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A critical examination of the insertion of intravenous cannulae.

Insertion of intravenous cannulae initially constitutes a technical challenge to medical students and doctors alike, but mastery of the mechanics of insertion and the commonness of the procedure has often resulted in complacency with regards attention to asepsis. Attention is drawn to several fundamental areas of inadequacy.

Antisepsis↗

[Asepsis and hospital architecture: the surroundings of the operating theatre (author's transl)].

The author contends one can not plan an operatief theatre and its organization, if it is dissociated from its immediate dependencies, entrances and exists. a) The necessity of the following dependencies is discussed: 1. an anesthetic room forming a sas between the entrance hall for the patient and the operating room that makes possible the preop. preparation; 2. an area where the surgeons may prepare, corectly ventilated and reserved to the entrance of the surgical team; 3. a reserve of sterile equipment in immediate contact with the operating threater; 4. a disposal area for the linen and soiled material and that may serve to the transfer of the patient after the operation, given the wastes be evacuated in thermosealed bags. b) The circuits of the personel is then considered with a study of the one way cloak-rooms, and an example is given. Then comes the introduction in these circuits of the so-called septic operating room and of room for decontamination of instruments that can be superimposed with the place of evacuation of the equipment. In conclusion, the author mentions the evacuation of atmospheric particles released in the operating theatre and the methods of improving asepsis. He suggests the surgeon be very critic concerning the techniques proposed by the advertising.

Antisepsis↗

[Optimum utilization of the ventilation system to reduce airborne bacteria in operating rooms].

In 4 operating theatres with 4 different air-conditioning equipments, the number of bacteria per m3 circulating air in the neighbourhood of the open wound has been investigated. The testing has been performed on comparable aseptic operations. The worst results were obtained in 2 conventional theatres, equipped with a modern-up-to-date air-conditioning. The number of bacteria was ranging between 230 and 270 per m3. A much better results was obtained in a theatre, equipped with a so-called germ-stop-wall, dividing the theatre into 2 sections, separating the surgical team and the open wound completely from the anaesthesist and other staff. With this arrangement, 45 germs per m3 were found. The best result with no bacteria at all is present in a vertical flow-enclosure with an exchange rate of 32 per hour. According to our 10-year experience, for aseptic surgery sterile air techniques should be adopted to improve asepsis and to decrease the risk of postoperative infection.

Air Conditioning↗