Why is antiseptic surgery important

While I could not but feel that this case, by its unfortunate issue, might lose much of its value in the minds of others, yet to myself it was perfectly conclusive of the efficacy of carbolic acid for the object in view.

At the same time it suggested some improvement in matters of detail. It showed that the acid may give rise to a serous exudation apt to irritate by its accumulation, and therefore that a warm and moist application would be advantageous to soothe the part, and also ensure the free exit of such exuded fluid. At the same time it appeared desirable to protect the crust with something that would retain the volatile organic acid more effectually than oiled silk or gutta-percha, through which it makes its way with the utmost facility.

For this purpose a metallic covering naturally suggested itself, and as ordinary tin-foil is unsuitable from its porosity, I employed thin sheet-lead, and afterwards block-tin, such as is used for covering the jars of anatomical preparations, superior to lead on account of the facility with which it can be moulded to any shape that is desired.

In the final article on abscesses, Lister gave similarly detailed instructions of how to prepare and apply dressings, elevating a previously subsidiary element of an operation into a pivotal procedure:. A solution of one part of crystallized carbolic acid in four parts of boiled linseed oil having been prepared, a piece of rag from four to six inches square is dipped in the oily mixture, and laid upon the skin where the incision is to be made.

The lower edge of the rag being then raised, while the upper edge is kept from slipping by an assistant, a common scalpel or bistoury dipped in the oil is plunged into the cavity of the abscess, and an opening about threequarters of an inch in length is made, and the instant the knife is withdrawn the rag is dropped upon the skin as an antiseptic curtain, beneath which the pus flows out into a vessel placed to receive it.

Readers were instructed further on the dilutions of carbolic acid, the usage of materials, scalpel techniques and drainage. The remainder of the article is similarly exact and hands-on:. About six teaspoonfuls of the above-mentioned solution of carbolic acid in linseed oil are mixed up with common whitening carbonate of lime to the consistence of a firm paste, which is in fact glazier's putty with the addition of a little carbolic acid.

This is spread upon a piece of sheet block-tin about six inches square; or common tinfoil will answer equally well if strengthened with adhesive plaster to prevent it from tearing, and in some situations it is preferable, from its adapting itself more readily to the shape of the part affected.

Lister ended with the case of a man who had an abscess that was repeatedly filled by putty infused with carbolic acid, which had to be changed regularly for four months.

The promised next article on simple incised wounds never appeared, and the reason was never explained. Perhaps it was the hostile reaction to his address at the Annual Meeting of the British Medical Association in Dublin that August, although it is more likely that the series was delayed until the following summer and presented instead in an address to the Medico-Chirurgical Society in Glasgow in May This address was published in five parts from July to April Pridgin Teale, stating that surgeons in Leeds had as much confidence as ever in the antiseptic treatment.

Lister published on antisepsis at this time in two modes: first, clinical studies in which his principles and practices were set out in the context of case histories of individual patients; and second, programmatic statements linked to germ theories, as when he advanced the benefits of antisepsis for the general salubrity of hospitals and the progress of medicine.

The two modes were not exclusive: in the programmatic pieces Lister cited groups of cases and statistics, but typically he did not describe performance. Many histories of Listerian antisepsis have tended to focus on the programmatic papers, which tended to prompt the strongest reactions from his critics, and ignore the seemingly mundane and technical clinical articles.

As we have seen, the antiseptic treatment was announced to the world in through a series of case histories, and Lister described a further 36 in detail over the next decade. When the British Medical Association met in Edinburgh in , Lister gave demonstrations in which surgeons were made eye-witnesses to the performance of antiseptically staged operations from start to finish.

Indeed, the print version contained updates on the progress that the patients had made since the demonstration. Lister then explained the rationale, further elaborating the materials and techniques necessary to convert his principles into practice. At times it seems that Lister was prepared to compromise on his principles and allow his methods to be judged on their results.

In his address in Edinburgh in August , Lister included the following as a footnote to the published lecture:. If anyone chooses to assume that the septic material is not of the nature of living organisms, but a so-called chemical ferment destitute of vitality, yet endowed with a power of self-multiplication equal to that of the organism associated with it, such a notion, unwarranted though I believe it to be by any scientific evidence, will in a practical point of view be equivalent to a germ theory, since it will inculcate precisely the same methods of antiseptic management.

It seems important that this should be clearly understood, because it appears to be often imagined that authors who are not satisfied by the strict truth of germ theory, but substitute for it some other hypothesis, invalidate antiseptic practice, which I must repeat, is not affected in one tittle by this theoretical discrepancy. He used solutions of carbolic acid spray to reduce the level of germs in the air around the patient.

The antiseptic system in practice in an operating room. This set of steel amputation instruments was made after antiseptic surgical techniques were in common use. Before that, instruments were often made of materials such as ivory and wood that were difficult to clean. Towels soaked in carbolic solution were lain on the patient and a sponge soaking in carbolic solution was used to wipe hands and instruments during operations.

The carbolic hand spray was a later development by Lister. Working in the carbolic spray was unpleasant and toxic. It enveloped staff and patient in a yellow mist with a sickeningly sweet, tar-like smell. This example is from c. The donkey engine was used by Lister around A carbolic spray was pumped into the air by an assistant using the long handle.

It was easier to use than a hand spray, especially during long procedures. Lister introduced catgut ligatures in as part of his antisepsis techniques. The ligatures were absorbed by the body once their work was done.

A local chemist made the product under Lister's direction. As the number of surgery related infections fell, the evidence that antisepsis worked became irrefutable and it was widely accepted by surgeons around the world. Lister even received Royal Approval when he used his carbolic spray during a surgical procedure on Queen Victoria. In this film, Consultant plastic surgeon Charles Bain discusses how modern surgeons are concerned about controlling infection in every aspect of surgery, from maintaining a sterile environment to surgical techniques that minimise the risk of infection.

The powder not admitted into the interstices of the mesh and there retained should be removed by gently shaking the cloth until the excess of the agent is disposed of. The resulting iodoform gauze constitutes not only a safe but one of the most valuable dressings for the protection of all kinds of wounds from infection.

The gauze should be applied in layers to a sufficient depth and extent to absorb the entire discharge. It is a dry dressing and does not favor decomposition as the moist variety do.

The iodoform adheres to the gauze with sufficient tenacity to prevent enough of it from coming in contact with the absorbing surface to induce poisoning. Wounds that have been thoroughly cleansed and rendered aseptic by other agents can be maintained in a healthy condition with the protection afforded by this gauze for a considerable period.

The healing process in many instances is completed with one dressing, even when the wound is ragged, contused, and inflamed. The progressive development of the principles involved in antiseptic surgery reveals the virtues as well as the deficiencies of the various antiseptic remedies. The search for one that is perfect is as yet unrewarded, although its vigorous prosecution has brought to the notice of the profession quite an array of drugs, possessing in a greater or less degree antiseptic properties.

The comparative merits of these different agents are gradually being demonstrated by many surgeons. Every year adds much to our knowledge of their general usefulness and their individual fitness for wounds and special purposes.

Permanganate of potassa, iodine, bromine, salycilic acid, acetate of alumina, naphthalin, subnitrate of bismuth, and the oil of eucalyptus are some of the more prominent agents receiving attention at present. In selecting and applying these remedies there are several rather important considerations to be borne in mind. Their indiscriminate and unintelligent employment, without reference to individual adaptation and effect, is apt to disappoint the expectation of the surgeon by results that are either negative or injurious.

Fresh, clean wounds require simply protection from the causes of inflammation. The chief of these is obviated by excluding the putrefactive germ with the external antiseptic dressing.

Whereas suppurating wounds in addition to, and premising, protection require the extermination of the bodies that have gained admission to, and are multiplying in, the discharge. In accomplishing these different objects not unfrequently more than one remedy can be used with benefit in the treatment of the same lesion.

As a rule, the degree of putrefaction present determines the required strength or vigor of the antidote. The majority of the germicides now in use produce injurious effects when introduced into the circulation in immoderate quantity. The danger of absorption depends in a measure upon the extent of surface exposed, as well as upon the length of the period of contact. As the principles of the antiseptic method have become more distinctly defined the more fully is the fact recognized that the natural secretions form the most suitable fluid for bathing healing surfaces.

When this is normal in character and amount the employment of antiseptic or other lotions to dilute or replace it is an uncalled-for and injurious interference with nature. The aim and object of this method is to protect the normal secretions from the organisms which render them abnormal.

The faithful and intelligent application of external protective dressings secures all the advantages that are to be derived from the use of antiseptic agents in the care of many wounds. Many of the cases of poisoning that have been reported can undoubtedly be reasonably attributed to their unadvised and too generous employment.

Some form of protection may be developed in the future which will enable us to dispense with drugs. At present, however, there is little or no light in this direction. In order to appreciate the great changes and the wonderful improvements in surgery since the introduction of the antiseptic treatment it is necessary to take a retrospective view of the results obtained previous to the last twenty years.

That this improvement and progress in the surgical art is attributable to the discovery of the putrefactive germ, and the consequent development of the principles and methods comprised in the antiseptic treatment, no fair-minded person familiar with the facts can for a moment doubt.

The unfortunate complications attending suppuration and the process of healing granulation induced by surgeons to avail themselves of very radical measures to secure healing by first intention.

Many limbs were sacrificed by amputation in order to avoid the risks associated with the healing of inconsiderable wounds by granulation. Even this extreme course of treatment too frequently failed in securing immunity from the evils connected with suppuration. The surgery of twenty years ago was so different from the surgery of today that a comparison between the two is unsatisfactory, being rendered so by the great variety of operations that are now practicable which then were rarely undertaken.

The contrast in treatment and results is equally great. Formerly the mortality following major operations was about thirty per cent. The present mortality after such operations is reduced to about five per cent. Conservative surgery has progressed surprisingly since the elimination of septic poisoning from the list of probable dangers attending the healing of open wounds. The success of conservatism has naturally resulted in narrowing the field of heroic surgery, which is employed now with more caution than formerly.

A comparison of the results of similar operations, as formerly conducted and as now treated with antiseptic protection, reveals in a marked degree the advantages of the new method.

Medical professionals routinely carry out surgical hand antisepsis before undertaking invasive procedures to destroy transient micro-organisms and inhibit the growth of resident micro-organisms. Antisepsis may reduce the risk of surgical site infections SSIs in patients.

To assess the effects of surgical hand antisepsis on preventing surgical site infections SSIs in patients treated in any setting. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony-forming units CFUs of bacteria on the hands of the surgical team. There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials comparing surgical hand antisepsis of varying duration, methods and antiseptic solutions.

Fourteen trials were included in the updated review. In general studies were small, and some did not present data or analyses that could be easily interpreted or related to clinical outcomes. These factors reduced the quality of the evidence. One study randomised participants to basic hand hygiene soap and water versus an alcohol rub plus additional hydrogen peroxide.

One study participants compared alcohol-only rub versus an aqueous scrub and found no clear evidence of a difference in the risk of SSI RR 0. One study participants compared alcohol rubs with additional active ingredients versus aqueous scrubs and found no clear evidence of a difference in SSI RR 1.

One study participants compared an alcohol rub with an additional ingredient versus an aqueous scrub with a brush and found no evidence of a difference in SSI RR 0. Four studies compared different aqueous scrubs in reducing CFUs on hands. Three studies found chlorhexidine gluconate scrubs resulted in fewer CFUs than povidone iodine scrubs immediately after scrubbing, 2 hours after the initial scrub and 2 hours after subsequent scrubbing.

All evidence was low or very low quality, with downgrading typically for imprecision and indirectness of outcome. One trial comparing a chlorhexidine gluconate scrub versus a povidone iodine plus triclosan scrub found no clear evidence of a difference—this was very low quality evidence downgraded for risk of bias, imprecision and indirectness of outcome.