Fire Safety Encyclopedia

Thermal methods of sterilization of medical instruments. Sterilization by boiling. Dry oven. Medical autoclave. Sterilization of surgical instruments Sterilization methods of surgical instruments Sterilization Steps of instrument sterilization

Sterilization of dressings and surgical drapes. Sterilization by autoclaving - very reliable way. Sterilized in an autoclave in Schimmelbusch bixes. Most often, dressings and surgical linen, sometimes porcelain and glass dishes, enamel basins, etc. are sterilized under pressure. Before autoclaving, the material and linen are placed (not tightly) in bixes, and if they are not there, in canvas bags or bags. The holes on the side wall of the bix are opened before loading the autoclave and closed after sterilization. The duration of sterilization depends on the readings of the manometer: at 1 atm. / 126.8 ° - 30 minutes; at 2 atm. / 132.9 ° - 20 minutes.

Sterilization with flowing steam carried out either in a special flow-steam sterilizer Koch, or use a saucepan or bucket with a lid. Water is poured into the vessel to 1/3 of its height, a lattice partition is inserted above the water level, on which the sterilized materials are placed in cloth bags or bix. After closing the vessel with a lid, in which there must be several small holes for the steam to escape, turn on the heating. The beginning of sterilization is considered the moment when the steam begins to come out from under the lid in a continuous stream, the temperature of the steam reaches 100 °. Duration of sterilization is at least 30 minutes.

Sterilization by ironing linen and dressings are allowed only in cases where other methods cannot be used. Usually the temperature of the iron reaches 150 °. First, lay out and iron the sheet on which the processing will take place, then bend the necessary material with water and iron it on both sides, while moving the iron slowly 2-3 times in one place. The ironed linen is folded with sterile tweezers into a sterile bix or bag.

Preparing the surgeon's hands

Preparing the surgeon's hands. Since the hands of the veterinarian constantly come into contact with objects contaminated with microorganisms, the preparation of the hands before the operation is of particular importance. The surgeon's hands are treated in two stages:

1.mechanical cleaning

2. treatment with antiseptic and tanning agents.

Hands are prepared in one of the following ways:

- Olivkov's way... Hands are first washed for 5 minutes with hot water (40-50 °) with a brush and soap. After that, wipe dry with a coarse towel and treat for 3 minutes with tampons moistened with an alcohol solution of iodine 1: 3000. Additionally, the subungual spaces and nail beds are treated with a 5% alcohol solution of iodine.

- Spasokukotsky-Kochergin method... Hands are washed in two basins with 0.5% ammonia solution for five minutes. Then wiped off with a towel and treated with 70 ° alcohol for five minutes. The subungual spaces are treated with 5% iodine solution;

- Kiyashov's way based on the use of 0.5% ammonia solution, in which hands are washed with brushes for five minutes and dried with a towel. Completes the preparation of the hands by processing with a 30% solution of zinc sulfate for three minutes, and the subungual spaces and nail beds with an additional 5% iodine solution.

When a boar was castrated, the hands were processed according to the Spasokukotsky - Kochergin method.

Sterilization of surgical instruments

Sterilization of surgical instruments... There are hot and cold methods for sterilizing instruments. Hot include: sterilization by boiling in water, filling and others; cold - sterilization in a triple solution of Karetnikov and others.

Sterilization by boiling in water... It is carried out in sterilizers. Washed instruments, syringes, needles and others are boiled for 30 minutes in distilled or boiled water.

To increase the sterilization effect, the instruments are boiled in a 3% solution of bicarbonate of soda or 0.25% sodium hydroxide solution for 10-15 minutes.

Cold method of sterilization in triple Karetnikov's solution... The solution consists of 20 grams of formolin, 3 grams of phenol and 1 liter of distilled water. The exposition is 30 minutes.

Pre-sterilization of instruments... For emergency operations, it is necessary to sterilize the instruments in advance. Pre-sterilization can be carried out according to Andreev's method. The tools are put in a two-layer linen bag, which is tied tightly and immersed in a boiling 20% ​​solution of baking soda for 15 minutes. After that, the bag is removed, suspended to drain the solution and dry.

Boiling instruments in a 20% baking soda solution without wiping them off does not cause corrosion. Instruments remain sterile for several months.

For this operation, sterilization by boiling in water is most acceptable.

Preparation of the operation field

Preparation of the operation field consists of mechanical cleaning, degreasing, antiseptic treatment, isolation of the operation field.

Mechanical cleaning includes washing with soap, removing hair by shaving or clipping. The magnitude of the field of operation must be sufficient to ensure sterile conditions.

Prepare the operation field in one of the following ways:

- the Grossif-Filonchikov method... The defatted field of the operation is "tanned" and aseptic with 5% iodine solution immediately after mechanical cleaning, and then immediately before tissue incision. The interval between treatments should be at least five minutes;

-Mouse method consists in the fact that after shaving, mechanical cleaning and degreasing, the operation field is treated with a 10% aqueous solution of potassium permanganate.

During the operation, the field was prepared according to the Grossif-Filonchikov method.

20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt

  • Number of slides: 20

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_1.jpg"">!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_2.jpg" all forms of life, including"> Методы стерилизации хирургических инструментов Стерилизация – это процесс устранения всех форм жизни, в том числе и инфекционных агентов (грибы, бактерии, споры, вирусы), которые присутствуют на поверхностях, содержатся в жидкостях.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_3.jpg" - objects that come into contact with the surface"> Методы стерилизации хирургических инструментов Подвергаться обязательной стерилизации должны: - предметы, которые соприкасаются с поверхностью ран, имеют контакт с кровью и инъекционными препаратами - диагностическая аппаратура, которая соприкасается со слизистыми оболочками и может вызвать их повреждение.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_4.jpg" removing petroleum jelly from them, and check"> Методы стерилизации хирургических инструментов Перед стерилизаций инструменты протирают, удаляя с них вазелин, и проверяют их исправность. Инъекционные иглы после удаления смазки промывают эфиром или спиртом. Сложные инструменты (ножницы, иглодержатели, гемостатические пинцеты) стерилизуют полураскрытыми или в разобранном виде. Режущие и колющие инструменты обвёртывают марлей для предохранения от затупления. Стерилизация инструментов – первый шаг на операции!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_5.jpg LANG: alt =" The goal is to prepare instruments for sterilization."> Алгоритм стерилизации хирургического инструментария І этап - подготовительный. Цель - подготовка инструментов к стерилизации. Проводят замачивание инструментария в моющем растворе, мытье в моющем растворе с помощью щеток, тщательное промывание проточной водой, ополаскивание дистиллированной водой, высушивание; ІІ этап - основной. Цель - собственно стерилизация. Стерилизация инструмента осуществляется горячими и холодными методами. ІІІ этап - заключительный. Цель - контроль качества стерилизации. Проводят с помощью химических индикаторов, которые отображают уровень необходимой для стерилизации температуры, которые закладываются в шкаф вместе с инструментом, или бактериологическим методом - проводят посев из инструментов на питательную среду.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_6.jpg LAN sterilization modes and alt =" a different method of sterilization of specific products depends on"> Методы, средства и режимы стерилизации Выбор того или иного метода стерилизации конкретных изделий зависит от особенностей изделия и самого метода – его достоинств и недостатков. Самые распространенные методы – паровой и воздушный.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_7.jpg" alt = "">!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_8.jpg" pressure. For this method use"> Паровой метод стерилизации Стерилизующий агент – горячий пар под давлением. Для этого метода используют автоклав. Упаковки: биксы, крафт-пакеты, бумага-ламинат, бязь. Материалы: полимеры, стекло, латекс, ткань, коррозийностойкие металлы. Достоинства: высокая проницаемость пара, большой выбор упаковки, дольше сохраняется стерильность, дешевый и простой в использовании метод. Недостатки: увлажнение изделий, вызывает коррозию металлов.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_9.jpg" thermometer. There are three"> Паровой метод стерилизации Работа автоклава контролируется показателями манометра и термометра. Существует три основных режима стерилизации: при давлении 1,1 атмосферы - 1 час, при давлении 1,5 атмосферы - 45 минут, при давлении 2 атмосферы - 30 минут.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_10.jpg" dry oven-sterilizers. Sterilizing agent"> Воздушный метод стерилизации Стерилизация осуществляется в специальных аппаратах - сухожаровых шкафах-стерилизаторах. Стерилизующий агент – сухой горячий воздух (160-200oС). Упаковки: крафт-пакеты, бязь. Материалы: металл, текстильные изделия. Достоинства: дешевый, простой метод, не вызывает коррозии металла, не происходит увлажнения упаковки и изделий. Недостатки: ограниченный выбор упаковки, медленное и неравномерное прогревание изделий, необходимость использования более высоких температур, невозможность использовать материалы из резины, полимеров.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_11.jpg" sterilizer and first dried for 30"> Воздушный метод стерилизации Инструменты укладывают на полки шкафа-стерилизатора и вначале высушивают в течение 30 минут при температуре 80°С с приоткрытой дверцей. Стерилизация осуществляется при закрытой дверце в течение 1 часа при температуре 180°С. После этого при остывании шкафа-стерилизатора до 50-70°С дверцу приоткрывают и при окончательном остывании разгружают камеру со стерильным инструментарием.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_12.jpg" clinic for sterilization of instruments"> Обжигание и кипячение Обжигание в настоящее время в хирургической клинике для стерилизации инструментов не используется. Обжигание металлических инструментов проводится открытым пламенем. Кипячение долгое время было основным способом стерилизации инструментов, но в последнее время применяется редко, так как при этом методе достигается температура лишь в 100°С, что недостаточно для уничтожения спороносных бактерий.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_13.jpg" of various capacities."> Обжигание и кипячение Инструменты кипятят в специальных электрических стерилизаторах различной емкости. Инструменты в раскрытом виде (шприцы в разобранном виде) укладывают на сетку и погружают в дистиллированную воду (возможно добавление гидрокарбоната натрия - до 2% раствора). Обычное время стерилизации - 30 минут с момента закипания. После окончания стерилизации сетку с инструментами достают с помощью специальных стерильных ручек.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_14.jpg" alt = "">!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_15! . Sterilizing agent - formaldehyde or"> Газовый метод стерилизации Для этого метода используют газовые стерилизаторы. Стерилизующий агент – формальдегид или этилен-оксид. Упаковки: бумага-ламинат, пергамент, крафт-бумага. Материалы: полимеры, стекло, металл. Достоинства: невысокая температура, использование любых материалов. Недостатки: токсичность для персонала и взрывоопасность при несоблюдении техники безопасности, продолжительный цикл стерилизации.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_16.jpg" alt = " negative impact on the quality of the toolkit,"> Газовый метод стерилизации Отличительной чертой метода является его минимальное отрицательное влияние на качество инструментария, в связи с чем способ используют прежде всего для стерилизации оптических, особо точных и дорогостоящих инструментов.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_17.jpg" is necessary for sterilizing products from heat-sensitive"> Радиационный метод стерилизации (лучевая стерилизация) Радиационный метод необходим для стерилизации изделий из термолабильных материалов. Стерилизующий агент – ионизирующие γ и β излучения. Упаковки: помимо бумажных используют пакеты из полиэтилена. Достоинства: надолго сохраняется стерильность в упаковке. Недостатки: дороговизна метода. Радиационный – основной метод промышленной стерилизации. Используется предприятиями, выпускающими стерильные изделия однократного применения.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_18.jpg Radiological LANG: alt =" Co60 and Cs137. Dose of penetrating radiation"> Радиационный метод стерилизации (лучевая стерилизация) Используются изотопы Со60 и Cs137. Доза проникающей радиации должна быть весьма значительной - до 20-25 мкГр, что требует соблюдения особо строгих мер безопасности. В связи с этим лучевая стерилизация проводится в специальных помещениях и является заводским методом стерилизации (непосредственно в стационарах она не производится). Стерилизация инструментов и прочих материалов проводится в герметичных упаковках и при целостности последних сохраняется до 5 лет. Герметичная упаковка делает удобными хранение и использование инструментов (необходимо просто вскрыть упаковку).!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_19.jpg with chemical solutions LANG: alt =" to bluntness of tools, in"> Стерилизация растворами антисептиков Стерилизация растворами химических антисептиков не приводит к затуплению инструментов, в связи с чем применяется для обработки прежде всего режущих хирургических инструментов. Для стерилизации в основном используют три раствора: тройной раствор*, 70° этиловый, 6% перекись водорода. В последнее время для холодной стерилизации оптических инструментов стали применять спиртовой раствор хлоргексидина, первомур и другие. Тройной раствор: карболовая кислота - 3 г, формалин - 20 г, сода - 15 г, вода - 1000 мл.!}

Src = "https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_20.jpg sterilization solutions LANG: alt =" unfolded (or disassembled)"> Стерилизация растворами антисептиков Для холодной стерилизации инструменты полностью погружают в раскрытом (или разобранном) виде в один из указанных растворов. При замачивании в спирте и тройном растворе инструменты считаются стерильными через 2-3 часа, в перекиси водорода - через 6 часов. Считаю этот метод самым оптимальным для использования «в поле».!}

From a functional point of view, surgical instruments are divided into conventional metal, cutting, plastic and rubber, as well as optical. The main regulatory document for the processing of medical instruments is: “Industry standard. Sterilization and disinfection of medical devices. Methods, means, regimes ("I 42-21 - 2-85. Order M3 of the USSR dated 06/10/85.). Taking into account the unfavorable epidemiological situation on AIDS, the OST was supplemented by the order of the GUZO and TsGSEN No. 222/80 of 06/27/00. SanPiN 2.1. 3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities" SanPiN 3.1.5.2826-10 "Prevention of HIV infection.

According to these documents, the following sequential stages of processing medical devices are assumed: disinfection, pre-sterilization cleaning and sterilization.

Disinfection is carried out in order to protect medical personnel from infection when handling instruments after surgery. Physical methods of disinfection (boiling, steam and air) in a hospital are practically not used due to their bulkiness, lack of efficiency, or because of the rapid wear of instruments. The following means are used as chemical methods: a) 3% chloramine solution - 60 min; b) 6% hydrogen peroxide solution - 60 min; c) 6% hydrogen peroxide solution + 0.5% detergent solution - 60 min; d) 4% formalin solution (formaldehyde) - 60 min; e) 4% hydrogen peroxide solution - 90 min; f) the drug "Sidex" - 15 min. All instruments are filled with one of these solutions until they are completely immersed. After disinfection, they are washed with running water.

Pre-sterilization cleaning is carried out to remove protein, fat and mechanical impurities, as well as drugs. During pre-sterilization cleaning, the following steps are performed sequentially: a) soaking for 15 minutes in a washing solution containing 3% hydrogen peroxide - 156 ml, detergent - 5 g and water to a volume of 1 liter; b) individual washing of each product in a washing complex for 30 seconds; c) rinsing with running water after using detergents - at least 3 minutes; d) rinsing with distilled water to wash off salts; e) drying the instruments until the moisture completely disappears.

Sterilization itself. The previously used boiling process retains its significance only for disinfection or sterilization of instruments for personal use. If the previous steps are carried out during the sterilization of any instruments, regardless of their type, then during direct sterilization, various methods are used differentially, depending on the type of instrument being sterilized.

Conventional metal instruments are sterilized in a dry oven or in a steam sterilizer (autoclave).

Sterilization of instruments in a dry heat cabinet is carried out with hot air for 1 hour at a temperature of 180 C without packaging (open method). To control the quality of sterilization in a dry heat oven, the following test indicators are used: hydroquinone (the indicator turns black) and thiourea (the yellow color of the indicator turns orange).

Sterilization in a steam sterilizer occurs as a result of exposure to water vapor. It consists of two metal chambers, nested one inside the other and hermetically sealed by a front cover. Steam from the steam generator enters the outer chamber, from it to the inner chamber and then to the condenser. If the outlet valve of the inner chamber is shut off, then the vapor pressure in the inner chamber begins to grow (up to a maximum of 2 atm.). In parallel, the steam temperature rises to 132 ° C at 2 atm. Conventional metal surgical instruments are sterilized at a pressure of 2 atm. within 20 minutes. Modern steam sterilizers should be of the continuous type, that is, they have two front covers on opposite sides of the apparatus, and these covers should be located in different rooms to completely isolate sterile and non-sterile material. In addition, steam sterilizers should be equipped with generators that create a pulsating vacuum to remove air from the sterilizer, which is a heat insulator and prevents effective sterilization. Instruments sterilized in a steam sterilizer are placed in Shimelbusch bixes or bixes with a special bacterial filter, as well as in special bags for sterilization. Sterile instruments from a closed Shimelbusch bix can be used within 3 days, from a closed bix equipped with a filter - within 20 days. After opening bixes or packages, their contents should be used within 1 day, subject to all aseptic rules.

There are several types of bags for sterilization: a) creped paper, which is wrapped in an envelope (in the absence of violations of the integrity of the package, it retains the state of sterility of the contents for 3 days); b) paper packaging with a strip of hot melt glue and a sterilization indicator [class (unopened packaging retains the sterility of the contents for 60 days); c) combined packaging, in which one side is made of laminated paper, and the other is made of polyethylene film, has a strip of hot glue and a class I sterilization indicator (unopened packaging retains the sterility of the contents for 1 year). Packaging bags for sterilization are produced by the European firms Rexam (England), SPS - lab. (France), Steriking (Finland), etc. Open sterilization in a steam sterilizer should not be carried out!

There are chemical (cold) methods of sterilization of instruments: 6% hydrogen peroxide solution at a temperature of 18 ° C for 6 hours, paraform or 16 “/ consolidated formaldehyde solution in sealed chambers for 48 hours, 0.5% water-alcohol solution chlorhexidine for 5 minutes, sterilization in special chambers with ethylene oxide RO), as well as radiation sterilization.


Cutting metal instruments (scalpels, surgical needles, scissors, etc.) are sterilized by cold methods so that they do not become blunt under the influence of hot steam. The most commonly used for this purpose is hydrogen peroxide or an alcoholic solution of chlorhexidine. Scissors can be sterilized in a dry heat cabinet. The best is industrial radiation or ethylene oxide sterilization of scalpels and single-use atraumatic sutures.

Plastic, rubber and optical instruments. Sterilization of rubber and plastic products is possible by the thermal method in a steam sterilizer under a pressure of 1.1 atm. within 45 minutes. Currently, disposable gloves sterilized by the industrial beam method are used, but in extreme conditions, rubber gloves can be sterilized by autoclaving. For the chemical method of sterilization, formalin vapors, ethanol, ethylene oxide, etc. are used.

In addition to gas sterilization of optical devices (endoscopes), a 0.5% alcohol solution of chlorhexidine, permur or sidex is used.

1.2.2. Sterilization of dressings and surgical drapes. Dressings and linen include large and small gauze napkins, gauze tampons, other special gauze and cotton products, as well as sheets, nappies and dressing gowns. The set of autoclavable material is called stacking. Steam sterilization is carried out in Schimmelbusch bixes, metal bixes with filters, as well as in cotton sheets or diapers. Bixes are supplied with labels, which should contain information about the contents of the bix and its belonging to a particular operating room or dressing room. The process of preparing a dressing for surgery or dressing is divided into 3 stages.

I stage pre-scoring preparation of the material. The gauze cloth is cut into pieces of various sizes, depending on what is to be made - small napkins, large napkins, tampons, etc. The gauze should be soft and absorbent. The dressing is folded so that the free edges are tucked into the napkins or tampons.

Stage II - laying and preparing the material for sterilization. There are 3 main types of bix stacking. The universal styling is usually used in dressing rooms and for small operations. At the same time, the material is placed in bixes in sectors (in one sector - small napkins, and in the other - large napkins, in the third - tampons, etc.) so that you do not have to violate sterility when searching for this or that type of material. Targeted placement includes everything you need to perform typical manipulations, procedures and minor operations (placement for tracheostomy, for catheterization of the subclavian vein, for epidural anesthesia, etc.). All the necessary tools, dressings and linen are placed in the bix. Species styling is used when working in large operating rooms. At the same time, one type of dressing material or linen is placed in the bix (in one - dressing gowns, in the other - sheets, in the third - napkins, etc.).

Currently, disposable surgical drapes made of nonwoven material (bed sheets, diapers, gowns, hats and masks), as well as packaging with gauze napkins of industrial radiation sterilization, are increasingly used.

III stage - sterilization. Sterilization of linen is carried out using the steam method under a pressure of 2 atm. at a temperature of 132 ° C for 20 minutes. Before loading into the autoclave, check if the holes in the bix are open. After sterilization, the holes in the bix while removing it from the autoclave are closed with a metal rotating tape on the body of the bix and the date of sterilization is marked on it.

TREATMENT OF THE SURGEON'S HANDS

Cleaning (washing) the surgeon's hands is a very important procedure. There are certain rules for hand washing. Consistently it is necessary to carry out: mechanical and chemical (degreasing) treatment, exposure to antiseptic agents and tanning (closing the pores to maintain the sterility of the skin surface).

Modern methods of hand treatment do not require special tanning (film-forming antiseptics or antiseptics with a tanning element are used).

Mechanical and chemical processing

Mechanical and chemical treatment is carried out by washing hands under a tap with a brush and soap. Hands are thoroughly washed from the fingertips to the upper third of the forearm. At the same time, a certain processing sequence is observed, which is based on the principle "do not touch the treated parts of the hands with less clean skin and objects."

The use of modern methods allows washing hands simply with soap or with liquid detergents (in the absence of household contamination of hands).

Decontamination(the process of destroying microorganisms in order to ensure infectious safety) of surgical instruments consists of disinfection, cleaning and sterilization. Instruments after purulent operations and dressings, operations in patients who have had hepatitis over the last 5 years, as well as at the risk of AIDS, are processed separately from others. All disinfection and treatment procedures are carried out by medical personnel in sufficient thickness latex gloves, gowns, masks, waterproof aprons, goggles, and sharp objects are handled with care.

After use, the instruments are rinsed in a container with a disinfectant solution and immersed in another container with a disinfectant solution so that the solution completely covers the instruments. The exposure is maintained depending on the used disinfectant solution.

After disinfection, the instruments are rinsed with running water. Cleaning is carried out by immersing the instruments in a special detergent solution containing detergent, hydrogen peroxide and water. Exposure 15 - 20 minutes at t 40 - 45 0 С. After that, the instruments are washed with a brush in the same solution, and then washed in running and distilled water. Drying is carried out under natural conditions on a sheet or in a dry heat cabinet at t - 80 0 С 30 minutes.

Sterilization of surgical instruments

Metal surgical non-cutting instruments are sterilized in a dry oven or autoclave. There are disposable instruments that are sterilized by radiation. The main method for sterilizing cutting instruments is the cold chemical method using antiseptic solutions, but it can be sterilized in a dry oven. The best sterilization method for them is gas or beam sterilization. Sterilization of rubber medical accessories (catheters, probes, drains, tips, gloves) is carried out by autoclaving at 1 atm. within 30 minutes.

Recently, disposable medical rubber and plastic accessories that have undergone factory radiation sterilization are increasingly used. For sterilization of optical instruments (laparoscope, gastroscope, etc.), the gas method and cold chemical sterilization are used.

LITERATURE

1. Barykina N.V., Zaryanskaya V.G. Nursing in surgery. Rostov n / a: "Phoenix", 2004.

2. Guide for paramedical workers / Ed. Yu.P. Nikitina, V.M. Chernysheva. - M .: GEOTAR - Media, 2007.

3. Osipova V.L. Disinfection: a tutorial / V.L. Osipova. - M .: GEOTAR - Media, 2009.

4. Decree No. 9 of February 13, 2009 "On the approval of the sanitary and epidemiological rules of SP 3.1.2485-09" "Prevention of nosocomial infections in hospitals (departments) of the surgical profile of medical institutions" / Chief nurse, - 2009, No. 5.

Sterilization is carried out in two stages: the first stage is pre-sterilization processing; the second is direct sterilization.

Pre-sterilization preparation includes disinfection, washing and drying. In connection with the high risk of the spread of AIDS and the performance of operations in patients who have undergone hepatitis, the rules for pre-sterilization preparation have been changed and equated to the methods of processing instruments that provide a guarantee of the destruction of the human immunodeficiency virus. Instruments after purulent operations with anaerobic infection, patients who have undergone hepatitis within the last 5 years, as well as at the risk of AIDS, are treated separately from others. Immediately after the operation, the instruments are immersed in disinfectants:

  • - 3% chloramine solution for 40-60 minutes or 6% hydrogen solution:
  • - peroxide - for 90 minutes, 0.5% polydesis solution - for 60 minutes, combined disinfectant of instruments - for 60 minutes.

After disinfection, the instruments are transferred to a washing solution (water, washing powder and hydrogen peroxide) at a temperature of 50 ° C for 20 minutes, then each instrument is washed with a brush in disassembled form and washed under running water. The stages and modes of cleaning tools are presented in table. 1.

Table 1

Stages and modes of pre-sterilization cleaning of instruments, combined with disinfection with Incept 10 A

The quality of the pre-sterilization treatment is checked by setting azopyram, phenolphthalein and benzidine samples for the presence of residual detergent components. blood and fat. At least 1% of the batch of instruments that have been processed at the same time is subject to control. The most convenient industrial indicator is sealed tubes, inside of which there is a powder - a mixture of sucrose and tartaric acid, at 180 ° C the powder becomes a liquid.

In addition, quality control of pre-sterilization processing is carried out by the Epidemiological Surveillance Center once a quarter. If the sample is positive, the entire batch of instruments is subjected to repeated pre-sterilization processing.

The next step is to dry the instruments in a dry heat cabinet at a temperature of 80 ° C for 20 minutes.

The choice of sterilization method depends on the type of surgical instrument to be sterilized.

All general surgical instruments are conventionally divided into four groups:

  • 1) metal - cutting (scalpels, scissors, suture needles, etc.);
  • 2) non-cutting: syringes, injection needles, clamps, etc .;
  • 3) rubber and plastic: catheters, probes, drains, etc .;
  • 4) optical: laparoscopes, gastroscopes, cystoscopes, etc.

Sterilization of surgical metal instruments

and glass products are produced in the following ways:

Dry hot air sterilization- aero sterilization, carried out in dry ovens. Disassembled instruments and syringes are placed in special metal nets or packed in kraft paper and sterilized at a temperature of 180-200 ° C for 1 hour. Products sterilized in kraft paper are kept sterile for 3 days, and in open nets should be used immediately after sterilization. To check sterilization, the most convenient industrial indicator is sealed tubes, inside of which there is a powder - a mixture of sucrose and tartaric acid, at 180 ° C the powder becomes a liquid.

For steam sterilization the instruments are placed in the Schimmelbusch box (fig. 1). The container is tightly closed with a lid, which is attached to the body of the box with a hinge, and closed with a lock. There are holes along the perimeter of the box that can be opened and closed with a movable metal belt, which is reinforced with a special lock. Bix is ​​loaded into autoclaves and sterilized at a pressure of 1.1 atm - 60 min, 1.5 atm - 45 min, 2 atm - 30 min. Shelf life in bix with a filter - 3 days. , without filter - 24 hours. The material to be sterilized is placed in the boxes loosely so that the steam can freely penetrate to the entire contents.

Rice. 1.

Sterilization of disposable instruments is carried out in sealed bags with ionizing radiation (uluchi), ultraviolet rays and ultrasound. At present, y-ray sterilization is preferred. For these purposes, 60 Co and | 37 C isotopes are used. Sterilization must be carried out in compliance with safety measures at the factory. While maintaining the tightness of the packages in which the y-ray sterilization was performed, the sterility is maintained for 5 years.

Sterilization boxes equipped with antibacterial filters (KSPF) are becoming widespread, in which the shelf life of sterile material can be increased to 1 month. If the box has been opened, the sterile material in it can only be used during that day.

Boiling as a sterilization method is currently not used and refers to disinfection.

Sterilization of cutting and piercing instruments carried out in the factory using y-rays, gas and cold chemical methods with the use of antiseptics. In dressing rooms, cutting and stabbing instruments are sterilized in dry heat ovens.

Chemical methods of sterilization include sterilization in sterilization chambers of an air one- or two-chamber sterilizer with a capacity of 80 dm 3 or more in formalin vapors.

At the bottom of the chamber, formalin is placed at the rate of 10 g per 10 dm 3 of the chamber, the sterilization time is 16 hours. Instruments with an ebonite base are sterilized by the chemical gas method: telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments. by sterilization, laparoscopic instruments are disinfected in a 3% aldezone solution by rinsing in one container. Then in the second container they are soaked for 1 hour and after the expiration of time they are rinsed under running water from disinfectants.

Chemical sterilization is carried out using liquid antiseptics: a triple solution of 96% ethyl alcohol, 6% hydrogen peroxide solution, a combined disinfectant, alaminol, bionol, lisacin. The instrument is immersed in one of the listed disinfectants according to the instructions for their use.

Before sterilization, rubber tubes, catheters, drains are washed with running water, kept for an hour in a 1% solution of chloramine, again washed with running water and dried. Then they are wrapped in gauze and sterilized at a pressure of 1 atm for 45 minutes.

Sterilization of reusable gloves is carried out after their pre-sterilization treatment. Used gloves are washed under running water with soap, disinfected in a 1% solution of chloramine or other antiseptics for 30 minutes, rinsed under running water, dried, checked for leaks, sprinkled with talcum powder, wrapped one by one in gauze napkins, put in bix and sterilized in an autoclave at a pressure of 1.1 ATM for 30 minutes or 1.5 ATM -1 5 minutes.

For surgical procedures, gloves are disinfected using one of the following methods:

  • 1) in a 4.8% solution of pervomur - 20 min;
  • 2) in a solution of hydrogen peroxide at 50 ° C - 180 min;
  • 3) in a 96% alcohol solution - 1 5 min;
  • 4) in a 10% solution of roccal - 30 min;
  • 5) in a 2% solution of chloramine - 2 tsp.

After disinfection, the gloves are washed twice in distilled water.

Sterilization of rubber and plastic products can be carried out in autoclaves with steam under a pressure of 1.1 atm - 30 min or 1.5 atm -1 5-20 min. Rubber and plastic products of single use are sterilized at the factory using y-rays.

To share with friends:
Similar publications