Sterilizers for surgical instruments. Thermal methods of sterilization of medical instruments. Sterilization by boiling. Drying cabinet. Medical autoclave. Video: The process of disinfection and sterilization of medical instruments

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 the 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 equated to methods for processing instruments that provide a guarantee of the destruction of the human immunodeficiency virus. Instruments after purulent operations in case of anaerobic infection, patients who had undergone for 5 recent years hepatitis, as well as at risk of AIDS, are treated separately from other

Immediately after the operation, the instruments are immersed in disinfectants(3% chloramine solution for 40-60 min or 6% hydrogen peroxide solution for 90 min, 0.5% polydez solution for 60 min, combined instrument disinfectant for 60 min). 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 from various materials” approved by the Ministry of Health of the Russian Federation in 1997 are used (Table 1).

Tab. 1.

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

The quality of pre-sterilization treatment is checked by setting azopyramic, phenolphthalein and benzine samples for the presence of residual components detergent, blood and fat. At least 1% of the batch of instruments that were simultaneously processed are subject to control. In addition, the quality control of pre-sterilization treatment is carried out by the Hygiene and Epidemiology Center once a quarter. With a positive sample, the entire batch of instruments is subjected to repeated pre-sterilization processing.

The next step is to dry the instruments in a dry oven at 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 conditionally 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, drains, 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 cabinets (Fig. 3). Instruments and syringes

Fig.3. Drying cabinet.

Unassembled chickens are placed in special metal nets or packed 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 are kept sterile for 3 days.

Fig.4. UFC 2.

For steam sterilization, the instruments are placed in Schimmelbusch cups, 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 biks with a filter - 3 days, without a filter - 24 hours.

Disposable instruments are sterilized in sealed bags with ionizing radiation (y-rays), ultraviolet rays and ultrasound. At present, y-ray sterilization is preferred. For these purposes, the isotopes "" "Co" and "" C. are used. Sterilization must be carried out in compliance with safety measures in the factory. While maintaining the tightness of the packages in which the sterilization was carried out with y-rays, sterility lasts 5 years.

Boiling as a method of sterilization is not currently 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 2% sodium bicarbonate solution for 30 minutes. Sterilization of cutting and stabbing instruments is carried out at the factory with y-rays, gas method and cold by chemical means with the use of antiseptics. In dressing rooms, cutting and stabbing instruments are sterilized in dry-heat cabinets.

Chemical methods of sterilization 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, the sterilization time is 16 hours. Ebonite-based instruments, telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments are sterilized by the chemical gas method. Before gas sterilization, laparoscopic instruments are disinfected in a 3% solution of aldezone by washing in one container, then they are soaked in the second container for 1 hour and after the time has elapsed, they are rinsed under running water from disinfectants.

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 needs special care and scrupulousness. In order to facilitate the work of physicians and the qualitative destruction of harmful microorganisms, sterilizing medical devices are actively used today. Their main advantages are convenience and reliability.

What must be sterilized in medical institutions?

The considered type of treatment is applied to all medical instruments in contact with the wound surface, mucous membranes, and the victim's blood.

This toolkit consists of the following components:

dressing material.
Laboratory glassware: beakers, thin glass tubes, cones.
Operating linen.
Needles.
Rubber products used for medical purposes: catheters, gloves, probes, drainage tubes.
Devices that touch damaged surfaces of the body.
Small dental instruments: burs, canal fillers, drills.
Devices and equipment for diagnostic measures.

Video: Cleaning and disinfection of conventional medical instruments

The main stages of sterilization

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

1. Disinfection

Provides for the elimination of harmful microorganisms in the room, on tools and consumables that 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 in the hospital of a person with an infectious disease is a reason for focal disinfection.
In general, on a weekly basis, in operating rooms and manipulation rooms, general cleaning. Wet cleaning of the premises is carried out every day. Such a set of activities is called preventive disinfection.

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

low level. Indicated for the disinfection of 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 reproduction 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.
High level. It is used to process medical devices that are used to contact blood, injection solutions, blood vessels, clean body tissues. The main components of this type of disinfection are a 6% hydrogen peroxide solution, aldehyde and chlorine compounds, as well as preparations containing peracetic acid. Such agents eliminate all pathogenic microparticles, except for the products of reproduction of fungi.
intermediate level. It makes it possible to cope with large lipid viruses, vegetative forms of bacteria. Non-lipid microviruses, bacterial reproduction products, are resistant to such purification. Intermediate level disinfection is used for instruments that come into contact with mucous membranes or with torn skin.

Disinfection is carried out in several ways:

Mechanical. It provides for wiping surfaces with a damp cloth, washing operating and bed linen, 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 disinfection of premises 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, steaming, dry air. This method is not dangerous for the clinic staff and is distinguished by its reliability.
Chemical. The most popular method of disinfection in medical facilities. It can be very aggressive for those who work with chemicals, so it is recommended to place the products to be disinfected on the grids in the chambers. The essence of the method under consideration is the immersion of medical inventory in disinfecting chemical solutions. The container into which these preparations are poured must be made of plastic, glass, or covered with a layer of enamel. The disinfectants themselves should be stored in tightly closed containers indicating the exact name of the drug, the date of its manufacture and the timing of use. When working with such substances, nurses should wear a respiratory mask, goggles and gloves. The room at this time should be ventilated or ventilated. It is not allowed to dilute any chemical solutions warm / hot water: this will provoke increased evaporation of substances harmful to the body.

All means of chemical disinfection, due to their composition, are conditionally divided into 7 groups:

Oxygen-containing drugs. Oxygen is the active ingredient here. The most prominent representative of this group is hydrogen peroxide.
Guanide-containing agents. 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.
Halogenated Substances, which are based on iodine, chlorine, and also bromine.
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.
Alcohols. Indicated for the treatment of work surfaces, medical equipment, as well as for the skin.
Preparations containing succinic or glutaraldehyde. Effectively cope with bacteria, viruses, spores, macro-organisms.
Phenol-based products. Often they are used to clean the premises where there are patients with tuberculosis.

Contaminated work equipment immediately after use 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 are contaminants on this stage, they are eliminated mechanically, by means of a ruff, napkin or brush.

2. Pre-sterilization cleaning (PSC)

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

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

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

3. Direct sterilization

It is a mandatory method 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 methods of sterilization:

1) Thermal

Subdivided into:

Steam using an autoclave. Disinfection is achieved by exposure to steam under overpressure. The causative agents of the disease begin to die here already at a temperature of 120C. This procedure can last from 15 minutes to 1 hour. The cleaning time depends on the material from which the product is made and the degree of contamination.
air using a dry oven. It is used to disinfect items 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 a small amount 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:

Plasma. Provides for the use of 20% hydrogen peroxide.
Ozone sterilization. Lasts about 60 minutes.
Cleaning with the use of vapors of chemical compounds. For such purposes can be used:

Ethylene oxide with methyl bromide: for sterilization of rubber, glass, metal, polymer products, as well as medical optics, pacemakers. For similar way disinfection using a gas sterilizer.
Vapors of formaldehyde and water. At a temperature of 75C in a stationary formalin sterilizer, rubber, glass, metal, polymer inventory is processed for 5 hours.

3) Radioactive

It is based on the principle of transformation of 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 the factory, 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 - the necessary equipment

To date, in medical practice, sterilizers are most often used, which are cleaned by means of hot air or steam.

Each of them has its own disadvantages and advantages.

Dry sterilization method negatively affects the strength of glass and metal. Small dental appliances also suffer: when exposed to temperatures above 160 C, they become dull and brittle. Another negative aspect of this type of disinfection is the inability to control the quality of cleaning items.
To date, the most efficient and high-quality means of disinfection is steam technique. It can be used to process tools that are sensitive to high temperatures. By means of the specified devices medical products pass all three stages of sterilization. Steam for sterilization in an autoclave 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, safety valve. In addition, the autoclave is equipped with a manometer and a thermometer to measure the vapor mass pressure and temperature, respectively.

Modern autoclaves come in three classes:

Class equipmentN. It does a good job of cleaning unwrapped cloth materials as well as solid smooth medical equipment.
class devicesS. They can be used for disinfection of objects made of cloth, which are packed, as well as for porous and smooth instruments.
Class B autoclaves. They are a 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:

Devices for careful packing of inventory before sterilization.
Washers for disinfection. Helps remove visible impurities. Their main purpose is the pre-sterilization treatment of medical instruments.
Distillers. Relevant for medical institutions that actively practice autoclaves - distilled water is used for steam cleaning.

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_2.jpg" alt=">Sterilization methods for surgical instruments Sterilization is the process of eliminating 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" alt=">Sterilization methods for surgical instruments ilizations should: - 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" alt=">Sterilization methods for surgical instruments ut, removing vaseline 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" alt=">Algorithm for sterilization of surgical instruments stage I - preparatory. The goal is to prepare instruments for sterilization."> Алгоритм стерилизации хирургического инструментария І этап - подготовительный. Цель - подготовка инструментов к стерилизации. Проводят замачивание инструментария в !} washing solution, washing in a detergent solution using brushes, thoroughly rinsing with running water, rinsing with distilled water, drying; Stage II - the main one. The goal is actually sterilization. Sterilization of the instrument is carried out by hot and cold methods. Stage III - final. The goal is to control the quality of sterilization. It is carried out using chemical indicators that display the level of temperature required for sterilization, which are placed in the cabinet along with the instrument, or by the bacteriological method - they are sown from the instruments on a nutrient medium.

Src="https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_6.jpg" alt=">Methods, means and modes of sterilization different method of sterilization of specific products depends"> 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_8.jpg" alt=">Steam sterilization method The sterilizing agent is hot steam under 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" alt=">Steam sterilization method a and 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" alt=">Air sterilization method Sterilization is carried out in special devices - dry heat sterilizing cabinets 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, !} textile products. Advantages: cheap, simple method, does not cause metal corrosion, packaging and products are not moistened. Disadvantages: limited choice of packaging, slow and uneven heating of products, the need to use higher temperatures, the inability to use materials from rubber, polymers.

Src="https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_11.jpg" alt=">Air sterilization method Instruments are placed on cabinet shelves- sterilizer and first dry 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" alt=">Firing and boiling Firing is currently in the surgeon ical instrument sterilization clinic"> 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 !} Lately rarely used, since this method achieves a temperature of only 100 ° C, which is not enough to kill spore-bearing bacteria.

Src="https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_13.jpg" alt=">Firing and boiling Tools are boiled in special electric sterilizers different capacities.Tools"> 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_15.jpg" alt=">Gas sterilization method isators The sterilizing agent is 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=">Gas sterilization method e negative impact on the quality of tools,"> 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" alt=">Radiation sterilization method (radiation sterilization) radiation method necessary for the sterilization of products from heat-labile"> 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" alt=">Radiation sterilization method (radiation sterilization) Isotopes are used 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 !} convenient storage and the use of tools (you just need to open the package).

Src="https://present5.com/presentacii-2/20171208%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov.ppt%5C20812-pr2-4_sterilizaciya_hirurgicheskih_instrumentov_19.jpg" alt=">Sterilization with antiseptic solutions Sterilization with antiseptic solutions does not bring septic tanks to blunt tools,"> 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" alt=">Sterilization with antiseptic solutions For cold sterilization of instruments completely immersed open (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».!}

Sterilization- This is the process of eliminating all forms of life, including infectious agents (fungi, bacteria, spores, viruses) that are present on surfaces, contained in liquids.

The following must be subject to mandatory sterilization:

Objects that come into contact with the surface of the wounds have contact with blood and injectables

Diagnostic equipment that comes into contact with mucous membranes and can cause damage to them.

There are three main stages of sterilization:

Disinfection

Pre-sterilization cleaning

Sterilization

Sterilization is achieved by the application of thermal, chemical or radioactive treatment.

The quality of sterilization largely depends on the contact of the sterilizing agent with the surface of the sterilized instrument. The choice of agent is related to the nature of the instrument to be sterilized.

The sterilization process takes place in special device which is called a sterilizer.

Sterilization Methods

1) Thermal sterilization method

- Steam sterilization (autoclaving)

During heat treatment, living organisms die. This process is accelerated by the addition of moisture, but regular steam is not sufficient for sterilization. Pressure is needed, more than atmospheric, which will allow raise the temperature of the steam to thermally destroy microbial life. Pressurized steam causes denaturation and coagulation of the protein and its enzymes in the cells.

The device in which steam sterilization takes place is called an autoclave. The entire sterilization cycle in an autoclave can take from 15 to 60 minutes, depending on the pressure, temperature and material of the instruments to be sterilized.

Autoclavingsuitable for items that tolerate moisture, high pressure(from 1 to 3.5 atmospheres above the external environment), as well as high temperature(from + 121°C to + 148°C). For example, surgical instruments.

An excellent representative of devices for steam sterilization is a series of autoclaves Statim . Compact cassette sterilizers extend the life of fragile instruments.

- Air sterilization (dry oven)

dry heat in the form of hot air is mainly used to sterilize objects based on anhydrous oils, petroleum products and powders, which cannot be sterilized by steam and gas. The death of microbial organisms occurs due to oxidation and the slow process of burning protein in cells. In the absence of moisture, higher temperatures are required during the sterilization process.

- Microwave sterilization

Under the action of non-ionizing microwave radiation, hyperthermic conditions are created that disrupt the vital processes of microorganisms. The cycle temperature is lower than with steam sterilization. The cycle time is much less - 30 seconds. Metal instruments can be sterilized by placing them under partial vacuum in a glass container. This type of sterilizer is perfect for small sterilization volumes.

2) Chemical sterilization method

- Gas sterilization

Ethylene oxide. Basic The sterilization cycle consists of five stages and takes about 2.5 hours, excluding the aeration time. The gas enters chemical reaction with amino acids, proteins, DNA and prevents the reproduction of microbial organisms.

This sterilization methodsuitable for items that cannot withstand the high temperature and humidity required for steam sterilization. Thanks to the low temperature conditions(+30° to +60°C), this sterilization method is well suited for medical devices with built-in electronics. The disadvantage of the method is easy flammability.

Formaldehyde.Gas kills microorganismsby protein coagulation in cells. This sterilization method is complex and less effective than other sterilization methods. Its use for sterilization has almost been abandoned in the United States, Canada and Australia, but it is still used in some countries in Europe and Asia.

- Plasma sterilization

Plasma isa state of matter other than a solid, liquid, or gaseous state. This state is achieved by creating a strong electrical or magnetic field. Free radicals of hydrogen peroxide interact with cell membranes, enzymes, nucleic acids and disrupt the vital functions of microorganisms.

Main Loop Plasma sterilization consists of four stages (vacuum generation, H2O2 injection, diffusion, plasma discharge). The process takes 1 to 3 hours.

This sterilization method is suitablefor objects that cannot withstand the high temperature and humidity required for steam sterilization.

- Ozone sterilization

Ozone is form of oxygen. The sterilization process occurs through oxidation, the destruction of organic and inorganic substances. Ozone penetrates the cell membrane, causing it to explode. Ozone is an unstable gas but can be easily generated from oxygen. Cycle time - up to 60 minutes depending on chamber size or load.

3) Radiation sterilization method

It is the most effective method sterilization, but limited to commercial use only.

ionizing radiationproduces ions that knock electrons out of atoms. These electrons strike an adjacent atom and either join or knock an electron out of a second atom. Ionic energy is converted into thermal and chemical energy. This energy causes the death of microorganisms by destroying the DNA molecule, which prevents cell division and the spread of biological life. The main sources of ionizing radiation are beta particles and gamma rays.

Each method sterilization has its own characteristics. When choosing one or another method, one should take into account the possible side effects especially when it comes to sterilizing various electronic devices.

Sterilization in surgery- used to disinfect surgical linen, dressings, instruments and some devices used during operations and dressings.

Operating linen (gowns, 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, the steam, heated to t° 100°, passes through the bixes embedded in the apparatus and exits. Such sterilization is unreliable, since it does not kill all bacteria (spore-bearing ones die at t ° above 120 °). Linen and dressings are folded in a form that most facilitates its use and prevents unnecessary manipulation with it. The preparation of linen and material is carried out by a nurse dressed in a gown, cap or scarf. People with pustular diseases should not take part in this. The prepared material and linen are placed in Schimmelbusch metal drums (biks), and bathrobes, sheets, towels, large napkins and tampons are placed in large biks, masks, small napkins, balls and cotton wool are placed in small ones. Placement of linen and material should be loose. Sheets, bathrobes, napkins, etc. should not be laid in horizontal, but in vertical layers. In large operating rooms, stacking is done so that each bix contains one kind of linen or material. In small operating rooms, and especially for trips to an emergency operation, everything necessary for the production of one intervention is placed in one bix, moreover, so that any object can be removed without touching all the others. A dressing gown, a cap, a mask for the operating nurse, who is the first to conduct personal aseptic training, are placed on top of all the contents.

When sterilizing in an autoclave, saturated water steam is used at t ° 120-132 ° under a pressure of 1.5-2 atm. The bactericidal properties of steam are enhanced if air is removed from the sterilized material. However, this is hampered by the fact that the material is in bixes. In institutions where there are large autoclaves, air is removed using vacuum pumps. In the absence of a pump, air is removed by blowing - for 10 minutes. the sterilization chamber operates as a fluid steam installation, i.e. with the outlet cock open, which is then closed. The sterilization time depends on the pressure and the quality of the material to be sterilized. The countdown starts from the moment the required pressure and temperature are established. At the same time, bixes with a homogeneous material should be placed in the autoclave. When sterilizing bixes with dissimilar material, the time is set according to the material that requires a longer sterilization time. Before laying in the autoclave in the bix, open all the holes. The autoclave should be loaded at the rate of 65-94 kg of linen or material per 1 m3 of the volume of the apparatus. The 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. At the end of sterilization, the autoclave is opened after 5-10 minutes. after removing the steam (this is necessary to dry the material). When removing the biks, the holes in them are immediately closed.

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

Sterilization of basins for washing hands is carried out by burning. 10-15 ml of denatured alcohol is poured into the basin and set on fire. Rotation of the pelvis in different planes burns its entire inner surface. The use of ether for these purposes is unacceptable because of the possibility of an explosion.

Catheters, tubes, drains are sterilized by boiling in distilled water for 30 minutes. New rubber products are washed with warm running water before boiling to remove talc. You can store them in a solution that is used to sterilize gloves.

Conditions sterilization of rubber products in an autoclave are similar to the conditions adopted for the sterilization of 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 instruments in distilled water. The instruments, washed with a brush and soap and dried after the previous operation, are immersed in water on a grid in special metal vessels - sterilizers, the dimensions of which vary depending on the number and size of the instruments. Boiling time for instruments is 30 minutes. If the instruments were previously used during a purulent operation, and especially if they were contaminated with anaerobic microbes or Pseudomonas aeruginosa, the boiling time is increased 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(when 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 packed in bixes or wrapped in sheets in an autoclave for 30 minutes. at a pressure of 2 am. Dry air sterilization is also used drying cabinets at t° 180-200° for 40 min. In emergency cases, sterilization of instruments by firing is allowed. Having laid them in a metal tray, they are doused with alcohol, which is set on fire. But from such sterilization, the instruments deteriorate, and the method is not reliable.

cutting tools when boiled in water, they become dull, so they are sterilized in a cold way. After washing with a brush and soap, they are immersed for 2 hours in 96% alcohol. Alcohol of a lower concentration causes rust. You can use solutions of the following composition: carbolic acid - 3 parts, sodium hydroxide - 15 parts, formalin - 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, rust formation is possible, therefore their use can only be recommended in the absence of alcohol. Exposure is the same as for sterilization with alcohol.

syringes sterilized 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°C, dry-air sterilization at t° 200°C for 30 minutes is best. The needles are boiled with mandrin or filled with water using a syringe. Otherwise, air is stored in their lumen, which prevents the entry of water (air heated to t ° 100 ° does not ensure sterility). New needles are cleaned of grease and three times for 20 minutes. boil in 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. Keep the needles dry, with mandrin. Disassembled syringes and needles can be stored in 96% alcohol in special metal cases or in glass vessel. Using the same syringe and needle for more than one person can lead to transmission of epidemic hepatitis, even if the instruments are boiled before each injection. A reliable means of prevention is the 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 t ° 45-50 ° (needles are washed using a specially dedicated 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 systems for intravenous transfusion of fluids and blood and for intra-arterial injection of blood, 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 soda) - 100 g, ammonia- 50 ml, water - 10 liters. After repeated washing with running water, they are boiled in distilled water for 30 minutes. and dry. Glass parts - control glasses and droppers - are washed with hydrochloric acid or a 10% solution of potassium dichromate in sulfuric acid and repeatedly with running water. Systems are mounted, placed in bixes or bags made of thick fabric and sterilized in an autoclave for 30-40 minutes at 2 am. Rubber tubes should not be sterilized more than 3 times, because they lose their 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 in a cold way. From boiling, they deteriorate, lose elasticity. Apply solutions of diiodide (two-iodide) mercury 1:1000, water-alcohol solution of formaldehyde; aqueous-alcoholic 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 length of 1.5-2 cm protrudes from the outside through the holes. The tubes are kept in the solution for at least 1 hour after they have been thoroughly mechanically cleaned of mucus and pus. To do this, the tubes are connected to faucet and within 15-30 min. washed with a strong stream of water, and then wiped inside and out with a swab dipped in ether. The tubes can be sterilized in an autoclave for 30 minutes. at a pressure of 1.5 am. They are placed in bix, the walls of which are covered with gauze or a towel. inner surface masks and blades of laryngoscopes 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. Devices for endoscopy are sterilized without optics by immersion in a solution of mercury oxycyanide 1: 2000 or mercury cyanide 1: 5000 for 6 hours. They are pre-washed with warm water and soap and, after drying, wiped with alcohol. The optical part is carefully wiped with alcohol and stored in a dry gauze cap. Ureteral catheters and elastic bougie, 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 formalin or formalin tablets. Metal bougie 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, staplers are cleaned of vaseline oil, which they are lubricated with after use, assembled, charged. Sterilization is carried out by boiling in distilled water in the assembled and charged form. Together with the apparatus, charged spare magazines with tantalum clips are boiled. If the device has cutting parts, they are sterilized separately according to the rules for sterilizing cutting tools.

Sterilization of products made of 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 immersion for several minutes in alcohol and washing with saline. Standard dentures come from the factory sterile in special packaging.

Glass products are sterilized in an autoclave at a pressure of 2 am within 20 min. or 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.
The Kocher method is used to process silk: 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. Washed silk is wound on glass slides, coils or gauze rollers and immersed successively for degreasing in ether for 12-24 hours and in 70% alcohol for the same time. Then, after 10 minutes of boiling in a 1:1000 sublimate solution, the silk is placed for storage in 96% alcohol in jars with ground stoppers. Before the operation required amount silks are boiled for 2 minutes. in a solution of sublimate 1: 1000.
Often used modifications of the Kocher method:

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

2. After washing, winding on coils, degreasing in ether and 70% alcohol and boiling in a mercuric chloride solution 1: 1000 (No. 0-4 for 15 minutes, No. 5-8 for 30 minutes), silk is placed for 3 days in 96% alcohol, then it is bacteriologically examined (inoculated) and filled with 96% alcohol for storage.

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

Kapron 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. Stored in 96% alcohol. Sterilization is allowed by boiling in water (20 min.), and then in a mercuric chloride solution 1:1000 (5 min.), as well as by the methods proposed for silk sterilization. Kapron and lavsan threads can withstand any number of boilings, including in sublimate.

Paper and linen threads sterilize like silk, or autoclaved along with dressings and underwear.
Catgut requires more complex sterilization due to the fact that it is made from an extremely infected material - the intestines of sheep, and it does not tolerate boiling and autoclaving. Sterilization of catgut according to the Sitkovsky method: catgut is degreased in ether for 12-24 hours, the threads are wiped with a swab dipped in a 1: 1000 sublimate solution, immersed 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 and paraffin-filled stopper 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 for uniform access of iodine vapor to all skeins of catgut. Catgut is considered sterilized No. 0-1 - after 3 days, No. 2-4 - after 4 days, No. 5-6 - after 5 days and after sowing is placed in dry sterile jars with ground stoppers.

Claudius method: for 14 days, catgut is kept in a solution: 1000 ml of distilled water, 10 g of pure iodine and 10 g of potassium iodide. Water can be replaced with formalin alcohol 1:1000.
There are other modifications of the Claudius method: catgut threads 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 made and stored in the same solution with its change 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. The 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 culture, catgut is stored in 96% alcohol, which is changed every 7-10 days.

Sterilization of instruments, including cutting tools, is possible with the help of ultrasound. The advantage of this method is that ultrasound also performs mechanical cleaning of instruments from blood and pus without damaging them. The instruments are placed in vessels with distilled water, and the emitter is lowered there. 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. Sterilization of linen, dressing material of tools, equipment, solutions, etc. is very effective with gamma radiation. The dose of penetrating radiation must be at least 2,000,000 - 2,500,000 roentgens.