Asepsis
Encyclopedia
Asepsis is the state of being free from disease-causing contaminants (such as bacteria
, virus
es, fungi, and parasites
) or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery
or medicine
to prevent infection
. Ideally, a surgical field is "sterile
" — free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation — but that is a situation that is difficult to attain, especially given the patient is often a source of infectious agents. Ie. there is no current method to safely eliminate all of the patients bacterial flora without causing significant tissue damage. However, elimination of infection is the goal of asepsis, not sterility.
showed that washing the hands prior to delivery reduced puerperal fever
. After the suggestion by Louis Pasteur
, Joseph Lister, 1st Baron Lister
introduced the use of carbolic acid as an antiseptic and reduced surgical infections rates. Lawson Tait went from antisepsis to asepsis, introducing principles and practices that have remained valid to this day. Ernst von Bergmann
introduced the autoclave
, a device used for the practice of the sterilization of surgical instruments.
practice. The procedure room is laid out according to specific guidelines, subject to regulations concerning filtering and airflow
, and kept clean between surgical cases. A patient who is brought for the procedure is washed and wears a clean gown. The surgical site is washed, possibly shaved, and skin is exposed to a germicide (i.e., an iodine
solution such as betadine
). In turn, members of the surgical team wash hands and arms with germicidal solution. Operating surgeons and nurses wear sterile gowns and gloves. Hair is covered and a surgical mask is worn. Instruments are sterilized through autoclaving, or, if disposable, are used once. Irrigation is used in the surgical site. Suture material or xenografts have been sterilized beforehand. Dressing material is sterile. Antibiotics are often not necessary in a "clean" case, that is, a surgical procedure where no infection is apparent; however, when a case is considered "contaminated," they are usually indicated.
Dirty and biologically contaminated material is subject to regulated disposal.
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
, virus
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
es, fungi, and parasites
Parasitism
Parasitism is a type of symbiotic relationship between organisms of different species where one organism, the parasite, benefits at the expense of the other, the host. Traditionally parasite referred to organisms with lifestages that needed more than one host . These are now called macroparasites...
) or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
or medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
to prevent infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
. Ideally, a surgical field is "sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
" — free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation — but that is a situation that is difficult to attain, especially given the patient is often a source of infectious agents. Ie. there is no current method to safely eliminate all of the patients bacterial flora without causing significant tissue damage. However, elimination of infection is the goal of asepsis, not sterility.
History
The modern concept of asepsis evolved in the 19th century. Ignaz SemmelweisIgnaz Semmelweis
Ignaz Philipp Semmelweis was a Hungarian physician now known as an early pioneer of antiseptic procedures. Described as the "savior of mothers", Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfection in obstetrical clinics...
showed that washing the hands prior to delivery reduced puerperal fever
Puerperal fever
Puerperal fever or childbed fever, is a bacterial infection contracted by women during childbirth or miscarriage. It can develop into puerperal sepsis, which is a serious form of septicaemia. If untreated, it is often fatal....
. After the suggestion by Louis Pasteur
Louis Pasteur
Louis Pasteur was a French chemist and microbiologist born in Dole. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies and anthrax. His experiments...
, Joseph Lister, 1st Baron Lister
Joseph Lister, 1st Baron Lister
Joseph Lister, 1st Baron Lister OM, FRS, PC , known as Sir Joseph Lister, Bt., between 1883 and 1897, was a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary...
introduced the use of carbolic acid as an antiseptic and reduced surgical infections rates. Lawson Tait went from antisepsis to asepsis, introducing principles and practices that have remained valid to this day. Ernst von Bergmann
Ernst von Bergmann
Ernst von Bergmann was a Baltic German surgeon. He is the beginner of aseptic surgery.Born in Riga, Livonia , in 1860 he earned his doctorate at the University of Dorpat, and later returned to Dorpat in 1871, where he was a professor of surgery until 1878...
introduced the autoclave
Autoclave
An autoclave is an instrument used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C for around 15–20 minutes depending on the size of the load and the contents. It was invented by Charles Chamberland in 1879, although a precursor known as the...
, a device used for the practice of the sterilization of surgical instruments.
Methods
Today's techniques include a series of steps that complement each other. Foremost remains good hygienicHygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
practice. The procedure room is laid out according to specific guidelines, subject to regulations concerning filtering and airflow
Air current
Air currents may be caused by differences in temperature, pressure, or impurity concentration. Temperature differences can cause air currents because warmer air is less dense than cooler air, causing the warmer air to appear "lighter." Thus, if the warm air is under the cool air, air currents will...
, and kept clean between surgical cases. A patient who is brought for the procedure is washed and wears a clean gown. The surgical site is washed, possibly shaved, and skin is exposed to a germicide (i.e., an iodine
Iodine
Iodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....
solution such as betadine
Betadine
Povidone-iodine is a stable chemical complex of polyvinylpyrrolidone and elemental iodine. It contains from 9.0% to 12.0% available iodine, calculated on a dry basis....
). In turn, members of the surgical team wash hands and arms with germicidal solution. Operating surgeons and nurses wear sterile gowns and gloves. Hair is covered and a surgical mask is worn. Instruments are sterilized through autoclaving, or, if disposable, are used once. Irrigation is used in the surgical site. Suture material or xenografts have been sterilized beforehand. Dressing material is sterile. Antibiotics are often not necessary in a "clean" case, that is, a surgical procedure where no infection is apparent; however, when a case is considered "contaminated," they are usually indicated.
Dirty and biologically contaminated material is subject to regulated disposal.