The art and science of surgery
Lois N. Magner, Oliver J. Kim in A History of Medicine, 2017
By the end of the nineteenth century, many surgeons had joined microbiologists in using improved methods of sterilization and were full participants in the debates concerning the relative merits of heat versus chemical sterilization and antiseptic versus aseptic methods. The goal of antisepsis is to kill the germs in and around a wound by means of germicidal agents. The goal of asepsis is to prevent the introduction of germs into the surgical site. Because almost all wounds contain some microbial contaminants, the concept of aseptic wounds is essentially a microbiological myth. On the other hand, antiseptics alone cannot guarantee uncomplicated healing; the immunological status of the patient and the pathogenic burden are important factors. Lister generally preferred his own antiseptic methods and, despite his admiration for Louis Pasteur, insisted on keeping his instruments in carbolic acid even after Pasteur and Charles Chamberland demonstrated that heat sterilization was superior to chemical disinfection of surgical instruments. Chamberland's autoclave, a device for sterilization by moist heat under pressure, was in general use in bacteriology laboratories in the 1880s.
Iatrogenic spinal infections
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Presurgical precautions are also important. Patient skin antisepsis is recommended at multiple time points with presurgery washes and intraoperative skin preparations (Malangoni, 1997). Common antiseptics generally consist of iodine- and chlorhexidine-based products (Malangoni, 1997). Iodine-based surgical antiseptics are effective against a wide range of Gram-positive and Gram-negative organisms, as well as fungi and viruses (McLure, 1992). Chlorhexidine gluconate has a broad activity against Gram-positive and Gram-negative bacteria, yeasts, and some lipid-enveloped viruses, but fungal coverage is reduced compared to iodine-based antiseptics (Milstone, 2008). Proper surgical handwashing technique with chlorhexidine or iodine scrubs is essential (Tanner et al., 2008). Avoidance of intraoperative containment sources include C-arm, scrubs, gowns, microscopes, graft materials, and implants (Kim et al., 2010). Thus, in the operating room, strict adherence to sterile technique is mandatory.
Venous and lymphatic disease: A historical review
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Until the end of the nineteenth century, the most effective therapy for all forms of venous disease remained leg elevation and compression, as advocated by Wiseman.12 Even the simplest surgical varicosity operations carried significant danger of infection, commonly followed by septic complications and venous thrombosis. Evaluation of proposed surgical procedures became possible after the acceptance of aseptic surgical techniques and the introduction of safe anesthesia.5 In 1867, Joseph Lister developed surgical antisepsis, which greatly increased the safety of groin incision by substantially reducing the risk of infection.3 Around the same time, anesthesiology had greatly improved, with the introduction of spinal and gas anesthesia. The progress of anesthesia and antiseptic techniques advanced the surgical treatment of varicose veins at an unprecedented pace.3
Specific complications associated with non-surgical rhinoplasty
Published in Journal of Cosmetic and Laser Therapy, 2020
Tuyet A. Nguyen, Shivani Reddy, Nima Gharavi
Standard techniques to minimize complications with filler injections regardless of anatomical location exist. Sterile skin preparation to reduce the risk of infection and slow, low-pressure injection techniques are crucial. In our experience, ideal antiseptics include hypochlorous acid and chlorhexidine wipes. Avoiding blood thinners, the use of firm pressure, or ice packs can help alleviate more common complications, such as erythema, ecchymoses, and swelling (17). If no contraindications exist, discontinuing unnecessary anticoagulation 2 weeks prior to the procedure may help prevent these complications. For nasal filler specifically, injections should be performed deep to the musculoaponeurotic layer in the preperiosteal layer for the safest approach (18,19). Larger caliber microcannula (27 gauge or larger, in our experience) use may reduce the risk of injury or intravascular injection of filler material (18). The glabella, which is more susceptible to intravascular cannulation and tamponade, can be treated with superficial dermal injections with a serial puncture technique (19). Again, it is crucial to understand the complex anatomy in this location paying particular attention in post-surgical patients where anatomy may be distorted.
Fatty acids, esters, and biogenic oil disinfectants: novel agents against bacteria
Published in Baylor University Medical Center Proceedings, 2023
Aruna Lamba, Jonathan Kopel, David Westenberg, Shubhender Kapila
Different microorganisms vary in their response to antiseptics and disinfectants. This is hardly surprising in view of their different cellular structure, composition, and physiology. Traditionally, microbial susceptibility to disinfectants has been classified based on these differences. In recent years, considerable progress has been made in understanding more fully the responses of different types of bacteria (Mycobacterium, nonsporulating bacteria, and bacterial spores) to antibacterial agents. As a result, resistance can either be a natural property of an organism (intrinsic) or acquired through mutation or through acquisition of plasmids (self-replicating, extrachromosomal DNA) or transposons (chromosomal or plasmid integrating, transmissible DNA cassettes).12–15 Intrinsic resistance is demonstrated by many gram-negative bacteria, bacterial spores, Mycobacterium, and Staphylococci. Resistance acquired through plasmid mediation is most widely associated with resistance to mercury compounds and other metallic salts. In recent years, acquired resistance to certain other types of biocides has been observed, notably in Staphylococci. As such, there is growing interest in investigating new disinfectants, such as fatty acid esters and biogenic oil vapors, to address this limitation.
Topical application of povidone-iodine/dimethylsulfoxide ophthalmic gel preparation in Dutch-Belted rabbits
Published in Cutaneous and Ocular Toxicology, 2019
Jesse S. Pelletier, John Devine, Kara Capriotti, Samuel B. Barone, Joseph A. Capriotti
Povidone-iodine (PVP-I) is an iodophor-containing compound that binds elemental iodine, solubilizes iodine for topical delivery and functions as a safe and effective antiseptic. It is used in almost every specialty of Western medicine and is considered an essential pharmaceutical component by the World Health Organization1. In aqueous solutions containing PVP-I, a complex multi-step equilibrium condition is established that effectively delivers active molecular iodine (I2) to any surface where it is applied2,3. This well-established antiseptic demonstrates wide ranging efficacy against bacteria, virus, yeast, fungi, and parasites4–6. It has a long history of use in dermatology and ophthalmology as a pre-surgical skin and surface disinfectant and has recently been in development for the treatment of a variety of active infections7. Although there are currently multiple over-the-counter preparations of PVP-I available, only Betadine 5% Ophthalmic Prep Solution (Alcon, Switzerland) is approved by the US Food and Drug Administration (FDA) for use on the ocular surface. There are no PVP-I preparations approved for repeat-dosing on the ocular surface and there remains some concern over the potential toxicity of higher concentration solutions when used repeatedly in this setting8. The formulations in this investigation utilize dilute PVP-I in order to minimize concentration-related corneal toxicity8.
Related Knowledge Centers
- Antibiotic
- Antifungal
- Antiviral Drug
- Disinfectant
- Tissue
- Virucide
- Infection
- Antimicrobial
- Sepsis
- Putrefaction