Surgical instruments sterilization method. Sterilization of veterinary instruments: basic methods. Putting on sterile seals

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

Pre-sterilization preparation includes disinfection, washing and drying. Due to the high danger of the spread of AIDS and the performance of operations on patients who have had hepatitis, the rules for pre-sterilization preparation have been changed and are equated to methods for processing instruments, which provide a guarantee of the destruction of the human immunodeficiency virus. Instruments after purulent operations for anaerobic infection, patients who underwent within 5 recent years hepatitis, as well as 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% polydez solution - for 60 minutes, combined instrument disinfectant - 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 rinsed under running water. The stages and modes of cleaning instruments are presented in table. 1.

Table 1

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

The quality of pre-sterilization treatment is checked by testing azopyramic, phenolphthalein and benzidium new sample for the presence of residual components detergent. blood and fat. At least 1% of the batch of instruments simultaneously subjected to processing is subject to control. The most convenient industrial indicator is sealed tubes containing powder - a mixture of sucrose and tartaric acid; at 180°C the powder becomes liquid.

In addition, quality control of pre-sterilization treatment is carried out by the Epidemiological Sanitation Center once a quarter. If the test is positive, the entire batch of instruments undergoes repeated pre-sterilization treatment.

The next stage is drying the instruments in a dry-heat oven at a temperature of 80°C for 20 minutes.

The choice of sterilization method depends on the type of surgical instruments 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, drainages, etc.;
• 4) optical: laparoscopes, gastroscopes, cystoscopes, etc.

Sterilization of surgical metal tools

and glass products are produced in the following ways:

Dry hot air sterilization- aerosterilization is carried out in dry-heat ovens. Disassembled instruments and syringes are placed in special metal mesh or packaged in kraft paper and sterilized at a temperature of 180-200°C for 1 hour. Products sterilized in kraft paper remain 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 containing powder - a mixture of sucrose and tartaric acid; at 180°C the powder becomes liquid.

For steam sterilization the instruments are placed in a 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 is closed with a lock. There are holes around the perimeter of the box that open and close using a movable metal belt, secured with a special lock. Bixes are loaded into autoclaves and sterilized at a pressure of 1.1 atm - 60 minutes, 1.5 atm - 45 minutes, 2 atm - 30 minutes. Shelf life in containers with a filter is 3 days. , without a filter - 24 hours. The material to be sterilized is placed loosely in the boxes so that the steam freely penetrates the entire contents.

Rice. 1.

Sterilization of disposable instruments is carried out in sealed bags using ionizing radiation (uluchi), ultraviolet rays and ultrasound. Currently, preference is given to sterilization with y-rays. For these purposes, the isotopes 60 Co and | 37 C are used. Sterilization must be carried out in compliance with safety measures in the factory. If the packages in which y-ray sterilization was carried out remain sealed, sterility is maintained for 5 years.

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

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

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

TO chemical methods Sterilization includes sterilization in the sterilization chambers of an air one- or two-chamber sterilizer with a capacity of 80 dm 3 or more with formalin vapor.

Formalin is placed at the bottom of the chamber at the rate of 10 g per 10 dm 3 chambers, sterilization time - 16 hours. Chemical gas method instruments that have an ebonite base are sterilized: telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments. Before gas sterilization, laparoscopic instruments are disinfected in a 3% aldesone solution by rinsing in one container. Then they are soaked in the second container for 1 hour and after that time are rinsed under running water to remove disinfectants.

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

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

Sterilization of gloves for reusable use is carried out after their pre-sterilization treatment. Used gloves are washed under running water and 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 pair at a time in gauze napkins, and placed in bags. 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 minutes;
• 2) in a solution of hydrogen peroxide at 50°C - 180 min;
• 3) in a 96% alcohol solution - 1 5 minutes;
• 4) in a 10% solution of roccala - 30 minutes;
• 5) in a 2% solution of chloramine - 2 hours.

After disinfection, 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 minutes or 1.5 atm -1 5-20 minutes. Rubber and plastic products single-use products are sterilized in the factory with y-rays.

Sterilization of surgical instruments is carried out by boiling, autoclaving and antiseptic substances. Non-cutting instruments are sterilized by boiling in a 1-2% solution of sodium bicarbonate, which prevents the oxidation of the metal and increases the boiling point. You can boil tools in distilled water. Instruments, washed with a brush and soap and dried after the previous operation, are lowered into water on a mesh in special metal vessels- sterilizers, the sizes of which vary depending on the number and size of instruments. Boiling time for tools is 30 minutes. If the instruments were previously used for purulent surgery, and especially if they were contaminated with anaerobic microbes or Pseudomonas aeruginosa, the boiling time increases to 45 minutes. or even boil them three times for 60 minutes. with water change. Such instruments are immersed in a saturated solution for several hours before boiling. boric acid(if contaminated with Pseudomonas aeruginosa) or into a lysoform solution. Boiling of instruments intended for “clean” and for purulent operations is carried out in separate sterilizers. Instruments can be sterilized by placing them in bags or wrapped in sheets in an autoclave for 30 minutes. at a pressure of 2 am. Dry air sterilization is also used in drying cabinets at t° 180-200° for 40 minutes. IN in case of emergency Sterilization of instruments by firing is allowed. Having placed them in a metal tray, they are doused with alcohol, which is set on fire. But such sterilization deteriorates the instruments, and the method is not reliable.

Cutting instruments become dull when boiled in water, so they are sterilized using a cold method. After washing with a brush and soap, they are immersed in 96% alcohol for 2 hours. Lower concentrations of alcohol cause rust. You can use solutions of the following composition: carbolic acid - 3 parts, caustic soda - 15 parts, - 20 parts, distilled water - 1000 parts; formalin - 20 parts, pure liquid phenol - 1.5 parts, sodium carbonate - 7.5 parts, distilled water - 500 parts. Sterilization in these solutions is less reliable and rust may form, so their use can only be recommended in the absence of alcohol. The exposure is the same as for sterilization with alcohol. Sterilize by boiling in distilled water for 30 minutes. Cylinders and pistons are boiled separately, wrapped in gauze. If the syringes are made of heat-resistant glass that can withstand temperatures above 200°, the best method is dry air sterilization at a temperature of 200° for 30 minutes. The needles are boiled with mandrels or filled with water using a syringe. Otherwise, air remains in their lumen, which prevents the flow of water (air heated to t° 100° does not ensure sterility). New needles are cleaned of grease and cleaned three times for 20 minutes. boil in a 2% sodium bicarbonate solution, changing the water each time. Then they are placed in gasoline for two hours and again boiled twice in a 2% solution of sodium bicarbonate. Store needles dry, with mandrins. Disassembled syringes and needles can be stored in 96% alcohol in special metal pencil cases or in a glass container. Sharing the same syringe and needle on multiple people can lead to the transmission of epidemic hepatitis, even if the instruments are boiled before each injection. A reliable means of prevention is a centralized sterilization system, in which each syringe and needle after a single use is returned to the sterilization room for special processing. The latter includes washing with a 10% solution of magnesium sulfate at a temperature of 45-50° (the needles are washed using a specially designated syringe) and immersion in the same solution for 15 minutes. This is followed by thorough rinsing with distilled water, boiling in it for 5 minutes and only then sterilization - dry air or in an autoclave (each syringe with needles is in a separate package).

Sterilization in surgery- used for disinfection of surgical linen, dressings, instruments and some devices used during operations and dressings.

Operating linen (robes, sheets, towels, masks) and dressings (gauze swabs, napkins and cotton wool) are sterilized with steam under pressure in an autoclave.

As an exception (in the absence of an autoclave), they resort to sterilization with flowing steam. In this case, steam, heated to a temperature of 100°, passes through the bixes placed in the apparatus and comes out. Such sterilization is unreliable, because it does not kill all bacteria (spore-bearing bacteria die at temperatures above 120°). Linen and dressings are folded in a form that makes it easier to use and prevents unnecessary manipulation. The preparation of linen and material is carried out by a nurse dressed in a robe, cap or scarf. People with pustular diseases should not take part in this. The prepared material and linen are placed in metal Schimmelbusch drums (bixes), and in large bins they are placed robes, sheets, towels, large napkins and tampons, in small ones - masks, small napkins, balls and cotton wool. The placement of linen and material should be loose. Sheets, bathrobes, napkins, etc. should be laid in vertical rather than horizontal layers. In large operating rooms, the arrangement is carried out so that each box contains one type of linen or material. In small operating rooms, and especially for emergency operations, everything necessary to perform one intervention is placed in one box, and in such a way that any item can be removed without touching all the others. A gown, cap, and mask are placed on top of the entire contents for the operating room nurse, who is the first to conduct personal aseptic preparation.

When sterilizing in an autoclave, saturated water steam t ° 120-132 ° under a pressure of 1.5-2 atm is used. The bactericidal properties of steam are enhanced if air is removed from the material being sterilized. However, this is complicated by the fact that the material is in bins. In institutions with large autoclaves, air is removed using vacuum pumps. If there is no pump, air is removed by blowing for 10 minutes. the sterilization chamber operates as a flowing steam installation, i.e. with the outlet valve open, which is then closed. Sterilization time depends on the pressure and quality of the material being sterilized. The countdown begins from the moment the required pressure and temperature are established. Bixes with homogeneous material should be placed into the autoclave at the same time. When sterilizing bixes with heterogeneous material The time is set according to the material that requires a longer sterilization time. Before placing it in the autoclave, all holes in the container are opened. The autoclave should be loaded at the rate of 65-94 kg of linen or material per 1 m3 of apparatus volume. Duration of sterilization of linen at a pressure of 2 am - 30 minutes, 1.5 am - 45 minutes; for dressings - at 2 am - 20 minutes, at 1.5 am - 30 minutes. Upon completion of sterilization, the autoclave is opened after 5-10 minutes. after removing steam (this is necessary to dry the material). When removing the bixes, the holes in them are immediately closed.

Control over the sterility of the material is carried out during each sterilization by physical and chemical methods. Biological control is the most reliable. It should be used for periodic control of sterilization, for example once a month, as well as in cases of suppuration after “clean” operations.

Hand washing basins are sterilized by burning. 10-15 ml of denatured alcohol is poured into a basin and set on fire. By rotating the pelvis in different planes, its entire internal surface is burned. The use of ether for these purposes is unacceptable due to the possibility of explosion.

Catheters, tubes, drainages are sterilized by boiling in distilled water for 30 minutes. Before boiling, new rubber products are washed with warm running water to remove talc. They can be stored in a solution that is used to sterilize gloves.

Conditions sterilization of rubber products in an autoclave are similar to the conditions adopted for sterilizing gloves. Sterilization of surgical instruments is carried out by boiling, autoclaving and antiseptic substances. Non-cutting tools sterilized by boiling in a 1-2% solution of sodium bicarbonate, which prevents the oxidation of the metal and increases the boiling point. You can boil tools in distilled water. Instruments, washed with a brush and soap and dried after the previous operation, are lowered into water on a grid in special metal vessels - sterilizers, the sizes of which vary depending on the number and size of instruments. Boiling time for tools is 30 minutes. If the instruments were previously used for purulent surgery, and especially if they were contaminated with anaerobic microbes or Pseudomonas aeruginosa, the boiling time increases to 45 minutes. or even boil them three times for 60 minutes. with water change. Before boiling, such instruments are immersed for several hours in a saturated solution of boric acid (if contaminated with Pseudomonas aeruginosa) or in a solution of lysoform.

Boiling of instruments intended for “clean” and for purulent operations is carried out in separate sterilizers. Instruments can be sterilized by placing them in bags or wrapped in sheets in an autoclave for 30 minutes. at a pressure of 2 am. Dry air sterilization is also used in drying cabinets at t° 180-200° for 40 minutes. In emergency cases, instruments may be sterilized by burning. Having placed them in a metal tray, they are doused with alcohol, which is set on fire. But such sterilization deteriorates the instruments, and the method is not reliable.

Cutting tools When boiled in water they become dull, so they are sterilized using a cold method. After washing with a brush and soap, they are immersed in 96% alcohol for 2 hours. Lower concentrations of alcohol cause rust. You can use solutions of the following composition: carbolic acid - 3 parts, caustic soda - 15 parts, formaldehyde - 20 parts, distilled water - 1000 parts; formalin - 20 parts, pure liquid phenol - 1.5 parts, sodium carbonate - 7.5 parts, distilled water - 500 parts. Sterilization in these solutions is less reliable and rust may form, so their use can only be recommended in the absence of alcohol. The exposure is the same as for sterilization with alcohol.

Syringes Sterilize by boiling in distilled water for 30 minutes. Cylinders and pistons are boiled separately, wrapped in gauze. If the syringes are made of heat-resistant glass that can withstand temperatures above 200°, the best method is dry air sterilization at a temperature of 200° for 30 minutes. The needles are boiled with mandrels or filled with water using a syringe. Otherwise, air remains in their lumen, which prevents the flow of water (air heated to t° 100° does not ensure sterility). New needles are cleaned of grease and cleaned three times for 20 minutes. boil in a 2% sodium bicarbonate solution, changing the water each time. Then they are placed in gasoline for two hours and again boiled twice in a 2% solution of sodium bicarbonate. Store needles dry, with mandrins. Disassembled syringes and needles can be stored in 96% alcohol in special metal cases or in a glass container. Sharing the same syringe and needle on multiple people can lead to the transmission of epidemic hepatitis, even if the instruments are boiled before each injection. A reliable means of prevention is a centralized sterilization system, in which each syringe and needle, after a single use, is returned to the sterilization room for special treatment. The latter includes washing with a 10% solution of magnesium sulfate at a temperature of 45-50° (the needles are washed using a specially designated syringe) and immersion in the same solution for 15 minutes. This is followed by thorough rinsing with distilled water, boiling in it for 5 minutes and only then sterilization - dry air or in an autoclave (each syringe with needles is in a separate package).

Sterilization of intravenous fluid and blood transfusion systems and for intra-arterial blood injection, they begin with the preparation of rubber tubes. They are washed with running water to remove talc and soaked for 6-8 hours. in a solution of sodium bicarbonate (bicarbonate of soda) - 100 g, ammonia- 50 ml, water - 10 l. After washing again with running water, they are boiled in distilled water for 30 minutes. and dry. Glass parts - control glasses and droppers - are washed hydrochloric acid or 10% solution of potassium dichromate in sulfuric acid and repeatedly with running water. The systems are mounted, placed in boxes or bags made of thick fabric and sterilize in an autoclave for 30-40 minutes at 2 am. Rubber tubes should not be sterilized more than 3 times, as they lose elasticity and strength. As an exception, systems can be sterilized by boiling in distilled water for 45 minutes.

Sterilization of anesthesia supplies- endotracheal tubes (rubber and plastic), removable inflatable cuffs and masks - carried out using a cold method. Boiling causes them to deteriorate and lose their elasticity. Use solutions of mercury diiodide (diiodide) 1:1000, aqueous-alcohol solution of formaldehyde; aqueous-alcohol solution of chloramphenicol 1:1000 or one of the solutions used for sterilization cutting tools. The solution is poured into a tall, wide cylinder, closed with a lid with holes along the diameter of the tube. They are placed vertically in the cylinder so that a 1.5-2 cm long segment protrudes from the outside through the holes. The tubes are kept in the solution for at least 1 hour after thorough mechanical cleaning of them from mucus and pus. To do this, the tubes are connected to a water tap and for 15-30 minutes. washed with a strong stream of water, and then wiped inside and out with a swab soaked in ether. The tubes can be sterilized in an autoclave for 30 minutes. at a pressure of 1.5 am. They are placed in a box, the walls of which are lined with gauze or a towel. Inner surface masks and laryngoscope blades are washed with a 0.5% solution of ammonia and wiped several times with a cloth moistened with 96% alcohol. Metal parts - adapter tubes, forceps, dental spacers - are sterilized by boiling. Endoscopy devices are sterilized without optics by immersion in a solution of mercuric oxycyanide 1:2000 or mercuric cyanide 1:5000 for 6 hours. They are washed first warm water with soap and after drying, wipe with alcohol. The optical part is thoroughly wiped with alcohol and stored in a dry gauze cap. Ureteral catheters and elastic bougies, made of silk and impregnated with a special varnish, are sterilized with formalin vapor in a glass or metal container, at the bottom of which there is a vessel with liquid formaldehyde or formaldehyde tablets. Metal bougies and catheters are sterilized by boiling. Dental instruments are sterilized by boiling or in a dry air chamber at t° 120° for 30-40 minutes. Before sterilization, stitching devices are cleaned of vaseline oil, with which they are lubricated after use, assembled, and charged. Sterilization is carried out by boiling in distilled water in assembled and charged form. Charged spare magazines with tantalum clips are boiled along with the device. If the device has cutting parts, they are sterilized separately according to the rules for sterilizing cutting instruments.

Sterilization of products from synthetic materials: vascular prostheses made of lavsan, terylene, taflon, nylon and dacron, as well as meshes made of these materials, are produced by boiling in distilled water for 30 minutes. followed by immersing them in alcohol for several minutes and rinsing with saline solution. Standard dentures leave the factory sterile in special packaging.

Glass products are sterilized in an autoclave at a pressure of 2 am within 20 min. or by boiling in distilled water - 30 minutes, or in a dry-air chamber at t° 150-160° - 1 hour.
Preparation for sterilization of soft suture material (silk, catgut, nylon, lavsan, hair) and its sterilization is carried out in the operating room.
To process silk, the Kocher method is used: the silk is washed with soap in warm water, rinse until the water runs clear and dry in a sterile towel. For this and subsequent manipulations, the nurse dresses as if for an operation. The washed silk is wound onto glass slides, spools or gauze rolls and sequentially immersed for degreasing in ether for 12-24 hours and in 70% alcohol for the same time. Then, after boiling for 10 minutes in a solution of sublimate 1:1000, the silk is placed for storage in 96% alcohol in jars with ground stoppers. Before surgery required amount silks are boiled for 2 minutes. in a solution of sublimate 1: 1000.
Modifications of the Kocher method are often used:

1. Bakulev’s method: silk in skeins is washed in a 0.5% solution of ammonia, dried and immersed in ether for degreasing for 1 day. Sterilize silk in an autoclave for 30 minutes. Store in 96% alcohol in sterile jars with ground stoppers.

2. After washing, winding on spools, degreasing in ether and 70% alcohol and boiling in a solution of sublimate 1: 1000 (No. 0-4 for 15 minutes, No. 5-8 for 30 minutes), the silk is placed for 3 days in 96% alcohol, then carry out bacteriological examination (inoculation) and fill it with 96% alcohol for storage.

3. Washed, reeled and defatted silk is sterilized in an autoclave for 15 minutes. under a pressure of 2 am and placed for 5 days in 96% alcohol. After control by sowing, the silk is ready for use. Sterilization in an autoclave reduces the strength of silk. Every 10 days, the alcohol in which the silk is stored is changed, and the sterility of the silk is checked by culture.

Nylon and lavsan threads are sterilized in an autoclave for 15 minutes. under a pressure of 2 am, placed in 96% alcohol for 5 days, then inoculated. Store in 96% alcohol. Sterilization is allowed by boiling in water (20 minutes), and then in a solution of sublimate 1:1000 (5 minutes), as well as by methods proposed for sterilizing silk. Nylon and lavsan threads can withstand any number of boilings, including in sublimate.

Paper and linen threads are sterilized like silk, or autoclave along with dressings and linen.
Catgut requires more complex sterilization due to the fact that it is made from extremely contaminated material - sheep intestines, and it does not tolerate boiling or autoclaving. Sterilization of catgut according to the Sitkovsky method: degrease the catgut in ether for 12-24 hours, wipe the threads with a swab soaked in a solution of sublimate 1: 1000, dip in a 2% aqueous solution of potassium iodide (No. 0-1 for 30 seconds, No. 2- 5 for 1 min., No. 6 for 2 min.), and then the catgut wound into rings is placed in a suspended state in a jar with a ground stopper filled with paraffin at a distance of 6-7 cm from the bottom, where dry iodine is located (in a 3-liter jar - 40 g, in a 5-liter jar - 60 g). Periodically, the jars are slightly shaken to ensure uniform access of iodine vapor to all skeins of catgut. Catgut is considered prosternized No. 0-1 - after 3 days, No. 2-4 - after 4 days, No. 5-6 - after 5 days and after sowing it is placed in dry sterile jars with ground-in stoppers.

Claudius method: for 14 days, catgut is kept in a solution: 1000 ml of distilled water, 10 g pure iodine and 10 g of potassium iodide. Water can be replaced with formaldehyde alcohol 1:1000.
There are other modifications of the Claudius method: threads of catgut rolled into rings are degreased in ether for 1 day and placed in a solution of 1000 ml of pure alcohol, 10 g of iodine and 10 g of potassium iodide for 14 days, changing this solution after 7 days. Then bacteriological control is carried out and stored in the same solution, changing it every 7-10 days. This is one of the most accepted methods in the USSR. Catgut can be sterilized in a solution of the following composition: 1000 ml of distilled water, 20 g of potassium iodide and 10 g of pure iodine. Catgut rolled into rings is placed in the solution twice for 8-10 days after keeping it for 12-24 hours. in ether, and then for 4-6 days - in 96% alcohol. After bacteriological inoculation, catgut is stored in 96% alcohol, which is changed every 7-10 days.

Sterilization of instruments, including cutting ones, is possible using ultrasound. The advantage of this method is that ultrasound also mechanically cleans instruments from blood and pus without damaging them. The instruments are placed in vessels with distilled water, and the emitter is lowered into it. Ultrasound is used with a frequency of 800 kHz and a power of 20-30 W/cm. In 10 minutes. Complete mechanical cleaning and sterility are achieved. Sterilization of linen, dressings, instruments, equipment, solutions, etc. with gamma radiation is very effective. The dose of penetrating radiation must be at least 2,000,000 - 2,500,000 roentgens.

Sterilization of medical equipment is a long and labor-intensive procedure that no clinic can do without. This manipulation takes place in three stages, each of which requires special care and scrupulousness. In order to facilitate the work of doctors and high-quality destruction of harmful microorganisms, sterilization devices are actively used today. medical devices. Their main advantages are convenience and reliability.

What must be sterilized in medical institutions?

The type of processing in question applies to all medical instruments in contact with the wound surface, mucous membranes, and the blood of the victim.

The specified toolkit consists of the following components:

1. Dressing material.
2. Laboratory glassware: beakers, thin glass tubes, cones.
3. Operating linen.
4. Needles.
5. Rubber products used for medical purposes: catheters, gloves, probes, drainage tubes.
6. Devices that touch damaged surfaces of the body.
7. Small dental instruments: burs, channel fillers, drilbors.
8. Devices and equipment for diagnostic activities.

Video: Cleaning and disinfection of conventional medical instruments

Main stages of sterilization

The procedure under consideration is carried out in three stages, the sequence of which must be followed without fail:

1.Disinfection

Provides for the elimination of harmful microorganisms in the room, on tools and consumables, which are used in clinics. At the same time, not only floors, walls and hard furniture are disinfected, but also the air, patient care products, sanitary facilities, etc.

• The stay of a person with an infectious disease in the hospital is a reason for carrying out focal disinfection.
• In general, weekly in operating rooms and manipulation rooms he carries out general cleaning. Wet cleaning premises is carried out every day. Such a set of activities is called preventive disinfection.

Based on the purpose of the equipment that comes into contact with the skin, disinfection is of three types:

1. Low level. Indicated for disinfecting devices that come into contact with intact skin. The main means of this type of disinfection are preparations containing chlorine, phenol, ethyl or isopropyl alcohol, as well as iodophors. These drugs are not capable of destroying the products of proliferation of fungi and bacteria, as well as small viruses of a non-lipid nature. They cope well with the rest of the group of pathogenic microparticles.
2. High level. It is used to treat medical devices that come into contact with blood, injection solutions, blood vessels, and clean body tissues. Main components specified type disinfectants are a 6% solution of hydrogen peroxide, aldehyde and chlorine compounds, as well as preparations including peracetic acid. Similar means eliminate all pathogenic microparticles, except fungal growth products.
3. Intermediate level. Makes it possible to cope with large lipid viruses, vegetative forms bacteria. Non-lipid microviruses, bacterial growth products, are resistant to such purification. Intermediate level disinfection is used for instruments that come into contact with mucous membranes or torn skin.

Disinfection is carried out in several ways:

• Mechanical. Includes wiping surfaces with a damp cloth, washing surgical linens and bed linen, and vacuuming furniture and floors. In addition, regular ventilation of all rooms in the clinic is mandatory.
• Biological. To eliminate certain harmful microorganisms, they turn to bacteriophages. These antagonists have a narrow spectrum of action, and therefore they are used mainly for disinfecting rooms and hard surfaces.
• Physical. Objects that are subject to disinfection are exposed to high temperatures. This can be boiling in a solution of distilled water with soda, steam treatment, or dry air. This method is not dangerous for clinic employees and is distinguished by its reliability.
• Chemical. The most popular disinfection method in medical institutions. It can be very aggressive for those who work with chemical reagents, so it is recommended to place products to be disinfected on grids in the chambers. The essence of the technique under consideration is to immerse medical equipment in disinfecting chemical solutions. The container into which these drugs are poured must be made of plastic, glass, or covered with a layer of enamel. The disinfectants themselves must be stored in tightly closed containers indicating the exact name of the drug, the date of its manufacture and terms of use. When working with such substances, nurses must wear a respirator mask, goggles and gloves. The room must be ventilated or ventilated at this time. It is not allowed to dilute certain chemical solutions with warm/hot water: this will provoke increased evaporation of substances harmful to the body.

All chemical disinfectants, due to their composition, are divided into 7 groups:

1. Oxygen-containing preparations. The active component here is oxygen. Most a prominent representative This group is hydrogen peroxide.
2. Guanide-containing products. They do a good job of eliminating a wide variety of pathogenic bacteria. They are represented by the following products: Gibitan, Lisetol AF, Fogucid, etc.
3. Halogen-containing substances, which are based on iodine, chlorine, and bromine.
4. Surfactants (surfactants), that do not lead to the formation of rust on metals over time. Thanks to their properties, it is possible to combine the procedure of disinfection and pre-sterilization cleaning.
5. Alcohols. Indicated for treating work surfaces, medical equipment, and also for the skin.
6. Preparations containing succinic or glutaraldehyde. Effectively cope with bacteria, viruses, spores, macroorganisms.
7. Phenol-based products. They are often used to clean rooms where tuberculosis patients are located.

Immediately after use, contaminated work equipment is immersed in a special container, which is filled with a chemical disinfectant solution. The height of the liquid above the level of the instrument must be at least 1 cm. In case of significant contamination, cleaning is carried out twice. Disinfection ends with washing medical equipment under running water. If there is contamination on at this stage, they are removed mechanically, using a brush, napkin or brush.

2. Pre-sterilization cleaning (PSC)

It is necessary for high-quality processing instruments that come into contact with wound surfaces and mucous membranes.

These devices are first disassembled and immersed in a container with a pre-prepared solution. For this technique, special solutions are prepared, or ready-made disinfectants are used. In the first case, water, hydrogen peroxide, and detergents are used.

The quality of cleaning of medical instruments is assessed by conducting special tests on three units of products.

3. Direct sterilization

It is a mandatory technique for processing instruments that come into contact with clean body tissues, blood vessels, and blood.

Complete sterilization is carried out using sterilizers - special equipment.

There are three main sterilization methods:

1) Thermal

Divided into:

• Steam using an autoclave. Disinfection is achieved by exposure to steam under overpressure. The pathogens here begin to die already at a temperature of 120C. This procedure can last from 15 minutes to 1 hour. Cleaning time depends on the material from which the product is made and the degree of contamination.
• Air, using a dry-heat oven. It is used to disinfect objects that, due to their specific structure, cannot be exposed to gases and vapors. Harmful microorganisms in such devices are eliminated under the influence of high temperatures (180 C).
• Microwave. Suitable for cleaning small amounts of surgical or laboratory equipment. The principle of sterilization is to place objects in a partial vacuum and expose them to microwaves. This manipulation takes only 30 seconds.

2) Chemical

There are several types:

1. Plasma. Involves the use of 20 percent hydrogen peroxide.
2. Ozone sterilization. Lasts about 60 minutes.
3. Steam cleaning chemical compounds. For similar purposes the following can be used:

• Ethylene oxide with methyl bromide: for sterilization of rubber, glass, metal, polymer products, as well as medoptics, pacemakers. For this method of disinfection, a gas sterilizer is used.
• Vapors of formaldehyde and water. At a temperature of 75C, equipment made of rubber, glass, metal, and polymer is processed in a stationary formaldehyde sterilizer for 5 hours.

3) Radioactive

Based on the principle of transforming ionic energy into chemical and thermal energy. This favors the destruction of the DNA of pathogens, which stops the process of reproduction of pathogenic microparticles and completely stops their existence.

This method is often used in factory conditions, during the mass production of medical equipment (for example, disposable syringes).

Video: The process of disinfection and sterilization of medical instruments

All methods of sterilization of instruments, dressings, etc. in medicine today – necessary equipment

Today, in medical practice Most often, sterilizers are used that clean using hot air or steam.

Each of them has its own disadvantages and advantages.

1. Dry sterilization method negatively affects the strength of glass and metal. Small dental devices also suffer: when exposed to temperatures above 160 C, they become dull and become brittle. One more negative point of the type of disinfection under consideration is the inability to control the quality of cleaning of objects.
2. Today, the most efficient and high-quality means of disinfection is steam technique. It can be used to process instruments that are sensitive to high temperatures. Using the specified devices medical products undergo all three stages of sterilization. Steam for autoclave sterilization is generated by boiling water in a boiler. The specified steam enters the sterilization chamber where contaminated objects are placed. In order to maintain normal pressure provided safety valve. In addition, the autoclave is equipped with a pressure gauge and thermometer to measure the vapor pressure and temperature, respectively.

Modern autoclaves come in three classes:

• Equipment classN. Works well for cleaning unwrapped fabric materials, as well as solid, smooth medical equipment.
• Device classS. Can be used to disinfect objects made of fabric that are packaged, as well as porous and smooth instruments.
• Class B autoclaves. Are universal device for sterilization, as they are suitable for any medical equipment. They are especially popular in dental clinics.

In order to facilitate and speed up the sterilization process, the medical goods market offers the following equipment:

1. Devices for careful packaging of equipment before sterilization.
2. Washing machines for disinfection. Helps get rid of visible dirt. Their main purpose is pre-sterilization treatment of medical instruments.
3. Distillers. Relevant for medical institutions Those who actively use autoclaves use distilled water for steam cleaning.

Sterilization of surgical instruments is carried out in two stages.

First stage - pre-sterilization treatment, second- direct sterilization. The sequence of pre-sterilization preparation depends on the degree of bacterial contamination of instruments.

Pre-sterilization preparation includes: disinfection, washing and drying. Due to the high risk of spreading AIDS and performing operations on patients who have had hepatitis, the rules for pre-sterilization preparation have been changed and are equated to methods for processing instruments, providing a guarantee of destruction of the human immunodeficiency virus. Instruments after purulent operations for anaerobic infections, patients who have had hepatitis within the last 5 years, as well as those at risk of AIDS are treated separately from others

Immediately after the operation, instruments are immersed in disinfectants (3% chloramine solution for 40-60 minutes or 6% hydrogen peroxide solution for 90 minutes, 0.5% polydes solution for 60 minutes, combined instrument disinfectant for 60 minutes). After disinfection, the instruments are transferred to a washing solution (washing powder, hydrogen peroxide and water) 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. Currently, the “Stages and modes of pre-sterilization processing of products made from various materials” approved by the Ministry of Health of the Russian Federation in 1997 are used (Table 1).

Table 1.

Stages and modes of pre-sterilization cleaning of instruments combined with disinfection with nnkrasent 10A.

The quality of pre-sterilization treatment is checked by performing azopyram, phenolphthalein and benzindine tests for the presence of residual detergent components, blood and fat. At least 1% of the batch of instruments simultaneously subjected to processing are subject to control. In addition, quality control of pre-sterilization treatment is carried out by the Center for Hygiene and Epidemiology once a quarter. If the test is positive, the entire batch of instruments undergoes repeated pre-sterilization treatment.

The next stage is drying the instruments in a dry-heat oven at a temperature of 80 ° C for 20 minutes.

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

All general surgical instruments are conventionally divided into three groups:

Metal - cutting (scalpels, scissors, suture needles, amputation knives, etc.), non-cutting (syringes, injection needles, clamps, tweezers, hooks, probes, etc.);

Rubber and plastic (catheters, probes, drainages, etc.);

Optical - laparoscopes, gastroscopes, choledochoscopes, cystoscopes, colonoscopes, bronchoscopes, etc.

Sterilization of surgical metal instruments and products made of glass produced in the following ways.

Sterilization with dry hot air (aerosterilization) is carried out in dry-heat ovens (Fig. 3). Tools and syringes

Fig.3. Dry heat cabinet.

Disassembled instruments are placed in special metal mesh or packaged in kraft paper and sterilized at a temperature of 180-200 ° C for 1 hour. After sterilization, surgical instruments are transferred to an ultraviolet chamber to maintain sterility during their use (Fig. 4.). Products sterilized in kraft paper remain sterile for 3 days.

Fig.4. UFC 2.

For steam sterilization, instruments are placed in Schimmelbusch bottles, loaded into autoclaves and sterilized at a pressure of 1.1 atm - 60 minutes, 1.5 atm - 45 minutes, 2 atm - 30 minutes. Shelf life in containers with a filter is 3 days, without a filter - 24 hours.

Disposable instruments are sterilized in sealed bags using ionizing radiation (y-rays), ultraviolet rays and ultrasound. Currently, preference is given to sterilization with y-rays. For these purposes, the isotopes """Co and ""C are used. Sterilization must be carried out in compliance with safety measures in the factory. If the packages in which sterilization was carried out by y-rays are sealed, sterility is maintained for 5 years.

Boiling as a method of sterilization is currently not used and refers to disinfection. Disinfection of instruments by boiling is carried out in electric sterilizers of various designs and capacities, on grids immersed in distilled water with the addition of a 2% sodium bicarbonate solution for 30 minutes. Sterilization of cutting and piercing instruments is carried out in the factory using y-rays, gas and cold chemical methods using antiseptics. In dressing rooms, cutting and stabbing instruments are sterilized in dry-heat ovens.

Chemical sterilization methods include sterilization in the sterilization chambers of an air sterilizer (one- or two-chamber) with a capacity of 80 dm 3 or more with formalin vapor. Formalin is placed at the bottom of the chamber at the rate of 10 g per 10 dm 5 of the chamber, sterilization time is 16 hours. Instruments with an ebonite base, telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments are sterilized using a chemical gas method. Before gas sterilization, laparoscopic instruments are disinfected in a 3% aldezone solution by rinsing in one container, then they are soaked in a second container for 1 hour and after the time is rinsed under running water to remove disinfectants.