1、 History Significance and Definition Asepsis of Surgical instrument and Dressing Preparation for Dr. and Pt. Key PointsHippocrates (460-377 BC) Separated medicine from philosophy Irrigated wounds with wine or boiled water Foreshadowing of AsepsisPasteur (1862) Discovered bacterium Developed Pasteuri
2、zation process Mikulicz-Radecki (1887)-face masksFurbringer (1889)-hands-scrubbingHalsted (1890)-surgical-gloves190619331947Steam SterilizationSteam Sterilization (1974)Early type of hot air sterilizer Advanced Sterilizer Low temperature system for endoscopic devices (1989) Plasma sterilizing system
3、(1993)nBasic principle of SurgerynBasic principle of Medicine Sterile free of all living microorganismsSterilization （灭菌）（灭菌）a process capable of destroying all forms of microbial life on inanimate surfacesAsepsis （无菌）（无菌）absence of microorganisms that cause disease; freedom of infectionDisinfection
4、 （消毒）（消毒）a process capable of destroying pathogenic microorganisms but, as ordinarily used, not bacterial spores Autoclaving Dry heat Microwave Infrared rays Boiling Burning Gas Sterilization Ethylene oxide Formaldehyde Soaking in Antiseptics High pressure 15-20 lbf/in2 High temperature 121-126 Time
5、 depend on T & P 30 min the most completely reliable sterilizationnStorage time2 WeeksnAttention 40cm 30cm 30cmArrangement3M Indicate Tape Flammable Stuff Liquid -degas Avoid being spoiled by moist heat Temperature = 160 Time = 1hours(4 hours for grease)-exposure to continuous dry heat Only if autoc
6、laving, dry heat, gas sterilization is NOT available (for metal, glass or rubber stuff) Minimum period is 20 min Period can be decreased to 10 min safely in addition of alkali Not effective against spore unless period 1 hour Drip in completely Time CalculationFor metal instrumentOnly in special situ
7、ation95% Ethanol Causing damage to the metal instrument2% Glutaraldehyde30min10% Formaldehyde20-30min70% Ethanol30min1：1000 Bromo Geramine30min1：1000 Chlorhexidinium 30min For delicate instrument, endoscope or laparoscopeAttention：nClean Before SoakingnDrip in Completely nOpen AxesnWash by Saline be
8、fore using Excellent sterilization for most heat-sensitive materials Destroy bacteria, viruses, fungi, spores Flammable and toxic and causing severe burnsMicrowaveTemperature =100Time = 5-20 minInfrared rays Temperature =160 Time = 60-120 minnReservationnWashingnInfection of P.aeruginosa, Tetanus, G
9、as-gangrene and HBV positive Single-use StuffBurnt outOthers 1. Gown, shoes cover2. Head cover, face mask3. Shorten nail General Preparation：Preparation for Dr. Washing hands & forearms with soap Delivering antiseptics onto wet hands, and scrubbing 3-5 min Rinsing thoroughly, dry with a sterile towe
10、lHands Scrubbing:Iodophor & Iodine Most efficient and broad-spectrum activity Rarely skin reaction Prolonged activity Not use on delicate skinChlorhexidine (Hibitane) Sensitive areas (perineum, face, genitalia, around eyes, infants)nDirection for SterilizationCenterAroundAroundCenternDistance for St
11、erilization 15cmnArea for SterilizationPreparation for Pt. -To separate contaminated area from sterile field Head cover Face mask Shoe cover Glove Gown Drape Large enough (20*20 feet) With appropriate ventilation Remaining closed & positive pressure NOT touch any non-sterilized goods with scrubbed h
12、ands NOT pass equipment through the contaminated field Change position face to face or back to back NOT lift or move the sterile drapes Check before /after Operation Strict aseptic technique is essential to minimize surgical infection rate It is the most important to keep asepsis principle in mind d
13、uring the any surgical procedure History Type of Transfusion Indication Transfusion Reactions Autologous transfusion Component Transfusion (1665)Philip (1825)Landsteiner (1900)How to store blood longer?Is there any suitable Blood SubstitutesSuccessful blood transfusion is relatively recent Crossmatc
14、hing Anticoagulation Plastic storage containerType of Transfusion：nWhole Blood；nBlood Component；RBC PLT FFP Leukocyte concentrate nPlasma Substitutes；Use of whole blood is considered to be a waste of resources Symptomatic anemia (providing oxygen-carrying capacity) Transfusion trigger (HCT30% ; HB10
15、g/dl) 1 Unit increases 3% HCT or 1g/dl Shelf life =42 d (1-6 ) Thrombocytopenia ( 50,000) Platelet dysfunction Each unit increase 5,000 PLTs after 1 H Profoundly granulocytopenia (500) Serious infection not responsive to antibiotic therapy Coagulation factor deficiencies 1 ml increases 1% clotting f
16、actors Being used as soon as possible Albumin, hetastarch, crystalliods are equally effective volume expander but safer than FFP After use of 5 U of RBCs, matching 2 U of FFP-Volume ExpanderDextran Most widely used Low/Middle M.W. (40,000-70,000) Massive transfusion could impair coagulation Occasion
17、al ALLERGIC reactionHydroxyethyl Starch Formulation (HES) More stable Containing essential electrolytes No allergic reactionIndication：nAcute massive blood loss;nAnaemia and hypoalbuminemia;nOverwhelming Infection;nDysfunction of Coagulation;Technique of Transfusion:nApproach Route:Peripheral Vein,
18、Center VeinnFiltration before Transfusion：nVelocity of Transfusion：5-10ml/minnDouble Check: Name, Type and CrossmatchnStorage Time: Citrate Phoshate DetroseAcidic Citrate Detrose 21D, 35DnPre-heat：nNo any other Medication：nObservation during / after Transfusion：AttentionAttention：Incidence：2%Chills,
19、 Fever 39-40.CHeadache, SweatinessNausea, Vomiting, Flushing15min-1hrFebrile Reactions ：nImmuno-reaction ：nEndo-toxins：nContamination or Hemolysis：nAnalyze possible reasons：nStop Transfusion ：nGeneral Support：Treatment：Febrile Reactions ：UrticariaAbdominal cramps DyspneaVomitingDiarrheaAnaphylactic
20、reactions：nImmuno-reaction： IgEnHereditary Immunoglobulin： IgAReason：nAdminister antihistaminesnAdminister epinephrine, diphenhydramine, and corticosteroids：nSupport airway and circulation as necessary：Treatment：Anaphylactic reactions：Burning at the intravenous (IV) line siteFever, Chills, DyspneaSh
21、ockCardiovascular CollapseHemoglobinuria, HemoglobinemiaRenal FailureDICHemolytic transfusion reactions nABO incompatibility nRh Incompatibility nNon-immune HemolysisnImmune Hemolysis Reasons：Hemolytic Transfusion Reactions nStop Transfusion as soon as reaction is suspectednCheck the name, type and
22、crossmatchnUrine Exam nRenal Protection (Aggressive Fluid Resuscitation, Furosemide)nDIC MonitorTreatment：Hemolytic Transfusion Reactions nDouble Check name,type and crossmatchnOperate carefully and routinely nTemperature MonitorPrevention：Hemolytic Transfusion ReactionsMassive transfusion complicat
23、ions:Volume OverloadCongestive Heart Failure TachycardiaTachypneaCyanopathynVolume OverloadnHeart Functional FailurenLung Functional FailureReasons：nStop TransfusionnHeart Functional SupportnDiuresis (Furosemide)Treatment：Massive Transfusion Complications:Contamination:FeverShockDICBacterial Contami
24、nationReasons：nStop TransfusionnBacterial Exam and Culture nAntibioticsTreatment：nDouble Check nOperate carefullyPrevention：Contamination:nHepatitis B, Hepatitis CnHIVnCytomegalovirus (CMV)nSyphilisnMalariaAcquired diseases ：nNo risk of infectious disease transmission nNo transfusion reactions nNo c
25、ompatibility testing nReduced demand on blood bank stores nAn immediate source of autologous blood nRed Blood CellsPacked RBCnWhite Blood CellsnPooled PlateletsBlood Cell： Saving blood source Less likely carrier of transmitted diseases Shortage of quality blood Greater shelf life than whole blood He
26、lping to make blood safer by filtration Infusing regardless of ABO type in some blood products giving only essential/desired blood componentnFresh Frozen Plasma Coagulation Factors Fibrinogen nFrozen Plasma FVFVIIInCryoprecipitateVWF FVIIIPlasma：nAlbumin Albumin or Volume expander nImmunoglobin nCoagulation FactorsHaemophilia VWPlasma Derivatives ：
