According to the types of respiration, all microorganisms are divided into three groups:

aerobic microbes, living and developing only in the presence of oxygen;

anaerobic microbes, existing only in an oxygen-free environment;

facultative anaerobic microbes, capable of existing both in the presence of oxygen and without it.

Depending on the nature of the microbes, the following are distinguished: kinds wound infection :

Purulent (pyogenic) infection . Pathogens: staphylococci, streptococci, diplococci, gonococci, Escherichia coli and typhoid bacilli, Pseudomonas aeruginosa and some others. Pyogenic microbes are found in large numbers on objects around us, in the air and especially in pus, feces, etc. If they enter the human body, then in the presence of special predisposing conditions they can cause the appearance and development of a wide variety of acute purulent diseases. If they get on the wound surface, then it becomes suppurated with possible further spread of infection.

Anaerobic infection Pathogens: microbes that cause the development of tetanus when they enter a wound, bacillus malignant edema, anaerobic cellulitis and gangrene, bacillus, dissolving tissue. Anaerobic microbes are found mainly in manured soil, so contamination of wounds with soil is especially dangerous.

Entry into the human body occurs in various ways:

1) upon contact with any object on the surface of which there are microbes ( contact infection ). This is the most common and most important view wound infection;

2) when saliva or mucus gets into the wound when talking, coughing, sneezing (droplet infection);

3) when microbes enter the wound from the air (air infection).

Specific infection. Pathogens: Loeffler's bacillus (wound diphtheria), hemolytic streptococcus (wound scarlet fever), etc.

Sources of infection wounds with microorganisms:

Exogenous source , when an infection enters the body from external environment:

From the air - airborne infection;

From objects in contact with the wound - contact;

With saliva and mucus secreted by staff when talking and coughing - drip;

From objects left in tissues, such as implantation sutures and tampons.

Endogenous infection is located in the patient’s body (on the skin, in the respiratory tract, intestines) and can be introduced into the wound directly during or after surgery through the blood and lymphatic vessels.

However, for the rapid and unhindered proliferation of microbes, certain conditions are necessary: ​​weakening of the person by blood loss, radiation, cooling and other factors. is caused by the action of In other conditions, the body's defenses operate and the pathological process does not develop.

End of work -

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Fundamentals of medical knowledge

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Vitebsk
Publishing house of the educational institution "VSU named after. P.M. Masherov" UDC BBK Published by decision of the scientific and methodological council of the Educational Institution "Vitebsk State

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Antiseptics and asepsis
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Antiseptics
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Antiseptic substances
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General anesthesia and its types
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Reanimation
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Bleeding. Transfusion of blood and its substitutes
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Danger of blood loss in children and adults
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Blood transfusion and plasma replacement solutions
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Complications from blood transfusion
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Acute specific infection
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Injuries of the trachea, larynx, large vessels of the neck
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Chest injuries
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Chest wounds
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Injuries to the urinary system
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Warning infectious complications in surgery. Asepsis, general questions. Sterilization. Treatment of surgeon's hands

1. Asepsis

Asepsis is a set of measures aimed at preventing contamination of the surgical wound by microorganisms. The principles of asepsis are implemented using various methods: chemical, physical, biological. The principles of asepsis must be observed carefully and strictly, starting from the first contact of the patient with the doctor in the emergency department, with the emergency doctor. First contact doctors, when faced with wounds and injuries, must provide first aid and transport the patient to the hospital as quickly as possible. To prevent infection from entering the wound, a sterile dressing is immediately applied to it. gauze bandage. In a surgical hospital, the principles of asepsis are ensured proper organization staff work, proper layout of departments, careful theoretical training on this issue. The main task of asepsis in a surgical hospital is to prevent microbial agents from entering the wound. All instruments, tissues, materials, and surgeon’s hands that come into contact with the wound must be sterile. In addition to preventing this route of infection entering the wound, it is necessary to prevent airborne transmission of infection.

One of the main points is the organization of hospital work. Each surgical hospital has different departments according to specialization. Such departments include thoracic, urological, cardiac surgery, etc. There is always a purulent surgery department. This department must be isolated from other departments, medical staff, patients themselves should not come into contact with patients from other departments. If such a department is not provided in the hospital, the department should have separate operating rooms, manipulation rooms, and dressing rooms for patients with purulent-inflammatory diseases. Doctors, nurses, materials and instruments, as well as rooms for such patients should be separated from other patients. In addition, it is known that the content of microorganisms in the air of the operating room increases significantly during the day, therefore, when working in the operating room, it is extremely important to dress in sterile clothes, use sterile gauze masks, caps, completely limiting any possibility of microorganisms entering the wound. It is especially important to follow these rules for students observing the operation directly next to surgical field.

2. Sterilization

This is a method aimed at eliminating living microorganisms and their spores from the surface of materials, instruments and other objects that come into contact with the wound surface before, after and during surgery.

Dressings, underwear, suture material, rubber gloves (some simple outpatient procedures, such as taking blood for analysis, can be carried out in disposable sterile gloves), and instruments should be sterilized. Distinguish following methods sterilization.

• 1. Boiling (the duration depends on the type of contamination).
• 2. Treatment with liquid steam or steam supplied under pressure in a special apparatus - an autoclave (for sterilization of contaminated dressings, linen, gowns, shoe covers). Its temperature is controlled various methods. One of these methods is to place test tubes containing substances whose melting point is equal to or slightly lower than the required temperature in the sterilization apparatus. The melting of these substances indicates that the temperature required for sterilization has been reached.
• 3. Bactericidal effect ultraviolet radiation(for air disinfection in operating rooms, dressing rooms and manipulation rooms).

Germicidal lamps are turned on at the end of the working day after cleaning the room for 3 hours, and if there is a large flow of patients during the day, it is advisable to carry out treatment with lamps during the day.

Treating the surgeon's hands using the Spasokukotsky-Kochergin method

Hand disinfection is one of the most important methods of asepsis, which completely prevents microorganisms from accessing the surgical field.

Before treating your hands using this method, you must wash your hands with soap and a brush. The surgeon's hands are thoroughly soaped using a brush in a certain direction. They begin to process their hands with proximal phalanges fingers, first their palmar surface, and then their dorsal surface. Carefully treat each finger and interdigital spaces, following the specified sequence.

Then wash the wrist: first from the palm, then from the back. The forearm is treated in the same sequence. The left hand is washed first, then the right hand according to the same principle. This allows you to cleanse the skin of your hands from contaminants received during the day during professional and household activities. Subsequently, the skin of the hands is treated using a special technique. The first stage includes treating hands in a 0.5% solution of ammonia.

The sequence of treatment of the surgeon's hands must be carefully followed. A solution of ammonia is placed in two basins, in each of which the hands are treated sequentially according to the described method for 3 minutes: first in one basin, and then for the same time in the other. After this, hands are blotted with a sterile napkin and then wiped dry.

The second stage is treating hands in the same sequence with a 96% alcohol solution for 4-5 minutes. After this, the surgeon puts on sterile gloves, after which he can only touch the surgical field.

Special attention is given to the treatment of the hands of a surgeon working in the department of purulent surgery. Sterility control must be especially thorough, for which it is necessary to disinfect hands not only before surgery, but also after examination purulent wound, manipulations in it, dressings. To do this, hands are treated according to the indicated method with gauze swabs moistened with 70% ethyl alcohol for 3 minutes.

Prevent penetration and development various infections Every person can, the main thing is to know the main dangers that lurk at every step and the ways of their spread. Sources of infection are places where microorganisms live and live.

There are two types of sources of infection - exogenous and endogenous. In the first case, we are talking about sources that are outside the human body, in the second – factors that are in the patient’s body.

In turn, exogenous sources of infection spread include:

• Patients with purulent-septic diseases;
• Animals;
• Bacilli carriers.

Do not forget that for a weakened body, a potential danger is posed not only by pronounced pathogenic microorganisms, but also by opportunistic pathogens, which are an integral part of various human tissues and organs, but in certain circumstances become a source of disease. Similar microflora is also present on foreign objects that surround a person.

Sometimes a person may not be sick himself, but may be a carrier of viruses, that is, a carrier of the bacilli. IN in this case the infection is likely to spread to both weakened people and healthy people, although to varying degrees.

IN in rare cases Animals act as sources of exogenous infection.

Pathogenic microflora penetrates the human body in the following ways:

• Air;
• Drip;
• Contact;
• Implantation;
• Fecal-oral;
• Vertical.

1. With the airborne method of spreading infection, microorganisms attack a person from the surrounding air, in which they are suspended or as part of dust particles. A person, by inhaling, can become infected with any disease that can be transmitted this way.

2. The droplet method of spreading infection means the penetration of pathogens into the wound, which are contained in small droplets of secretions from the upper respiratory tract. But microorganisms enter this environment from an infected person when coughing, talking and sneezing.

3. When they talk about contact path spread of infection, we are talking about the penetration of microbes through objects into wounds and damaged areas of the skin through direct contact. Thus, you can become infected through surgical and cosmetic instruments, personal and public items, clothing, and so on.

4. With implantation infection, pathogens enter the human body in the case of various operations that involve leaving foreign objects in the body. These can be suture materials, synthetic vascular prostheses, artificial heart valves, pacemakers, etc.

5. Fecal-oral infection is the penetration of infection into the human body through the gastrointestinal tract. Pathogenic microflora can enter the stomach through unwashed hands, dirty and contaminated food, water and soil.

6. The vertical method of spread of infection refers to the transmission of viruses from mother to fetus. In this case, they most often talk about HIV infections and viral hepatitis.

Endogenous infection provokes a disease from within or from the integument of the human body. Its main foci include:

• inflammation of the covering layer - epithelium: carbuncles, boils, eczema, pyoderma;
• focal infections of the gastrointestinal tract: pancreatitis, caries, cholangitis, cholecystitis;
• respiratory tract infections: tracheitis, bronchitis, pneumonia, sinusitis, lung abscess, bronchiectasis, frontal sinusitis;
• inflammation of the urogenital tract: salpingoophoritis, prostatitis, cystitis, urethritis, pyelitis;
• foci of unknown infections.

Endogenous infection occurs by such methods as contact, hematogenous and lymphogenous. In the first case, bacteria can enter the wound from skin surfaces close to the surgical incisions, from the opened lumens internal organs during operations or from a source of inflammation located outside the area surgical intervention. Pathways of infection spread, such as hematogenous and lymphogenous, mean the penetration of viruses into the wound through lymphatic and blood vessels from the source of inflammation.

Hospital infection

The concept of hospital infection appeared in the 70-80s of the 20th century, as cases of infections caused by highly pathogenic strains of microorganisms that circulate inside medical institutions, while they are practically never found outside them. These strains were formed by selecting the most adapted antibiotic-resistant microorganisms that spread from sick patients to hospital staff and vice versa. These microorganisms include: Escherichia coli, Staphylococcus aureus, Protea, Pseudomonas aeruginosa, peptococci, bacteroides, and fungi. According to WHO definition, HIV infection and viral hepatitis in hospitals is also referred to as this type spread of infection.

Reservoirs nosocomial infections are:

• leather;
• hair;
• bed of the sick;
• staff uniforms;
• oral cavity;
• intestines (feces).

The main route of transmission of infections within hospitals is contact, although previously it was considered airborne.

Unfortunately, it is impossible to completely eliminate the likelihood of infection through hospital transmission, but today a number of measures have been developed to help significantly reduce the risk of infection.

It has been observed that the longer a patient or worker stays in a hospital facility, the higher the risk of contracting infections. This is especially true for patients with purulent-septic diseases. Hospital infections often develop in patients who are forced to stay in a hospital bed for a long time and have limited movements.

In many developed countries today, constant bacteriological monitoring of pathogens of hospital infections is carried out. If certain microorganisms are detected, appropriate preventive measures spread of infection.

Ways of infection entering the wound

The skin and mucous membranes isolate the internal environment from the external and reliably protect the body from the penetration of microbes. Any violation of their integrity is an entry point for infection. Therefore, all accidental wounds are obviously infected and require mandatory surgical treatment. Infection can occur from the outside (exogenous) by airborne droplets(when coughing, talking), by contact (when touching the wound with clothing, hands) or from the inside (endogenous). Sources of endogenous infection are chronic inflammatory diseases skin, teeth, tonsils, ways of spreading infection - blood or lymph flow.

As a rule, wounds become infected with pyogenic microbes (streptococci, staphylococci), but infection can also occur with other microbes. Infection of a wound with tetanus bacilli, tuberculosis, and gas gangrene is very dangerous. Prevention of infectious complications in surgery is based on strict adherence to the rules of asepsis and antisepsis. Both methods represent a single whole in the prevention of surgical infection.

Antiseptics - a set of measures aimed at destroying microbes in the wound. There are mechanical, physical, biological and chemical methods of destruction.

Mechanical antiseptics includes carrying out primary surgical treatment of the wound and its toilet, i.e., removal of blood clots, foreign objects, excision of non-viable tissue, washing of the wound cavity.

Physical method is based on the use of ultraviolet irradiation, which has a bactericidal effect, and the application of gauze dressings, which absorb wound fluid well, dry the wound and thereby contribute to the death of microbes. The same method involves the use of a concentrated saline solution (the law of osmosis).

Biological method based on the use of serums, vaccines, antibiotics and sulfonamides (in the form of solutions, ointments, powders). Chemical method The fight against microbes is aimed at the use of various chemicals called antiseptics.

Drugs used against pathogens of surgical infections can be divided into 3 groups: disinfectants, antiseptics and chemotherapy. Disinfectants substances are intended primarily to destroy infectious agents in the external environment (chloramine, sublimate, triple solution, formaldehyde, carbolic acid). Antiseptic products are used to destroy microbes on the surface of the body or in serous cavities. These drugs should not be absorbed in significant quantities into the blood, as they can have a toxic effect on the patient’s body (iodine, furatsilin, rivanol, hydrogen peroxide, potassium permanganate, brilliant green, methylene blue).

Chemotherapy the drugs are well absorbed into the blood when in various ways administration and destroy microbes in the patient’s body. This group includes antibiotics and sulfonamides.

inflammatory diseases. Doctors, nurses, materials and instruments, as well as rooms for such patients should be separated from other patients. In addition, it is known that the content of microorganisms in the air of the operating room increases significantly during the day, therefore, when working in the operating room, it is extremely important to dress in sterile clothes, use sterile gauze masks, caps, completely limiting any possibility of microorganisms entering the wound. It is especially important to follow these rules for students observing the operation directly near the surgical field.
2. Sterilization
This is a method aimed at eliminating living microorganisms and their spores from the surface of materials, instruments and other objects that come into contact with the wound surface before, after and during surgery.
Dressings, underwear, suture material, rubber gloves (some simple outpatient procedures, such as taking blood for analysis, can be carried out in disposable sterile gloves), and instruments should be sterilized. The following sterilization methods are distinguished.
1. Boiling (the duration depends on the type of contamination).
2. Treatment with flowing steam or steam supplied under pressure in a special apparatus - an autoclave (for sterilization of contaminated dressings, linen, gowns, shoe covers). The temperature in it is controlled by various methods. One of these methods is to place test tubes containing substances whose melting point is equal to or slightly lower than the required temperature in the sterilization apparatus. The melting of these substances indicates that the temperature required for sterilization has been reached.
3. Bactericidal effect of ultraviolet radiation (for disinfecting the air in operating rooms, dressing rooms and manipulation rooms).
Germicidal lamps are turned on at the end of the working day after cleaning the room for 3 hours, and if there is a large flow of patients during the day, it is advisable to carry out treatment with lamps during the day.
3. Treatment of the surgeon’s hands using the Spasokukotsky-Kochergin method
Hand disinfection is one of the most important methods of asepsis, which completely prevents microorganisms from accessing the surgical field.
Before treating your hands using this method, you must wash your hands with soap and a brush. The surgeon's hands are thoroughly soaped using a brush in a certain direction. They begin to process the hands from the proximal phalanges of the fingers, first their palmar surface, and then their dorsal surface.
Carefully treat each finger and interdigital spaces, following the specified sequence. Then wash the wrist: first from the palm, then from the back. In the same sequence

forearm is treated. The left hand is washed first, then the right hand according to the same principle. This allows you to cleanse the skin of your hands from contaminants received during the day during professional and household activities. Subsequently, the skin of the hands is treated using a special technique.
The first stage includes treating hands in a 0.5% solution of ammonia. The sequence of treatment of the surgeon's hands must be carefully followed. A solution of ammonia is placed in two basins, in each of which the hands are treated sequentially according to the described method for 3 minutes: first in one basin, and then for the same time in the other. After this, hands are blotted with a sterile napkin and then wiped dry.
The second stage is treating hands in the same sequence with a 96% alcohol solution for 4-5 minutes. After this, the surgeon puts on sterile gloves, after which he can only touch the surgical field.
Particular attention is paid to the treatment of the hands of a surgeon working in the department of purulent surgery. Control over sterility must be especially careful, for which it is necessary to clean hands not only before surgery, but also after examining a purulent wound, manipulating it, and dressing it. To do this, hands are treated according to the indicated method with gauze swabs moistened with 70% ethyl alcohol for 3 minutes.
46 Dressing - definition, indications.
The concept of dressing
Bandages are usually applied in a dressing room. This is where the dressing process takes place. Bandaging is understood as a therapeutic and diagnostic procedure consisting of removing the old bandage, performing preventive, diagnostic and therapeutic measures in the wound and applying a new bandage. To perform a dressing, appropriate indications are needed.?
The main indications for dressing are:?
1. 1st day after surgery. The need for bandaging one day after the operation is due to the fact that in the presence of any wound, even one seemingly hermetically sutured, the lower layers of gauze always get wet with ichor within the first day, since fibrin has not yet bonded the edges of the wound.?
The ichor is good nutrient medium for microorganisms.
The purpose of dressing on the 1st day after surgery is prophylactic - removing the wet dressing material and treating the edges of the wound with antiseptics to prevent infectious complications.?
2. The need to perform diagnostic measures in the wound: monitoring the progress of the healing process.?

3. The need for therapeutic manipulations: removal of sutures, removal of drainage, excision of necrotic tissue, rinsing with antiseptics, stopping bleeding, administering medications and much more.?
4. The bandage has ceased to perform its function, the immobilizing bandage does not provide immobility, the hemostatic bandage does not stop bleeding, the occlusive bandage does not create a tightness, etc..?
5. Wetting the bandage. A bandage that is wet with wound discharge or blood does not fulfill its function and is a conductor for secondary infection.?
6. The bandage has moved from the place where it was applied.?
When removing an old dressing, one should proceed from two basic principles: a minimum of discomfort for the patient and compliance with aseptic standards.?
To remove the bandage painlessly, you should carefully peel off the gauze, while holding the skin around with adhesive bandages, do not put pressure on the wound area, and do not sudden movements. When the dressing dries to extensive wounds in some cases, it is soaked with antiseptic solutions: 3% hydrogen peroxide, 2-3% boric acid, etc..?
Removal of the upper non-sterile layers of the bandage, gauze is carried out with gloved hands; all procedures in the dressing room are performed in rubber gloves! After this, removing the sterile dressing material that is in direct contact with the wound, as well as performing all further manipulations with the wound, can only be done with a sterile instrument.
The material used during dressing is dumped into a kidney-shaped basin, and after its completion from the basin into special tanks for disposal, while the basin itself and the used instruments are placed in a storage tank for disinfection.?
47Measurement of pulse, blood pressure and respiratory rate.
When measuring the pulse, the patient's hand should lie freely, without tension. The hand of the person being examined in the area of ​​the wrist joint is clasped with the right hand so that the first finger is located on the ulnar side, and the second, third and fourth finger are on the radial artery. Having felt the pulsating artery, it is pressed with moderate force to inside radius bone. If it is impossible to determine the pulse on the radial artery, the pulse is examined on the temporal or carotid arteries, and this must be done especially carefully, since pressure on the artery can cause dizziness in the patient and slow cardiac activity.
If there is a sudden increase in heart rate, up to 150 beats per minute, nurse must provide the necessary first aid. To do this, she counts the pulse, determines its filling, tension and rhythm, and then takes necessary measures to relieve psycho-emotional stress in the patient by putting her to bed.?

Determination of respiratory rate
The combination of inhalation and subsequent exhalation is considered one breathing movement. The number of breaths in 1 minute is called the respiratory rate (RR) or simply the respiratory rate.
Normally, breathing movements are rhythmic. Respiratory rate in an adult healthy person at rest it is 16-20 per minute; in women it is 2-4 breaths more than in men. In the lying position, the number of breaths usually decreases to 14-16 per minute, in an upright position it increases to 18-20 per minute. In a newborn, the respiratory rate is 40-50 times per minute, by the age of 5 it decreases to 24, and by the age of 15-20 it is 16-20 times per minute. For athletes, the respiratory rate can be 6-8 per minute.
Determination of the frequency of respiratory movements is carried out unnoticed by the patient; at this moment, the position of the hand can simulate the determination of the pulse rate. The patient's position is lying or sitting, while taking his hand as for examining the pulse, but observing the excursion of the chest and counting the respiratory movements for 1 minute. The result of the NPV is recorded in the appropriate documentation.
48Asepsis.Methods.
Asepsis methods
Asepsis includes the consistent implementation of measures for sterilization of linen, clothing, dressings, instruments, air in the operating room and dressing rooms, and preparation of personnel hands.
Asepsis methods. Infertility is achieved by such physical factors, How heat hot dry air, boiling, flowing steam, pressurized steam, ultraviolet irradiation, ionizing radiation, ultrasound, etc.
Ultra-violet rays
The sun's rays have a bactericidal property, especially short-wave ultraviolet rays. When exposed to sunlight, bacteria quickly die; spores are less susceptible to ultraviolet rays. High dust levels in the air sharply reduce the bactericidal effect of sunlight.
Ionizing radiation
Radioactive isotopes cobalt-60 and cesium-137 emit y-rays that have a bactericidal effect. Sterilization by ionizing radiation is carried out at special installations at medical industry enterprises. Reliable disinfection is achieved suture material, items made of plastic, rubber.
Ultrasonic sterilization
The method is undergoing a study stage, but in practice, devices are used to sterilize the surgeon’s hands. The method is fast, reliable and convenient.
Air filtration

In operating rooms where organ transplants are performed, special air purification is used. The air is filtered through special filters that retain chamberlain candle microbes. Conventional operating rooms are equipped with air conditioners or air purifiers.
Yu. Hesterenko
49 Antiseptics. Methods .
Antiseptics lat. anti - against, septicus - rotting - a system of measures aimed at destroying microorganisms in a wound, pathological focus, organs and tissues, using mechanical and physical methods influences, active chemicals and biological factors.
Types of antiseptics
There are types of antiseptics depending on the nature of the methods used: mechanical, physical, chemical and biological antiseptics. In practice they usually combine different types antiseptics.
Depending on the method of using antiseptics, chemical and biological antiseptics are divided into local and general; local, in turn, is divided into superficial and deep. With superficial antiseptics, the drug is used in the form of powders, ointments, applications, for washing wounds and cavities, and with deep antiseptics, the drug is injected into the tissue of the wound inflammatory focus of puncture, etc.
General antiseptics mean saturating the body with antiseptic agents, antibiotics, sulfonamides, etc. They are carried into the source of infection by the blood or lymph flow and thus affect the microflora.
Mechanical antiseptics
See also: Primary surgical treatment of a wound
Mechanical antiseptics is the destruction of microorganisms by mechanical methods, that is, the removal of areas of non-viable tissue, blood clots, and purulent exudate. Mechanical methods are fundamental - if they are not carried out, all other methods are ineffective.
Mechanical antiseptics includes: cleaning the wound, removing purulent exudate, removing clots, cleansing the wound surface and skin - performed during dressing, primary surgical treatment of the wound, dissection, revision, excision of the edges, walls, bottom of the wound, removal of blood, foreign bodies and foci of necrosis, restoration of damaged tissue - suturing, hemostasis - helps prevent the development purulent process, that is, it turns an infected wound into a sterile wound. Secondary surgical treatment, excision of non-viable tissues, removal of foreign bodies, opening of pockets and leaks, drainage of the wound - is carried out in the presence of an active infectious process.

Indications - presence of a purulent focus, lack of adequate outflow from the wound, formation of extensive areas of necrosis and purulent leaks, other operations and manipulations, opening of ulcers, puncture of ulcers
“Ubi pus - ubi es” - “you see pus - release it.”
Thus, mechanical antisepsis is a true treatment for infection surgical methods, using surgical instruments.
Physical antisepsis
Physical antiseptics are methods that create unfavorable conditions in the wound for the development of bacteria and the absorption of toxins and tissue breakdown products. Based on the laws of osmosis and diffusion, communicating vessels, universal gravity and others. Methods: use of hygroscopic dressing materials, cotton wool, gauze, tampons, napkins - suck out wound secretions with a lot of microbes and their toxins hypertonic solutions used to wet the dressing material, draw its contents from the wound into the bandage. However, you should know that hypertonic solutions have a chemical and biological effect on the wound and on microorganisms, environmental factors such as washing and drying. When dried, a scab is formed, which promotes healing sorbents carbon-containing substances in the form of powder or fibers drainage passive drainage - the law of communicating vessels, flow-flushing - at least 2 drainages, liquid is introduced one at a time, the other is removed in an equal volume, active drainage - drainage with a pump technical means laser - radiation with high directionality and energy density, the result is a sterile coagulation film ultrasound - cavitation bubbles and H+ and OH?,
UV - for treating rooms and wounds, hyperbaric oxygenation, x-ray therapy - treatment of deep-lying purulent foci in osteomyelitis, bone panaritium.
Chemical antiseptic
Chemical antiseptics - the destruction of microorganisms in a wound, pathological focus or the patient’s body using various chemical substances.
Highlight: disinfectants used in asepsis for processing instruments, washing walls, floors, etc., in fact antiseptics externally, for treating the skin, surgeon's hands, washing wounds and mucous membranes, chemotherapeutic agents, antibiotics and sulfonamides - inhibit the growth of bacteria, an important property - the only means that have specific action on

certain groups of microorganisms are classified as biological antiseptics.
Chemical antiseptics are substances used for topical use that create high concentration antibacterial drug directly at the site of inflammation. These drugs are more resistant than antibiotics to the effects of inflammation and tissue necrosis. The positive qualities of the drugs are wide range antibacterial action, bactericidal effect, low drug resistance of microorganisms. The drugs are characterized by poor absorption, the possibility of long-term storage, and rare side effects.
Chemical antiseptics include derivatives of nitrofuran, acids and alkalis, dyes, detergents, oxidizing agents, derivatives of quinoxyxaline, metal salts sublimate, lapis.
Methods of using chemical antiseptics. Local application: and the use of dressings with antiseptic drugs in the treatment of wounds and burns; drugs can be used in the form of solutions; they wash the wound during dressing, ointments and powders; b injection of solutions of antibacterial drugs into the wound, closed cavities, followed by aspiration through drains.
General use: a reception antibacterial agents orally in the form of tablets in order to influence the patient’s microflora during his preparation for intestinal surgery, as well as subsequent general action on the body after absorption of the drug into the blood; b intravenous administration of certain drugs furazidine, sodium hypochlorite.
Biological antiseptics
Biological antiseptics is the use of biological products that act both directly on microorganisms and their toxins, and act through the macroorganism.
These drugs include: antibiotics and sulfonamides, which have a bactericidal or bacteriostatic effect; enzyme preparations, bacteriophages - bacteria eaters; antitoxins - specific antibodies, means for passive immunization, formed in the human body under the influence of serums, toxoids, means for active immunization, immunostimulating agents. Antitoxins are one of the immunity factors for tetanus, diphtheria, botulism, gas gangrene and other diseases.
Antibiotics are chemical compounds of biological origin that have a selective damaging or destructive effect on microorganisms. Antibiotics used in medical practice are produced by actinomycetes, molds, and some bacteria. This group of drugs also includes synthetic analogues and derivatives of natural antibiotics.

By spectrum antimicrobial action Antibiotics differ quite significantly; in addition, by acting on a microorganism, antibiotics cause either a bacteriostatic or bactericidal effect.
There are four main mechanisms of antimicrobial action of antibiotics: disruption of bacterial cell wall synthesis, disruption of the permeability of the cytoplasmic membrane, disruption of intracellular protein synthesis, disruption of RNA synthesis.
In the process of using antibiotics, microorganisms may develop resistance to them. The emergence of resistant strains is a serious problem modern medicine. To avoid or slow down this process, there are principles of antibiotic treatment: careful justification of prescriptions, justification for the choice of antibiotic based on laboratory data, a characteristic clinical picture, antibiotics with the same side effect that coincide with the existing pathology cannot be prescribed, individual sensitivity, characteristics of penetration into various tissues, and also the age of the patient, prescribing an adequate dose is always therapeutic, withdrawal should be abrupt, the optimal course of treatment is on average a week, lengthening is possible, but less is not possible, since clinical recovery occurs earlier than laboratory recovery - the danger of relapse, the choice of route and frequency of administration depends on the localization of the process and duration the action of the antibiotic is a mandatory assessment of the effectiveness of the action; if it is not effective, it is recommended to combine antibiotics with each other or with sulfonamides, but it is dangerous to prescribe more than two drugs at the same time due to severe side effects.
In clinical practice, using exclusively one method to combat infection is impractical and often ineffective. Therefore, the concept of mixed antiseptics is introduced.
Mixed antiseptics is the effect on the microbial cell, as well as on the human body, of several types of antiseptics. More often their action is complex. For example: primary surgical treatment of a wound, mechanical and chemical antiseptics are supplemented by biological antiseptics by introducing antitetanus serum, antibiotics and the prescription of physiotherapeutic procedures, physical antiseptics.
Also an example of mixed antiseptics is peritoneal dialysis for purulent peritonitis