It's an infection! The Ermakovs firmly adhere to their version: the misfortune with Olya's child is the result of an intrauterine infection. Attached is a list of Olga's diseases - apparently from a medical record, which includes chlamydia, mycoplasmosis and untreated infertility for 9 years

The most common complications in surgery are infectious. They can be fatal despite brilliantly performed surgery. The prevention of such complications is the main principle of surgery, which is based on asepsis and antisepsis.

Asepsis - a set of measures aimed at preventing the entry of infectious agents into a wound or human body.

Antiseptics - a set of measures aimed at fighting infection in the human body, preventing or eliminating the infectious inflammatory process.

Both methods are a single whole in the prevention of surgical infection. They should be considered from the point of view of the relationship between the source of infection, the ways of its transmission and the susceptibility of the organism.

Any science goes through certain stages of development. In surgery, a radical revolution came with the introduction of antiseptics and asepsis, which determined the line between the pre-antiseptic and antiseptic periods. And this is not accidental, since mortality in the pre-antiseptic period, even after small incisions or punctures, reached more than 80%. In the 19th century, even a surgeon like Billroth had a 50% mortality rate after mastectomy and strumectomy. Patients died from suppuration of wounds, erysipelas, gangrene, sepsis. The priority in the development of the antiseptic method belongs to the English surgeon Joseph Lister (1829-1912). His work revolutionized surgery and marked the beginning of a new stage in its development.

Surgeons of the 18th century identified purulent complications of wounds (phlegmon, erysipelas, tetanus, etc.) with putrefaction, which, in their opinion, was caused by the effect of air on the wound, which cools and dries the wound. Therefore, they recommended occlusive, airtight dressings, and the English surgeon Benjamin Bell advised dressings to be done as quickly as possible in order to limit the time of exposure to air (especially "impure") on the wound. His compatriot Pringl believed that in order to purify the air, it is necessary to better ventilate the hospital premises.

The French surgeon Putot (XVIII century) established an important fact that was important for the subsequent formation of the main principles of contact infection of wounds: purulent wound discharge from one patient, when it enters the wound of another, causes purulent inflammation in the latter. So, when using already used dressing material or material that is contaminated with hands, "infected with the bad air of the sick", wounds become infected.

The assumption of the role of microbes in the development of purulent complications of wounds was also expressed by other surgeons. N.I. Pirogov during the Crimean War (1853-1856) wrote: “... we can safely say that most of the wounded die not so much from the injuries themselves, but from hospital infection ... The time is not far from us when a thorough study of traumatic and hospital miasm will give surgeons another direction.” N.I. Pirogov believed that the infection (“miasma”) was transmitted through hands, linen, mattresses, dressings, and recommended hygiene measures in this regard. He used alcohol, iodine, silver nitrate to treat wounds, capable of destroying "miasma".

The priority in the systemic use of antiseptics belongs to the Hungarian obstetrician I. Semmelweis, who in 1847 used a bleach solution to disinfect the birth canal of puerperas, hands, tools and all other objects in contact with the birth canal. I. Semmelweis approached this method not by chance: he experimentally proved the presence of a contaminated beginning in the secretions from the uterus of women with puerperal fever (sepsis): rabbits, into whose blood the secretions were injected, died. Based on this, I. Semmelweis believed that the transfer of an infectious principle from a sick puerperal to a healthy one, its penetration through an extensive wound surface, which is the uterus after childbirth, leads to the development of sepsis. The use of the treatment method proposed by I. Semmelweis led to a decrease in mortality in his clinic by a third. However, the method did not gain popularity, since most surgeons considered air infection to be the cause of wound infection.

The immediate prerequisite for the development of the antiseptic method in surgery by J. Lister was the discovery in 1863 of the causes of fermentation and putrefaction by Louis Pasteur, who found that they are based on the penetration and vital activity of specific microorganisms. L. Pasteur also developed methods for preventing these processes. The undoubted merit of J. Lister is that he transferred the discovery of L. Pasteur to surgery, drew parallels between putrefaction and suppuration of wounds, considering the cause of suppuration to be penetration from outside

some disease-causing principles. Based on this, he proposed to close the wound with a special bandage that does not allow air to pass through, and to prevent decay in the wound, use phenol. The choice of phenol was not accidental - it is an integral part of the tar, and at that time garbage pits were poured with tar to prevent decay in them. A few years earlier, Lemaire had established the disinfecting effect of phenol. Using phenol to treat open fractures, J. Lister got an excellent result. After two years of research, he created a system for the prevention of purulent complications of wounds and in 1867 published a work entitled "On a new method of treating fractures and abscesses with comments on the causes of suppuration." The essence of prevention was the fight against airborne and contact infection and was reduced to the destruction of bacteria with the help of phenol in the air, on hands, instruments and other objects in contact with the wound. The effectiveness of the system for the prevention of infectious complications using the Lister method was convincingly confirmed by a several-fold decrease in the frequency of deaths from purulent complications.

And despite the fact that earlier there were suggestions about the role of some external factors in the development of septic complications and some means were proposed to prevent complications, J. Lister's merit is that he created a system of prevention - the antiseptic method. The main components of this system were a multi-layer Lister bandage, processing of hands, instruments, air sterilization in the operating room. The bandage consisted of the following layers: a bandage made of silk impregnated with a 5% phenol solution was adjacent to the wound, 8 layers of gauze impregnated with the same solution with the addition of rosin were applied over it, covered with a rubberized cloth or oilcloth and fixed with gauze bandages impregnated with phenol. The surgeon's hands, instruments, dressing and suture material were washed with 2-3% phenol solution. The operating field was treated with the same solution. In the operating room, a phenol solution was sprayed with a spray gun before and during the intervention to sterilize the air.

The use of the Lister method led to a decrease in the frequency of purulent complications of wounds, but also revealed disadvantages. The use of phenol solutions, in addition to a positive one, also had a negative effect, causing general intoxication of patients, tissue burns in the wound area, kidney damage, diseases of surgeons (dermatitis, burns, hand eczema). Attempts were made to replace phenol with other substances: a solution of mercury dichloride (mercuric chloride), boric or salicylic acid, potassium permanganate, etc. However, the more antimicrobial

The more pronounced was their toxic effect on the body.

In the history of antiseptics, dramatic moments are also known. Thus, the idea expressed by L. Pasteur in 1880 that all purulent inflammations have one pathogen was questioned by E. Bergman as unproven and therefore doubtful. The Swiss surgeon C. Garre (1857-1928), to prove the correctness of L. Pasteur, rubbed a microbial culture of staphylococcus from the colonies obtained by sowing the pus of a patient with osteomyelitis into the skin of his left forearm. A large carbuncle surrounded by multiple small boils developed at the site of infection. When sowing pus, staphylococcus aureus was isolated. The doctor recovered. After conducting an experiment on himself, he empirically proved that staphylococci cause various purulent diseases: abscess, furuncle, carbuncle, osteomyelitis.

Gradually, interest in the Lister method and its modifications was lost, and after 25 years it was replaced by the aseptic method, which consisted in sterilizing all objects in contact with the wound. The founder of asepsis was the German surgeon E. Bergman, who previously worked in Russia. At the Congress of Surgeons in Berlin in 1890, he reported on a new method of combating wound infection and demonstrated successfully operated patients under aseptic conditions. J. Lister, who chaired the congress, congratulated E. Bergman on his success, calling the aseptic method a brilliant achievement of surgery.

The proposed aseptic method is based on the principle of destroying the microbial flora on all objects in contact with the wound by exposure to high temperature (boiling, hot steam, etc.). Since 1892, the asepsis method has been used in many clinics around the world. The results were so striking that there were calls to completely abandon the antiseptic method (the fight against infection in the human body) and even to exclude antiseptics from surgical practice. However, it turned out to be impossible to do without them in surgery: the treatment of the surgeon's hands and the operating field, the sanitation of purulent cavities, and many other activities are impossible without antibacterial drugs, especially since new low-toxic antiseptics appeared over time, and antiseptic methods were replenished not only with chemical, but also with physical ones. means (laser, ultrasound, etc.).

The main requirements for antiseptic agents are as follows: bactericidal or bacteriostatic effect on micro-

roorganism; no irritating toxic effect on tissues when applied topically; preservation of properties in contact with biological fluids (blood, exudate, pus) and air (they should not be volatile); in addition, their production should be cheap.

SOURCES AND WAYS OF SPREAD OF INFECTION IN SURGERY

Under source infections understand the habitats, development, reproduction of microorganisms. In relation to the body of the patient (wounded), exogenous (outside the body) and endogenous (inside it) sources of surgical infection are possible.

main sources exogenous infection- patients with purulent-inflammatory diseases, bacillus carriers, less often - animals (Scheme 1). From patients with purulent-inflammatory diseases, microorganisms enter the external environment (air, surrounding objects, hands of medical personnel) with pus, mucus, sputum and other secretions. If certain rules of behavior, mode of operation, special methods of processing objects, tools, hands, dressings are not observed, microorganisms can enter the wound and cause a purulent-inflammatory process. Microorganisms enter the wound from the external environment in various ways: contact - in contact with the wound of infected objects, instruments, dressings, surgical linen; by air- from the ambient air in which the microorganisms are located; implantation-

Scheme 1.exogenous infection.

infection when leaving in the wound for a long time or permanently certain objects (suture material, bone fixators and other implants) infected during the operation or due to violation of the rules of sterilization.

Animals as a source of surgical infection play a lesser role. When carcasses of sick animals are processed, anthrax infection is possible. With the excrement of animals, causative agents of tetanus, gas gangrene can enter the environment. On surrounding objects, in the ground, these microorganisms are in the form of spores for a long time. In case of accidental injuries, they can penetrate into the wound with earth, scraps of clothing and other objects and cause specific inflammation.

source endogenous infection are chronic inflammatory processes in the body, both outside the operation area (diseases of the skin, teeth, tonsils, etc.), and in the organs on which the intervention is performed (appendicitis, cholecystitis, osteomyelitis, etc.), as well as the microflora of the oral cavity, intestines , respiratory, urinary tract, etc. The ways of infection in endogenous infection are contact, hematogenous, lymphogenous (Scheme 2).

contactwound infection is possible if the operation technique is violated, when exudate, pus, intestinal contents can get into the wound, or when microflora is transferred on instruments, swabs, gloves due to non-compliance with precautions. From the hearth

Scheme 2.endogenous infection.

inflammation located outside the operation area, microorganisms can be brought in with lymph (lymphogenic route of infection) or through the bloodstream (hematogenous route of infection).

Asepsis methods are used to fight exogenous infection, antiseptic methods - with endogenous infection, including those that have entered the body from the external environment, as happens with accidental injuries. For successful prevention of infection, it is necessary that the fight is carried out at all stages (source of infection - ways of infection - organism) by a combination of aseptic and antiseptic methods.

To prevent infection of the environment in the presence of a source of infection - a patient with a purulent-inflammatory disease - first of all, organizational measures are necessary: ​​treatment of such patients in special departments of surgical infection, performing operations and dressings in separate operating rooms and dressing rooms, the availability of special personnel for treatment sick and caring for them. The same rule exists for surgery on an outpatient basis: admission of patients, treatment, dressings and operations are performed in special rooms.

Bacillus carriers (they include people who are practically healthy, but emit pathogenic microflora into the environment, most often from the nose, pharynx) must be removed from work in surgical institutions and appropriately treated, they are allowed to return to work only after bacteriological control.

ASEPSIS

Drugs that have an antibacterial effect on pyogenic microflora are divided into two groups - chemotherapeutic agents (see. antiseptic) and chemicals for disinfection and sterilization.

Preparations used for disinfection and sterilization are used to prevent infection from entering the wound, i.e. to fight infection along the way of its transmission. Some chemical antibacterial agents can be used as both chemotherapeutic agents and agents for disinfection and sterilization (for example, chlorhexidine, hydrogen peroxide, etc.).

Of the chemicals for disinfection and sterilization, preparations are widely used in surgery. iodine: A 5% and 10% alcohol solution is used to lubricate the skin around the wound, treat superficial wounds and abrasions, and the surgical field.

Iodine + potassium iodidecontains about 4.5% free iodine; before use, it is diluted with distilled water in a ratio of 1:4.5. The drug is used to treat the surgical field.

Povidone-iodine -compound of iodine with polyvinylpyrrolidone, contains 0.1-1% iodine. Used for the treatment of hands, the operating field.

Chloramine B (Chloraminum) used in the form of (1-3%) solution for disinfection of hands, patient care items, non-metallic instruments, premises.

Performic acid in combination with hydrogen peroxide (Pervomur, preparation C-4) is intended for the treatment of hands before surgery. Prepare a special solution (see. Preparation of hands for surgery). The drug is also used for the treatment of surgical instruments and rubber gloves.

Ethanol (Spiritus aethylicus) used in the form of a 70% or 96% solution for the treatment of hands, surgical field, optical instruments, suture material.

Formalin (Formalinum) - solution containing 36.5-37.5% formaldehyde. Used as a 0.5-5% solution for disinfection of gloves, instruments, catheters, drains.

Degmicide (Degmicidum)contains 30% degmin (quaternary ammonium compound). Apply a 1% solution (i.e. at a dilution of 1:30) to treat the surgical field and the surgeon's hands.

Benzalkonium chloride in the form of a 1% or 10% solution is used to sterilize instruments (at a dilution of 1:1000; exposure - 30 minutes), rubber gloves, drains (at a dilution of 1:4000; exposure - 24 hours). In order to prevent corrosion of instruments, sodium carbonate is added at the rate of 2 g per 1 liter of working solution.

Chlorhexidineavailable as bigluconate (Chlorhexidini bigluconas). Synonym - gibitan. Produced in the form of a 20% solution. For treatment of the surgical field and disinfection of instruments, the solution is diluted with 70% ethanol solution in a ratio of 1:40. The resulting 0.5% water-alcohol solution treats the surgical field 2 times with an interval of 2 minutes. Instruments are sterilized by immersing them in the solution for 2 minutes.

Of the modern means for disinfection and pre-sterilization preparation, Alaminol (Russia) is used. The active ingredient is a 5% solution of alkyldimethylbenzylammonium chloride and an 8% solution of glyoxal, as well as a surfactant, pH 3.5. It has a broad bactericidal action against nonspecific pyogenic flora, causative agents of tuberculosis, fungi, viruses, as well as detergent properties.

Used for disinfection of indoor surfaces, furnishings, sanitary equipment, linen, surgical instruments, endoscopes. The concentration of the agent according to the preparation is 1-10%, the preparation is dissolved in water.

Application - wiping surfaces or immersing objects in a disinfectant solution. The solution is used repeatedly. Quality control of pre-sterilization preparation is carried out using a test for residual blood (benzidine, amidopyrine test). Processing time (immersion) of metal products, plastics - 60 minutes at a concentration of 5%, contaminated linen (soaking) - 120 minutes at a concentration of 5%.

Disinfectant "Kemi-side" (Russia). The active principles are 1,1-bifenide - 3-3.5%, 5-chloro-2-hydroxydiphenylmethane - 2.6-3.2%. The spectrum of bactericidal action is wide: it includes tuberculosis bacillus, viruses, fungi. The drug is diluted with water, prepare a 0.5%, 1%, 2% solution.

It is used for disinfection of devices, appliances, sanitary equipment, wall surfaces, tables, floors. Method of disinfection - single or double wiping.

Disinfectant "Lizafin-special" (Russia). Active ingredients: alkyldimethylbenzylammonium chloride, glutaraldehyde, glycosol, denatured alcohol.

Antimicrobial spectrum - bacteria, including tuberculosis bacillus, viruses, fungi. Has detergent properties.

Apply in concentrations of 1-5% of the drug. Used for disinfection of surfaces (floor, walls), surgical tables, furniture, patient care items. They are used for pre-sterilization treatment of objects made of glass, metal, plastics - endoscopes, instruments. Disinfection is carried out by soaking, wiping, immersion. The processing time of instruments, endoscopes when using a 1% solution is 60 minutes, 1.5% - 30 minutes, 2% - 15 minutes when immersed in the drug solution.

The fight against microflora on the ways of airborne infection

The surgical hospital includes several main functional units: the operating unit, the wards of the surgical department, dressing rooms, treatment rooms, etc.

The success of the prevention of exogenous infection in surgical patients is possible under the condition of an integrated approach at all stages.

stay of the patient in the hospital: admission department - surgical department - diagnostic rooms - dressing room - operating room.

All work surgical hospital for the prevention of exogenous infection begins with the division of patients into "clean" and "purulent". Patients with purulent-inflammatory surgical diseases are hospitalized in purulent (infectious) surgical departments, which are completely isolated from clean departments. They have their own staff, dressing rooms, operating rooms, treatment rooms (for infusions, infusions, blood sampling for laboratory tests, etc.). This section should be in a separate room. If there is only one surgical department, special wards for infected patients are allocated in it, the wards are located in one part of it (compartment) with a separate dressing room in the same compartment.

In the reception area where the primary examination and examination of those admitted are carried out, the flows of patients are immediately divided into “clean” and “purulent”. In the admission department, sanitary and hygienic treatment is performed, which involves washing the patients (hygienic bath or shower) and changing their clothes. Under certain conditions (pediculosis, scabies), special treatment is carried out, as well as disinfection and disinfestation of linen.

In the surgical department to maintain the sanitary regime, daily wet cleaning is carried out using antiseptic agents and once every 3 days - wet cleaning of the walls (wiping with a damp brush, rag). The department furniture is subjected to wet processing. Regular ventilation, the use of air conditioners can reduce the degree of bacterial contamination of the premises of the department. The sanitary regime for the staff is important: a shower before starting work, change of clothes and shoes, wearing caps. An important means of prevention is the examination of personnel for bacillus carrying (smears from the nose, throat) and the isolation of employees with colds and pustular diseases.

The main route of wound infection in the operating room- contact (about 90% of cases), only in 10% of cases infection occurs by air. Each member of the surgical team, despite the special preparation for the operation, sterile surgical underwear, compliance with the work regime, releases up to 1500 microorganisms per minute into the surrounding air. For 1-1.5 hours of work of one surgical team, bacterial air pollution in the operating room increased

is 100% covered. The permissible number of microorganisms in 1 m 3 of air in the operating room before starting work should not exceed 500, during the operation - 1000, provided that there are no pathogenic microorganisms in the air. It is possible to maintain this level with the help of special devices of the ventilation system, operating mode and cleaning of the operating room, disinfection of air and objects.

The surgical hospital includes several main functional units: an operating unit, surgical departments, dressing rooms, and procedural ones.

Operating block - a set of special premises for performing operations and carrying out activities that support them. The operating unit should be located in a separate room or wing of the building, connected by a corridor with surgical departments, or on a separate floor of a multi-storey surgical building. More often there are operating rooms separated from each other for performing interventions in “clean” and “purulent” patients, although it is more expedient to provide a separate, isolated operating unit for purulent surgical departments.

The operating block is separated from the surgical departments by a special vestibule - more often it is a part of the corridor into which the premises of the general operating block open. To ensure the sterility regime in the operating unit, special functional zones are allocated (Scheme 3).

1. Sterile zone combines operating room, preoperative room and sterilization room. In the premises of this zone, the following actions are performed: in the operating room - the operation itself; in the preoperative room - preparing the surgeon's hands for surgery; in the sterilization room - sterilization of instruments that will be needed during the operation or reused.

2. To the high security zone includes such premises as a sanitary inspection room, consisting of rooms for undressing personnel, showers, cabins for putting on sterile clothes. These rooms are arranged in series, and the staff leaves the dressing booth directly or through the corridor to the preoperative room. The same zone includes rooms for storing surgical instruments and devices, anesthesia equipment and medicines, a blood transfusion room, rooms for the duty team, a senior operating nurse, and a sanitary unit for the personnel of the operating unit.

3. restricted zone, or technical area, combines production facilities to ensure the operation of the operating unit

Scheme 3.Operating unit device.

ka: there are air conditioning equipment, vacuum installations, installations for supplying the operating room with oxygen and narcotic gases, there is also a battery substation for emergency lighting, a darkroom for developing x-ray films.

4. In the zone of general regime there are offices of the head, senior nurse, rooms for sorting dirty linen, etc.

The operation mode of the operating unit provides for the restriction of its visits. Only the surgeons participating in the operation and their assistants, operating nurses, anesthesiologists and anesthetists, and a nurse for the current cleaning of the operating room should be in the sterile regime zone. Students and trainee doctors are allowed into the sterile regime zone. The workers of the operating unit wear special clothes: gowns or jackets and trousers that differ in color from the clothes of the employees of other departments.

Control over the sterility regime of the operating unit is carried out periodically by bacteriological examination of the air in the operating room, washings from the walls, ceiling, apparatus and instruments. Materials for sowing are taken once a month; weekly, in addition, selectively do sowing from the hands of the workers of the unit to control sterility.

The sterile mode in the operating room is achieved by preventing the introduction of microorganisms from other rooms and their spread. Special arrangement of the operating unit, the use of sterile airlocks before entering the operating room, preparing the patient for the operation (washing, changing underwear, shaving the hair in the area of ​​the operating field), preparing the personnel for the operation (mandatory changing clothes, using sterile underwear, putting on shoe covers, caps, masks, hand sanitization) significantly limit the entry of microorganisms into the operating room.

Microorganisms in the air, on objects are very rarely found in an isolated form - they are mainly fixed on microscopic dust particles. Therefore, careful removal of dust, as well as prevention of its entry into the operating room, reduces the degree of microbial contamination.

The operating room has the following types of cleaning: preliminary, current, postoperative, final and general.

Before starting the operation, wipe all objects, appliances, window sills with a damp cloth, remove dust that has settled overnight (preliminary cleaning). During the operation, napkins, balls, instruments that have fallen on the floor are constantly removed. (current cleaning). In the interval between operations, when the patient is taken out of the operating room, linen, napkins, instruments are removed; wipe the operating table with a damp cloth moistened with a solution of antiseptic agents and cover it with a sheet; wipe the floor with a damp cloth (postoperative cleaning). At the end of the working day, produce final dress-

ku, which includes wet cleaning with wiping the ceiling, walls, window sills, all objects and equipment, floors using disinfectant solutions (1-3% hydrogen peroxide solution with a synthetic detergent, benzalkonium chloride solution, etc.) and then turning on bactericidal lamps.

At the end of the week, carry outgeneral cleaningoperating room. It begins with the disinfection of the operating room: the ceiling, walls, all objects, the floor are sprayed with a disinfectant solution, and then removed by wiping. After that, a general wet cleaning is carried out and bactericidal ultraviolet (UV) lamps are turned on. General cleaning can be extraordinary - if the operating room is contaminated with pus, intestinal contents, after surgery in patients with anaerobic infection (gas gangrene).

For irradiation of air and objects in the operating room, floor (mobile), wall, ceiling bactericidal UV lamps of various powers are used (Fig. 1). Germicidal lamps, equipped with special screens that protect against direct exposure to UV rays, can work in the presence of people in the operating room.

In addition to bactericidal lamps, aerosols of bactericidal substances can be used to disinfect the air in the operating room.

Rice. 1.Bactericidal ultraviolet lamps: a - ceiling; b - floor (mobile) type "Mayak".

Rice. 2.Operating room with laminar air flow: 1 - filter; 2 - air flow; 3 - fan; 4 - pre-filter; 5 - opening for outside air; 6 - perforated floor.

lyable by a special apparatus of the "Dezinfal" type. As bactericidal substances, a mixture containing a 3% solution of hydrogen peroxide and 0.5% lactic acid is used. Spraying should be carried out the day before, in extreme cases - at least 2 hours before the start of the operation.

Prevention of air pollution in the operating room is achieved by a mechanical ventilation system, carried out by supplying air from the street or by recirculating it. With the help of supply ventilation, air is forced through the filters into the operating room. Together with the dust settling on the filters, microbes fixed on it are removed. Air exits the operating room through natural crevices. This flow direction avoids the ingress of polluted air from the rooms adjacent to the operating room, including from the surgical departments. In the absence of a centralized system for cleaning air from dust and microbes, special mobile air cleaners (VOPR-1.5) can be used. For 15 minutes of operation of the apparatus, the number of microbes in the operating room decreases by 7-10 times.

For some interventions (such as organ transplants requiring subsequent use of immunosuppressive agents, implantation of prostheses, operations for extensive burns), operating rooms with laminar flow of sterile air-conditioned air are used (Fig. 2). The number of microorganisms

Mov in such operating rooms is ten times lower than with a conventional air conditioning system. The laminar flow provides 500-fold exchange of air per hour, which is injected under a pressure of 0.2-0.3 atm. through a special filter, which is the ceiling of the operating room, and exits through the holes in the floor. This creates a constant vertical flow: sterile air enters the operating room, and its directed flow carries away microorganisms that have entered the air from the patient or persons involved in the operation. Laminar air flow can be either vertical or horizontal.

In old operating rooms, it is possible to install a special box isolator with a laminar air flow: the walls of the box made of plastic or glass do not reach the floor, and the sterile air injected through the ceiling filter creates a vertical laminar flow that displaces the air in the box into the gaps formed between its walls and the floor (Fig. 3).

Rice. 3.Box isolator with laminar air flow, installed in the operating room.

The fight against microflora at the stages of contact infection of the wound

To prevent contact infection everything that comes into contact with the wound must be sterile. This is achieved by special processing of surgical linen, dressing and suture material, gloves, instruments, processing of the surgeon's hands and the surgical field. Sterilization(sterilis- barren) - complete release from microorganisms of all objects, solutions, materials. Disinfection provides for the destruction of pathogenic microbial flora. Sterilization of the suture material is aimed at preventing both contact and implant infection of the wound.

Sterilization of instruments, dressings and underwear includes the following main stages: I - pre-sterilization preparation of the material; II - laying and preparation for sterilization; III - sterilization; IV - storage of sterile material. All these steps are performed in accordance with the industry standard "Sterilization and Disinfection of Medical Devices".

Instrument sterilization

Stage I - pre-sterilization preparation

The purpose of pre-sterilization preparation is a thorough mechanical cleaning of instruments, syringes, injection needles, transfusion systems, the removal of pyrogens and the destruction of the hepatitis virus. Personnel must wear rubber gloves.

Used but uninfected instruments they are thoroughly washed with running water with brushes in a separate sink for 5 minutes (instruments contaminated with blood are washed immediately, preventing the blood from drying out) and then soaked for 15-20 minutes in one of the special washing solutions heated to 50 ° C. Syringes are processed disassembled.

After soaking, the tools are washed in the same solution with ruffs, brushes (locks, teeth, notches are especially carefully treated), then rinsed with warm water for 5 minutes and rinsed in distilled water for 1 minute. After that, the instruments and syringes are placed in a dry-air sterilizer at a temperature of 85 ° C for drying, after which they are ready for sterilization.

Instruments and syringes contaminated with pus or intestinal contents pre-placed in enameled containers with 0.1% solution

diocide solution for 30 min. Then, in the same solution, they are washed with ruffs, brushes, rinsed with running water and dipped in one of the washing solutions, carrying out further processing according to the method described above.

Instruments after an operation performed on a patient with an anaerobic infection, soaked for 1 hour in a special solution consisting of a 6% hydrogen peroxide solution and a 0.5% detergent solution, then washed with a brush in the same solution and boiled for 90 minutes. Only after that, the instruments are prepared for sterilization in the same way as uninfected instruments. After 1 day (time for germination of spores), they are subjected to autoclaving or boiling (fractional sterilization).

Sterilization of needles is carried out involuntarily when it is not possible to use disposable needles.

Puncture, injection needles after use, they are washed with a syringe with warm water, and then with 1% sodium bicarbonate solution, the needle channel is cleaned with a mandrin, washed with 0.5% ammonia solution and running water. After that, the needle with the inserted mandrin is boiled for 30 minutes in a 2% solution of sodium bicarbonate, and after 8-12 hours it is re-distilled for 40 minutes and dried, after which the needle channel is dried by blowing with diethyl ether or alcohol using syringe or rubber bulb. Needles contaminated with pus are thoroughly washed, the lumen is washed with running water; then they are placed for 1 hour in a disinfectant solution, additionally washing the canal with a syringe or a rubber bulb, and subjected to the same further treatment as needles not contaminated with pus.

Transfusion systems medicinal substances or blood of single use, but forcedly used repeatedly. Careful processing is carried out to prevent post-transfusion reactions and complications. In modern conditions, one-time systems for transfusion, sterilized in the factory, are used. The reusable system is dismantled immediately after a blood or drug transfusion - the glass parts, a dropper and rubber tubes are separated, washed thoroughly with running water, kneading the rubber tube with your fingers (for better removal of blood residues). Parts of the system are immersed for 2 hours in a special solution heated to 60 ° C, containing 1% sodium bicarbonate solution and 1% ammonia solution. Then the parts of the system are washed with running water and boiled in distilled water for 30 minutes, washed again with water, stretching the rubber tubes, and boiled again for 20 minutes in distilled water. The system is then assembled and packaged for sterilization.

Latex gloves. In modern practice, disposable gloves are used, sterilized at the factory. If it is necessary to reuse gloves contaminated with blood, they are washed without removing them from the hands with running water until the blood is completely removed, dried with a towel and placed for 30 minutes in a 0.5% ammonia solution or in a washing and disinfecting solution. Then they are thoroughly washed with running water, hung out on a rope to dry, and then packaged for sterilization.

Rubber gloves contaminated with pus or intestinal contents must be destroyed. If necessary, they are washed in running water and placed in a washing and disinfecting solution for 1 hour, rinsed with running water and packaged for sterilization. These gloves can be used to work in a purulent dressing room.

For controlFor completeness of blood removal from objects that have undergone pre-sterilization treatment, a benzidine test is used: 3 drops of a 1% solution of benzidine and hydrogen peroxide are applied to the object. The appearance of a blue-green color indicates traces of blood left on the objects. In this case, reprocessing is necessary.

Stage II - styling and preparation for sterilization

For sterilization in dry heat sterilizers, the instruments are placed in metal boxes, stacking them vertically in one layer. Unassembled syringes are wrapped in 2 layers of special thick paper. Lids from boxes are sterilized side by side. Recently, disposable syringes, sterilized at the factory, have been mainly used.

For steam sterilization under pressure in steam sterilizers (autoclaves), the instruments are wrapped in a waffle towel or cotton cloth in the form of a bag and placed on a metal tray or mesh. For specific typical operations, a set of instruments is prepared in advance (for example, for operations on the lung, heart, bones, blood vessels), placed on a special mesh and wrapped in a sheet in the form of a bag.

The cylinder and plunger of the syringe are placed separately in gauze and wrapped in a piece of cotton fabric in the form of a bag, which is placed in a sterilization box (bix). For mass sterilization of syringes in autoclaves (centralized sterilization), a special packing made of cotton fabric with pockets is used. Disassembled syringes are placed in pockets, needles and tweezers are nearby. Each package contains up to 5 syringes.

The styling is wrapped in a cotton diaper in the form of a bag and placed in a sterilizer.

Dry rubber gloves are sprinkled with talcum powder (outside and inside), laid with gauze napkins, wrapped in a napkin in pairs and placed in a separate bix.

The assembled blood transfusion systems are checked for the strength of the rubber tubes, the tightness of their connection with glass parts, and the compliance of the cannulas with the pavilions of the needle. The system is rolled up in the form of 2-3 rings, without bending the rubber tubes, wrapped in a large gauze napkin, then in a waffle towel and placed in bixes.

Stage III - sterilization

Sterilization of instruments, syringes (with a mark on the syringe of 200 ° C), needles, glassware is carried out in dry-heat cabinets-sterilizers(Fig. 4). Items are loosely placed on the shelves of the sterilizer in

Rice. 4.Dry heat cabinet-sterilizer (diagram): a - front view; b - side view; 1 - body; 2 - control panel; 3 - stand; 4 - thermometers (contact and transistor thermostats); 5 - electric heating elements; 6 - cabinet door.

metal boxes (with the covers removed) and turn on the heating. With the door open, the temperature is brought to 80-85 ° C and dried for 30 minutes - moisture is removed from the inner surfaces of the cabinet and objects to be sterilized. Then the door is closed, the temperature is brought to the set temperature (180 °C), maintaining it automatically, and sterilized for 60 minutes. After turning off the heating system and lowering the temperature to 70-50 ° C, the cabinet door is opened and metal boxes with tools are closed with lids with a sterile instrument. After 15-20 minutes (after complete cooling of the sterilizer), the chamber is unloaded.

When working with a dry heat sterilizer, safety measures must be observed: the device must be grounded, after sterilization, the cabinet door should be opened only when the temperature drops to 70-50 °C. It is forbidden to use a defective device.

Sterilization of instruments, syringes, blood transfusion systems can be performed in a steam sterilizer(autoclave) (Fig. 5).

Rice. 5.Steam sterilizer (autoclave), diagram of its device: a - side view; b - front view; 1 - thermometer; 2 - manometer; 3 - heat source; 4 - introductory tap; 5 - outlet valve; 6 - outer wall of the sterilizer; 7 - the inner wall of the sterilizer.

Packed items are placed in the sterilization chamber. If the packages are placed in bixes, then their grids must be open. Bixes or other packages are laid loosely so that the steam is distributed evenly.

Surgical instruments and syringes are sterilized for 20 minutes at 2 atm 1, which corresponds to a temperature of 132.9 °C. The start time of sterilization is counted from the moment the appropriate pressure is reached. Rubber gloves, blood transfusion systems, rubber drainage tubes are sterilized at 1.1 atm (steam temperature 120 ° C) for 45 minutes. When unloading the autoclave, the holes in the bixes are closed.

Sterilization methods in dry heat and steam sterilizers should be considered as basic. The method of sterilization by boiling is used in small medical institutions where there is no centralized sterilization. Stationary or portable electric boilers are used, in which instruments, syringes, needles, glass objects, rubber drains, catheters, gloves can be sterilized.

Distilled water is poured into the boiler, to increase the boiling point of water and destroy the bacteria shell, add 20 g of sodium bicarbonate per 1 liter of water (2% solution). A thin quilted layer of cotton wool with gauze is laid at the bottom of the boiler so that the salts that fall out in the form of scale settle on it, and not on the tools.

Disassembled instruments are placed on special nets and lowered with hooks to the bottom of the boiler, leaving the handles of the hooks outside, and the boiler is closed with a lid. Sterilization time - 40 minutes from the moment of boiling water. At the end of sterilization, the mesh with instruments is picked up with hooks, allowed to drain and transferred to a special table covered with a sterile sheet folded in 4 layers. The operating nurse lays out the instruments on the large operating table.

Syringes and needles are sterilized separately from instruments, disassembled (by boiling in distilled water without adding sodium bicarbonate), for 45 minutes. Syringes and needles for lumbar puncture and intravenous infusions are boiled in double-distilled water without the addition of sodium bicarbonate.

Instruments, syringes and needles contaminated with pus, feces, after special pre-treatment, are sterilized by boiling for 90 minutes in a separate boiler.

1 1 atm = 1.013 x 10 5 Pa

Tools, syringes and needles used in patients with gas gangrene are subject to careful processing and subsequent fractional boiling sterilization. They are boiled for 1 hour, removed from the boiler and left at room temperature for 12-24 hours (for germination of spores), and then re-sterilized by boiling for 1 hour (fractional sterilization).

The main method of sterilizing rubber products (drainages, catheters, gloves) is autoclaving. In exceptional cases, they are subjected to boiling for 15 minutes.

Sterilization of instruments and items not subject to heat treatment(endoscopes, thoracoscopes, laparoscopes, devices or blocks of devices for cardiopulmonary bypass, hemosorption) are carried out in a special gas sterilizer GPD-250. Items for sterilization are placed in a sealed sterilization chamber (Fig. 6), which is filled with ethylene oxide. Exposure time - 16 hours at a temperature of 18? Sterilization can also be carried out with a mixture of ethylene oxide and methylene bromide at a temperature of 55 ° C for 6 hours.

Sterilization of instruments and optical devices (laparoscopes, thoracoscopes) can be carried out in an alcohol solution of chlorhexidine and pervomur. With such sterilization (by chemical means), metal boxes with lids are used, which prevents the drug from evaporating and polluting the indoor air; in the absence of special dishes, use enameled or glass. Tools are poured with a solution (so that it completely covers them) and closed with a lid.

In emergency cases, when it is impossible to ensure the sterilization of instruments by any of the above methods, the burning method is used. 15-20 ml of alcohol is poured into a metal basin or tray, several tools are placed on the bottom and the alcohol is set on fire. The burning method is not reliable enough, it is fire and explosive (the presence of oxygen, narcotic vapors in the indoor air), therefore, it is resorted to in exceptional cases, strictly observing fire safety measures.

Cutting instruments (scalpels, scissors) become dull during sterilization by conventional methods, so it is carried out with little or no heat treatment. After pre-sterilization preparation, the instruments are immersed in a 96% ethanol solution for 30 minutes or in a triple solution for 3 hours. Only short-term boiling of cutting instruments is allowed. Scalpels are placed in a separate grid, their blades are wrapped with gauze and boiled in distilled water without adding sodium bicarbonate for 10 minutes, then placed in a 96% ethanol solution for 30 minutes.

Sterile material is stored in a special room. It is not allowed to store non-sterile and sterile materials in the same room. The sterility of the material in bixes (if they have not been opened) is maintained for 48 hours. If the materials were placed in linen packages (towels, sheets, diapers) and placed in biks for sterilization (for example, blood transfusion systems, rubber drains, syringes), they can be stored in these bixes for up to 3 days. With centralized sterilization, syringes remain sterile for 25 days.

Sterilization of dressings, surgical linen Stage I - pre-sterilization preparation of the material

Dressings include gauze balls, napkins, tampons, turundas, bandages. They are used during surgery and dressings to drain the wound, stop bleeding, drain or tamponade the wound. The dressing material is prepared from gauze and cotton wool, less often from viscose and lignin. It must have the following properties:

1) be biologically and chemically intact, not adversely affect the healing process;

2) have good hygroscopicity;

3) be minimally loose, since the separated threads can remain in the wound as foreign bodies;

4) be soft, elastic, do not injure tissues;

5) easy to sterilize without losing their properties;

6) be cheap in production (taking into account the large consumption of material); consumption rate per year for 1 surgical bed - 200 m of gauze and 225 bandages; only for such a small operation as an appendectomy, about 7 m of gauze is spent.

The dressing material is prepared from gauze, previously cut into pieces. The gauze is folded, turning the edges inward so that there is no free edge (fabric fibers can crumble from it). The material is harvested for the future, replenishing its stocks as it is spent. For the convenience of calculating the material consumed during the operation, it is placed before sterilization in a certain way: balls - in gauze bags of 50-1000 pieces, napkins - in bundles of 10 pieces. Dressings, except for bandages not contaminated with blood, are burned after use.

Surgical drapes include surgical gowns, sheets, towels, masks, caps, shoe covers. The material for their manufacture is cotton fabrics - coarse calico, linen. Reusable surgical underwear should have a special label and be washed separately from other underwear, in special bags. Dressing gowns should not have pockets, belts; the sheets had to be hemmed. Bathrobes, sheets, diapers, towels for sterilization are folded in the form of rolls so that they can be easily unrolled when used.

Stage II - laying and preparing the material for sterilization.

The dressing material and surgical underwear are placed in biks (Fig. 7). In the absence of bixes, sterilization in linen bags is allowed.

With universal installation a material intended for one small typical operation (appendectomy, hernia repair, phlebectomy, etc.) is placed in a bix (bag). With targeted placement in a bix (bag) lay the necessary set of dressings

Rice. 7.Bix Schimmelbusch.

rial and operating linen intended for a specific operation (pneumonectomy, gastric resection, etc.). With view laying a certain type of dressing material or linen is placed in the bix (bix with dressing gowns, bix with napkins, bix with balls, etc.).

First, the serviceability of the bix is ​​checked, then an unfolded sheet is placed on its bottom, the ends of which are outside. The dressing material is laid vertically in sectors in bundles or packages. The material is laid loosely to provide steam access, indicators of the sterilization mode are placed inside (maximum thermometers, melting substances or test tubes with a test microbe), the edges of the sheet are wrapped, the bix is ​​closed with a lid and the lock is snapped into place. An oilcloth tag is attached to the bix lid indicating the date of sterilization and the name of the person who carried it out.

When sterilizing in a bag, the dressing or underwear is not laid tightly, the bag is tied with ribbons, lowered into another similar bag and tied. If it is necessary to use the material, the bag is placed on a stool, the nurse unties the upper bag, spreads its edges and slides it down. The operating nurse unties the inner bag with sterile hands, opens it and removes the material.

Stage III - sterilization

The operation of the autoclave is allowed only if there is a permit from the Inspectorate of Boiler Supervision with a mark in the passport of the apparatus. Persons who have passed the technical minimum for the operation of the autoclave and have the appropriate permit are allowed to work with the autoclave. Working with the autoclave requires strict adherence to the operating instructions for the device. Must comply general safety rules:

Be sure to ground the electrically heated steam sterilizer;

Do not start work on a faulty device;

During operation, do not leave the device unattended;

Do not add water to the funnel while the sterilizer is in operation;

At the end of sterilization, turn off the heater from the mains and close the steam inlet valve into the sterilization chamber from the steam generator;

Open the lid of the sterilization chamber only after the pressure gauge pointer drops to zero.

The sterilization time starts counting from the moment the set pressure is reached. The dressing material and surgical underwear are sterilized for 20 minutes at a pressure of 2 atm (temperature 132.9 ° C).

Stage IV - storage of sterile material

At the end of sterilization and drying of the laundry, the sterilization chamber is unloaded, the bixes are removed, the grate is immediately closed and transferred to a special table for sterile material. Bixes are stored in locked cabinets in a special room. The permissible shelf life of dressings and underwear, if the bix has not been opened, is 48 hours from the end of sterilization. Material and linen sterilized in bags are stored for no more than 24 hours.

Sterility control

The control of the sterility of the material and the mode of sterilization in autoclaves is carried out by direct and indirect (indirect) methods. The direct method is bacteriological: sowing from dressings and linen or using bacteriological tests. Sowing is carried out as follows: bix is ​​opened in the operating room, small pieces of gauze moistened with isotonic sodium chloride solution are carried out several times over the linen, after which the pieces of gauze are dipped into a test tube, which is sent to the bacteriological laboratory.

For bacteriological tests, test tubes with a known spore-bearing non-pathogenic culture of microorganisms that die at a certain temperature are used. The test tubes are inserted deep into the bix, and at the end of sterilization they are removed and sent to the laboratory. The absence of microbial growth indicates the sterility of the material. This test is carried out 1 time in 10 days.

Indirect methods for monitoring the sterility of the material are used constantly with each sterilization. For this, substances with a certain melting point are used: benzoic acid (120 °C), resorcinol (119 °C), antipyrine (110 °C). These substances are available in ampoules. They are also used in test tubes (0.5 g each) closed with a gauze stopper. 1-2 ampoules are placed in the bix between the layers of the material to be sterilized. The melting of the powder and its transformation into a continuous mass indicate that the temperature in the bix was equal to the melting point of the control substance or exceeded it. To control the sterilization regime in dry heat sterilizers, powdered substances with a higher melting point are used: ascorbic acid (187-192 ° C), succinic acid (180-184 ° C), pilocarpine hydrochloride (200 ° C), thiourea (180 ° C) .

The most objective of the indirect methods for controlling the sterilization regime is thermometry. In each bix between the sterilized

1-2 thermometers are laid with the material. Their indicators reflect the maximum temperature, but do not indicate the exposure time (during what period this temperature was maintained in the sample), and therefore this method does not exclude direct control of sterility using bacteriological tests.

Sterilization of devices for inhalation anesthesia

Devices for artificial lung ventilation and inhalation anesthesia can be the cause of cross-infection of patients and the spread of nosocomial infection. Infection of the respiratory tract of patients is fraught with the development of inflammatory complications in the postoperative period, occurring in the form of pneumonia, bronchitis, tracheitis, pharyngitis. In this regard, the disinfection of anesthetic and respiratory equipment is one of the important asepsis measures aimed at preventing contact and inhalation infection of the patient's respiratory tract.

To prevent such complications, the following basic recommendations should be followed.

1. Endotracheal tubes should be disposable, they should be sterilized in a cold way in the factory.

2. After anesthesia, artificial ventilation of the lungs, the devices, elements of the respiratory circuit are treated with antiseptic chemicals. The devices are processed in assembled form. A 0.5% alcoholic solution of chlorhexidine can be used: 1 ml of a 20% aqueous solution of chlorhexidine is dissolved in 40 ml of a 96% ethanol solution. The mixture is poured into the vaporizer of the anesthesia machine or the humidifier of the machine for artificial lung ventilation. Ventilation is carried out along a semi-closed circuit for 1 hour at a gas flow rate of 2 l/min. Then the remnants of the antiseptic are removed, the apparatus is ventilated for 15 minutes along a semi-open circuit.

As an antiseptic in such situations, you can use a 40% aqueous solution of formaldehyde (formalin). To do this, pour 100 ml of formalin into the evaporator or humidifier and ventilate for 20 minutes. Then the remains of formalin are removed, ammonia solution is poured in and ventilation is continued until the smell of ammonia disappears completely.

For sterilization of assembled devices, the gas method (using ethylene oxide) or γ-radiation can be used.

3. If the devices were used in patients with purulent diseases, tuberculosis of the lungs or respiratory tract, disassemble the respiratory circuit (remove hoses, fittings, valve box covers, breathing bag, adsorber). All parts must be washed under a stream of warm water, then soaked in a hot washing solution (see. Sterilization of instruments) for 15 min. In the same solution, each part is washed with a cotton-gauze swab for 30 s, after which it is rinsed with running water and then with distilled water. The actual sterilization treatment of parts is carried out with a 0.5% aqueous solution of chlorhexidine, placing them in containers for 30 minutes, or with a 3% hydrogen peroxide solution (80 minutes), or a 3% formaldehyde solution (30 minutes). In the latter case, when infected with Mycobacterium tuberculosis, the exposure is increased to 90 minutes. The best option is to use plastic hoses, disposable masks in such situations.

After treatment with an antiseptic, the parts are thoroughly washed with sterile water for 10 minutes, dried and stored under aseptic conditions until use.

Sterilization of endoscopic equipment

The problem of infection during endoscopic examinations is acute due to the risk of infection of patients and personnel with virulent microorganisms.

The main stages of sterilization of endoscopic devices and instruments are their mechanical cleaning, washing, pre-sterilization treatment and sterilization, drying and storage.

Cleaning solutions are used to clean endoscopes (see Sterilization of instruments).

After the completion of the endoscopic examination, contaminants (gastric, intestinal juice, mucus, blood, etc.) are immediately removed from the endoscope mechanically using detergents: from the outer surface - using tissue wipes, from the channels (biopsy, surgical) - with a special brush, and also by supplying them with a sufficient amount of air, water or a solution of neutral soap; Rigid endoscopes are disassembled into component parts before cleaning.

For the treatment of endoscopes, 0.5% aqueous or alcoholic solution of chlorhexidine, 70% ethanol solution, 2.5% glutaraldehyde solution, Cydex preparation, 3% and 6% hydrogen peroxide solutions at a temperature of 20–2 ° C are used.

In addition to the immersion method, it is also possible to wipe the outer surface of the working part of the endoscope with napkins 3 times (successively, first with one napkin intensively moistened in an antiseptic solution, then after filling the endoscope channels with a solution for 15 minutes - the second and third).

Parts of the endoscope are treated with antiseptic solutions by immersion in an enameled or glass container closed with a lid; parts of rigid endoscopes are also immersed (with the exception of the optical parts of instruments and flexible parts of fiber endoscopes). In recent years, new, so-called ultra-hermetic models of fiberscopes have appeared, which can be completely immersed in an antiseptic solution. The channels are filled with this solution using a syringe or electric suction.

Special installations (washing machines) have been developed for pre-sterilization cleaning and sterilization of flexible endoscopes, which differ in the volume of disinfectant poured into a special bath.

The remains of antiseptic agents are removed from the endoscopic equipment using distilled water, passing it through the channels of the endoscope and washing it from the outside. Then, by repeatedly supplying air through the channels of the endoscope, the remaining water is removed.

Sterilization of endoscopic instruments can be carried out in a gas sterilization chamber using ethylene oxide or a mixture of ethylene oxide and methylene bromide (see Sterilization of instruments).

Endoscopes placed in sterile bags made of dense cotton fabric are stored in a vertical position in special cabinets.

Hand preparation for surgery

Hand washing is an important means of preventing contact infection. Surgeons, operating and dressing nurses must constantly take care of the cleanliness of their hands, take care of their skin and nails. The greatest number of microorganisms accumulates under the nails, in the area of ​​the nail folds, in skin cracks. Hand care provides for the prevention of cracks and calluses of the skin, cutting nails (they should be short), deburring. Work associated with contamination and infection of the skin of the hands must be performed with gloves. Proper hand care should be considered as a step in preparing them for surgery. Hand treatment in any way begins with mechanical cleaning.

The classical methods of processing hands include the methods of Furbringer, Alfeld, Spasokukotsky-Kochergin. The methods of Furbringer and Alfeld are only of historical significance. Spasoku-Kotsky-Kochergin method can be used as forced when it is not possible to apply modern methods. The method involves mechanical cleaning of hands with 0.5% ammonia solution. Hands are washed in two basins for 3 minutes with a napkin; perform sequential movements, as when washing with a brush, starting with the fingers of the left hand. In the first pelvis, hands are washed up to the elbows, in the second - up to the border of the upper and middle thirds of the forearm. At the end of washing, the hands are rinsed with an ammonia solution and the brushes are raised up so that drops of water flow down to the elbows. From now on, the hands are constantly above the forearms. The skin of the hands is dried with sterile napkins: first, both hands (this napkin is thrown), then successively the lower and middle thirds of the forearms.

Disinfect the skin with wipes moistened with 96% alcohol, treating the hands and lower third of the forearms twice for 2.5 minutes, then the ends of the fingers and nail ridges; nail beds and folds of the skin of the fingers are smeared with a 5% alcohol solution of iodine.

Modern methods of processing hands include cleaning them by washing with running water and soap or using liquid detergents and subsequent treatment with chemical antiseptics.

Hand treatment with Pervomour (preparation C-4). Pervomur is a mixture consisting of formic acid and hydrogen peroxide. First, prepare the main solution, which includes 81 ml of 85% formic acid and 171 ml of 33% hydrogen peroxide solution. These parts are mixed in a glass bottle with a ground stopper and placed in a refrigerator for 2 hours, periodically shaking the bottle. When formic acid and hydrogen peroxide interact, performic acid is formed, which has a strong bactericidal effect. From the specified amount of the stock solution, 10 liters of working solution can be prepared by diluting it with distilled water. The working solution is suitable for use during the day. When preparing the solution, it is necessary to work with rubber gloves to prevent burns with a concentrated solution of formic acid or hydrogen peroxide. Hand treatment involves pre-washing them for 1 minute with running water and soap. Then the hands and forearms to the level of the middle third are washed with napkins in a basin with Pervomur solution for 1 min and dried with sterile napkins. In one pelvis, 5 people can handle hands.

Hand sanitizing with chlorhexidine. The drug is available in the form of a 20% aqueous solution. For the treatment of hands, a 0.5% alcohol solution is prepared: 12.5 ml of a 20% chlorhexidine solution is added to 500 ml of 70% alcohol. Hands are pre-washed with running water and soap, dried with sterile wipes or a towel, and then wiped with a gauze swab moistened with the prepared solution for 2-3 minutes.

Hand treatment with AHD preparations, Eurosept. These products contain antiseptics such as ethanol, chlorhexidine, polyol fatty acid ester. A few milliliters of the solution are poured onto the hands and the skin of the hands is rubbed to the middle third of the forearms twice for 2-3 minutes. Hands are washed for 1 minute beforehand.

Accelerated Hand Treatments used in outpatient practice or in forced (for example, military field) conditions. For accelerated disinfection of hands, a film-forming preparation, cerigel, is used, which has a strong bactericidal effect. It consists of polyvinyl butyrol and 96% ethanol solution. Hands are washed with soap and water, dried thoroughly. 3-4 ml of cerigel is poured into the palm of the hand and the fingers, nail beds and ridges, hands and the lower part of the forearm are thoroughly moistened with it for 10 s. Half-bent fingers are kept in a spread position for 2-3 minutes, until a cerigel film is formed on the skin, which has protective and bactericidal properties. At the end of the operation, the film is easily removed with gauze balls moistened with alcohol.

Hand treatment can be done by rubbing the skin with 96% ethanol solution for 10 minutes (Brun's method) or 2% iodine alcohol solution for 3 minutes.

Operating field preparation

Preliminary preparation of the site of the proposed surgical incision (surgical field) begins on the eve of the operation and includes a general hygienic bath, a change of linen. On the day of the operation, the hair is shaved in a dry way directly at the site of the surgical access, then the skin is wiped with alcohol.

Before surgery on the operating table, the operation field is widely lubricated with a 5% alcohol solution of iodine. The operation site itself is isolated with sterile linen and again smeared with 5% alcohol solution of iodine. Before and after suturing the skin, it is treated with the same alcohol solution. This method is known as the Grossikh-Filonchikov method. For processing

iodine preparations are also used in the surgical field, for example, iodine + potassium iodide, povidone-iodine; apply them according to the same method as the iodine solution.

In case of skin intolerance to iodine in adult patients and in children, the treatment of the surgical field is carried out with a 1% alcohol solution of brilliant green (Bakkal's method).

To treat the surgical field, use a 0.5% alcohol solution of chlorhexidine, as well as to treat the surgeon's hands before surgery.

In case of an emergency operation, the preparation of the surgical field consists in shaving off the hair, treating the skin with 0.5% ammonia solution, and then using one of the methods described above.

PREVENTION OF IMPLANT INFECTION OF RAS

Under implantation understand the introduction, implantation into the human body of various materials, tissues, organs, prostheses.

Infection by air or contact is caused by short-term exposure during the performance of certain surgical procedures (dressings, operations, therapeutic manipulations, diagnostic methods). When introducing microflora with implantable materials (implantation infection of the body), it is in the human body during the entire period of the implant. The latter, being a foreign body, supports the developing inflammatory process, and the treatment of such a complication will be unsuccessful until the rejection or removal of the implant (ligature, prosthesis, organ) occurs. It is possible from the very beginning (due to the formation of a connective tissue capsule) to isolate the microflora together with the implant with the formation of a “dormant” infection, which can manifest itself after a long time (months, years).

The materials implanted in the human body include suture material, metal clips, brackets, as well as prostheses of blood vessels, joints, canvas made of lavsan, nylon and other materials, human and animal tissues (vessels, bones, dura mater, skin), organs (kidney, liver, pancreas, etc.), drains, catheters, shunts, cava filters, vascular coils, etc.

All implants must be sterile. They are sterilized in various ways (depending on the type of material): γ-radiation, autoclaving, chemical, gas sterilization,

boiling. Many prostheses are produced in special packages, factory-sterilized with γ-radiation.

The most important in the occurrence of implantation infection is suture material. There are more than 40 types of it. To connect tissues during the operation, threads of various origins, metal clips, brackets, and wire are used.

Both absorbable and non-absorbable sutures are used. Absorbable natural threads are catgut threads. Lengthening the resorption of catgut is achieved by impregnating the threads with metals (chrome-plated, silver catgut). Synthetic absorbable sutures made of Dexon, Vicryl, Occilon, etc. are used. non-absorbable natural threads include threads from natural silk, cotton, horsehair, flax, synthetic threads - threads from kapron, lavsan, dacron, nylon, fluorolone, etc.

Used to connect (stitch) tissues atraumatic suture material. It is a suture thread pressed into the needle, so when the threads are passed through the puncture channel, the tissues are not additionally injured.

The suture material must meet the following basic requirements:

1) have a smooth, even surface and do not cause additional tissue damage when punctured;

2) have good handling properties - slide well in tissues, be elastic (sufficient extensibility prevents compression and necrosis of tissues during their increasing edema);

3) be strong in the knot, not have hygroscopic properties and not swell;

4) be biologically compatible with living tissues and not have an allergic effect on the body;

5) the destruction of the threads must coincide with the timing of wound healing. Suppuration of wounds occurs much less frequently when using

suture materials with antimicrobial activity due to the antimicrobial preparations introduced into their structure (letilan-lavsan, fluorolone, acetate and other threads containing nitrofuran preparations, antibiotics, etc.). Synthetic threads containing antiseptic agents have all the advantages of suture materials as such and at the same time have an antibacterial effect.

The suture material is sterilized γ-radiation in factory conditions. Atraumatic suture material is produced and sterilized in a special

Noah packaging, the usual material - in ampoules. Atraumatic threads in the package and ampouled skeins of silk, catgut, nylon are stored at room temperature and used as needed. Metal suture material (wire, staples) is sterilized in an autoclave or boiling, linen or cotton threads, threads from lavsan, kapron - in an autoclave. Kapron, lavsan, linen, cotton can be sterilized according to the Kocher method. This is a forced method, and it provides for a preliminary thorough mechanical cleaning of the suture material with hot water and soap. The skeins are washed in soapy water for 10 minutes, changing the water twice, then they are washed from the washing solution, dried with a sterile towel and wound on special glass spools, which are placed in jars with a ground stopper and filled with diethyl ether for 24 hours to degrease, after which is transferred to jars with 70% alcohol for the same period. After extraction from alcohol, the silk is boiled for 10-20 minutes in a 1:1000 mercury dichloride solution and transferred to hermetically sealed jars with 96% alcohol. After 2 days, bacteriological control is carried out, with a negative result of sowing, the material is ready for use. Synthetic threads can be sterilized by boiling for 30 minutes.

Sterilization of catgut. In the factory, catgut is sterilized with γ-rays, mainly these threads are used in surgery. However, it is possible to sterilize catgut in a hospital environment, when it is not possible to use the material sterilized in the factory. Chemical sterilization of catgut provides for preliminary degreasing, for which catgut threads rolled into ringlets are placed in hermetically sealed jars with diethyl ether for 24 hours. according to Claudius diethyl ether is drained from the jar, catgut rings are poured for 10 days with Lugol's aqueous solution (pure iodine - 10 g, potassium iodide - 20 g, distilled water - up to 1000 ml), then Lugol's solution is replaced with fresh and catgut is left in it for another 10 days . After that, Lugol's solution is replaced with 96% alcohol. After 4-6 days, they are sown for sterility.

Gubarev's methodprovides for sterilization of catgut with Lugol's alcohol solution (pure iodine and potassium iodide - 10 g each, 96% ethanol solution - up to 1000 ml). After degreasing, diethyl ether is drained and the catgut is poured with Lugol's solution for 10 days, after replacing the solution with a new catgut, the catgut is left in it for another 10 days. After bacteriological control, with favorable results, the use of the material is allowed.

Sterilization of prostheses, structures, stitching materials. The method of sterilization in a hospital environment is determined by the type of material from which the implant is made. So, metal structures (paper clips, brackets, wire, plates, pins, nails, screws, screws, knitting needles) are sterilized at high temperature in a dry-heat cabinet, autoclave, boiling (as non-cutting surgical instruments). Complex prostheses, consisting of metal, plastics (heart valves, joints), are sterilized using chemical antiseptic agents (for example, in chlorhexidine solution) or in gas sterilizers.

Prevention of implantation infection during organ and tissue transplantation involves taking organs under sterile conditions, i.e. operating theaters close to work. At the same time, careful observance of asepsis provides for the preparation of the hands and clothes of surgeons, sterile surgical underwear, processing of the surgical field, sterilization of instruments, etc. The organ removed under sterile conditions (after washing it with a sterile solution, and, if necessary, washing the vessels from blood and ducts from biological fluids), is placed in a special sterile sealed container lined with ice and delivered to the transplantation site.

Prostheses made of lavsan, capron and other synthetic materials (vessels, heart valves, a mesh to strengthen the abdominal wall during hernia repair, etc.) are sterilized by boiling or placing them in antiseptic solutions. Prostheses sterilized in an antiseptic solution should be thoroughly rinsed with a sterile isotonic sodium chloride solution before implanting them into the human body.

hospital infection

Hospital(nosocomial) infection -diseases or complications of diseases or operations, the occurrence of which is associated with the infection of patients in a surgical hospital.

The primary source of infection is patients with purulent diseases.

Microorganisms through objects, air, linen can pass from one patient to another in a surgical hospital. Staphylococcus aureus, Escherichia coli, Proteus, Klebsiella, Pseudomonas aeruginosa are more common. The microbial flora is highly resistant to antibacterial agents. In debilitated, operated patients, this flora can cause the development of purulent complications. Infection is possible from both exogenous and endogenous sources, where the hospital flora

hit earlier: nasopharynx, pharynx, skin of the patient. It is possible to develop a mass disease (complication) - an outbreak of hospital infection.

To combat this infection, organizational measures are of great importance: a strict sanitary regimen of the department, closing the departments for thorough sanitization during an outbreak of infection, shortening the pre- and postoperative stay of patients in the hospital, rational antibacterial therapy (change of antibacterial agents, bacteriological control over the effectiveness of therapy ), the use of combined antiseptic methods, the use of closed drainage methods, etc.

Problems of HIV infection in surgery

The spread of AIDS among the population poses a threat of infection to surgical hospital personnel who come into contact with the blood of infected patients during operations, dressings, infusions, injections, punctures, blood sampling for research, during diagnostic procedures, etc.

Preventive measures include timely detection of infected patients, for which all patients in surgical hospitals are examined for HIV. In order to identify and isolate AIDS patients, clinical examination takes into account such manifestations of the disease as pneumocystosis, pneumonia, Kalosha's sarcoma, the presence of immunodeficiency, lymphadenopathy, diarrhea, weight loss, respiratory candidiasis. An emergency blood test for the HIV antigen allows you to confirm or reject the diagnosis in patients of this group.

The personal safety rules for personnel provide (in accordance with order No. 86 of 08/30/89 of the USSR Ministry of Health) the need to work in rubber gloves when performing any manipulations in surgical hospitals, any contact with the blood and biological fluids of patients. In addition, during surgery, HIV-infected patients must use special masks and goggles; in case of contact with blood, biological fluids on various objects, skin, mucous membranes, it is necessary to treat them with antiseptics. After use, surgical instruments are soaked in 3% chloramine solution (30 min) or 6% hydrogen peroxide solution (90 min), followed by the usual pre-sterilization treatment.

Of great importance for prevention is the widespread use of syringes, instruments, systems for single-use intravenous infusion.

ANTISEPTICS

There are mechanical, physical, chemical and biological antiseptics.

Mechanical antiseptic

The basis of mechanical antiseptics is the removal from an infected, purulent wound, a purulent focus of non-viable tissues, pus, fibrin, which are the habitat and nutrition of the microbial flora. The removal of devitalized tissues, although not a direct, but an indirect effect on the microflora, contributes to the sterilization of the wound.

Mechanical antiseptic options include primary surgical treatment infected wounds, the purpose of which is to excise the edges, walls and bottom of the wound within healthy tissues (see. wounds). Together with excised tissues, hemorrhages, hematomas, blood clots, foreign microbodies, as well as the microflora in them, are removed from the wound. The earlier such an operation is performed, the more likely it is to achieve sterility of the wound.

If the microbial flora began to develop in the infected wound, which is possible with untimely or incomplete primary surgical treatment, or the wound is purulent from the very beginning (after opening abscesses, phlegmon), apply secondary surgical treatment wounds. Excision of the edges, walls, bottom of the wound is not performed, but removed from it mechanically (with a scalpel, scissors, vacuuming, washing with a jet of liquid under pressure) necrotic tissues, pus, fibrin, open purulent pockets, evacuate streaks. At the same time, the microbial flora is also removed and, although the sterility of the wound cannot be achieved, the amount of microflora in it decreases and favorable conditions are created for wound healing.

Any wound dressing carries elements of mechanical antiseptics. (wound toilet). Removal of dressings soaked in blood, pus, tampons, washing the wound with a jet of liquid, removal of freely lying necrotic tissues, sequesters, drying the wound with balls and tampons contribute to the removal of microbial flora from it, the amount of which decreases by 10-20 times.

Physical antiseptic

Physical antiseptic methods are based on the use of the laws of capillarity, hygroscopicity, diffusion, osmosis, the siphon principle, exposure to laser energy, and ultrasound.

Drainagewounds, purulent foci (abscesses, empyema) provides for the creation of conditions for the outflow of wound discharge into the external environment (into a bandage, special dishes with antiseptic solutions). A gauze swab is used as drainage in the treatment of wounds. Tampons of various sizes are prepared from a strip of gauze and loosely injected into the wound. Due to its hygroscopicity, the tampon absorbs blood, exudate, pus. Its draining properties appear up to 8 hours, after which it can turn into a “plug” that clogs the wound and disrupts the outflow of exudate from it. To increase the drainage properties of the dressing, tampons are moistened hypertonic(5-10%) solution sodium chloride. This contributes to the creation of a high osmotic pressure, which leads to an increase in the outflow of fluid from the wound into the dressing.

In addition to the usual tampon, apply tampon von Mikulich-Radetsky. A large gauze napkin with a thread sewn to its middle is inserted into the wound. The napkin is placed on the bottom and walls of the wound, a "bag" is formed, which is filled with gauze swabs. When the tampons are saturated with wound discharge, they are removed, leaving a gauze pad, and the cavity formed is filled with new tampons. Tampons are changed several times - until the outflow of purulent discharge stops, after which the napkin is also removed by pulling the thread.

Drainage can be done using rubber, vinyl chloride and other tubes of different diameters, which are inserted into the wound, abscess cavity, joint (with purulent arthritis), pleura (with purulent pleurisy), into the abdominal cavity (with purulent peritonitis). The resulting pus, tissue decay products, and with them microorganisms are released into the bandage through one or more drainages. The drainage can be connected by a tube to a vessel into which some antiseptic solution is poured; then the wound discharge will be released into the vessel, thereby reducing the contamination of the dressing. Through drainage, chemical antiseptics, antibiotics, proteolytic enzymes are injected into the wound or purulent cavity.

For more effective washing of wounds and purulent cavities in them (except for drainage for outflow of wound discharge), another tube is inserted, an antibacterial drug solution is injected through it, along with which tissue decay products, pus, blood and fibrin are removed from the wound through drainage (Fig. 8 ). Thus, by combining the methods of physical and chemical antiseptics, conditions are created for flow-flushing drainage. This method is also used in the treatment of purulent pleurisy and peritonitis. To increase the efficiency of the method, proteolytic enzymes are used as a washing solution, which

Rice. 8.Flushing drainage (a), active aspiration from the wound (b).

promote faster melting of non-viable tissues, pus, fibrin (method of flow enzymatic dialysis).

If the drained cavity is airtight (sutured wound, pleural empyema, purulent arthritis, abscess cavity), apply active aspiration (vacuum drainage). The vacuum in the system can be created using a Janet syringe, which removes air from a sealed jar with a drain connected to it, or using a water jet suction or a three-jar system. This is the most effective method of drainage, it also helps to reduce the cavity of the wound, its faster closure and elimination of inflammation, and in case of pleural empyema - straightening of the lung compressed by exudate.

Aseptic conditions in the wound can be created by placing a limb with a wound or the patient himself (with extensive burns) in a special chamber, in which, using the installation shown in Fig. 9 create an abacterial environment.

Rice. 9.Installation for the treatment of wounds in an abacterial environment (scheme). 1 - input filter; 2 - compressor; 3 - bacterial filter; 4 - air duct; 5 - insulator (chamber); 6 - insulator lock.

laser radiation in the form of a beam of low power, it has a bactericidal effect and does not have a damaging effect on tissues. A carbon dioxide laser is mainly used, the focused beam of which has an evaporating effect on necrotic tissues and microorganisms. A very thin coagulation film is formed on the walls and bottom of the wound, which prevents the penetration of microorganisms and their toxins into the tissues. Laser radiation is used to treat wounds.

Has a bactericidal effect ultrasound (US) low frequency. In a liquid medium (wound, closed cavity), ultrasound exhibits physical and chemical properties. In a medium exposed to ultrasound, the effect of cavitation is created - shock waves appear in the form of short pulses with the formation of cavitation bubbles. At the same time, under the influence of ultrasound, water is ionized with the formation of H + and OH - , under the influence of which redox processes stop in the microbial cell. Ultrasound cavitation is used to treat wounds.

Chemical antiseptic

The decrease in the effectiveness of antibiotics in the body is determined by a number of conditions:

Low concentration of the drug in the focus of inflammation due to insufficient penetration of it into the tissues due to low organotropism or microcirculation disorders;

Inactivation of the drug by mediators and inflammatory products due to a violation of redox processes, changes in pH, the influence of inflammatory products and tissue death;

The impact of various drugs used in complex treatment due to direct antagonism or a violation of the pharmacokinetics of antibiotics.

Chemical antiseptics - substances used for topical application, allowing you to create a high concentration of an antibacterial drug directly in the focus of purulent inflammation. The drugs are more resistant to the effects of inflammation products or tissue necrosis than antibiotics. The antibacterial activity of antiseptics is increased by the use of other means and methods of antiseptics - physical factors (drainage, ultrasound, laser energy, plasma), necrolytic-proteolytic enzymes, sodium hypochlorite, biological (bacteriophages), etc.

The positive qualities of antiseptics are a wide antibacterial spectrum of their action, mainly a bactericidal effect, a relatively low drug resistance of microorganisms to them with a low prevalence of these forms. The drugs are distinguished by poor absorption, stability during long-term storage, rare side effects (irritant and allergic).

Nitrofuran derivatives. The drugs are effective against pyogenic coccal flora.

Nitrofuralused in aqueous solutions of 1:5000 for washing purulent wounds during dressing, abscess cavity and empyema - through drainage (for example, with purulent pleurisy, purulent fistula with osteomyelitis), etc.

Furazidinused in the form of a 0.1% solution for the same purposes as nitrofural. The drug can also be used intravenously at a dose of 300 ml.

Nitrofural is part of the film-forming drug "lifusol" (Lifusolum) which is produced in the form of an aerosol and is used to treat superficial wounds, burns. It forms a protective film on the surface of the wound with an antimicrobial effect. The film is stored for 5-7 days.

group of acids.For washing wounds, purulent cavities or purulent fistulas, a 2-3% aqueous solution of boric acid is used. (Acidum boricum).

Salicylic acid (Acidum salicylicum) has antibacterial and keratolytic effect. Apply in the form of powders, ointments, 1% and 2% alcohol solutions.

Oxidizers.This group includes hydrogen peroxide and potassium permanganate, which, when combined with organic substances, release atomic oxygen, which has an antimicrobial effect.

Hydrogen peroxide solution (Solutio Hydrogeniiperoxydi diluta) used in the form of a 3% aqueous solution during dressings, for washing purulent wounds, purulent fistulas, empyema, abscesses. Abundant foam formed during washing helps to remove pus, fibrin, and necrotic tissues from the wound. Has deodorizing properties.

Urea peroxide (Hydroperitum) - complex preparation of hydrogen peroxide and urea. Available in tablets. For washing wounds, a 1% solution is used (2 tablets are dissolved in 100 ml of water).

Potassium permanganate (Kaliipermanganas) used in the treatment of purulent wounds (0.1-0.5% solution), burns (2-5% solution), for washing cavities (0.02-0.1% solution).

Dyes.

Brilliant green (Viride nitens) used in the form of a 1-2% alcohol or aqueous solution for lubrication of superficial wounds, abrasions, treatment of pustular skin diseases.

Methylthioninium chloride used to lubricate superficial wounds and abrasions (3% alcohol solution), treat burns (1-2% alcohol solution) and wash purulent cavities (0.02% aqueous solution).

Detergents.Chlorhexidine (Chlorhexidinum) is a 20% aqueous solution of chlorhexidine digluconate. For washing wounds, a solution of 1:400 is prepared, for washing body cavities with purulent inflammation - 1:1000; 1 ml of a 20% solution of chlorhexidine is diluted, respectively, in 400 and 1000 ml of distilled water. Benzyldimethyl-myristoylamino-propylammonium has a pronounced antibacterial effect. The spectrum of action, like that of chlorhexidine, is aerobes, anaerobes, fungi. Apply 0.01% solution.

Derivatives of quinoxyxaline. Hydroxymethylquinoxyline dioxide has a wide spectrum of antibacterial action: it is effective against Escherichia and Pseudomonas aeruginosa, Proteus vulgaris, gas gangrene pathogens. Apply in the form of a 0.5-1% solution.

electrochemical solutions. Sodium hypochlorite 0.03-0.12%. Spectrum of action - aerobes, anaerobes, mushrooms.

Ways to use chemical antiseptics

Local application chemotherapeutic agents: a) the use of dressings with antiseptic drugs in the treatment of wounds and burns;

gov; preparations can be used in the form of solutions (they wash the wound during dressing, moisten swabs), ointments and powders; b) the introduction of solutions of antibacterial drugs into the wound, closed cavities, followed by aspiration through drainage - washing, flow drainage (a combination of physical and chemical antiseptics); examples of the combined use of physical and chemical antiseptics are peritoneal dialysis in purulent peritonitis, flow drainage of the pleural cavity in purulent pleurisy; c) for the sanitation of the abdominal cavity, drugs are used that are acceptable for intravenous administration (hydroxymethylquinoxylindioxide, sodium hypochlorite, furazidin).

General application chemotherapeutic agents include: a) taking antibacterial drugs orally (in the form of tablets) with the aim of locally affecting the microflora of the gastrointestinal tract in preparing patients for surgery on the intestines and the general effect on the body after absorption of the drug into the blood; b) intravenous administration of certain chemotherapeutic drugs (hydroxymethylquinoxylindioxide, furazidin, sodium hypochlorite).

Biological antiseptic

Biological antiseptics involves the use of biological agents to fight infection in the human body. The range of drugs is extremely wide, the ways of their application and the direction of action are different. Conventionally, they can be divided into preparations for local and general antibacterial effects. To the group biological antiseptics include drugs that can activate the protective antimicrobial factors of the body (immunity). These can be both drugs with a specific direct antimicrobial action (the introduction of ready-made specific antibodies - passive immunization agents), and drugs that stimulate the effects of antibodies. Means of immune protection also stimulate non-specific immune reactions - the synthesis of cellular immunity factors in the body.

Antibiotics

Among antibacterial drugs, an important place is occupied by antibiotics. Their use in modern conditions presents significant difficulties, which is due to a change in the species composition and properties of the microbial flora - the spread of microorganisms with drug resistance. The main causative agents of purulent-inflammatory diseases

diseases (staphylococci and gram-negative bacteria - Escherichia coli, Proteus, Pseudomonas aeruginosa, etc.) have acquired a high degree of antibiotic resistance and even antibiotic dependence due to the mutagenic effect of antibiotics. Among the pathogens of purulent-inflammatory diseases, a certain place is occupied by opportunistic microorganisms - non-spore-forming (non-clostridial) anaerobes and mainly bacteroids, which are naturally resistant to most antibiotics.

The main antibiotics, the use of which is indicated for the treatment and prevention of inflammatory diseases, are the following.

Penicillins.One of the most active is benzylpenicillin (a natural antibiotic). Semi-synthetic penicillins divided into two groups: 1) penicillinase-resistant (for example, oxacillin), active against gram-positive microbial flora; they are used for staphylococcal infections of various localization: pneumonia, abscess, pleural empyema, osteomyelitis, abscess and phlegmon of soft tissues, with wounds; 2) semi-synthetic broad-spectrum penicillins: ampicillin, carbenicillin; these drugs are effective in the treatment of burns, wound infections.

Cephalosporins.This group includes cefazolin, cephalexin - cephalosporins I and II generation; third generation drugs - cefotaxime, ceftazidime, ceftriaxone; IV generation - cefepime.

Aminoglycosides.These include gentamicin, kanamycin, sisomycin, tobramycin, amikacin (semi-synthetic aminoglycoside). The drugs have oto- and nephrotoxic effects.

macrolides(erythromycin, oleandomycin, azithromycin).

Tetracyclines.This group includes tetracycline, oxytetracycline, semi-synthetic tetracyclines - doxycycline.

Fluoroquinolones(ofloxacin, ciprofloxacin, levofloxacin).

Carbapenems:imipenem + cilastatin, meropenem.

Lincosamines(lincomycin).

Glycopeptides(vancomycin).

Broad-spectrum antibiotics that affect both gram-negative and gram-positive flora are semi-synthetic penicillins, cephalosporins, aminoglycosides, fluoroquinolones.

Proteolytic Enzymes

Proteolytic enzymes are biological antiseptic agents. They have the ability to lyse (melt) necro-

tized tissues, fibrin, pus, have an anti-edematous effect and enhance the therapeutic effect of antibiotics. Known enzyme preparations animal origin- trypsin, chymotrypsin, ribonuclease, collagenase; bacterial - terrilitin, streptokinase, asperase, iruksol (ointment for enzymatic wound cleansing; contains clostradyl peptidase, a proteolytic enzyme isolated from Clostridium histolyticum, and chloramphenicol) vegetable - papain, bromelain.

Enzyme preparations

Proteolytic enzyme preparations are used locally in the treatment of purulent wounds, trophic ulcers in the form of a solution or powder. On a wound or ulcer treated with a solution of hydrogen peroxide or nitrofural, apply napkins moistened with a solution of enzymes; with abundant wound discharge, the wound is covered with powder. Some enzymes are used in ointments (iruksol, asperase). The drugs are used until the wounds or ulcers are completely cleansed of necrotic tissues and pus. Doses of drugs are indicated in the instructions for their use.

Enzyme solutions are used for intracavitary administration: into the pleural cavity (with purulent pleurisy), the joint cavity (with purulent arthritis), the abscess cavity. The drugs are administered by puncture of the cavities or through drainage tubes after the preliminary removal of pus by aspiration. With a lung abscess, if it does not drain through the bronchi, the abscess is punctured through the chest wall with the introduction of an enzyme solution into its cavity. Enzymes can be delivered into the lung abscess cavity through a catheter or bronchoscope. In osteomyelitis, enzymes are injected into the medullary canal or bone cavity by puncture of the bone with a needle or through drains installed during the operation. Purulent fistulas are washed with a solution of enzymes. In case of purulent diseases of the lungs, inhalation proteolytic enzymes using inhalers.

Used in the treatment of inflammatory infiltrates electrophoresis enzymes. Trypsin or chymotrypsin are used for these purposes.

As anti-inflammatory agents, proteolytic enzymes (trypsin, chymotrypsin) are injected intramuscularly at a dose of 0.07 mg/kg.

Proteolytic enzymes, together with a solution of procaine, can be used to infiltrate tissues in the initial forms of inflammation or be part of solutions for procaine blockades. So, in the initial forms of mastitis, a retromammary blockade is performed (see. Local anesthesia), 70-80 ml of a 0.25% solution of procaine, 10 mg of chymotrypsin or trypsin and 500,000 units of kanamycin are injected into the retromammary space.

bacteriophages

To combat microorganisms in the human body, a bacterial virus is used - a bacteriophage that can reproduce in a bacterial cell and cause its lysis.

Bacteriophages differ in specific action. Anti-staphylococcal, anti-streptococcal bacteriophages, bacteriophage-anticols are used. A polyvalent bacteriophage contains several phages and is used when the causative agent is unknown. After examination and identification of the pathogen, a specific bacteriophage is prescribed. Bacteriophages are used for irrigation of purulent wounds, infiltration of tissues surrounding the wound, introduction into purulent cavities through drains and microirrigators. In purulent diseases of the lungs, the bacteriophage is injected endotracheally or directly into the abscess cavity by puncturing it through the chest wall. In sepsis, a specific bacteriophage is injected intravenously.

immune remedies

Toxoids are used for active immunization. Staphylococcal toxoid injected subcutaneously at 0.1 ml into the scapular region, then every 2-3 days the injection is repeated, increasing the dose by 0.1 ml, gradually increasing it to 1 ml. In emergency cases, 0.5 ml of staphylococcal toxoid is administered before the operation.

Tetanus toxoid used for planned and emergency prophylaxis of tetanus. The injection of the drug in emergency cases is combined with a prophylactic dose of tetanus toxoid (see. wounds).

For passive immunization, preparations containing antibodies to certain pathogens of a surgical infection are used.

Antistaphylococcal hyperimmune plasma is a native (liquid or frozen) blood plasma of donors immunized with adsorbed staphylococcal toxoid. The titer of antistaphylococcal plasma must be at least 6 IU. Plasma is used at the rate of 4-6 ml / kg, administered intravenously for severe infectious diseases caused by staphylococci (sepsis, purulent peritonitis, osteomyelitis, etc.). The drug is administered once or repeatedly, depending on the patient's condition.

For targeted immunotherapy antipseudomonal, anticolibacillary hyperimmune plasma, containing the corresponding antibodies.

Antistaphylococcal γ -globulin are made from the blood of donors immunized with adsorbed staphylococcal toxoid. 1 ml of the drug contains 20-50 IU of antistaphylococcal antitoxin. Produced in sterile form in sealed ampoules. One therapeutic dose of the drug is 100 IU of antitoxin. Antistaphylococcal γ-globulin is used for the treatment and prevention of staphylococcal diseases - sepsis, peritonitis, pleurisy, osteomyelitis, etc. The drug is administered intramuscularly.

Immunoglobulin human normal - lyophilized polyvalent human immunoglobulin. The drug has a wide range of antibodies against bacteria, viruses and other pathogens. It is administered intravenously for severe bacterial infections, including sepsis, at a dose of 0.4-1.0 g/kg daily for 1-4 days.

Tetanus toxoid γ -globulin are made from the blood of donors immunized with tetanus toxoid. Produced in sterile sealed ampoules, 1 ml of solution contains 150 IU of anti-tetanus antibodies. Used for the prevention and treatment of tetanus. The drug is administered intramuscularly. Immunity lasts up to 1 month (see Chapter 10).

Anti-tetanus serum - immune serum obtained from the blood of animals (horses) immunized with tetanus toxoid. One serum ampoule contains 1500-3000 IU, prophylactic dose of serum - 3000 IU. A single dose of prophylactic serum protects against tetanus for up to 5 days. The therapeutic dose of serum exceeds the prophylactic dose by 10 times. In all cases, serum is administered with caution because of the danger of an anaphylactic reaction.

Antigangrenous serum - immune serum of animals (horses) containing antibodies to the four main pathogens of gas (anaerobic) gangrene - Closotridium perfringens, Cl. oedematiens, Cl. septicum, Cl. histolyticum. Used for prophylactic and therapeutic purposes. For prophylactic purposes, serum is administered intramuscularly, for therapeutic purposes - intravenously with precautions (due to the danger of allergic reactions).

Immunostimulating drugs

Immunostimulating drugs that increase the nonspecific immunological defense of the body include prodigiosan, lysozyme, levamisole.

Prodigiosan -bacterial polysaccharide, stimulates leukopoiesis, activates the T-system of immunity, stimulates phagocytosis. Indications for its appointment are a decrease in the activity of phagocytosis and inhibition of leukopoiesis, which is expressed in a decrease in the number of lymphocytes and monocytes, and according to the immunogram, in a decrease in the number of B-lymphocytes circulating in the blood. The drug is prescribed 50 mcg 4 times a day with an interval of 3-4 days.

Levamisolestimulates the formation of T-lymphocytes, phagocytes, increases the synthesis of antibodies. The drug (6 times a day, every other day) is prescribed with a decrease in the number of T-lymphocytes in the blood, inhibition of phagocytosis. The course dose is 150 mg.

Lysozyme -natural humoral factor of nonspecific reactivity, acts bactericidal. The drug increases the nonspecific defense of the body, enhances the action of antibiotics.

thymus extract- a drug obtained from the thymus gland (thymus) of cattle, stimulates immunological processes - enhances the reaction of cellular immunity and phagocytosis, regulates the number of T- and B-lymphocytes. In acute and chronic purulent processes, accompanied by a decrease in cellular immunity, 10-30 mg of thymus extract is administered intramuscularly daily for 5-20 days, for the prevention of postoperative purulent-inflammatory complications before surgery, 10-20 mg is administered for 5-7 days . The drug is diluted with isotonic sodium chloride solution immediately before injection.

Prevention of endogenous infection of wounds

Prevention of wound infection during surgery from endogenous sources is carried out by various methods. Careful observance of the technique of surgical intervention helps to prevent contact infection: sequential performance of surgical techniques, isolation of the wound with napkins, towels from the possible ingress of pus when opening an infected organ (for example, the colon), abdominal cavity (with purulent peritonitis), removal of the appendix , gallbladder in case of their purulent inflammation, etc. After the “dirty” stage of the operation, it is obligatory to change instruments, napkins, gloves, and, if necessary, surgical linen.

To reduce the risk of endogenous infection, elective surgeries are postponed to carry out sanitation of foci of infection in the organization.

nism (runny nose, tonsillitis, tonsillitis, pharyngitis, prostatitis, adnexitis, carious teeth, furunculosis, etc.). In cases where the disease threatens the patient's life (bleeding, traumatic injuries, etc.), an emergency operation is performed, despite the presence of foci of infection in the body, surgeons are forced to take risks in order to save the patient's life. To reduce the possibility of transfer of microbial flora to the area of ​​surgical intervention, the patient is prescribed antibacterial drugs, primarily antibiotics, immediately before the operation, during it and after the end in order to influence the focus of infection and maintain the concentration of the drug in the blood necessary to destroy microbes that have penetrated into the blood from the focus of inflammation. This blocks the hematogenous route of infection. Mandatory measures are taken to prevent contact infection during surgery, if the focus of chronic infection is located in the surgical area.

Various infections for pregnant women are of great danger, since they can infect the fetus in utero.

Water should not be taken directly from lakes or rivers when there is a high risk of contamination. If necessary, boil the water for one minute to remove cryptosporidium and other microorganisms from the water. Using a submicron water filter for personal use may reduce the risk of infection. Be aware that swimming can accidentally ingest water and increase the chance of acquiring Cryptosporidium, even in public pools. Avoid situations where you can breathe in environmental spores, especially damp and dark areas. Hot tubs with hot water, saunas and other shared bathrooms are generally not recommended. Bacteria and other microorganisms thrive in warm water. However, if the immunosuppressed person is confident that the bath is disinfected regularly as recommended, there are no contraindications that prevent its use. Caving should not be practiced due to the contamination risks associated with guano exposure. Travel abroad: For people at very high risk of infection, this risk increases when traveling to developing countries.

• source of infection, such as a sick person;
• pathogen transmission mechanism - horizontal, vertical, artificial or artificial;
• susceptible organism.

• bacillus carriers are patients or medical workers, less often animals;
• patients with purulent-inflammatory diseases;
• iatrogenic infections, when infection occurs from medical staff within the walls of the hospital.

Ways of infection with exogenous infection

Horizontal

• Airborne. The most common way of infection. From the air, macroscopic "creatures" get inside a healthy person. It is enough to be near the source of infection - a sick person or inhale contaminated air. In this way, measles and a number of other diseases are spread.
• Air-dust. This type is typical for pathogenic agents that retain their pathogenic properties for several days. When sneezing and coughing, they enter the air, then settle on dust particles and enter the body. These are pathogenic microorganisms of diseases such as diphtheria, scarlet fever, tuberculosis.
• Fecal-oral. The causative agents of diseases of "dirty hands" - intestinal infection, helminthiasis and salmonellosis. There are two methods here. The first is the alimentary method of infection, when pathogens settle on food, getting on them from the soil, animal waste. The second is the aquatic mode of distribution. Drinking raw water, you can get cholera or typhoid fever.
• Contact household. Allocate direct and indirect routes of infection. With direct transmission, a person becomes infected by direct contact with the patient through saliva, kiss, sex. These are gonorrhea, syphilis, as well as erysipelas, herpes, scabies. With the indirect method, pathogens settle on various household items, that is, the carrier of the virus, for example, dried himself with a towel or took a glass and left some of his "pathogenic friends" on them. A healthy person used the same items and after some time fell ill with dysentery or typhoid.
• Transmissive. Infection occurs as a result of human interaction with disease carriers. In the non-specific way, the carriers are insects - flies and cockroaches, which carry pathogenic microorganisms on their paws that get on food or drinks. Flies can introduce typhoid fever bacillus, hepatitis A virus, or intestinal pathogens into food. Insects that carry only one type of disease are “responsible” for a specific route of infection. Mosquitoes carry malaria, ticks carry encephalitis, fleas carry plague, and lice carry typhus.

vertical

• hepatitis B;
• measles;
• chickenpox;
• bacteria - staphylococci and streptococci.

Those who choose to travel should avoid food and drink that may be contaminated, in particular raw fruits and vegetables, raw or undercooked meats and seafood, tap water, ice made with tap water, milk and water. unpasteurized dairy products and products offered by street vendors. Among the foods and drinks that are generally safe from the point of view of infections are very hot foods, fruits that the traveler himself removes the skin or peel, bottled drinks, coffee and hot tea, beer, wine and water when boiled for one minute. . Although treating water with iodine or chlorine is not as effective as boiling water, this method can be used when it is not possible to boil water. Generally, preventive antimicrobials are not recommended for travelers, but your doctor may advise you to take certain medications with you. The effectiveness of these agents depends on local antimicrobial properties that are rarely known. Consult your doctor's decisions based on your level of risk of infection, as well as the region and duration of your trip. If you're feeling good, you can dust, scrub, clean windows, mop floors, and clean bathrooms in the usual way. However, avoid cleaning or removing dust from places where a lot of precipitation can be filmed. Use common sense and avoid cleaning areas that haven't been touched in years. In general, construction or renovation sites should be avoided due to the possibility of fungi or mold scattered in the dust. If this cannot be avoided, an immunocompromised person can reduce the risk of infection by using a special respirator that filters particles tightly attached to the face. Wear gloves when washing heavily soiled areas and toilets. . There are a few cases where a mask is appropriate, such as if an immunosuppressed person has to enter an area under construction or renovation, or be exposed to heavy dust or debris emissions.

Infection of a child can also occur during childbirth and during lactation, so HIV-infected and syphilis-infected women are strictly prohibited from breastfeeding their children from the first days of their lives.

artificial or artificial

• hepatitis B, C, D;
• toxoplasmosis;
• malaria;
• syphilis;
• listeriosis.

There are two types of such a source of infection - hemocontact and inhalation.

In addition, if it is necessary to have close contact with other people suffering from a respiratory infection, the mask reduces the risk of infection. Drugs that your doctor or health care provider may prescribe or recommend to you.

• Filgrastim Pegfilgrastim Sargrast.
• Sulfamethoxazole - trimethoprim Acyclovir ® Fluconazole ® Intraconazole ®.

When to call your doctor or health care provider for a possible infection. Call immediately if you have.

• Chills or tremor.
• Sudden onset of new pain without explanation.

Blood contact includes such methods of infection:

• Transfusion. Infection occurs during the transfusion of blood or its components. This can happen due to poor-quality examination of the donor, reuse of disposable instruments, absence or incorrect sterilization of reusable surgical instruments, violation of the rules for storing biological material - blood and its components.
• Transplant. Infection during transplantation of donor organs.
• Parenteral. Microorganisms enter the body when the integrity of the skin or mucous membranes is damaged during surgery, injections or diagnostic measures. Infection can occur if non-sterile surgical instruments are used, re-use of disposable instruments, when an infected specialist works without gloves or a mask.

Blood in the urine. You need to urinate more often than usual.

• A sore throat.
• Sores in the mouth.
• White coating on the mouth, especially on the tongue.
• Signs of a bladder infection.
• Burning when urinating.

The main symptom of infection is intoxication of the body, which manifests itself in the form of:

• weaknesses;
• dizziness;
• nausea;
• vomiting;
• rashes;
• elevated body temperature;
• flow from the nose.

Symptoms vary depending on the type of pathogen, but if you can try to protect yourself from some infections transmitted by airborne, fecal-oral or contact routes, then with an artificial route of infection, nothing depends on a person.

Do you want to be tested for gonorrhea? Find a Health Center →

But if you see signs of gonorrhea, get it tested immediately. Here we will explain what to look for.

Gonorrhea doesn't always have symptoms

Prevention

• during epidemics of viral infections, large crowds of people are avoided;
• wear a multilayer gauze bandage that needs to be changed frequently - every 2 hours;
• temporarily refuse, if possible, to communicate with people who have signs of the disease;
• indoors, the air is disinfected using ultraviolet lamps or other disinfection devices (even daily ventilation reduces the number of germs in the air);
• when they come from the street, they wash their hands with soap, be sure to rinse their face, and after going to the clinic or hospital they wash their nose.

• do not use other people's personal hygiene products;
• wet cleaning is carried out in the room;
• if there is a patient at home, then in common areas for washing floors, toilets, bathrooms and kitchens, an antiseptic is used;
• they try to isolate a sick person for the duration of the illness.

Gonorrhea can cause more serious health problems and even cause infertility if left untreated. However, it is usually easily treated with medication. Most people with a vagina who get gonorrhea have no symptoms. If they show symptoms of gonorrhea, they appear about a week after contracting this infection.

Abnormal vaginal discharge, which may be yellowish or bloody. Bleeding between periods. People with a penis are more likely to have symptoms if they get gonorrhea. Symptoms usually appear a week after infection.

• wash their hands - before and after eating, when preparing food, after going to the toilet and outside;

  Petted a pet or played with it? Don't forget to wash your hands with soap!

• vegetables and fruits are washed thoroughly under running water; for best effect, use a soft sponge or brush;
• dishes are brought to full readiness, avoiding eating uncooked meat, steaks with blood;
• water and milk are boiled, since at high temperatures the bulk of the pathogenic microflora dies.

Keep an eye on your pets - use flea collars and wash your pets regularly with flea shampoos.

Yellow, white, or green discharge from the penis Pain or burning when urinating Pain or swelling in the testicles Gonorrhea can also infect the anus if you have anal sex, or you can spread the infection to your anus from another part of your body. Anal gonorrhea usually does not show symptoms. However, signs of gonorrhea in the anus may include.

Itching in or around the anus Discharging from the anus Pain in bowel movements. . Throat infections caused by gonorrhea also usually do not cause symptoms. If symptoms appear, it's usually just a sore throat. If you or your sexual partners have any of these symptoms, contact your nurse, or doctor.

What factors, other than the ability of the immune system to resist the attack of viruses, further increase the likelihood of infection is not known exactly. For example, if out of four children playing together in the same conditions, one has a streptococcal infection, then not all three, but only two, may become infected. The third has a chance to become a carrier of an infection that will or will not manifest itself in his body in the future. The probability of infection, in a word, is determined by antibacterial resistance and type-specific immunity.

Biological warfare is the use of microbiological agents for hostile purposes. It is not clear if other countries or dissident groups have the resources for biological warfare. For various reasons, experts consider the use of biological agents unlikely in formal warfare. However, biological agents are considered by some to be ideal weapons for terrorists. These agents may be provided clandestinely and may have delayed effects, allowing the user to remain undetected.

Potential biological agents include carbuncle, botulinum toxin, brucellosis, hemorrhagic fever virus, plague, smallpox, and tularemia. Each is potentially fatal and, with the exception of carbuncle, botulinum toxin, and tularemia, can be passed from one person to another. Direct human-to-human transmission of brucellosis is extremely rare.

An infection of the same type in the organisms of different people can manifest itself in different ways. One child will have rhinitis, another will have tonsillitis, and the third will have otitis media. The fight against streptococcal infection is complicated by the fact that many strains practically do not respond to the treatment of their habitat with hot water. That is why washing toys and dishes in warm water, even with the use of chemicals, does not give a positive result in the destruction of bacteria. At a temperature of 70 degrees, microbes also continue to live, but 90% of them die after one hour. Exposure to negative temperatures will also not give an effect: if the blood is frozen, streptococci can live in it for several months. Exposure to strong disinfectants can be effective.

Anthrax spores are relatively easy to prepare and, unlike most other agents, can be airborne, creating the possibility of spread by aircraft. Theoretically, 1 kg of anthrax could kill up to 1,000 people, although technical difficulties in preparing the spores as a fine enough powder may actually limit the number of deaths to a fraction of that number.

Most people have been infected with anthrax without developing the disease, possibly due to the widespread use of the antibiotic ciprofloxacin. However, there was extreme public concern about these incidents. The number of false threats of anthrax was very high. More false alarms, both rumors and reports of anxious citizens who confused harmless materials with anthrax, have been reported since the carbuncle attack.

Infection of healthy people can only occur through contact with a sick person. These bacteria are not transmitted by any other living organisms. Both a simple carrier of viruses and an already sick person can infect. Bacteria easily spread in the air when communicating with the patient, get and retain their activity on toys, dishes, and other objects. Even in a dried state, the bacteria continue to be in the air or on surfaces, and when it enters the body, they begin to damage.

The bacterium was introduced by a religious cult that was trying to influence the results of local elections. No one died and the elections were not affected. Chicken soup, toasted slices, fruit, liquids only: we all have our own way of coping with a cold, flu or stomach upset. But scientists now understand that there is actually a link between the food we eat when we are sick and recovery time, and that, depending on the infection, it is better to eat or not eat at all.

A study that has just been done on mice has shown that eating more food when fighting a viral infection like the common cold and flu can help speed up recovery, but on the other hand, if we fight a bacterial infection like a food poisoning, food intake can seriously worsen the situation.

The most susceptible to streptococci are small children who are not yet accustomed to the rules of personal hygiene and constant hand washing. However, it cannot be said that bacteria will not settle in the human body of an adult. The chances of catching an infection decrease only after the age of forty. Exacerbation and growth of morbidity occur in the autumn-winter time.

When animals are infected, they stop eating, which switches their metabolism to starvation. The question is, is there any benefit from this and is it also important for people? - lead researcher Ruslan Maizhov. Before moving on to the survey results, let's first take a look at how our body reacts to various infections. We basically know two types of infections: bacterial and viral.

Bacterial infections, which include bronchitis and pneumonia, are caused by single-celled organisms that can develop and multiply in our bodies. Fortunately, most bacterial infections are treatable with antibiotics to limit their colonies. Viral infections, such as the flu or a cold, on the other hand, are not self-replicating like bacteria. Instead, they take our cells and make them make more copies of the virus and therefore spread throughout the body. Viral infections usually do not respond to antibiotic treatment, but some antiviral agents can prevent their spread in intact cells. When we are infected with harmful bacteria or viruses, our immune system is instantly activated, the first defensive response is increased inflammation in different areas of the body.

For introduction and vital activity in the human body, streptococci choose the surface of the tonsils, as well as lymphoid tissue on the respiratory organs. There are cases, but much less often, when an infection in the human body appears through the skin, on which there are wounds and cracks, burns or diaper rash. In the place where streptococci are introduced, a primary focus is formed, from where the inflammatory process originates. From it, in the future, microbes also enter other tissues of the internal organs, causing severe general intoxication. Microbes are active, multiply, release toxic products and components resulting from protein breakdown. Often a streptococcal infection turns into necrosis - purulent tissue damage with their subsequent death.

Streptococcal infection tends to spread at an astonishingly fast rate in tissues and organs. At the initial stages of their impact, phlegmon and periadenitis develop. With further entry of microbes into the Eustachian tubes, inflammation is localized in the middle ear, which causes otitis media, sinusitis, ethmoiditis, mastoiditis. The advanced stage of the disease may result in the formation of purulent metastases and septicopyemia. Timely initiated and competently prescribed treatment is a guarantee that the spread of infection can be stopped and the onset of irreversible pathological changes can be prevented.

It is impossible to recognize a streptococcal infection on your own. For this, clinical examinations and analyzes are necessary so that doctors can isolate streptococci in the group of bacteria present in the body. The earlier the patient goes to the doctor, the higher the likelihood that the diagnosis will be carried out correctly.

Relationships between endogenous and exogenous oncornaviruses

The constant presence of virogens in normal cells naturally creates the conditions for the emergence of both recombinant and hybrid viral particles and phenotypic mixing of endogenous viruses with exogenous viruses (infectious and oncogenic). This somewhat "artificial" hybridization can lead to the emergence of new types of oncogenic viruses (especially when hybridizing oncogenic viruses with xenotropic endogenous viruses) with a very wide range of blastomogenic effects on different species and even classes of animals.

To date, the formation of true recombinant genomes of endogenous and exogenous avian oncornaviruses has been established. Genetic recombinations also occurred between chf and RSV using ts-mutants of this virus. Similar genome connections could be transformed into stable forms by the formation of a provirus in the next replication cycle.

Numerous cases of isolation of viruses with an altered spectrum of pathogenicity have also been recorded, in particular, from heterologous cells (rats, hamsters) transformed with different strains of MSV.

The transformation process in such cell systems typically results in the activation of the endogenous virus and the creation of hybrid oncogenic viruses (pseudotypes) of the endogenous virus and MSV. The genomes of the resulting hybrid particles usually contain a region (or regions) complementary to the cells (rats or hamsters). Moreover, sometimes the genomes of hybrids can contain several heterologous regions.

For example, MSV-Ki and MSV(RaLV) RNAs have base sequences of both the endogenous mouse virus and the endogenous rat virus, while viruses isolated from MSV-H-induced hamster tumors carry regions in their genome that are complementary to endogenous viruses of mice, rats, and hamsters. From tumors induced by carcinogens, viruses were isolated whose genome contained sequences complementary only to endogenous viruses of the corresponding animal species (Levy, 1976).

Co-cultivation of Erythrocebus patas baboon and monkey cells with Kirsten murine sarcoma virus-transformed mink cells and subsequent treatment of the mixed culture with 5'-bromo-leoxyuridine isolated two new C-type isolates designated PP-IR and EP-IR (Sherr et al. ., 1976).

The genome of the viruses is represented by RNA, which was partially homologous to endogenous C-type viruses of mice and rats and Ki - MSV. In addition, the RNA PP-IR and EP-IR contain sequences identical to those in the RNA of the endogenous baboon C-type virus.

Both viruses were able to reproduce in the cells of cats, horses and minks, only transformed by Ki-MSV, while maintaining genetically stable antigenic properties and genomic sequences during the year of cultivation. They also expressed proteins related to both rodent and feline C-type viruses.

As the main structural component, both viruses contained p30, which was immunologically most related to p30 FeLV.

The reverse transcriptase of both viruses, although partially antigenically related to the enzyme of C-type viruses of mice and rats, nevertheless differed from the reverse transcriptase of the previously described viruses.

It is assumed that the isolates are genetic recombinants formed between the genome of the endogenous primate C-type virus and the Ki-MSV sequences present in mink cells transformed with this virus.

The relationship between endogenous and exogenous viruses can be very diverse. There are numerous and well-known data on the complementation of various defective oncogenic viruses by various endogenous viruses, as a result of which the latter could complete their reproductive cycle. For example, ecotropic endogenous rat viruses (RaLV-SD and RaLV-F) can "rescue" MSV from cells unproductively transformed with MSV-Ki (Rasheed et al., 1976).

At the same time, the presence of an endogenous virus in the genome of a normal cell can block the integration and even exogenous infection of this cell with a closely related but pathogenic oncornavirus.

Using various strains of MTV and murine leukemic viruses as an example, it was shown that an endogenous virus prevents the integration of pathogenic variants of these viruses into the genome of terminal cells and thereby prevents the vertical transmission of oncogenic genetic information, i.e., the hereditary fixation of a tumor disease and the possible death of a population from it.

Subsequently, it turned out that in the case of all known pathogenic natural strains of sarcoma-leukemic complexes of mammals (mice, cats, monkeys, etc.), the vertical transmission of the pathogenic strain did not take place, i.e., terminal cells were reliably protected not only from integration, but also from exogenous infection with these viruses (Levy, 1976).

The mechanism of this protection is not yet known. It is suggested that one of the possible options is the presence of a strictly defined locus in terminal cells for the integration of the virogen. If it is busy, then superinfection with another oncornavirus is excluded.

"Mechanisms of viral oncogenesis",
A.I. Ageenko

In the population of endogenous murine oncornavirus MuLV induced in BALB/3T3 cells by 5-ioddesoxyuridine, both the xenotropic virus and the ecotropic N-type virus were present (Laprevotte et al., 1977). Upon infection of rat NRK cells with a xenotropic virus, foci of morphological transformation with spindle-shaped cells were formed. Ecotropic MuLV induced transformation foci with rounded cells. These properties of the transformed cells were preserved during further passaging…

Crucially, there is as yet no direct evidence for vertical transmission by terminal cells of defective or non-defective genomes of these viruses, although sarc-specific sequences have been found in normal cells of several bird and mouse species (Stehelin, 1976; Wang Lu Hai et al., 1976; Frankel , Fischinger, 1976, 1977). There is reason to believe that sarc genes are also present in normal rat cells, in ...

Thus, based on a comparison of experimental data, it can be assumed that normal cells lack oncogenes, at least in the form in which they are found in the genome of exogenous or endogenous (passaged) oncornaviruses. Consequently, evidence has not yet been obtained for the central postulate of the Huebner-Todaro hypothesis, according to which the oncogene is constantly present in every normal cell. Then what...

Of particular interest is the commonality of certain cell surface proteins and endogenous viruses, which, on the one hand, are normal components of the cell, and, on the other hand, are part of virion proteins, i.e., are viral proteins. Such proteins, for example, include the so-called antigen-Gix, which is a type-specific gp69/71 glycoprotein of the endogenous Gross virus and other ecotropic viruses and is localized on ...

The study of the body's immunological reactions to the protein products of the genes of endogenous viruses began only 2-3 years ago. At the same time, this aspect of the problem of endogenous viruses is of paramount importance, since already initial studies have shown that immunoreactivity can probably be one of the mechanisms for regulating virogen expression. Fundamentally important both for theory and for ...

A pathogen enters our body in several ways. Let's list them:

1. By air. The airborne route of infection is the most common. It is characteristic of viruses and bacteria. Microbes either circulate freely in air masses or are attached to tiny dust particles.
2. Drip. When sneezing, coughing, talking, a person releases billions of drops of saliva and nasal mucus. In these drops, infectious pathogens move.

With the spread of viral epidemic diseases (ARVI, influenza), a combination of these two ways of infection occurs.

1. Contact. The causative agent is located on the skin of a sick person or on the mucous membranes. When a patient comes into contact with household items or a healthy person, he transmits an infectious agent that causes infection. The contact route of transmission in all sexual infections (syphilis, gonorrhea, HIV), in some viral diseases (infectious mononucleosis), in fungal diseases (onychomycosis of the feet).
2. Through insect bites. Diseases such as plague, typhus, malaria, borreliosis have a transmissible transmission route. The pathogen lives and multiplies in the gastrointestinal tract of insects (fleas, lice, mosquitoes, ticks) and, when bitten with saliva, enters a person's bloodstream.
3. Through the mouth. The fecal-oral route of transmission is through ingestion of contaminated food and water. All foodborne infections (cholera, salmonellosis, dysentery, rotavirus) have a similar mode of transmission.

Prevention

Ways of transmission of infection are studied by the science of epidemiology. Physicians must have such information in order to competently carry out disease prevention.

Masks can be used as a means of protection against airborne infections. They annually prove their effectiveness in influenza epidemics. It is better to use a four-layer gauze bandage, which should be changed every 2-3 hours. To protect yourself from airborne infections, you should avoid crowded places. After the street, you need to wash your hands with soap (dust particles, saliva and mucus may remain on your hands), wash your face, rinse your nose with saline.

Deep rinsing of the nose is considered the only reliable measure for the prevention of respiratory infections.

Prevention of contact diseases consists in the use of protective equipment during sexual intercourse, thorough disinfection of premises after outbreaks of contact infections, and caution when using public baths and toilets.

Avoiding insect bites is enough to prevent vector-borne infections. Although it is difficult even in urban environments. To do this, use special repellents, protective clothing. In places where malaria is spread, swamps are drained, and forest areas are treated with insecticides. In hot countries, I use special mosquito nets on windows, which are treated with a special repellent solution. Ticks lurk in tall grass, so lawn mowers often work in public recreation areas.