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agent that kills or inhibits the growth of microorganisms on the external surfaces of the body. Antiseptics should generally be distinguished from drugs such as antibiotics that destroy microorganisms internally, and from disinfectants, which destroy microorganisms
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the totality of measures taken to prevent infection of a wound by microbes, including the sterilization of everything that comes in contact with the wound and is either temporarily or permanently introduced into the organism during an operation.
In 1867 the English surgeon J. Lister proposed the use of carbolic acid in the battle against infection. Later it was found that carbolic acid is not entirely safe for either patients or surgeons; poisoning and complications during the healing of the wound, including necrosis—mortification of tissues—were observed. The search was undertaken for new methods of neutralizing microbes, methods that would not have a negative effect on the patient’s organism. Researchers established the fact that microorganisms are killed by high temperatures (boiling, hot air, and so forth); this discovery laid the foundation for the development of the aseptic method (physical antisepsis). The German surgeons E. Bergman and K. Schimmelbusch greatly contributed to the progress of asepsis in the 1880’s and may rightly be considered the founders of asepsis. In Russia asepsis became widespread in the 1890’s (V. A. Ratimov, M. S. Subbotin, P. I. D’iakonov, and others). In contemporary surgical practice, disinfection (sterilization) is achieved mainly by physical methods—that is, high temperature (boiling, heating), high temperature in combination with increased pressure (autoclaving), and ultraviolet rays. To maintain asepsis, all surgical operations are carried out only in special operating rooms under conditions that eliminate infectious microbes—that is, smooth, easily washed walls and the absence of unnecessary objects and furniture. The disinfection of the air in operating rooms is achieved by means of ultraviolet radiation from bactericidal lamps. Access to operating rooms is permitted only to a small number of people who wear special clothes, shoes, and masks made from gauze. Operating room personnel who have been exposed to festering diseases or who are carriers of infection are not permitted to work in the operating room. Surgeons and surgical nurses begin the operation after washing their hands with sterile brushes according to a special method and after treating them with agents that kill microbes on the surface of the skin and prevent the spread of microbes from the sudoriferous and sebaceous glands (tanning agents). The personnel perform the operation wearing sterile smocks and rubber gloves. The operating area—the place where the incision is made—is shaved, treated with an alcohol solution of iodine, and isolated from the other portions of the body with sterile sheets. Sterilization of operating room linen—smocks, caps, gauze masks, towels, sheets, gloves, and so forth—and also of the dressings is achieved by autoclaving in a biks, in which the material is kept sterile for several days. Metal instruments are boiled in sterilizers; cutting instruments (which become dull when boiled) and material used for joining tissues (sutures), such as silk, catgut, nylon and capron thread, and metallic and tantalic clips, are sterilized by immersion in 96 percent alcohol; cystoscopes and other instruments with optical systems are immersed in corrosive sublimate for a period of time that ensures the destruction of microbes (from several hours to five days). Articles made of plastic and used in plastic surgery in the making of prostheses to replace certain organs—artificial esophagi, blood vessels, cardiac valves, joints, and so forth—are sterilized with chemical substances. Washbasins, trays, and other objects are disinfected by heating.
All contemporary surgical work is based on strict observation of the rules of asepsis, although even the use of antiseptic means is not excluded. The organization of special operating rooms and dressing rooms for the performance of operations and dressing accompanied by the opening up of the lumen of the intestines or of a suppurative focus or for the execution of these operations after other so-called clean operations makes possible the most complete asepsis.
In the case of organ transplants, asepsis must approach the conditions of complete sterilization. Everything that comes in contact with the patient during and after the operation is disinfected—that is, the air, the linen (sterile or antimicrobial material is used), and so forth.
REFERENCESBreido, I. S. Istoriia antiseptiki aseptiki v Rossii. [Leningrad,] 1956.
Mnogotomnoe rukovodstvo po khirurgii, vol. 1. Moscow, 1962. Pages 159–73.
A. B. GALITSKII