General Surgery

• Asepsis (AKA disinfection) Definition:


  Killing of microorganisms from outside of the operative wound by means of physical methods
• Antisepsis (AKA sterilisation) definiton 


  Killing of microorganisms (in and out of body) with chemical methods
• Sepsis Definiton 


  generalised reaction to pathogenic microorganism which is evident clinically by signs of inflammation
• Sterilisation vs Disinfection:


  Sterilisation = Process of complete destruction of all microbes or microorganism and their bacterial endospores on a substance by exposure to physical or chemical agents.

  Disinfection = Process of reducing/removing microbes for micro-organisms except bacterial endospores but kill vegetative forms of bacteria.
• Operating theatre:

  • Sterile space in which surgery is performed
  • Nose and throat of personnel and patient are periodically checked for microorganisms
  • Hands of surgeon after disinfection is checked for microorganisms
  • All surfaces in operating room are treated with disinfectants
• Structure of operating theatre:

  • Maximum comfort
  • Cleanliness, enough light, physiological temperature.
  • Seperate from other wards
  • NOT LESS THAN 40mm2 in one operation table
  • Height- 3.2-3.25 metres
• What must each operating room be equipped with?

  • One operating table- placed in centre
  • Ceiling and side lamps- light must be intensive, no shadows, movable
  • Instrument tables
  • Schimellbusch drums
  • Anesthesiology module
  • Central aspiration and O2 system
  • Electrocoagulation
  • Laparoscopic module with instrument set
  • Intraoperative ultrasonography set
  • Laser ablation set
• Additional rooms in surgery:

  • Sterilization room and sterilization facility
  • Washing room for soft materials
  • Washing room for surgical team
  • Anesthesia room for preoperatvie premedication
  • Cast room
  • Changing room
  • Surgery storage room for instruments
• Methods of sterilization


  • Dry heat
  • Steam (moist heat)
  • Ionising radiation
  • Electro beam
  • Chemical sterilization
• Dry heat


  Can be done by baking and flaming, used for metals
• Steam (moist heat)


  • Autoclave which uses heated steam under pressure to sterilise
  • Basic regimens are 120 degrees and 1 atm for 45 mins and also 134 degrees and 3 atm for 20 minutes
  • Moist heat is superior to dry heat
• Ionising radiation

  Gamma sterilisation involves radioactive cobalt 60 isotope and is used for heat-sensitive items
• Electro beam


  • Used commonly to sterilize pharmaceutical packaging products and medical devices
  • Beam of electrons is passed through the object
• Chemical sterilization


  • For disinfecting equipment that is NOT suitable for steam treatment
  • Ethylene oxide used which even kills spores
  • Objects for sterilizations are placed dry in folio bags for 2 days
  • Bactericidal effect and is used for catheters, tubes, endoscopes
  • Very toxic and explosive
  • Very expensive
• Materials for sterilization are placed either in drums of schimmelbusch or metal containers of different sizes, shape and cover with double walls
• Operative field preparation:

  • Treated twice with iodine gasoline solution
  • Then 70% alcohol is applied again for extraction of fats
  • Placement of opaque sticky folio on operative field
  • After skin and subcutaneous fat incision, drapes are sutured to the borders of operative wound
• What is antisepsis?


  Antisepsis is killing of microorganisms with chemical methods. An antiseptic is a substance that slows down growth of microorganisms. They're frequently used in hospitals and other medical settings to reduce the risk of infection during surgery and other procedures.
• What is asepsis?

  Asepsis is killing of microorganisms on human body surface with physical methods. It serves as infection prophylaxis
• What is disinfection?

  Microbial eradication with chemical substances
• What is sterilization?

  Microbial eradication with physical methods
• History of antiseptic period:

  • Pre-antiseptic period- upto 80% of operated patients died from infection
  • Joseph Lister (1867) created model of prophylaxis of wound infection by chemical substances, introduced dressings as form of defense and lethality dropped due to this
  • There was no disinfection of rooms, drapes, instruments and hands of surgeon.
  • There were some prophylactic measures such as washing out wounds with boiled rain water, wine, boiling oil or alcohol
  • Use of drums/containers
• What is Lister’s method and what are the drawbacks?

  • Wound dressing with 5% solution of carbolic acid
  • Disinfection with 2-3% solution for hands, instruments, operative field and surgical materials
  • Air pulverization with 2.5% solution
  • Drawbacks- Carbolic acid is toxic, inhaling leads to poisoning, rashes and eczema, tissue wound necrosis
• Types of Antisepsis:

  • Physical
  • Chemical
  • Mechanical
  • Biological
  • Mixed
  • Local or General
• Physical Antisepsis:


  creating of conditions in wound that bacteria cant tolerate such as UV rays, drainage tubes, open treatment of wounds (air will dry wound and prevent growth)
• Mechanical Antisepsis:


  Primary surgical wound treatment, irrigate wound and fash out foreign bodies, eliminates necrosis, evacuates hematomas, extracts foreign bodies. Example is gluteal abscess.
• Chemical Antisepsis:


  Local or general mode of action, can be organic or non-organic such as sulphonamide
• Biological Antisepsis:


  treatment with serum and vaccines such as antibiotics, antitoxins, immunoglobulin application
• Mixed Antisepsis:


  combination of action both on bacterial cell and macroorganism. 
• Superficial or deep Antisepsis:


  on body surface or injected in tissues
• Local and general Antisepsis:


  Local acts in site of application and general is applied far from site and distributed by blood
• What are antiseptics?


  Antiseptics are chemical substances that are applied to living tissue/skin to reduce the possibility of infection
• What are types of antiseptics accoring to mode of action?

  • Bactericidal- kill organisms in contact
  • Bacteriostatic- disturb vital processes and metabolism in microbes
• What are the complications of antisepsis?

  • Intoxication
  • Lesions
  • Allergic reaction
  • Dysbacteriosis
• Requirements for successful antiseptic:

  • Bacteriocidal or bacteriostatic effect
  • Non toxic or cells, tissues and organs
  • To act in contact with live tissues
  • To be stable
  • To be affordable
  • Not to oppose local defence
  • Easy storage
• Structures of antiseptics

  • Halogen- iodine, iodine alcohol, hibitane, chloramines
  • Oxygenators- Hydrogen peroxide, Kmn04, boric acid
  • Organic- alcohol, formalin, lysol
  • Heavy metal- sublimate, silver nitrate
  • Dyes- methylene blue, rivanol, tripaflavine
  • Sulfonamides
  • Antibiotics
• Skin:


  This is largest organ of body and one of best indicators of general health. Examination is dependant on inspection but palpation of skin lesion must also be performed
• Skin moisture


  is related to secretion of sweat gland. Profuse sweating is called Diaphoresis. Absence of sweating could be due to neurologic disorders, skin disease, drugs etc
• Skin elasticity


  is related with age, nutritional status, subcutaneous fat
• Skin rashes


  are frequently one of manifestation of systemic diseases and are important for diagnosis
• What are the skin colour changes?

  • Pallor paleness (due to decreased blood supply to skin)
  • Cyanosis bluish discolouration of skin and mouth membranes due to lack of oxygen. Could be connected to heart or respiratory diseases
  • Yellow skin also known as jaundice caused by biliruibin in blood
  • Redness due to dilation of capillaries which increases blood flow. Physiologically seen after sports or drinking or in polyglobinemia
  • Discolouration Virtiligo or leukoplakia (lesion on inside of cheek due to irritation)