Aseptic techniques were first widely adopted in the late 19th century. Prior to this, the importance of sterilizing an area was known, and antiseptics were used to clean locations, tools, and equipment that needed to be sterile, such as when performing surgery.
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While antisepsis is concerned with the removal of microorganisms immediately before, during, and after surgery or other work, asepsis is concerned with the maintenance of sterile conditions through good hygiene procedures.
When was the importance of asepsis first recognized?
In the mid-19th century, Louis Pasteur performed several experiments demonstrating the validity of the germ theory and disproving the widely accepted idea of spontaneous generation. Around this time, the development of anesthetics allowed surgeons to perform longer, more complex surgeries on patients, which also largely increased the risk of infection.
In the 1840s, the Hungarian surgeon Ignaz Semmelweis noted that on maternity wards where doctors who also worked in other areas of the hospital were present, the mortality rates were significantly higher than on those wards that were operated by midwives only. He introduced hand washing procedures on these wards. The number of deaths due to infection on these maternity wards dropped dramatically following the implementation of this rule.
Similarly, having noted the poor condition of hospitals where soldiers were placed during the Crimean war, Florence Nightingale collected extensive data regarding the number and cause of death of these soldiers over a two year period. It was found that a majority of deaths at these hospitals were entirely preventable through aseptic techniques, and the changes she implemented saved many lives during this period.
Antisepsis or asepsis?
Antiseptic surgery was largely pioneered by Joseph Lister in the 1860s, when he used phenol (known at the time as carbolic acid) as a disinfectant. He would sterilize the operating theatre and surgical tools with phenol, and even soak bandages in the substance before dressing wounds. Although this was effective, he failed to recognise the importance of asepsis at the time.
Robert Koch, through his work with anthrax and tuberculosis, demonstrated that particular diseases were the result of the presence of specific microorganisms within the body, and so strongly reinforced the work of Louis Pasteur and the idea of asepsis.
This led the medical community to stop relying solely on antiseptic techniques and emphasize asepsis as well. They also began to realize the downsides to the use of disinfectants, including the fact that they were highly poisonous, and their entry into a wound was often severely damaging.
In the later decades of the 19th and early 20th centuries, sterilized surgical gowns and gloves became more commonplace. In 1890 William Stewart Halstead requested that the Goodyear Rubber Company make a pair of thin rubber gloves, initially with the intention that they protect his hands an those of his nurses from the caustic effects of the phenol disinfectant that was still being used.
It became clear that disinfecting the gloves in this way and adhering to aseptic techniques in the operating theatre was a superior method. Autoclaves were also used to disinfect the gloves and gowns. It was not until the 1960s that the first commercially available pre-sterilized gloves were manufactured by the Ansell Company.