How to sterilize surgical scissors. Methods for sterilizing surgical instruments

Stage 1 - pre-sterilization preparation. Her goal is thorough mechanical cleaning instruments, syringes, injection needles, transfusion systems, removal of pyrogenic substances and destruction of the hepatitis virus. Personnel must wear rubber gloves when working.
Used but uninfected instruments are thoroughly washed with clean water using brushes in a separate sink for 5 minutes (instruments contaminated with blood are washed immediately, not allowing the blood to dry out) and then soaked for 15-20 minutes in one of the special cleaning solutions, heated up to 50vC. Syringes are processed in disassembled form.
Composition of washing solutions: solution A - perhydrol 20 g, washing powder (such as “News”, “Progress”, “Astra”, etc.) 5 g, water 975 ml; solution B - 2.5% hydrogen peroxide solution 200 ml, Novost washing powder 5 g, water 795 ml.
After soaking, the instruments are washed in the same solution with ruffs and brushes (locks, teeth, and notches are treated especially carefully), then rinsed with warm water for 5 minutes and rinsed in distilled water for 1 minute. After this, the instruments and syringes are placed in a dry air sterilizer at a temperature of 85 ° C to dry, after which they are ready for sterilization.
Instruments and syringes contaminated with pus or intestinal contents are first placed in enamel containers with a 0.1% diocide solution or a 5% Lysol solution for 30 minutes. Then, in the same solution, they are washed with brushes and brushes, rinsed with running water and dipped in one of the washing solutions, carrying out further processing according to the method described above.
After an operation performed on a patient with an anaerobic infection, instruments are soaked for 1 hour in a special solution consisting of a 6% hydrogen peroxide solution and a 0.5% detergent solution ( washing powder), then wash with a brush in the same solution and boil for 90 minutes. Only then are the instruments prepared for sterilization in the same way as uninfected instruments. After 1 day (time for spore germination), they are subjected to autoclaving or boiling (fractional sterilization).
After use, puncture and injection needles are washed with a syringe with warm water and then with a 1% solution of sodium bicarbonate; the needle channel is cleaned with a mandrel and washed with a 0.5% solution ammonia and running water.

After this, the needle with the inserted mandrin is boiled for 30 minutes in a 2% sodium bicarbonate solution, and after 8-12 hours - again in distilled water for 40 minutes and dried, after which the needle channel is dried by blowing with ether or alcohol using a syringe or rubber pears. Needles contaminated with pus are thoroughly washed, their lumen is washed with running water; then place it in a 5% Lysol solution for 1 hour, additionally rinsing the canal with Lysol using a syringe or rubber bulb, and subject it to the same further treatment as needles not contaminated with pus.
Systems for transfusion of drugs or blood require careful handling to prevent post-transfusion reactions and complications. IN modern conditions use disposable transfusion systems that are factory sterilized. A reusable system immediately after blood transfusion or medicinal product disassemble - separate the glass parts, dropper and rubber tubes, rinse thoroughly with running water, kneading the rubber tube with your fingers (for better removal blood residues). Parts of the system are immersed for 2 hours in a special solution heated to 60 °C, containing 1% sodium bicarbonate solution and 1% ammonia solution. Then the parts of the system are washed with running water and boiled in distilled water for 30 minutes, washed again with water, kneading the rubber tubes, and boiled again for 20 minutes in distilled water. The system is then mounted and packaged for sterilization.
Stage 2 - laying and preparation for sterilization. For sterilization in dry heat sterilizers, instruments are placed in metal boxes, stacked vertically in one layer. Disassembled syringes are wrapped in 2 layers of special thick paper. Box lids are sterilized nearby. IN Lately Typically, disposable syringes are used, factory sterilized.
To sterilize with steam under pressure in steam sterilizers (autoclaves), instruments are wrapped in a waffle towel or cotton cloth in the form of a bag and placed on a metal tray or mesh. For specific typical operations, a set of instruments is prepared in advance (for example, for operations on the lung, heart, bones, blood vessels), placed on a special mesh and wrapped in a sheet in the form of a package.
The cylinder and piston of the syringe are placed separately in gauze napkins and wrapped in a piece cotton fabric in the form of a package, which is placed in a sterilization box (biks). During mass sterilization of syringes in autoclaves (centralized sterilization), a special packing made of cotton fabric with pockets is used. Disassembled syringes are placed in the pockets, with needles and tweezers nearby. Each pack contains up to 5 syringes. The bundles are wrapped in a cotton diaper in the form of a bag and placed in a sterilizer.
Dry rubber gloves are sprinkled with talcum powder (outside and inside), lined with gauze napkins, wrapped in pairs in a napkin and placed in a separate box.
Assembled systems for blood transfusion, the strength of rubber tubes is checked, the tightness of their connection with glass parts and the compliance of the cannulas with the needle pavilions. The system is rolled up in the form of 2-3 rings, avoiding bending of the rubber tubes, wrapped in a large gauze napkin, then in a waffle towel and placed in boxes.
Stage III - sterilization. Sterilization of instruments, syringes (marked on the syringe with 200 °C), needles, and glassware is carried out in dry-heat sterilizer cabinets (Fig. 4). Items are placed freely on the shelves of the sterilizer in metal boxes(with the covers removed) and turn on the heating. With the door open, bring the temperature to 80-85 °C and dry for 30 minutes - remove moisture from the internal surfaces of the cabinet and the items being sterilized. Then the door is closed, the temperature is brought to the set temperature (180 °C), maintaining it automatically, and sterilized for 60 minutes. After turning off the heating system and reducing the temperature to 70-50 °C, open the cabinet door and close the metal boxes with instruments with sterile instruments. After 15-20 minutes (after the sterilizer has completely cooled), the chamber is unloaded.
When working with a dry-heat sterilizer, it is necessary to observe safety measures: the device must be grounded, after sterilization is completed, the cabinet door should be opened only when the temperature drops to 70-50 °C. Do not use a faulty device.
Sterilization of instruments, syringes, and blood transfusion systems can be done in a steam sterilizer (autoclave). The packaged items are placed in a sterilization chamber. If packages are placed in bins, their grilles must be open. Bixes or other packages are laid loosely so that the steam is distributed evenly.
Surgical instruments and syringes are sterilized for 20 minutes at 2 atm, which corresponds to a temperature of 132.9 °C. The start time of sterilization is counted from the moment the corresponding pressure is reached. Rubber gloves, blood transfusion systems, rubber drainage tubes are sterilized at 1.1 atm (steam temperature 120 °C) for 45 minutes. When unloading the autoclave, close the holes in the containers.

Sterilization methods in dry heat and steam sterilizers should be considered as basic. The boiling sterilization method is used in small medical institutions where there is no centralized sterilization facility. They use stationary or portable electric boilers in which instruments, syringes, needles, glass objects, rubber drains, catheters, and gloves can be sterilized.
Distilled water is poured into the boiler; to increase the boiling point of water and destroy the bacterial shell, add 20 g of sodium bicarbonate per 1 liter of water (2% solution). A thin quilted layer of cotton wool and gauze is placed at the bottom of the boiler so that the salts that fall out in the form of scale settle on it and not on the instruments.
Disassembled tools are placed on special grids and lowered with hooks to the bottom of the boiler, leaving the handles of the hooks outside, and the boiler is covered with a lid. Sterilization time is 40 minutes from the moment the water boils. At the end of sterilization, the mesh with instruments is picked up with hooks, allowed to drain and transferred to a special table covered with a sterile sheet folded in 4 layers. The operating nurse lays out instruments on a large operating table.
Syringes and needles are sterilized separately from instruments, disassembled (by boiling in distilled water without adding sodium bicarbonate), for 45 minutes. Syringes and needles for spinal puncture and intravenous infusions are boiled in double-distilled water without adding sodium bicarbonate.
Instruments, syringes and needles contaminated with pus, feces, after special pre-treatment, are sterilized by boiling for 90 minutes in a separate boiler.
Instruments, syringes and needles used in patients with gas gangrene must be carefully processed and subsequently sterilized by boiling. They are boiled for 1 hour, removed from the boiler and left at room temperature for 12-24 hours (for spore germination), and then re-sterilized by boiling for 1 hour (fractional sterilization).

In emergency cases when it is impossible to ensure sterilization of instruments
none of the above methods, use the burning method. 15-20 ml of alcohol is poured into a metal basin or tray, several tools are placed on the bottom and the alcohol is set on fire. The burning method is not reliable enough, fire and explosion hazards (presence of oxygen, vapors of narcotic substances in the indoor air), therefore it is resorted to in exceptional cases, strictly observing fire safety measures.
Cutting instruments (scalpels, scissors) become dull during sterilization using conventional methods, so it is carried out with virtually no heat treatment. After pre-sterilization preparation, instruments are immersed in 96% ethanol for 30 minutes or in a triple solution for 3 hours. Only short-term boiling is allowed cutting tools. Scalpels are placed in a separate mesh, their blades are wrapped in gauze and boiled in distilled water without adding sodium bicarbonate for 10 minutes, then placed in 96% ethyl alcohol for 30 minutes.
Stage IV - storage of sterile material. Sterile material is stored in a special room. Storage of non-sterile and sterile materials in the same room is not allowed. The sterility of the material in the containers (if they have not been opened) is maintained for 48 hours. If the materials were placed in linen packages (towels, sheets, diapers) and placed in containers for sterilization (for example, blood transfusion systems, rubber drains, syringes), they can be stored in these containers for up to 3 days. With centralized sterilization, syringes remain sterile for 25 days.

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 efficiently destroy harmful microorganisms, sterilization medical devices are actively used today. Their main advantages are convenience and reliability.

What must be sterilized in medical institutions?

This type of treatment is applied to all medical instruments that come into contact with the wound surface, mucous membranes, and the blood of the victim.

The specified 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 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, general cleaning is carried out weekly in operating rooms and manipulation rooms. 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:

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.
High level. Used for treating medical devices that come into contact with blood, injection solutions, blood vessels, clean body tissues. The main components of this type of disinfection are a 6% solution of hydrogen peroxide, aldehyde and chlorine compounds, as well as preparations including peracetic acid. Such products eliminate all pathogenic microparticles, except for fungal growth products.
Intermediate level. Makes it possible to cope with large lipid viruses and vegetative forms of 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 to be disinfected 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. Can be quite aggressive for those working with chemical reagents Therefore, 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:

Oxygen-containing preparations. The active component here is oxygen. The most prominent representative of this group is hydrogen peroxide.
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.
Halogen-containing substances, which are based on iodine, chlorine, and 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 treating work surfaces, medical equipment, and also for the skin.
Preparations containing succinic or glutaraldehyde. Effectively cope with bacteria, viruses, spores, macroorganisms.
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 contaminants are present 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 excess pressure. 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 high temperatures(180 C).
Microwave. Not suitable for cleaning large quantity 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. Involves the use of 20 percent hydrogen peroxide.
Ozone sterilization. Lasts about 60 minutes.
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, sterilizers that clean using hot air or steam are most often used.

Each of them has its own disadvantages and advantages.

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.
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 these devices, medical devices 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, it is 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. 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 packaging of equipment before sterilization.
Washing machines for disinfection. Helps get rid of visible dirt. Their the main objective– pre-sterilization treatment of medical instruments.
Distillers. Relevant for medical institutions that actively use autoclaves - distilled water is used for steam cleaning.

The need to sterilize veterinary instruments is intuitively clear - it is designed to prevent the penetration of microorganisms into the wound being treated and, as a result, infection of the patient upon contact.

General information

Widely used in medical and veterinary practice different kinds sterilization, which are divided into:

physical;
chemical methods.

Classic representatives of the first group include heat sterilization methods such as boiling, pasteurization, steam treatment under pressure, dry heat, ultrasonic and radiation sterilization.

At chemical methods microorganisms are removed with various solutions: iodine, formalin, acids, etc.

Basic sterilization methods

Boiling method for a long time was and remains the most common. Its essence is to heat the instrument in a disinfection boiler in distilled water with a 2% sodium bicarbonate solution. Boiling is used to treat metal containers and non-sharp tools. Cutting products quickly deteriorate when boiled, which is why scalpels, scissors, etc. immerse in a boiler for about 2 minutes, after which they are immersed in alcohol for several hours. Currently, sterilization by boiling is rarely used in medicine, since some microorganisms die only at temperatures of 150-200 degrees - when treated with steam or calcined in a dry-heat oven.

Special steam sterilizers modern models fully automated. This allows you to process each type of tool (packed in special boxes) according to a program specified by the manufacturer, which guarantees high degree asepsis. In addition to instruments, steam can be used to sterilize reusable catheters, drainages, gloves, underwear, etc. At the end of steam sterilization, bacteriological control of sterility is carried out using special indicators.

The use of steam during sterilization is a risk factor for burns, which electric dry-heat ovens do not have. There is no moisture, and it is also good to process the cutting tool without the risk of reducing its quality and service life. After laying the equipment being processed, it is heated to 140 degrees in 10-15 minutes and then, if necessary, to 200 degrees. Drying ovens can be various sizes and are located in close proximity to the operating room: the collection of the processed instrument is carried out exclusively in sterile clothing.

Gas sterilization is used to process polymer products and is based on the properties of ethylene oxide (and some other gases) to have a bactericidal effect on the instrument. Disadvantage - explosion hazard (you have to add to the composition carbon dioxide) And long time waiting until the gas is completely released from the internal structure.

Radiation sterilization is widespread when processing suture material, disposable syringes, catheters, etc. Ionizing radiation completely removes microorganisms, which, in combination with subsequent sterile packaging, allows instruments and devices sterilized by radiation to be stored for long months and even years.

Each of us at least once in our lives has wondered about sterilizing instruments for surgical procedures. Even if you took an ordinary needle to pick out a splinter and first rubbed it on the edge of your T-shirt (in best case scenario cotton wool with alcohol). More severe survivalists burn the tip of the knife over the flame in order to then cut the enemy bullet out of their buttocks...

In this publication I want to tell you the main points of preparing a surgical instrument before using it. So, let's begin…

ATTENTION!

This text has been corrected with the help of my colleagues and due to many inaccuracies. For which we thank them very much. I must also apologize to the readers for the mistakes made. In my practice, they use methods that involve the use of ready-made solutions and special equipment (autoclaves and dry-heat ovens). I tried to describe more ancient (and accessible) methods, relying on publicly available sources, which is why there are so many inaccuracies.
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I’ll say right away that sterilization is only one (final) part of the entire preparation of a surgical instrument. In total, there are three such parts: disinfection, washing*, and sterilization itself. I want to clarify right away. The difference between disinfection and sterilization is that disinfection involves the destruction of pathogenic microbes (those that cause disease), and sterilization involves the destruction of absolutely all. [ Disinfection is the destruction of all microorganisms. Sterilization - destruction of all microorganisms and their spores]

* - modern surgery combines disinfection and washing into the general concept of “pre-sterilization preparation”, but this only applies to terms... the essence does not change from this

Disinfection.

A freshly used instrument is contaminated with blood, pus and other body fluids. He is infected. It is very dangerous to carry out any manipulations with it - any accidental cut, puncture or simply contact with damaged skin can lead to you becoming infected with some kind of nasty thing. Therefore, the used instrument is immediately immersed in a bath of disinfectant immediately after the operation. In this case, it must be completely immersed in the solution. A 3% chloramine solution (exposure 40-60 minutes) or a 6% hydrogen peroxide solution (exposure 90 minutes)* is used as disinfectants. After disinfection, the instrument is washed with running water to remove the disinfectant. The procedure must be carried out with gloves (to protect yourself from infection).

* - It is necessary to take into account the fact that when processing (soaking) a large number of instruments, especially if they are heavily contaminated with blood or pus, the activity of the disinfectant solution decreases over time. But in this case, we are considering one survivalist, and his daily turnover of instruments will be negligible compared to that of a regional hospital.

The washing up.

Now our tool is not infected. But there is still “dirt” on it in the form of tissue remnants and medicines. Now all this crap needs to be washed off. The tool is immersed in a special washing (alkaline) solution, which includes detergent (washing powder), hydrogen peroxide and water*. Solution temperature 50-60°C, exposure 20 minutes. After this, the instruments are washed with brushes in the same solution, and then in running water. These manipulations must also be carried out with gloves to protect yourself from aggressive chemicals.

Proportions:
Water- 978 ml.
Hydrogen peroxide (27.5%)- 17 ml. (!!! - It is this high concentration that is produced by diluting 33% perhydrol.)
Washing powder- 5 g.

After washing, the instrument must be dried. Drying can be done naturally. Recently, especially during subsequent sterilization with hot air, instruments are dried in a dry-heat oven at 80°C for 30 minutes. After drying, the instruments are ready for sterilization.

The disinfectants and detergents that I described were used in medicine until recently and for us they have one advantage - they are more or less accessible. Modern medicine has many specially developed products that combine the properties of disinfectants and detergents. Thus, two separate stages have merged into one, when the instrument is first immersed in the solution, sour, disinfected there, and then washed in it with a brush.

Sterilization.

So, our tool is disinfected, clean and dried. Now he is ready for us to sterilize him. The methods for carrying it out vary. There are many classifications, but I personally like to divide them into two types: hot And cold. The choice of sterilization type depends on the type of instrument or material. Do not forget that Everything that comes into contact with the wound should be sterilized, and if you think that these are only tweezers and a scalpel, then you are deeply mistaken. This includes rubber gloves (once they were reusable), dressings, and optical equipment (for laparoscopic operations). Hot way easier to use, more reliable, but how do you imagine frying delicate optics or plastic/rubber?

In this regard, all instruments subject to sterilization are conditionally divided into groups:
1. Metal:
a) blunt (tweezers, clamps, needle holders...);
b) piercing and cutting (needles, scalpels, scissors...);
2. Containing plastic/rubber components.
3. Optics.

Only instruments belonging to category 1.a) can be sterilized using the hot method without any consequences. When exposed to high temperatures, piercing and cutting objects become dull very quickly and become unusable. Although if there is no other way out, then they can also be heat treated. Rubber gloves can also withstand several cycles of hot sterilization.

Hot sterilization methods:

Burning and boiling

Burning is currently not used in surgical clinics to sterilize instruments. The method can be used at home if it is impossible to use others. Burning metal tools held open flame. Typically, the instrument is placed on a metal tray, a small amount of ethyl alcohol is poured in, and it is set on fire. [ the method of igniting alcohol does not stand up to criticism and cannot be used for sterilization]

Boiling has long been the main method of sterilizing instruments, but recently it is rarely used, since this method reaches a temperature of only 100 ° C, which is not enough to destroy spore-bearing bacteria.

Instruments are boiled in special electric sterilizers of various capacities. Opened instruments (disassembled syringes) are placed on a mesh and immersed in distilled water (possibly adding sodium bicarbonate - up to 2% solution).

Regular time sterilization - 30 minutes from the moment of boiling.

After sterilization is completed, the mesh with instruments is removed using special sterile handles.

Pressure steam sterilization (autoclaving)

An autoclave (pressurized steam sterilization apparatus) can heat water at elevated pressure. This increases the boiling point of water and, accordingly, the temperature of the steam to 132.9 ° C (at a pressure of 2 atmospheres).

Surgical instruments, dressings, linen and other materials are loaded into the autoclave in special metal boxes - Schimmelbusch boxes. Bixes have side holes which are opened before sterilization. The lid of the box is tightly closed.

After loading the bixes, the autoclave is closed with a sealed lid and necessary manipulations to start it working in a certain mode. The operation of the autoclave is controlled by a pressure gauge and thermometer.

There are three main sterilization modes:
at a pressure of 1.1 atmospheres - 1 hour,
at a pressure of 1.5 atmospheres - 45 minutes,
at a pressure of 2 atmospheres - 30 minutes.

After sterilization is completed, the bixes remain in the hot autoclave for some time to dry with the door slightly open. When removing the bixes from the autoclave, close the holes in the walls of the bixes and mark the date of sterilization (usually on a piece of oilcloth attached to the bixes). A closed container keeps the items in it sterile for 72 hours.

Hot air (dry heat) sterilization

The active agent in this sterilization method is heated air. Sterilization is carried out in special devices - dry-heat sterilizers.

The instruments are placed on the shelves of the sterilizer cabinet and first dried for 30 minutes at a temperature of 80°C with the door ajar. Sterilization is carried out with the door closed for 1 hour at a temperature of 180°C. After this, when the sterilizer cabinet cools down to 50-70°C, the door is opened slightly and upon final cooling, the chamber with sterile instruments is unloaded.

Sterilization in an autoclave and dry-heat oven is currently the main, most reliable method of sterilization surgical instruments.

In this regard, hospitals usually have special central sterilization departments (CSD), where, using these two methods, the most simple and frequently used instruments from all departments of the hospital are sterilized (syringes, needles, simple surgical kits, probes, catheters, etc.) .

Cold sterilization methods:

Radiation sterilization

Antimicrobial treatment can be carried out using ionizing radiation (gamma rays), ultraviolet rays and ultrasound. Most Applications In our time, sterilization with gamma rays has been achieved.

The isotopes Co60 and Cs137 are used. The dose of penetrating radiation must be very significant - up to 20-25 μGy, which requires compliance with particularly strict safety measures. In this regard, radiation sterilization is carried out in special rooms and is a factory method of sterilization (it is not performed directly in hospitals).

Sterilization of instruments and other materials is carried out in sealed packages and, if the latter are intact, are preserved for up to 5 years. Sealed packaging makes convenient storage and use of tools (you just need to open the package). The method is beneficial for sterilizing simple disposable instruments (syringes, suture material, catheters, probes, blood transfusion systems, gloves, etc.) and is becoming increasingly widespread. This is largely explained by the fact that during radiation sterilization the properties of the objects being sterilized are not lost at all.

Gas sterilization

Gas sterilization is carried out in special sealed chambers.

The sterilizing agent is usually: formaldehyde vapor (formaldehyde tablets are placed at the bottom of the chamber [ paraform]) or ethylene oxide. Instruments placed on a mesh are considered sterile after 6-48 hours (depending on the components of the gas mixture and the temperature in the chamber).

Distinctive feature method is its minimum bad influence on the quality of instruments, and therefore the method is used primarily for sterilization of optical, particularly precise and expensive instruments.

Unlike radiation sterilization, the method is used directly in hospitals.

Sterilization with antiseptic solutions

Sterilization with solutions of chemical antiseptics, as well as radiation and gas sterilization, refers to cold sterilization methods and does not lead to dulling of instruments, and therefore is used for processing primarily cutting surgical instruments.

For sterilization, three solutions are mainly used: triple solution*, 96° ethyl alcohol [ ethyl alcohol should only be 70°, since this concentration most effectively kills microorganisms] and 6% hydrogen peroxide. Recently, an alcohol solution of chlorhexidine, pervomur and others have been used for cold sterilization of optical instruments.

Triple solution:
carbolic acid- 3 g,
formalin- 20 g,
soda- 15 g,
water- 1000 ml.

For cold sterilization, instruments are completely immersed in an open (or disassembled) form in one of the specified solutions. When soaked in alcohol and triple solution, instruments are considered sterile after 2-3 hours, in hydrogen peroxide - after 6 hours.

I consider this method to be the most optimal for use “in the field”.

Some of the information (in the form of ready-made text) was taken by me from this site. I can recommend him to anyone interested in surgery. The information is well systematized, presented in an accessible form and not too specialized. About surgery in general terms.

Thank you for your attention.

The processing of all instruments includes the sequential implementation of two stages: pre-sterilization treatment and sterilization itself. The method of sterilization primarily depends on the type of instruments.

Pre-sterilization preparation.

Pre-sterilization preparation consists of disinfection, washing and drying. All types of instruments are subjected to it. The type and volume of pre-sterilization treatment in the recent past depended on the degree of infection of instruments. Thus, in the past, the processing of instruments was significantly different after clean operations (dressings), purulent operations, operations in patients who had hepatitis and were classified as at risk for AIDS. However, at present, given the high danger of the spread of HIV infection, the rules for pre-sterilization preparation have been tightened and are equated to methods for processing instruments that provide an unconditional guarantee of the destruction of HIV. It should be noted that instruments after purulent operations, operations on patients who have had hepatitis within the last 5 years, as well as when there is a risk of HIV infection, are treated separately from others. All pre-sterilization procedures must be performed with gloves!

Disinfection (disinfection).

Immediately after use, instruments are immersed in a container with disinfectants (accumulator). In this case, they must be completely immersed in the solution. As disinfectants, use a 3% solution of chloramine (exposure 40–60 minutes) or a 6% solution of hydrogen peroxide (exposure 90 minutes). After disinfection, the instruments are washed with running water.

The washing up.

The tools are immersed in a special washing (alkaline) solution, which contains detergent (washing powder), hydrogen peroxide and water. Solution temperature 50 – 60 “C, exposure 20 minutes. After soaking, wash the instruments with brushes in the same solution, and then in running water.

Drying can be done naturally. Recently, especially during subsequent sterilization with hot air, instruments are dried in a dry-heat oven at a temperature of 80 C for 30 minutes. After drying, the instruments are ready for sterilization.

Actually sterilization.

The choice of sterilization method primarily depends on the type of surgical instruments.

All surgical instruments can be divided into three groups:

Metal (cutting: scalpel, scissors, surgical needles, etc.) (non-cutting: syringes, needles, clamps, tweezers, hooks, etc.)

rubber and plastic (catheters, probes, drainages, enema tips, etc.)

optical (laparoscope, gastroscope, choledochoscope, cystoscope, etc.).

The main method of sterilization of non-cutting metal instruments is sterilization with hot air in a dry-heat oven or autoclave under standard conditions. Some types of simple instruments (tweezers, clamps, etc.) intended for one-time use can be sterilized by radiation.

Sterilization of cutting metal instruments.

Sterilization of cutting instruments using thermal methods leads to their dullness and loss of necessary properties. The main method of sterilizing cutting instruments is a cold chemical method using antiseptic solutions. The best methods of sterilization are gas sterilization (in an ozone-air chamber) and radiation sterilization in a factory. The latter method has become widespread when using disposable scalpel blades and surgical needles (atraumatic suture material).