Cleanliness is next to . . .
Blog Author: George Szasz, CM, MDPosted: Wednesday, December 21, 2016 - 11:51
Not long ago a few Vancouver news outlets reported that 200 patients from Lions Gate Hospital received a notice about a malfunction of the equipment used to clean surgical instruments. This was alarming news: sterilization of surgical instruments is, of course, the key to modern antiseptic and aseptic approaches to surgical procedures.
Historically these methods were developed indirectly, thanks to the thermal sterilization procedures being developed by the food industry in the early 1800s and, directly, thanks to Dr Ignaz Philipp Semmelweis (1818–1865) of hand-washing fame and Dr Joseph Lister (1827–1912) the inventor of antiseptic surgery. Dr Lister learned about Louis Pasteur’s (1822–1895) work on microbial fermentation and envisioned this process as the same as that causing infection and gangrene. He postulated that microbes from unwashed surgical instruments, bed linen, surgeons’ coats and hands, and the air in the operating room were responsible for putrefaction. Having heard of creosote being used to disinfect sewage, he applied carbolic acid compounds in various forms on wounds and in the operating theatre. In 1867 at a meeting of the British Medical Association he reported that “during the last 9 months not a single instance of pyemia, hospital gangrene, or erysipelas [had] occurred” in his Glasgow Royal Infirmary surgical ward. In Canada Dr S.E. Bain, a regimental surgeon, was the first (in 1868) to publish an account in the Canadian Medical Journal of his positive experiences with the Listerian antiseptic procedures. Also in 1868 Dr Archibald Edward Malloch (1844–1919) of Brockville, Ontario, served as house surgeon to Dr Lister, and upon his return to Canada he became a pioneer in, and major advocate of, antiseptic surgery in this country. In 1897 Dr Lister (now Lord Lister) visited Drs Chapman Davie Jr. and John Duncan, both noted surgeons in Victoria. Dr Lister was impressed by the new operating room at the Royal Jubilee Hospital, built to his standards. On his suggestion two postoperative recovery rooms, the first in Canada, were constructed in the structure.
Since those days the carbolic acid spray in the operating room has given way to today’s strict aseptic surgical techniques and modern sterilization methods. These methods are complex: they must be efficient, rapid, with penetrating capabilities, compatible with different materials, nontoxic, adaptable to the myriads of various types of instruments and appliances that must meet the surgeons’ specifications, and, of course, be cost effective. Fortunately, modern monitoring capabilities at Lions Gate Hospital led to the discovery and isolation of the malfunction in one of their sterilizing units before further problems could have occurred.
—George Szasz, CM, MD
Pitt D, Aubin AM. Joseph Lister, father of modern surgery. Can J Surg 2012;55:E8-E9.
Roland CG. The early years of antiseptic surgery in Canada. J Hist Med Allied Sci 1967;22:380-391.
Victoria Medical Society. Pemberton memorial operating room: Preserving the past, envisioning the future. Accessed 21 December 2016. www.victoriamedicalsociety.org/pemberton-or.
This posting has not been peer reviewed by the BCMJ Editorial Board.