ASEPTIC &

ANTISEPTIC &
Alvian Andriyanto, dr.
What is Aseptic Technique?
 Aseptic technique aims to prevent pathogenic organisms, in
sufficient quantity to cause infection, from being introduced to
susceptible sites by hands, surfaces and equipment. (National
Health and Medical Research Council, 2010)
 Aseptic technique protects patients during invasive clinical
procedures by employing infection control measures that
minimise, as far as practicably possible, the presence of
pathogenic microorganisms.
Why practice Aseptic Technique?
 Aseptic technique reduces the risk of health care
associated infections.
 Aseptic technique is required for all invasive
procedures.
 Aseptic technique has been shown to significantly
improve the practice of clinicians performing
procedures and reduce the risk of infection.
Definition
 fi ni t io n
De
Aseptic & Infection Control

Source of Infection:
Air
Tools & Surgery
Skin sufferers
Viscera
Blood
Pus (pus)

Aseptic Is An Absolute Requirement Of Surgery

 principles of Medical Asepsis
 Perform hand hygiene
 Use of personal protective equipment and hand hygiene if
contact with body fluids or potentially contaminated
secretions
 Clean and disinfect shared patient equipment
 Clean and disinfect the environment
 Healthcare providers free of disease and up to date on
immunizations
Surgery increases the risk of infection!

Army Medicine/CC
Surgical Asepsis
Surgical asepsis, also known as “sterile technique” is
aimed at removing all microorganisms.
Surgical asepsis is used for all surgical/sterile
procedures.
Necessary components of surgical asepsis include:
 Knowing what is sterile
 Knowing what is not sterile
 How to keep the first two conditions separate
 How to remedy contamination immediately
 Principles of Surgical Asepsis

 The patient should not be the source of contamination

 The operating room (OR) team should not be the source of
contamination
 The surgical scrub should be done meticulously
 The OR technique of the surgeon is very important
 Recognize potential environmental contamination
 Hand Hygiene
The substance of asepsis

iStockphoto
 What is Hand Hygiene

 Handwashing with soap and water

 Antiseptic Handwash
 Alcohol-based Hand Rub
 Surgical Antisepsis
 Transmission of pathogens on
Hands
Five elements
 Germs are present on patients and surfaces near patients
 By direct and indirect contact, patient germs contaminate healthcare
provider hands
 Germs survive and multiply on healthcare provider hands
 Defective hand hygiene results in hands remaining contaminated
 Healthcare providers touch/contaminate another patient or surface
that will have contact with the patient.
When to perform hand hygiene
The 5 Moments Consensus recommendations
WHO CDC Guidelines on Hand Hygiene in healthcare, 2002

1. Before touching • Before and after touching the patient

a patient

2. Before clean / • Before donning sterile gloves for central venous catheter insertion; also for insertion
aseptic of other invasive devices that do not require a surgical procedure using sterile gloves
procedure • If moving from a contaminated body site to another body site during care of the same
patient

3. After body fluid • After contact with body fluids or excretions, mucous membrane, non-intact skin or
exposure risk wound dressing
• If moving from a contaminated body site to another body site during care of the same
patient
• After removing gloves

4. After touching • Before and after touching the patient

a patient • After removing gloves

5. After touching • After contact with inanimate surfaces and objects (including medical equipment) in
patient the immediate vicinity of the patient
surroundings • After removing gloves
Survival of Pathogens on Surfaces

Pathogen Survival
MRSA 7 days – 7 months
VRE 5 days – 4 months
Acinetobacter 3 days -5 months
C.difficile (spores) 5 months
Norovirus 12 – 28 days
HIV Minutes to hours
HBV 7 days
HCV 16 hours –A,4etdays
Kramer al (2006). BMC Infect Dis; 6:130; CDC
 ANTISEPTIC
 Disinfectants are strong chemical agents that inhibit or kill
microorganisms

 Antiseptics are disinfecting agents with sufficiently low

toxicity for host cells→can be used directly on skin, mucous
membranes, or wounds

 Sterilants kill both vegetative cells and spores when applied to

materials for appropriate times and temperatures
COMMONLY USED TERMS RELATED TO KILLING
OF MICROORGANISMS
Disinfection
DISINFECTANTS are chemical agents that inhibit or
kill microorganisms (surgical apparatus, periphery of
the patient, and the objects used by the patient).
Disinfection It is the application of chemicals to destroy
most pathogenic organisms on inanimate surfaces
Can be accomplished by application of chemical agents,
use of physical agents (ionizing radiation) dry or moist
heat, superheated steam(autoclave, 120̊ C)
IDEAL DISINFECTANT
 effective at room temperature,
 noncorrosive and nontoxic,
 inexpensive,
 capable of killing the vegetative form of all
pathogenic organisms,
 require limited time of exposure
PROCESS OF DISINFECTION
Prevents infection by reducing the number of
potentially infective organisms either by killing,
removing or diluting them.
 Application of chemical agent
 Use of ionizing irradiation, dry or moist heat or
superheated steam (autoclave, 120◦ C)
-PHYSICAL-
 The ideal antiseptic has to have similar properties as
an ideal disinfectant. But the primary importance for
antiseptics is the selective toxicity which means
toxicity to microorganisms but not to human cells.
The degree of selectivity of the antiseptic agents can
change depending on the tissues they contact.
Antiseptic drugs are used in:
 The treatment of skin infections
 Prevention of infections in cuts and wounds
 Cleaning the skin area of surgery from
microorganisms
 Proflaxy and treatment of infections in mucosal
areas such as mouth, nose and vagina that are open
to environment
 As a scrub for surgeans and the medical personnel
CLASSIFICATIONS OF ANTISEPTICS
AND DISINFECTANTS

1. Those that denature proteins,

2. Those that cause osmotic disruption of the cell,
3. Those that interfere with specific metabolic
processes.

 The first and second classifications are tend to kill

the organisms.
 The third one affects cell growth and reproduction
without killing the cell.
MECHANISM OF ACTION
Phenols, iodine, alcohols, aldehydes and metallic
compounds denature proteins and DNA bases.

Cationic detergents interfere with plasma membrane’s

permeability and cause leakage of enzyme, coenzyme
and metabolites.

Oxidizing compouns oxidize functional molecules in

the microorganisms.
Various kinds of antiseptics
 Alcohol: strong bactericidal, non sporocidal
 Halogen & Compounds
 2% Iodine: kills spores 2-3 hours
 irritation of the wound (pain)
 Povidone iodine: not stimulating, for the face of the
genitalia ext, mucous membranes
 Yodoform: antiseptic ulcers
 Chlorhesidine: bakterisid, fungicid, colorless, non-
stimulating skin & mucosa
Various kinds of antiseptics
Oxidation
Potassium permanganate: purple crystals,
bactericidal & fungicid
Perhidrol (H2O2): Kills anaerobic bacteria

Heavy metals and salts

Mercury chloride (sublimate): bacteriostatic &
fungistatik
Merkurokrom (red medicine): bacteriostatic weak,
accelerate dry wounds
Various kinds of antiseptics
 Acid: boric acid 3% bacteriostatic weak

 Phenol properties:
 Trinitro phenol (1% picric acid): bakterisid & local
anesthetics
 Heksaklorofan: wash hands immediately surgery

 Quadternary ammonium base:

 Etakridin (rivanol): antiseptic ulcers, compresses &
irrigation
c. Sterilization of surgical equipment
Heating
No pressure:
Trinitro phenol (1% picric acid): bakterisid & local
anesthetics
Heksaklorofan: wash hands immediately surgery
Flamber: burning with spirit / alcohol, min 5 min
With Pressure:
Autoclave: steam pressure 750 mmHg, 120o, 10-15
min
 Piric acid

Autoclave
c. Sterilization of surgical equipment

 Chemical:
 Formal tablets: 24 hours
 Ethylene oxide gas:
toxic, flammable
 Radiation:
 the power of X-ray or
ultraviolet radiation
THANK YOU