ASEPSIS SHARON HARVEY 28/7/05

ASEPSIS MEDICAL MEDICAL USED DURING DAILY ROUTINE CARE TO BREAK THE INFECTION CHAIN USED DURING DAILY ROUTINE CARE TO BREAK THE INFECTION CHAIN SURGICAL SURGICAL REQUIRES ABSENCE OF ALL MICRO- ORGANISMS REQUIRES ABSENCE OF ALL MICRO- ORGANISMS

ASEPSIS IS THE CONTROL OR ELIMINATION OF: INFECTIOUS AGENTS INFECTIOUS AGENTS CLEANSING CLEANSING DISINFECTION AND STERILISATION DISINFECTION AND STERILISATION

CLEANSING THE REMOVAL OF ALL FOREIGN MATERIALS THE REMOVAL OF ALL FOREIGN MATERIALS FROM OBJECTS FROM OBJECTS GENERALLY INVOLVES WATER GENERALLY INVOLVES WATER MECHANICAL ACTION MECHANICAL ACTION WITH OR WITHOUT DETERGENTS WITH OR WITHOUT DETERGENTS

DISINFECTION/STERILISATION DISINFECTION DISINFECTION ELIMINATES PATHOGENIC ORGANISMS WITH THE EXCEPTION OF BACTERIAL SPORES ELIMINATES PATHOGENIC ORGANISMS WITH THE EXCEPTION OF BACTERIAL SPORES STERILISATION STERILISATION ELIMINATES AND DESTROYS ALL MICRO- ORGANISMS, SPORES AND VIRUSES ELIMINATES AND DESTROYS ALL MICRO- ORGANISMS, SPORES AND VIRUSES

ASEPTIC TECHNIQUE A METHOD USED TO PREVENT CONTAMINATION OF WOUNDS AND OTHER SUSCEPTIBLE SITES A METHOD USED TO PREVENT CONTAMINATION OF WOUNDS AND OTHER SUSCEPTIBLE SITES USING ONLY STERILE OBJECTS AND FLUIDS USING ONLY STERILE OBJECTS AND FLUIDS

PRINCIPLES OF WOUND CLOSURE SHARON HARVEY

NORMAL WOUND HEALING 3 MAJOR PHASES OF WOUND HEALING INFLAMMATORY PHASE LASTS 4-6 DAYS INFLAMMATORY PHASE LASTS 4-6 DAYS PROLIFERATIVE PHASE BEGINS BETWEEN 1 AND 4 DAYS AFTER INJURY AND ENDS DAYS LATER PROLIFERATIVE PHASE BEGINS BETWEEN 1 AND 4 DAYS AFTER INJURY AND ENDS DAYS LATER MATURATION PHASE BEGINS DAYS AFTER INJURY AND CAN LAST UP TO 2 YEARS. MATURATION PHASE BEGINS DAYS AFTER INJURY AND CAN LAST UP TO 2 YEARS.

TYPES OF WOUND HEALING PRIMARY INTENTION PRIMARY INTENTION THIS IS THE SIMPLEST FORM OF HEALING. THIS IS THE SIMPLEST FORM OF HEALING. THE SKIN IS CLEANLY INCISED THROUGH A SURGICAL INCISION OR TRAUMATIC LACERATION THE SKIN IS CLEANLY INCISED THROUGH A SURGICAL INCISION OR TRAUMATIC LACERATION THIS TYPE OF WOUND CAN BE CLOSED BY SUTURES OR STAPLES THIS TYPE OF WOUND CAN BE CLOSED BY SUTURES OR STAPLES

TYPES OF WOUND HEALING SECONDARY INTENTION SECONDARY INTENTION BURNS, PRESSURE ULCERS AND WOUNDS WITH LARGE PIECES OF SKIN MISSING HEAL THIS WAY BURNS, PRESSURE ULCERS AND WOUNDS WITH LARGE PIECES OF SKIN MISSING HEAL THIS WAY NO EDGES ARE AVAILABLE FOR SUTURING NO EDGES ARE AVAILABLE FOR SUTURING SKIN CELLS EPITHELIZE FROM THE EDGE OF THE WOUND SKIN CELLS EPITHELIZE FROM THE EDGE OF THE WOUND INCREASED TIME FOR HEALING INCREASED TIME FOR HEALING AT RISK OF LOCAL AND SYSTEMIC INFECTION AT RISK OF LOCAL AND SYSTEMIC INFECTION

TYPES OF WOUND HEALING TETIARY INTENTION TETIARY INTENTION THE WOUND IS LEFT OPEN TO HEAL THE WOUND IS LEFT OPEN TO HEAL THESE WOUNDS ARE INFECTED AND NEED FREQUENT IRRIGATION AND DRESSING CHANGES THESE WOUNDS ARE INFECTED AND NEED FREQUENT IRRIGATION AND DRESSING CHANGES PATIENTS WITH PERITONITIS OR RUPTURED APPENDIX MAY REQUIRE THIS PATIENTS WITH PERITONITIS OR RUPTURED APPENDIX MAY REQUIRE THIS

FACTORS AFFECTING WOUND HEALING NUTRITION NUTRITION GENERAL PHYSICAL HEALTH GENERAL PHYSICAL HEALTH MEDICATIONS MEDICATIONS

GOALS OF WOUND CARE REMOVE NECROTIC TISSUE REMOVE NECROTIC TISSUE PREVENT, ELIMINATE OR CONTROL INFECTION PREVENT, ELIMINATE OR CONTROL INFECTION ABSORB DRAINAGE (EXUDATE) ABSORB DRAINAGE (EXUDATE) MAINTAIN A MOIST WOUND ENVIRONMENT MAINTAIN A MOIST WOUND ENVIRONMENT PROTECT THE WOUND FROM FURTHER INJURY PROTECT THE WOUND FROM FURTHER INJURY PROTECT THE SURROUNDING SKIN FROM INFECTION AND TRAUMA PROTECT THE SURROUNDING SKIN FROM INFECTION AND TRAUMA

METHODS OF WOUND CLOSURE STERISTRIPS STERISTRIPS TOPICAL GLUE (DERMABOND) TOPICAL GLUE (DERMABOND) SUTURES SUTURES STAPLES STAPLES

SUTURES ARE AVAILABLE IN A WIDE VARIETY OF MATERIALS INCLUDING SILK, NYLON, STEEL, LINEN ARE AVAILABLE IN A WIDE VARIETY OF MATERIALS INCLUDING SILK, NYLON, STEEL, LINEN SUTURE MATERIALS ARE EITHER NATURAL OR SYNTHETIC SUTURE MATERIALS ARE EITHER NATURAL OR SYNTHETIC TWO MAIN CATEGORIES OF SUTURE MATERIAL – ABSORBABLE AND NON ABSORBABLE TWO MAIN CATEGORIES OF SUTURE MATERIAL – ABSORBABLE AND NON ABSORBABLE SUTURES ARE AVAILABLE WITH OR WITHOUT A NEEDLE ATTACHED SUTURES ARE AVAILABLE WITH OR WITHOUT A NEEDLE ATTACHED WITH NEEDLE ATTACHED – CALLED AN ATRAUMATIC SUTURE WITH NEEDLE ATTACHED – CALLED AN ATRAUMATIC SUTURE

SUTURES ARE USED TO: ARE USED TO: HOLD TOGETHER INTERNAL STRUCTURES HOLD TOGETHER INTERNAL STRUCTURES CLOSE INTERNAL STRUCTURES CLOSE INTERNAL STRUCTURES CLOSE THE WOUND IN LAYERS CLOSE THE WOUND IN LAYERS CLOSE THE SKIN INCISION CLOSE THE SKIN INCISION SECURE DRAINAGE TUBES SECURE DRAINAGE TUBES

SURGICAL SKIN STAPLES OFTEN USED AS THE METHOD OF CHOISE FOR CLOSING SKIN INCISIONS OFTEN USED AS THE METHOD OF CHOISE FOR CLOSING SKIN INCISIONS VERY POPULAR IN NEUROSURGERY, GYNAECOLOGY, ORTHOPAEDICS, GENERAL AND VASCULAR SURGERY VERY POPULAR IN NEUROSURGERY, GYNAECOLOGY, ORTHOPAEDICS, GENERAL AND VASCULAR SURGERY PROVIDE MORE STRENGTH THAN MANY OTHER SUTURE MATERIALS AND TEND TO CAUSE LESS IRRITATION PROVIDE MORE STRENGTH THAN MANY OTHER SUTURE MATERIALS AND TEND TO CAUSE LESS IRRITATION

ADVANTAGES OF SKIN STAPLES GRASP ONLY THE SUPERFICIAL SKIN LAYER (ESSENTIAL THAT UNDELYING TISSUE HAS BEEN APPROXIMATED CORRECTLY) GRASP ONLY THE SUPERFICIAL SKIN LAYER (ESSENTIAL THAT UNDELYING TISSUE HAS BEEN APPROXIMATED CORRECTLY) PROVIDES A SECURE HOLD PROVIDES A SECURE HOLD LESS UNDERLYING TISSUE TRAUMA THAN WITH SUTURES LESS UNDERLYING TISSUE TRAUMA THAN WITH SUTURES BAR OF THE STAPLE DOES NOT COME IN CONTACT WITH SKIN SO LESS LIKELIHOOD OF CROSS HATCHING EFFECT AS WITH SUTURES BAR OF THE STAPLE DOES NOT COME IN CONTACT WITH SKIN SO LESS LIKELIHOOD OF CROSS HATCHING EFFECT AS WITH SUTURES

REMOVAL OF SUTURES SUTURE REMOVAL IS DETERMINED BY THE RATE OF EXPECTED TISSUE HEALING, TYPE OF TISSUE SECURED AND LOCATION OF WOUND SUTURE REMOVAL IS DETERMINED BY THE RATE OF EXPECTED TISSUE HEALING, TYPE OF TISSUE SECURED AND LOCATION OF WOUND THEREFORE – WOUND ASSESSMENT VITAL, BUT PLANS NEED TO BE FLEXIBLE TO TAKE ACCOUNT OF THE PATIENT AND THE RATE OF TISSUE REPAIR THEREFORE – WOUND ASSESSMENT VITAL, BUT PLANS NEED TO BE FLEXIBLE TO TAKE ACCOUNT OF THE PATIENT AND THE RATE OF TISSUE REPAIR

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