Breaches in Asepsis and Antisepsis

Causes and mechanisms of wound infection development

Breaches of sterility rules inevitably lead to the development of an infectious process. The primary cause of local complications is the active proliferation of pathogenic microflora directly in the area of injury or surgical intervention.

This process is facilitated by a favorable environment within the wound. Factors that significantly increase the risk of suppuration include:

• Large blood collections (hematomas).
• Areas of necrotic (dead) or marginally viable tissues.
• Pronounced microcirculatory disorders.

Extensive soft tissue injuries pose a particular danger in terms of infection, as they create wide entry gates for pathogens. If the local infectious process is not managed promptly, the risk of severe systemic complications—such as pneumonia and generalized wound infection—increases significantly.

Infectious complications in traumatology and orthopedics

In bone and joint surgery, failure to follow aseptic requirements and improper selection of implant materials lead to critical consequences requiring prolonged and complex treatment.

Deep surgical site infection is one of the most severe complications of joint arthroplasty. When it develops, prosthesis components often have to be removed, resulting in a flail joint. If the risk of infection recurrence during revision arthroplasty is too high—for instance, due to poor soft tissue condition, severe comorbid pathology, or uncorrectable immunodeficiency—arthrodesis (artificial fusion) of the joint becomes the only viable option.

Metallosis and delayed suppuration can occur when the rules for selecting osteosynthesis hardware are violated. A mandatory requirement is the use of plates and screws made from a homogeneous metal and strictly from the same set. Randomly mixing components from different metals triggers an electrochemical conflict that leads to metallosis of the surrounding tissues and their subsequent suppuration.

Furthermore, the presence of infection is a major obstacle to normal bone union. Any internal fixation procedures are strictly contraindicated in the presence of uncontrolled local inflammatory processes or undiagnosed systemic chronic infections.

Infection prevention across treatment stages

Prevention of purulent-inflammatory complications should begin from the first minutes after injury and continue throughout the entire treatment period.

At the pre-hospital stage:

1. Application of aseptic dressings. Their main and only purpose is to prevent additional microbial contamination of the wound during patient transport. Unnecessary dressing changes must be strictly avoided; adjusting and re-bandaging the dressing should only be done out of absolute necessity.
2. Early (prophylactic) administration of broad-spectrum antibiotics. This is especially critical in the presence of wounds and open fractures. Therapy should be initiated within the first hours following trauma, even if arrival at the hospital is delayed.
3. Mandatory tetanus prophylaxis (according to the established schedule) and prevention of anaerobic infection.

In the inpatient setting:

• Strict adherence to aseptic rules during dressings and surgeries.
• Precise execution of surgical techniques and careful tissue handling.
• Administration of perioperative antibiotic prophylaxis.
• Avoidance of surgical interventions in the presence of contraindications (local inflammation, metal allergies).

Asepsis in care: prevention of urinary tract infections and pressure ulcers

Competent and thorough round-the-clock care for critically ill patients is impossible without strict adherence to antiseptic standards, particularly in preventing specific complications.

Prevention of urinary tract infections In cases of urinary retention (e.g., in patients with spinal cord injuries), the preferred method of urine drainage is intermittent urinary catheterization (3–6 times daily) combined with antibiotic therapy. With strict adherence to asepsis and antisepsis rules, this method prevents infection even with prolonged use (up to 6–8 months). The use of an indwelling catheter requires extreme caution and is acceptable long-term only if the bladder is regularly irrigated (2–3 times daily).

Management of pressure ulcers Therapy for established pressure ulcers requires a comprehensive approach aimed at combating infection and necrosis. It includes:

• Surgical debridement (necrectomy).
• Physical and chemical modalities (vacuum-assisted closure, proteolytic enzymes).
• Local application of antibacterial wound dressings.
• Systemic antimicrobial therapy, including antiseptics, antibiotics, ozone therapy, and ultraviolet irradiation.

Class and exam questions

What else to study on this topic

• Indications and contraindications for knee arthrodesis
• Principles of antibacterial therapy in open fractures
• Comprehensive methods for the prevention and treatment of pressure ulcers
• Management tactics for patients with urination disorders
• Absolute indications for emergency hospitalization in trauma

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.