STERILI SASI DAN ANTIBIOTIKA

Agus Barmawi Sub Bagian Bedah Digestif Bagian Bedah FK UGM

Sterilization
Processes by which all pathogenic and non pathogenic micro organisms, including spores are killed. This term refers only to a process capable of destroying all forms of microbial life, including spores.

Infection
Invasion of the body by pathogenic microorganisms, and the reaction of tissues to their presence and to toxins generated by organisms.

Asepsis
Usaha untuk mempertahankan agar alat dan perlengkapan bedah tetap dalam keadaan sucihama (de Jong., Syamsuhidayat,1997)

Absence of microorganisms that cause disease; freedom from infection; exclusion of microorganisms. Adj,. Aseptic: without infection (Atkinson, Kohn, 1986)

Antisepsis
Usaha membunuh kuman diluar tubuh agar tidak dapat masuk lagi melalui luka bedah dan tumbuh didalam tubuh (de Jong.,Syamsuhidayat,1997)
Prevention of sepsis by exclusion, destruction, or inhibitition of growth or multiplication of microorganisms from body tissue and fluids (Atkinson., Kohn, 1986)

Microorganisms
Living organisms, invisible to the naked eye, including bacteria, fungi, viruses, yeast, and mold.

Pathogenic
Producing or capable of producing disease

Pathogenic Microorganisms
The microorganisms that cause infectious disease They can invade healthy tissue through some power of their own, or can injure tissue by a toxin their produce

Sepsis
Severe toxic febrile state resulting from infection with pyrogenic microorganisms, with or without associated septicemia

Septicemia
Clinical syndrome characterized by significant invasion of microorganisms from a focus of infection in tissues into the bloodstream. Microorganisms my multiply in the blood

Aerobe
Microorganisms that requires air or presence of oxygen for maintenance of life. Adj., aerobic

Anaerobe
Microorganisms that grows best in oxygen free or one that cannot tolerate oxygen, e.g., Clostridium species that cause gas gangrene. Adj., anaerobic

Antibiotics
Substances, both natural or synthetics, that inhibit grows of or destroy microorganisms. Used as therapeutic agents against infectious diseases, some are selective for a specific organism; some are broad spectrum

Antisepsis
Usaha membunuh kuman diluar tubuh agar tidak dapat masuk lagi melalui luka bedah dan tumbuh didalam tubuh (de Jong.,Syamsuhidayat,1997)
Prevention of sepsis by exclusion, destruction, or inhibitition of growth or multiplication of microorganisms from body tissue and fluids (Atkinson., Kohn, 1986)

Asepsis
Usaha untuk mempertahankan agar alat dan perlengkapan bedah tetap dalam keadaan sucihama (de Jong., Syamsuhidayat,1997)

Absence of microorganisms that cause disease; freedom from infection; exclusion of microorganisms. Adj,. Aseptic: without infection (Atkinson, Kohn, 1986)

Antiseptics
Organic or inorganic chemicals compounds that combat sepsis by inhibiting growth of microorganisms without necessarily killing them. Use on skin and tissue to arrest growth of endogenous (resident flora) microorganisms, they must not destroy tissue

Disinfectants
Agents that kill all growing or vegetative forms of microorganisms, thus completely eliminating them from inanimate objects.

Disinfection
Chemical or physical process of destroying all pathogenic microorganisms except spore bearing ones; used inanimate objects, but not on strength of agent and nature of contamination.

Classification of infection
Classification by source
1.Community acquired infections *natural diseases processes *incubating before patients admission *spontaneous infections *need for operative treatment 2. Nosocomial infection *infection in hospital patient *as complications of operative or non operative procedure, ocuring with or as operative care

result of

Lanjutan Example of various nosocomial infection a.UTI, infected by decubiti b.Cellulitis or abscess formationop. procedure c.Thromboplebitis d.Liver, lung or visceral abscess e.Bacteremia or septicemia

Classification by Etiology 1. Bacterial infection. Infection caused by aerobic bacteria, microaerophilic bacteria, anaerobic bacteria or mixed infection 2. Nonbacterial infection. Infections by fungi or viruses

1.

Factors Affecting Infection Rates

a. Malnutrition b. Age. Premature, infants, and geriatric c. Obesity. Avasculer subcutaneus fatty tissues are especially susceptible d. Chronic diseases. Fibrocystis disease, diabetes mellitus, alkoholism, and malignancy upset normal physiology e. Remote focus of infection, especially in the respiratory and or urinary tracts. f. Impaired defense mechanism g. Cardiovascular or respiratory determinant. Tissue perfusion or structural bronchopneuonia

Factors Affecting Infection . . . . . . . . h. Duration of preoperative hospitalization i. Types of operation j. Duration of operation k. Operative technique l. Catheter and drains m. Indiscriminate use of antibiotics n. Breakdown of isolation procedure

The most common pathogens are : 1. Aerobic bacteria a. Gram-positive cocci, staphylococcus aereus, staphylococcus epidermidis, streptococcus group B, streptococcus group D. b. Gram negative cocci, Neisseria gonorrhoeae

c. Gram-positive bacilli, Bacillus species, Mycobacterium species. d. Gram negative-bacilli, Escherichia coli, Klebseilla species, Pseudomonas aeruginosa, Pseudomonas cepacia, proteus species, serretia marcescense, citrobacter species, salmonella species, haemophylus enfluenzae, enterobacter aerogenes, enterobacter clocae

the most common. 2. Micro aerophylic bacteria a. Gram negative cocci, such as hemolytic and non hemolytic streptococci. 3. Anaerobic bacteria a. Gram-negative cocci such aspeptostreptococcus, peptococcus b.Gram-positive bacilli, clostrdium tetani, and clostridium welchii

The most . c. Gram-negative bacilli, Bacteroides species, bacteroides fragillis. 4. Nonbacterial microorganisms a. Viruses, herpes, hepatitis b. Fungi, candida albicans, histo plasmosis capsulatum, phycomycosis species

Antbiotic Therapy Antibiotics is antimicrobial drugs or agent are a prominent part of surgeons armamentarium. Antibiotic act : . Killing/inhibiting the growth bacteria . Antibiotics are ajuvants to, not substitutes for, strics adherence to asepstic principles and careful operatif technique.

The common antibiotics : Penicillins Cephaloporins Aminoglycosides Some are inactive by penicillinaseantagonizes the action of penicillin, eg., stpahylococcus aureus. Several synthetics penicillins are resistent to penicillinase, eg., cephalosporins, but cross sensitivity between them and penicillins. They have a broadspectrum of effectiveness and low toxicity.

Antibiotics.cont Aminoglycocide . Effective against gram (-) org. .eg., pseudomonas, serratia, e. coli . Ototoxic, nephrotoxic . Precipatate when mixed with heparin . Incompatible with cephalosporin & penicillin (bases) . Should be given at seaparate times/lines . With anesthetic agent, neuromuscular may have adverse reactionresp. distr.

Antibioticscont Incidence of allergic to penicillin high Should be questioned before administered Signs of toxicity: . Skin rash . Gastrointest distrub. . Renal disorder . Fever . Blood dyscracias

Use Antibiotics in Surgery

Principles of Antibiotics Prophylaxis
Choose an AB effective against the pathogens most likely to be encountered. Choose an AB with low toxicity. Administer a single, fully therapeutics dose intravenously 30-60 min. preoperatively Administer a second dose of AB if the operation last longer than 4 hours or twice the half-life of the AB Give two or three doses preoperatively. There is no need to extend administration beyond 24 h. Use of AB is appropriate when infection is frequent or when consequences of infection would be unusually severe.

Indication.
1. Clean op with graft, prosthetic device. 2. Intraumatic wound 3. Intesatinal tract has been entered as aresult of trauma 4. Elective op. on intestine or colon 5. High-risk biliary tract op 6. Gynecologic op 7. Studies indicate that prophylactics AB can lower incidence complication in clean surgery.

Therapeutic Use of Antibiotics 1. Oral AB on out patient basis 2. Severe surgical infection should iv AB 3. Empiric therapy 4. Broad spectrum my be given while waiting result of cultures and sensitivity test.

Sterilization Parameter of sterilization

1.Bioburden, degree of contamination 2. Bioresistance, including such factors as heat and/or moisture sensitivity and product stability 3. Bioshielding, characteristics of packaging materials 4. Density, factors affecting penetration and evacuation of agent

Process Associated of Sterilization

1.Temperature 2.Time 3.Purity of agent and air, and residual effects or residues 4.Saturation/penetration 5. Capacity of sterilizer

Methods of Sterilization 1. Steam under pressure moist heat (physical) 2. Ethylene oxide gas (chemical) 3. Activated glutaraldehyde (chemical) 4. Hot air dry heat (physical) 5. Ionizing radiation (physical)