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GeneralOperativeSurgerySurgerySurgeryismedicaltreatmentinwhichsomeone'sbodyiscutopensothatadoctorcanrepair,remove,orreplaceadiseasedordamagedpart.Classificationofsurgery

（1）basedontheconditionemergencyselectiveoperation（benigntumour）limitedoperation（therioma）emergencyoperation（

ruptureofspleen、trauma）（3）basedonthelesion

propertiesanddifficultyone-stageoperationtwo-stageoperationMultiperiod

operationOpetatingRoom-OR75%questionsaboutanatomyNeverarguewiththescrubnurseDonottouchanythingKeepquiet,neverrunFeelfaintFeelswellASEPSISHistoryBasicConceptionMethodsTechniqueTheOriginHippocrates(460-377BC)TheOathofMedicinewoundsmustbecleanedwithwine,boiledwaterorcleanrainwaterKoch

(1881)GermanHotsteamBeginningofsterilizationHalsted

(1852~1922)ThefirstsurgeonprofessorinJohnsHopkinsGlovesThefatherofAmericanSurgery

BASICCONCEPTIONSterilization－useofphysicalproceduresorchemicalagentstodestroyallmicrobialforms,includingbacterialsporesDisinfection－useofphysicalproceduresorchemicalagentstodestroymostmicrobialforms;bacterialsporesandotherrelativelyresistantorganismsmayremainviableSterilizationTotaldestructionofallmicrobes,includingBacterialsporesMycobacteria,TBNonenveloped(nonlipid)virusesFungiSterilizationPhysicalmethodsChemicalmethodsSterilizationPhysicalmethods:HeatFiltrationRadiationDryheat171°C1h160°C2hSpecialchambersGlasswareMoistheat:Boiling100°C5-6mindisinfectioinMoistheat:

AutoclavingSteamunderpressureThemostreliablesterilizationAnyheatandmoistresistantmaterialsMilkBeer63°C30min72°C15minMoistheat:Pasteurization

MoistheatDryheatPenetratingpotencyhigher lowerTempforproteinclottinglower higher

TimeshortlongSterilizingpotency:Moistheat>>DryheatRemovesbacteriaandfungiFromairandsolutionsTheycannotremovevirusesandsmallerbacteriaSterilizationbyfiltrationUltraviolet(limitation:directexposure)Lonizingradiation(microwaveorgammarays)SterilizationbyradiationEthyleneoxide(Strictregulations:extremelytoxic)FormaldehydegasHydrogenperoxidevaporsSterilization-chemicalmethods:GasvaporsterilantsPeraceticacid0.2%AnoxidizingagentExcellentactivityNon-toxicendprodutsGluteraldehyde2%Toxic:caremustbeusedwhenhandingthischemicalSterilization-chenmicalmethods:LiquidchemicalsterilantsDisinfectionDestroyingmostofthemicrobialformsBacterialspores

andrelativelyresistantorganismsremainviableDisinfectantsaresubdividedintohigh-,intermediate-,low-levelagentsDisinfection-ChemicalMethods：HighKillingallmicrobesincludingendosporesandTBglutaricdialdehydeformaldehydeperoxyaceticacidepoxyethaneMediumKillingallnon-sporemicrobesincludingTBalcoholchlorinesiodophorsLowKillingvegetativebacteriaandlipophilicviruses,butresistedbyendospores,TBandhydrophilic(non-enveloped)viruseschlorhexidinebromogeramineExcellentactivityagainstallgroupsoforganismsExceptsporesNon-toxicInactivatedbyorganicmaterialAlcoholsExcellentactivity(skinantiseptics)SlightlymoretoxicInactivatedbyorganicmaterialFrequentlyusedwithalcoholsIodophorsPrincipleofAsepticTechniquePrincipleofAsepticTechnique-11.Thesurroundingsshouldbeclean,roomy.ThesurroundingsTheoperating-table30minutes,stopcleaningandminimizemovingPrincipleofAsepticTechnique-22.Thehospitalpersonnel’sappearanceshouldconformtothestandard.capandmasktrimfingernailswashhandsPrincipleofAsepticTechnique-33.Knowingthebasicconcept.AsepticareaNon-asepticareaAsepticsupplyPrincipleofAsepticTechnique-44.Thearticlesshouldbeplacedorderlyandlabeledclearly.KeepasepticarticlesinsterilecontainersorsterilepackagesthelabelonthepackageonlyusedoncePrincipleofAsepticTechnique-55.Senseofasepticintheprocedure.KeepawayfromtheasepticfacetotheasepticareaDonotreachacrosssterilefieldKeepthenon-asepticarticlesfarawayAvoidtalking,coughingandsneezingNodoubtAnysurgicalprocedureneedSterilesurgicalinstrumentsCleanpatientLargeandwellventilatedoperatio

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