Aseptic Methods. The aseptic method for the treatment of wounds admits of the use of germicidal solutions and heat upon the field of operation, upon the hands of the operator and of his assistants, and upon the instruments employed. After this has been accomplished, placing absolute dependence upon this sterilization, no germicidal or antiseptic substances are brought into contact with the wound, sterilized salt solution or plain sterilized water being used, if necessary, to flush the wound, the dressings employed having been sterilized by dry heat or moist heat.
Sterilization of the Hands. Experimental investigation has shown that the failure of the surgeon’s efforts to render his hands absolutely aseptic, has been the productive cause of infection in many wounds.
The hands and finger nails may be best sterilized by first rubbing them with spirits of turpentine; then scrubbing them with soap and water; and then using a sterilized nail brush freely. The scrubbing should be done for several minutes. The hands should then be rinsed to remove the soap, and then soaked for about ten minutes in a solution of bichloride, strength, 1 to 2500. If turpentine has not been used before washing with the soap, strong alcohol or ether should be well rubbed over the hands before they are immersed in the bichloride solution. Perhaps the best way of rendering the hands sterile is to scrub them with green soap and water, then mix a tablespoonful of commercial chloride of lime and half a tablespoonful of carbonate of soda with enough water to make a paste. When this has assumed a thick creamy consistency, it should be rubbed into the hands until the grains of lime disappear and the skin feels cool; then rinse the hands in sterile water.
Sterilization of Instruments. Instruments may be sterilized by boiling them for fifteen minutes in water in which a tablespoonful of washing soda has been added for each quart. This prevents rusting of the instruments and also makes the water a better solvent for any fatty matter which may be upon the instruments, thus increasing the sterilizing effect of the heat.
Sterilization of the Feet. As most patients do not apply water as freely or as frequently to the feet as to other portions of the body, there is usually present an excessive amount of thickened epidermis, which is very difficult to render sterile. For operations in chiropody the feet should be thoroughly moistened with soap and water, scrubbed vigorously with a brush, then soaked in a solution of bichloride of mercury of 1 to 1000 strength, and then wrapped up in a towel soaked in the same solution while waiting for the operator.
AGENTS EMPLOYED TO SECURE ASEPSIS
Bichloride of Mercury is used for the disinfection of the hands and skin and for the irrigation of wounds. Biniodid of mercury is extensively employed and in the same strengths as the bichloride. It is, however, a more powerful germicide, while being less irritative, and neither forms a mercuric albuminate nor tarnishes metal instruments.
Carbolic Acid. This acid is derived from coal tar, and although known as early as 1834 as the first antiseptic recommended and used by Lister, is not so popular since the discovery that bichloride of mercury possesses more germicidal action.
Gangrene of the skin and subjacent tissues has often been traced to the long continued use of dilute solutions of carbolic acid or of ointments containing small quantities of the drug. Gangrene of the fingers and toes is by no means infrequent as a consequence of its use. Another condition frequently seen is the systemic poisoning through absorption. One of the first symptoms noticed from such absorption is irritation of the urinary tract and carboluria. This poisoning is more apt to take place when the weaker solutions are used than when the pure acid is used, as the destruction produced by the pure acid prevents its absorption.
The effect of carbolic acid upon the urine (See Chapter II, “Carbolic Acid”) is to cause it to become smoky a short time after it is voided. The urine shows a complete absence or diminution of the sulphates, and albumin is generally present. When these symptoms present themselves, the use of carbolic acid should be withdrawn, and the administration of sulphate of soda and atropin begun. If the condition has existed for any length of time and the patient is weak and exhausted, stimulants are indicated.