Lecture of sterility in obstetrics

2021-03-21 12:00 AM

The area of ​​vegetable clinging after vegetable peeling is an extremely wide gateway for pathogens to directly enter the mother's circulation, causing infection.

Aseptic is a whole set of measures and techniques to protect the body from all infections by pathogenic microorganisms such as bacteria, viruses, fungi, and protozoa ...

Disinfection are operations that have a temporary result in a moment that allows to eliminate or kill most microorganisms or inactivate viruses, but not the spores.

Sterilization is a method aimed at completely destroying all types of bacteria, including the spores and viruses.

Every year, around the world more than 500,000 pregnant mothers die from various reasons. Bacterial infection is the second leading cause of death for pregnant mothers. The infection situation is even more serious and serious in countries facing many economic difficulties. Furthermore, this is a avoidable cause of death. There are many cases, just because of a minor defect in sterility that leads to unfortunate deaths. Although there are many new and very good antibiotics, the aseptic work is getting more and more attention. It can be said that the majority of infections in obstetrics are caused by physicians. Sterility is a very fundamental problem. Practicing aseptic is doing preventive medicine. Investing in aseptic work is the most profitable. Sterility in obstetrics has its own characteristics.

Some of the features of obstetrics relate to sterility

During pregnancy, the mother's immune response tends to decrease to allow the fetus to exist favorably in the mother's body. That is the positive side of the matter. But that makes the mother's body more susceptible to pathogens. The mother's resistance will be reduced if there is a lot of blood loss before, during and after delivery.

During labor and postpartum, the enlarged cervix creates favorable conditions for pathogens to enter the uterus. Penetration into the uterus is more advantageous if there is an existing infection in the vagina, if there are interventions that do not guarantee sterility into the uterine cavity. From the uterine cavity, pathogens can spread by lymphatic, blood or neighboring pathways. In particular, the pathogen can spread along the two oviducts, enter the peritoneum, causing peritoneal infection.

The area of ​​vegetable clinging after vegetable peeling is an extremely wide gateway for pathogens to penetrate directly into the mother's circulation, causing the worst form of infection with a high mortality rate, which is sepsis.

The remaining organs in the uterus such as vegetables, the fetal organization are the favorable environment for bacteria to grow, from which the infection spreads.

In obstetrics, lower line procedures always carry a high risk of infection, especially those that directly interfere with the uterine cavity through the vagina.

The above are some of the favorable conditions for infections to occur in obstetrics. Those are also the reasons that sterility is so important. All medical staff working in the obstetric and obstetric profession must be aware of the importance of sterility and must strictly adhere to the principles of sterility while working.

Mechanism of infection for patients

While in hospital, patients always face many risks of infection. Infection to the patient can be done through the following ways:

Infections from the outside: pathogens from the outside environment (air, water, dust ...) enter the patient's body. Closer to home, pathogens from clothing, medical tools (needles, syringes, knives, scissors, gloves ...) are not well disinfected.

Cross-contamination in hospitals: pathogens are spread from one patient to another through utensils, daily activities, through medical equipment that are not well disinfected, through unclean hands. In many cases, if you do not comply with the sterile regulations well, it is the medical staff who helps carry germs from one patient to another.

Self-infection: pathogens that are available on the patient's body, for example, when urinating without good antiseptic, can cause bladder infection with bacteria already present on the patient.

For medical staff

The first thing to be aware of is the importance of implementing sterility in everyday work. Work clothes must be clean, always cleaned. Every procedure and surgery must wear a proper hat and mask. The hat must cover all hair, the mask must cover the mouth and nose. The nails are always cut short. Hand washing is very important. Wash hands to prevent the transfer of pathogens to uncontaminated areas by removing most microorganisms from health-care workers' hands. Hand washing is the simplest and most important technique to prevent infection in the hospital. Note before washing hands need to remove watches and all jewelry worn on hands.

Wash your hands normally with soap and clean water, and dry after washing. Hand washing is normally performed before giving the patient a medication, between care that does not require sterility, before eating, after exiting the toilet ...

Hand washing with antiseptic is carried out for everyone before leaving the workplace, after working with fabrics, dirty objects, before any sterile care, after a care of infection ...

Surgical hand washing is applied to everyone involved in surgery or some procedures such as opening the endotracheal tube, exposing the veins, placing the umbilical venous catheter ...

For pregnant women

During pregnancy

Pregnant women play a decisive role. Pregnant women must follow the hygiene rules during pregnancy, do not wash in ponds, lakes, dirty water. Every day, perform clean cleaning of the external genitals, especially after passing bowel and urinating. We always remember that during pregnancy, pregnant women are prone to vaginal infections and urinary tract infections. In many cases, the clinical manifestations of the infection are atypical or the clinical manifestations are absent. These infections need to be diagnosed and treated early, to avoid long term causing serious consequences. In addition, it is necessary to improve the systemic resistance with a nutritious diet, supplement with iron to avoid anemia.

During labor

Women should be washed thoroughly before giving birth. The external genitals need to be shaved and cleaned. All pregnant women are allowed to have an enema before entering the delivery room, except in upcoming cases. After cleaning, should make a sterile loincloth. During the monitoring of labor, to minimize the internal visit, each time the inner visit must wear sterile gloves, before the examination. It is advisable to arrange an isolated delivery room for pregnant women suffering from infectious diseases.

After giving birth

After giving birth, pregnant women should exercise early, avoid lying down for long time to create conditions for dead-end services and infections. The perineal layer is cleaned several times a day (no less than 2 times) with clean water, blot dry after washing. After each defecation or urination, they are washed and blotted dry. Pregnant women can clean themselves. Clothes are changed and washed. The two mammary glands need to be wiped and kept clean, feeding early and breast-by-breast to avoid breast complications.

For vehicles and tools

Delivery room

Should be located in a high dry place, the book will, away from sources of pollution, have means to effectively avoid dust (1g of dust contains 1500000 bacteria). The area is large enough, the inside should not be displayed too many things that make it difficult to clean. Floors must be tiled for easy cleaning. The floor should be cleaned 2 times a day, wiped wet, not brushed. Wet wiping is a quick, effective, and hygienic way to get rid of dust. The ceiling is cleaned once a quarter. The walls are cleaned every month. Clean footwear is required to wear separately in the delivery room. Under our conditions, the maternity and maternity are not allowed in the room. The delivery tables should be separated from each other. After each delivery, a clean delivery table must be cleaned, the drainage basin and blood spilled immediately.

Water source

Adequate water supply to a hospital or medical facility means water that meets safety standards and is sufficiently available for patient care and other hospital operations to maintain a safe hospital environment and limit the spread of the disease. In obstetrics, the demand for water is even greater. It is estimated that each hospital bed needs an average of 300 to 350 liters of water per day.

Tool

All tools must be disinfected, sterilized in accordance with specifications, used immediately or stored in sealed containers in a place without dust. Cleaning tools is the first important step in the sterilization and sterilization process because it removes all dust and dirt. Without proper cleaning, sterilization and sterilization will not yield results. The dirt on tools is a refuge for bacteria to avoid contact with antiseptic chemicals, and at the same time reduce the activation of antiseptic chemicals. Sterilization is carried out on instruments that are in contact with the membrane (respiratory apparatus), non-sterile tools such as endoscopes and non-sterile tools (potty, duck). Sterilization is applied to all objects that are placed in direct contact with blood or sterile areas of the body and some tools are inserted into non-sterile compartments such as milk bottles, breast bottles or dressings. . There are many methods of sterilization and sterilization, so it is necessary to choose the appropriate method for each type of instrument.

Table: Some sterilization methods


Boiling: Water must be boiled continuously for 30 minutes (note this is not a sterilization method), no longer applicable in hospitals.

Soak in 70 or 90 alcohol for 10 minutes.

Presept tablets (dichloroisocyam urate) 2.5 g tablets mixed in 10 liters of water, soak for 60 minutes.

Formaldehyde: time 30 minutes.

Cidex soak for 15 minutes.

Idophor (Betadine) for 30 minutes.

Phenol 1 - 2% for 30 minutes.
 

Table: Temperature, pressure, and time required to sterilize tools by steam.

Tool

 

Temperature

Pressure (kg)

Time after reaching temperature and pressure (min)

Linens

1200C

7 kg

30

Rubber

1200C

7 kg

15

Surgical instrument package

1200C

7 kg

30

Surgical instrument without package

1200C

7 kg

15

Glass

1200C

7 kg

15

The sterilization and sterilization work should be monitored by bacterial culture. Instruments that have been sterilized but have not yet been used must still be re-sterilized. The autoclave and baby food prepared in a hospital must be checked with routine bacterial cultures. The autoclave should have a color indicator to show that the device has passed the autoclave cycle (sulfur powder, color indicator tape ...). For milk, 1 ml was randomly selected from the batch of prepared milk to send for testing. The number of bacteria counted at the acceptable level is 25 / ml. When the number of bacteria exceeds the acceptable level, it is necessary to review the preparation technique.

In short, the thoroughly aseptic practice has helped us to avoid unfortunate infections and ensure safety in treatment.