GeneralOperative

SurgerySurgerySurgery

is

medical

treatment

in

whichsomeone's

body

is

cut

open

so

that

adoctor

can

repair,

remove,

or

replace

adiseased

or

damaged

part.Classification

of

surgery（1）based

on

the

condition

emergencyselective

operation（

benign

tumour

）limited

operation

（

therioma）rupture

of

spleen

、3.

emergency

operation（trauma）（3）

based

on

the

lesion

propertiesand

difficultyone-stage

operationtwo-stageoperationMulti

period

operationAppearancewound

dressing,

skin

closure,

and

youCleanNo

religiousNo

political

buttonsOpetatingRoom-OR75%

questions

aboutanatomyNever

argue

with

the

scrubnurseDo

not

touchanythingKeep

quiet,

never

runFeel

faintFeel

swellASEPSISASEPSISHistoryBasic

ConceptionMethodsTechniqueThe

OriginHippocrates(460-377

BC)The

Oath

of

Medicinewounds

must

be

cleaned

withwine,

boiled

wateror

clean

rain

waterKoch(1881)GermanHot

steamBeginning

ofsterilizationHalsted

(1852~1922)The

first

surgeonprofessor in

JohnsHopkinsGlovesThe

father

ofAmerican

SurgeryBASIC

CONCEPTIONAseptic

technique－

Aseptictechnique

isthe

technique

aiming

to

prevent

all

kinds

ofmicroorganisms

from

invading

the

body

in

theprocess

of

medical

treatment

and

nursing

careand

it

also

means

the

technique

that

preventgerm

free

articles

and

environment

fromcontaminated.BASIC

CONCEPTIONSterilization－

useof

physicalprocedures

orchemical

agents

to

destroy

all

microbialforms,

including

bacterial

sporesDisinfection－

useof

physicalproceduresorchemical

agents

to

destroy

most

microbialforms;

bacterial

spores

and

other

relativelyresistant

organisms

may

remain

viableSterilizationTotal

destruction

of

all

microbes,

includingBacterial

sporesMycobacteria,

TBNonenveloped

(nonlipid)

virusesFungiDisinfectionDestroying

most

of

the

microbial

formsBacterial

spores

and

relatively

resistant

organismsremain

viableDisinfectants

are

subdivided

into

high-,intermediate-,

low-

level

agentsSterilizationPhysical

methodsChemical

methodsSterilizationPhysical

methods:HeatFiltrationRadiationSterilization

by

heatMoist

heatDry

heatDry

heat171°C

1h160°C

2hSpecial

chambersGlasswareMoist

heat:

Boiling100°C5-6mindisinfectioinMoist

heat:AutoclavingSteam

under

pressureThe

most

reliablesterilizationAny

heat

and

moist

resistantmaterialsdownward

displacementPressure

=104.0~137.3

kPaTemperature

=121~126℃Time

=30minpre-vacuum

autoclavePressure

=170

kPaTemperature

=133℃Time

=4~6minMoist heat:AutoclavingMilkBeer63°C

30min72°C

15

minMoist heat:PasteurizationMoist

heatDry

heatPenetrating

potencyhigherlowerTemp

for

protein

clottinglowerhigherTimeshortlongSterilizing

potency:

Moist

heat

>>

DryheatRemoves

bacteria

and

fungiFrom

air

and

solutionsThey

can

not

removeviruses

and

smaller

bacteriaSterilization

by

filtrationUltraviolet

(limitation:

direct

exposure)Lonizing

radiation

(microwave

or

gammarays)Sterilization

by

radiationEthylene

oxide

(

Strict

regulations:extremely

toxic)Formaldehyde

gasHydrogen

peroxide

vaporsSterilization-chemical

methods:Gas

vapor

sterilantsPeracetic

acid

0.2%

An

oxidizing

agentExcellent

activityNon-toxic

end

produtsGluteraldehyde

2%Toxic:

care

must

be

used

when

handingthischemicalSterilization-chenmical

methods:Liquid

chemical

sterilantsDisinfectionDestroying

most

of

the

microbial

formsBacterial

spores

and

relatively

resistant

organismsremain

viableDisinfectants

are

subdivided

into

high-,intermediate-,

low-

level

agentsDisinfection-Chemical

Methods：HighKilling

all

microbesincluding

endospores

andTBglutaric

dialdehydeformaldehyde

peroxyaceticacidepoxy

ethaneMediumKilling

all

non-sporemicrobes

includingTBalcoholchlorinesiodophorsLowKilling

vegetative

bacteriaand

lipophilic

viruses,butresisted

by

endospores,

TBand

hydrophilic

(non-enveloped)

viruseschlorhexidinebromogeramineExcellent

activity

against

all

groups

oforganismsExcept

sporesNon-toxicInactivated

by

organic

materialAlcoholsExcellent

activity

(

skin

antiseptics)Slightly

more

toxicInactivated

by

organic

materialFrequently

used

with

alcoholsIodophorsPrinciple

of

Aseptic

TechniquePrinciple

of

Aseptic

Technique-11.

The

surroundings

should

be

clean,

roomy.①

Thesurroundings②

The

operating-table③

30

minutes,

stop

cleaning

and

minimize

movingPrinciple

of

Aseptic

Technique-2appearance

shouldThe

hospital

personnel’sconform

to

the

standard.cap

and

masktrim

fingernailswash

handsPrinciple

of

Aseptic

Technique-3Knowing

the

basic

concept.Aseptic

areaNon-aseptic

areaAseptic

supplyPrinciple

of

Aseptic

Technique-44.

The

articles

should

be

placed

orderly

and

labeledclearly.①

Keep

aseptic

articles

in

sterile

containers

or

sterilepackages②

the

label

on

thepackage③

only

used

oncePrinciple

of

Aseptic

Technique-55.

Sense

of

aseptic

in

theprocedure.①