無菌術(shù)-教學(xué)講解課件

AsepsisAsepsisAsepsisHistorySignificanceandDefinitionAsepsisofSurgicalinstrumentandDressingPreparationforDr.andPt.KeyPointsAsepsisHistoryHistoryandSignificanceHistoryandSignificanceHippocrates(460-377BC)SeparatedmedicinefromphilosophyIrrigatedwoundswithwineorboiledwaterForeshadowingofAsepsisHistory:Hippocrates(460-377BC)SeparPasteur(1862)DiscoveredbacteriumDevelopedPasteurizationprocessHistory:Pasteur(1862)History:History:

Mikulicz-Radecki(1887)---facemasks

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

Halsted(1890)---------------surgical-glovesHistory:Mikulicz-Radecki(Sterilizationfor

SurgicalInstrumentsSterilizationfor

Sur190619331947SteamSterilizationHistory:190619331947SteamSterilizatioSteamSterilization(1974)SteamSterilization(1974)EarlytypeofhotairsterilizerMicrowaveOven(1947)EarlytypeofhotairsterilizAdvancedSterilizerLowtemperaturesystemforendoscopicdevices(1989)Plasmasterilizingsystem(1993)AdvancedSterilizerLowtemperBasicprincipleofSurgeryBasicprincipleofMedicine Significance:BasicprincipleofSurgerySignDefinitionSterile

freeofalllivingmicroorganismsSterilization

（滅菌）aprocesscapableofdestroyingallformsofmicrobiallifeoninanimatesurfacesAsepsis

（無菌）absenceofmicroorganismsthatcausedisease;freedomofinfectionDisinfection

（消毒）aprocesscapableofdestroyingpathogenicmicroorganismsbut,asordinarilyused,notbacterialsporesDefinitionSterileAutoclavingDryheatMicrowaveInfraredraysBoilingBurningGasSterilizationEthyleneoxideFormaldehydeSoakinginAntisepticsSterilizationandDisinfectionAutoclavingGasSterilizationStHighpressure15-20lbf/in2Hightemperature121-126℃TimedependonT&P30min

themostcompletelyreliablesterilizationAutoclaving

(SteamunderPressure)HighpressurethemostcompletStoragetime 2WeeksAttention 40cm30cm30cm Arrangement 3MIndicateTape FlammableStuff Liquid---degas AutoclavingStoragetime 2WeeksAutoclaviAvoidbeingspoiledbymoistheatTemperature=160℃Time=1hours(4hoursforgrease)----exposuretocontinuousdryheatDryHeatAvoidbeingspoiledbymoisthOnlyifautoclaving,dryheat,gassterilizationisNOTavailable(formetal,glassorrubberstuff)Minimumperiodis20minPeriodcanbedecreasedto10minsafelyinadditionofalkaliNoteffectiveagainstsporeunlessperiod>1hourDripincompletelyTimeCalculationBoilingOnlyifautoclaving,dryheat,FormetalinstrumentOnlyinspecialsituation 95%Ethanol Causingdamagetothemetalinstrument BurningFormetalinstrumentBurning2%Glutaraldehyde 30min10%Formaldehyde 20-30min70%Ethanol 30min1：1000BromoGeramine 30min1：1000Chlorhexidinium

30min

Fordelicateinstrument,endoscopeorlaparoscopeSoakCleaninginAntiseptics2%Glutaraldehyde 30minSoakAttention：CleanBeforeSoakingDripinCompletelyOpenAxesWashbySalinebeforeusingSoakCleaningAttention：SoakCleaningExcellentsterilizationformostheat-sensitivematerialsDestroybacteria,viruses,fungi,sporesFlammableandtoxicandcausingsevereburnsGasSterilization

Ethyleneoxide&FormaldyhydeExcellentsterilizationformoMicrowaveTemperature=100℃Time=5-20minMicrowaveTemperature=100℃Infrared

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

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

Center

Around AroundCenterDistanceforSterilization 15cmAreaforSterilizationAsepsis: PreparationforPt.DirectionforSterilization A

---Toseparatecontaminated

areafromsterilefield

HeadcoverFacemaskShoecoverGloveGownDrapeAsepticMechanicalBarrier

---ToseparatecontaminDrapeDrape

SterileEnvelope

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

OperatingRoomLargeenough(>20*20feet) OpeNOTtouchanynon-sterilizedgoodswithscrubbedhandsNOTpassequipmentthroughthecontaminatedfieldChangepositionfacetofaceorbacktobackNOTliftormovethesteriledrapesCheckbefore/afterOperation

AsepsisinoperativeprocedureNOTtouchanynon-sterilizedgStrictaseptictechniqueisessentialtominimizesurgicalinfectionrateItisthemostimportanttokeepasepsisprincipleinmindduringtheanysurgicalprocedureConclusionStrictaseptictechniqueisesBloodTransfusionBloodTransfusionHistoryTypeofTransfusionIndicationTransfusionReactionsAutologoustransfusionComponentTransfusionBloodTransfusionHistoryBloodTransfusionHistoryandSignificanceHistoryandSignificanceLower

(1665)FirstbloodtransfusionLower(1665)FirstbloodtransPhilip(1825)FirsthumanbloodtransfusionPhilip(1825)FirsthumanbloodLandsteiner

(1900)

DiscoveryofABOtypeLandsteiner(1900)

DiscoveryoHowtostorebloodlonger?WorldwarIHowtostorebloodlonger?WorlIsthereanysuitable

BloodSubstitutesWorldwarIIIsthereanysuitableWorldwarSuccessfulbloodtransfusionisrelativelyrecentCrossmatchingAnticoagulationPlasticstoragecontainerBloodTransfusionSuccessfulbloodtransfusioniTypeofTransfusion：WholeBlood；BloodComponent；

RBCPLTFFPLeukocyteconcentrate

PlasmaSubstitutes；UseofwholebloodisconsideredtobeawasteofresourcesBloodTransfusionTypeofTransfusion：WholeBlooSymptomaticanemia(providingoxygen-carryingcapacity)Transfusiontrigger(HCT<30%;HB<10g/dl)1Unitincreases3%HCTor1g/dlShelflife=42d(1-6℃)RedBloodCellsSymptomaticanemia(providingThrombocytopenia(<50,000)PlateletdysfunctionEachunitincrease5,000PLTsafter1HPlateletsThrombocytopeniaPlateletsProfoundlygranulocytopenia(<500)SeriousinfectionnotresponsivetoantibiotictherapyGranulocytesProfoundlygranulocytopenia(<Coagulationfactordeficiencies1mlincreases1%clottingfactorsBeingusedassoonaspossibleAlbumin,hetastarch,crystalliodsareequallyeffectivevolumeexpanderbutsaferthanFFPAfteruseof5UofRBCs,matching2UofFFPFreshFrozenPlasma(FFP)Coagulationfactordeficiencie--VolumeExpanderDextranMostwidelyusedLow/MiddleM.W.(40,000-70,000)MassivetransfusioncouldimpaircoagulationOccasionalALLERGICreactionHydroxyethylStarchFormulation(HES)MorestableContainingessentialelectrolytesNoallergicreactionPlasmaSubstitutes--VolumeExpanderDextranPlasmaIndication：Acutemassivebloodloss;Anaemiaandhypoalbuminemia;OverwhelmingInfection;DysfunctionofCoagulation;BloodTransfusionIndication：AcutemassivebloodTechniqueofTransfusion:ApproachRoute:

PeripheralVein,CenterVeinFiltrationbeforeTransfusion：VelocityofTransfusion：

5-10ml/minBloodTransfusionTechniqueofTransfusion:ApproDoubleCheck:Name,TypeandCrossmatchStorageTime: CitratePhoshateDetrose AcidicCitrateDetrose

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

Vomiting Diarrhea Anaphylacticreactions：TransfusionReactions Urticaria AnaphylacticreactiImmuno-reaction： IgEHereditaryImmunoglobulin：IgAReason：AdministerantihistaminesAdministerepinephrine,diphenhydramine,andcorticosteroids：Supportairwayandcirculationasnecessary：Treatment：Anaphylacticreactions：Immuno-reaction： I Burningattheintravenous(IV)linesite Fever,Chills,Dyspnea Shock CardiovascularCollapse Hemoglobinuria,Hemoglobinemia RenalFailure DIC HemolytictransfusionreactionsTransfusionReactions Burningattheintravenous(IABOincompatibilityRhIncompatibilityNon-immuneHemolysisImmuneHemolysis Reasons：HemolyticTransfusionReactionsABOincompatibilityReasons：HeStopTransfusionassoonasreactionissuspectedCheckthename,typeandcrossmatchUrineExam RenalProtection (AggressiveFluidResuscitation,Furosemide)DICMonitor Treatment：HemolyticTransfusionReactionsStopTransfusionassoonasreDoubleCheckname,typeandcrossmatchOperatecarefullyandroutinely TemperatureMonitorPrevention：HemolyticTransfusionReactionsDoubleCheckname,typeandcroMassivetransfusioncomplications: VolumeOverload CongestiveHeartFailure Tachycardia Tachypnea Cyanopathy TransfusionReactionsMassivetransfusioncomplicatiVolumeOverloadHeartFunctionalFailureLungFunctionalFailure Reasons：StopTransfusionHeartFunctionalSupportDiuresis (Furosemide)Treatment：MassiveTransfusionComplications:VolumeOverloadReasons：StopTrContamination: Fever Shock DIC

BacterialContamination Reasons：TransfusionReactionsContamination: Fever BacterialStopTransfusionBacterialExamandCultureAntibiotics Treatment：DoubleCheckOperatecarefullyPrevention：Contamination:StopTransfusionTreatment：DoubHepatitisB,HepatitisCHIVCytomega