Asepsis

Asepsis
In 1878 Robert Koch discovered that most infection causing microbes were not air born, but instead they were transferred from one surface to the other via contact.  Consequently, there was a large transformation of the surgical field from antisepsis to asepsis, a process that attempted to create a germ free environment in the operating room.

 

 

Steam Sterilization
In 1881 Charles Chamberland invented the steam sterilizer, known as the autoclave.  The autoclave was used to clean surgical tools and kill bacteria by heating water, held within the autoclave, to 140°C.  After about 20 minutes the tools would be completely sterilized.  Despite Chamberland’s ingenuity, the sterilization of surgical equipment was slow to catch on.  Only very few surgeons actually used the autoclave or other techniques in the early 1880s.



Father of Asepsis
Gustav Adolf Neuber has been frequently overlooked as the inventor ofasepsis.  In 1884 he founded a clinic which used the principles of asepsis to treat each patient.  Neuber implemented strict rules and regulations that his apprentices were obligated to follow to ensure the cleanliness of the rooms and instruments.  Surgical were required to wash their hands, faces, and arms before entering the operating rooms.  The rooms were also isolated from other parts of the building so that no materials could enter or exit the operating rooms.  Even the air was sterilized by running through vents that passed the building’s heating system, heating the air and kill bacteria.  Furthermore, Neuber used dry, peat aprons when operating on patients which would dry very quickly and would stay sterilized longer than aprons and articles of clothing soaked in antiseptic fluids.  In 1886 Neuber published a monograph which described his techniques that kept the environment around the patient sterile.  He set the standard for aseptic practice.  


 Neuber’s Followers
Ernst von Bergmann of Berlin and his assistant, Curt Schimmelbusch, established their reputations in the field of asepsis in 1890 at tenth International Medical Congress held in Berlin.  The congress hosted 7,000 visitors in total from all over the world and Bergmann gave a group of visiting surgeons a tour of their clinic.  The tour group was impressed with their demonstrations on the effects of unsterilized instruments, utilizing culture plates to show the manifestation of infection.  They wanted to show surgeons that practicing asepsis made a very large difference in the outcome of a surgery.  Bergmann even went as far to show off his patients and their wounds from recent surgeries to allow visitors to see how quickly their scars and wounds were healing using the aseptic method.  Schimmelbusch also made a name for himself starting a few years after the tenth International Medical Congress, when he invented the “Schimmelbusch drum”, which was a machine used to sterilize wound dressing materials and surgical garb.

 Perfecting Asepsis
Although surgeons washing their hands with soap and/or alcohol was common practice by the 1890’s, the advent of surgical gloves even further decreased the rate of infection in hospitals. Starting in 1842, Thomas Watson suggested the use of surgical gloves during operations, but it wasn’t until the late 1890’s when the trend really caught on. William Stewart Halstead, a surgeon from Johns Hopkins University in Baltimore, MD, started this craze when he had two pairs of gloves made for one of his scrub nurses, who was having allergic reactions to the sublimate hand washed being used in the hospital. Eventually, the rest of the surgical team started wearing gloves too, and by 1897, all of the surgeons at Hopkins were wearing rubber gloves.  Soon the whole nation was wearing gloves to prevent infection.