Dr Yuda handaya SpB,FInaCS,Fmas

Surgery is used to both as a treatment, and as an aspect of treatment, for many conditions, including:•Physical trauma, e.g. wounds •Anatomical Abnormalities •Disorders of function •Inflammation •Ischaemia and infarction •Metabolic disorders •Neoplasia •Other abnormalities of tissue growth, e.g. cysts, hyperplasia or

Organ hypertrophy, as well as some cancers, if caught early enough •Deformity and heavy scarring. •Brain damage and nerve damage

A.OMPHALOCELE B. GASTROSCHIZIS

C.TUMOR D. ATRESIA ANI

DSTC-Indonesia 4

Unit Kolonoskopisarana, prasarana, asesori, sarana, prasarana, asesori, kolonoskopkolonoskop

ROBOTIK LAPAROSCOPI

Antiseptics (Greek αντί, against, and σηπτικός, putrefactive) are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. They should generally be distinguished from antibiotics that destroy microorganisms within the body, and from disinfectants, which destroy microorganisms found on non-living objects. Some antiseptics are true germicides, capable of destroying microbes (bacteriocidal), whilst others are bacteriostatic and only prevent or inhibit their growth

Aseptic TechniqueThe goal of aseptic technique is to reduce the

possibility of microbial.Components of successful aseptic technique

include:Preparation of the patient Preparation of the surgeon Sterilization of instruments and supplies Appropriate surgical technique Anesthesia and intra-operative monitoring Antibiotic usage Postsurgical care Record keeping

Sterilization of instruments and suppliesAll instruments and supplies that come in contact with the

surgical site must be sterile. A number of options are available to sterilize surgical equipment and supplies.

Autoclave- Relies on pressurized steam, is extremely reliable, and cost effective. However, instruments must be durable (e.g., stainless steel) and the process is relatively slow, from 15 to 60 minutes. Instruments are typically wrapped or sealed in packs that are opened as needed on the day of surgery.

Ethylene oxide- A gaseous sterilant that requires specialized containment equipment. This is a good sterilization method for supplies that cannot tolerate high heat such as plastics and catheters. It is more costly than autoclaving and typically is performed overnight.

Cold sterilant solutions (hypochlorite, glutaraldehyde, etc.)- Generally, cold sterilants must have prolonged contact time (15 - 60 minutes) to sterilize surgical equipment. In addition, the instruments must be rinsed completely with a sterile solution like saline to prevent tissue irritation. Note: Alcohol is not a sterilant.

Hot bead sterilizer- This device is a small tabletop unit, approximately 6 x 6 x 8 inches. The appliance heats a small container of Pyrex beads to approximately 250 C and can sterilize the tips of metal surgical instruments in 10-20 seconds. It is very useful for sterilizing instruments between rodents when performing multiple surgeries.

Pre-sterilized items- Many instruments and supplies can be purchased in sterilized packaging. Such items must be used prior to the label expiration date.

Sterile gloves must be used for all procedures. Prior to donning gloves, the surgeon must scrub the hands and forearms with a disinfectant soap for a minimum of 3 minutes, followed by drying with a sterile towel.

A new pair of sterile gloves must be worn for each patient.

A cap, face mask, shoe covers and sterile gown must be worn for all survival large animal surgeries.

Preparation of the surgeon and Nurse

1) Sterile procedure for opening

2) Instruments

3) Organization

4) Secondary Pack

Revised 7/12/01

Start with a Sterile Pack

Notice the edges, pull top edge away from you first, then, pull nearest edge toward you.

Secondary Pack-Purpose, to have the minimal amount of sterile equipment so that only the tips of the instruments need to be dry sterilized-Notice the silk suture for the muscle are already pre-swaged-there are ties, plugs, syringes, 2x2’s-most importantly, a sterile trochar

Topics

Preoperatif Aseptic Techniques

Preoperative Concerns

Surgical AreasSupport AreaTwo Preparation AreasOperating AreaPostoperative AreaDisinfecting vs. Sterilization

Preoperative ConcernsInstrumentation

Disinfection of InstrumentsAlcohols Chlorine Chlorohexidines

Preoperative Concerns

Sterilization of InstrumentsPhysical Methods

Autoclave Dry Heating Ionization Radiation

Sterilization of InstrumentsChemical Methods

Gas ChlorineHydrogen PeroxideAldehydes

Preoperative ConcernsSelfScrubbing

ClothesHands and Arms

GowningGloving

TERIMAKASIH