Terapia i pielęgnacja rany zakażonej wymaga przestrzegania zasad lawaseptyki, antyseptyki oraz aseptyki. Czym różnią się te pojęcia i jakie jest ich znaczenie w procesie leczenia rany?
Oczyszczenie rany
Lawaseptyka to pojęcie oznaczające obmywanie rany i eliminowanie zanieczyszczeń fizycznych, chemicznych i biologicznych, a także biofilmu bakteryjnego.
Regularne oczyszczanie rany jest jednym z warunków koniecznych do utrzymania prawidłowego, niepowikłanego gojenia. Do usuwania ze środowiska rany substancji szkodliwych (zanieczyszczeń, substancji trujących, pozostałości tkanek, toksyn, drobnoustrojów) służą preparaty lawaseptyczne, czyli środki zawierające substancje zmniejszające napięcie powierzchniowe, które pozwalają na optymalne oczyszczenie i nawilżenie rany.
Oczyszczanie rany za pomocą lawaseptyków odbywa się poprzez wprowadzenie preparatu na ranę w sposób bezpośredni lub za pomocą strzykawek tłokowych bądź rozpylających czy też tłokowych systemów irygacyjnych. Wytworzona w ten sposób siła mechaniczna wypłukuje z rany martwe tkanki, mikroorganizmy, a także zebrany w niej wysięk i krew.
Działanie czyszczące płynu lawaseptycznego jest wzmocnione przez właściwości chemiczne wchodzącego w jego skład detergentu. Lawaseptyki to zazwyczaj łagodne roztwory wodne o niskim efekcie cytotoksycznym wobec zdrowych tkanek, jednak coraz częściej włącza się do nich substancje antyseptyczne oraz takie, które wpływają na napięcie powierzchniowe.
Lawaseptyki są pomocne przy usuwaniu przyschniętego do rany opatrunku. Skutecznie powstrzymują także powstawanie biofilmu, łagodzą odczucia bólowe i utrzymują odpowiedni poziom wilgotności w ranie.
Podstawowym celem stosowania lawaseptyków jest przede wszystkim usunięcie z powierzchni rany możliwie jak największej ilości zanieczyszczeń i drobnoustrojów, a nie ich zabicie. Dlatego też powinny one zawsze być stosowane w połączeniu z antyseptykami.
Eliminacja drobnoustrojów
Głównym celem stosowania antyseptyków na rany jest niszczenie znajdujących się na ich powierzchni drobnoustrojów oraz hamowanie ich wzrostu i namnażania. W Polsce najczęściej stosuje się preparaty antyseptyczne na bazie oktenidyny, poliheksanidu, podchlorynu sodu i jodu.
Skuteczność antyseptyków w leczeniu ran zależy od ich aktywności przeciwdrobnoustrojowej oraz od stopnia cytotoksyczności.
Preparat antyseptyczny powinien mieć szerokie spektrum działania przeciwdrobnoustrojowego, obejmujące także grzyby, pierwotniaki, wirusy, przetrwalniki bakteryjne i mikroorganizmy antybiotykooporne. Skład antyseptyku i stężenie substancji aktywnych powinny przy tym być zoptymalizowane w taki sposób, by preparat nie uszkadzał w istotny sposób zdrowych komórek i nie opóźniał w ten sposób procesu gojenia.
Bardzo istotne jest, by stosowany na ranę antyseptyk był zgodny farmakologicznie z opatrunkiem o zawartości substancji antybakteryjnej oraz z lawaseptykiem (jeżeli zawiera on substancję przeciwdrobnoustrojową). Np. antyseptyków na bazie jodu nie można stosować razem z opatrunkami zawierającymi srebro.
Jałowość środowiska
Aseptyka to postępowanie, które polega na zapewnieniu bakteriologicznej jałowości pomieszczenia, materiałów opatrunkowych i narzędzi stosowanych w pielęgnacji rany. Celem takiego działania jest niedopuszczenie do rozwinięcia się infekcji w środowisku rany poprzez jej kontaminację.
Rzetelne stosowanie zaleceń antyseptyki, lawaseptyki i aseptyki jest koniecznym warunkiem zapewnienia niepowikłanego gojenia rany.
Źródła: http://prawoimedycyna.pl/, https://chirurgia-transplantacyjna.wum.edu.pl/, https://mgr.farm/, https://www.sciencedirect.com/
Przeczytaj także: Nowe czasopismo naukowe o leczeniu ran – „Forum Leczenia Ran”
Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Zakażeń”:
Nowoczesne antyseptyki – definicje, obszar zastosowania, mechanizmy działania i oporności
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