the murder of a president. New York: Doubleday. ISBN   978-0-385-52626-5. OCLC   700205578.
  5. 1 2 3 4 5 6 Schlich, Thomas (July 2012). "Asepsis and Bacteriology: A Realignment of Surgery and Laboratory Science1". Medical History. 56 (3): 308–334. doi:10.1017/mdh.2012.22. ISSN   0025-7273. PMC   3426977 . PMID   23002302.
  6. ↑ Flack, Harvey. Lawson Tait. Thomas Vicary Lecture.
  7. ↑ "History of Infection Control and its Contributions to the". Medscape. Retrieved 2020-04-21.
  8. ↑ "William Stewart Halsted". portraitcollection.jhmi.edu. Retrieved 2020-04-21.
  9. ↑ "Developments in bacteriology - Attempts to prevent illness and disease – WJEC - GCSE History Revision - WJEC". BBC Bitesize. Retrieved 2020-04-21.
  10. 1 2 "Aseptic Surgery". research.uci.edu. Retrieved 2020-04-21.
  11. 1 2 3 4 5 "Medical Asepsis (Clean Technique)" (PDF). Indiana Department of Health.
  12. ↑ "Microbiology Techniques & Troubleshooting". Science Buddies.
  13. ↑ "Bios 318 Microbiology methods manual". www.ruf.rice.edu.
  14. ↑ Yool, Donald A. Small Animal Soft Tissue Surgery. CABI.
  15. ↑ Feldman, Noa; Rotter-Maskowitz, Aviva; Okun, Eitan (2015-11-01). "DAMPs as mediators of sterile inflammation in aging-related pathologies". Ageing Research Reviews. Damage-associated molecular patterns and their pathological relevance in ageing. 24 (Pt A): 29–39. doi:10.1016/j.arr.2015.01.003. ISSN   1568-1637. PMID   25641058. S2CID   33283933.
  16. ↑ "Injectable Corticosteroids". www.hopkinsmedicine.org. Retrieved 2020-04-21.
  17. ↑ Holland, Christian; Jaeger, Lothar; Smentkowski, Ulrich; Weber, Beate; Otto, Christina (15 June 2012). "Septic and Aseptic Complications of Corticosteroid Injections". Deutsches Ärzteblatt International. 109 (24): 425–430. doi:10.3238/arztebl.2012.0425. ISSN   1866-0452. PMC   3394381 . PMID   22787504.
  18. 1 2 "Surgical Site Infections". www.hopkinsmedicine.org. 22 November 2019. Retrieved 2020-04-21.
  19. ↑ "Surgical Site Infections - Health Encyclopedia - University of Rochester Medical Center". www.urmc.rochester.edu. Retrieved 2020-04-21.
  20. ↑ Owens, C. D.; Stoessel, K. (November 2008). "Surgical site infections: epidemiology, microbiology and prevention". The Journal of Hospital Infection. 70 (Suppl 2): 3–10. doi:10.1016/S0195-6701(08)60017-1. ISSN   0195-6701. PMID   19022115.
  21. ↑ "Superbug, super-fast evolution". evolution.berkeley.edu. April 2008. Retrieved 2020-04-21.
  22. ↑ Kourtis, Athena P. (2019). "Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections — United States". MMWR. Morbidity and Mortality Weekly Report. 68 (9): 214–219. doi: 10.15585/mmwr.mm6809e1 . ISSN   0149-2195. PMC   6421967 . PMID   30845118.
  23. ↑ "Basic Statistics | HIV Basics | HIV/AIDS | CDC". www.cdc.gov. 2020-03-20. Retrieved 2020-04-21.
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