Preparations used for cold sterilization of surgical instruments. Sterilization of surgical instruments methods of sterilization of surgical instruments sterilization
The main way to sterilize surgical instruments is boiling.
For boiling, simple or electric sterilizers, enameled dishes with a lid are used.
The heat source can be a gas or electric stove. Boiling sterilizes metal, glass, rubber objects. Before boiling, the instruments are disassembled, opened, mandrels are removed from the injection needles, and the glass and sharp parts of the instruments are wrapped in 1-2 layers of gauze. Boil in water or in solutions of caustic or bicarbonate soda. The duration of sterilization from the moment of boiling water is 20 minutes, in alkaline solutions - 10-20. After the specified period, the mesh with the instruments is removed from the sterilizer using special hooks, and the instruments are laid out on a sterile tissue or left in the sterilizer, after draining the water. Syringes are usually left in water until they are completely cool.
Glass surgical instruments (syringes), devices (test tubes, beakers) are boiled separately from metal instruments without the addition of alkalis.
Rubber items (tubes, gloves, catheters, drains) are sterilized in an autoclave or in boiling water for 30 minutes. It can also be treated with chemical solutions by immersion. Gloves worn on hands are recommended to be treated with an alcohol solution of formalin.
Sterilization by burning (flaming) is used to disinfect large instruments and enamelware (basins for instruments). Tools are placed in an enamel dish or sterilizer, doused with a small amount of alcohol and fired. Metal instruments can be flambéed on the fire of an alcohol lamp or set on fire with cotton soaked in alcohol. This method of sterilization is not very good, since blood clots, wool, bacteria can remain in the holes, locks of instruments, and the instruments themselves, especially their cutting parts, are badly damaged during firing.
Sterilization of instruments with chemical agents refers to the cold sterilization method. The tools are completely immersed for 30-60 minutes in disinfectant solutions: lysol, carbolic acid, Karetnikov's liquid, formalin, sodium carbonate, ethyl alcohol, or for 4-6 hours - in hydrogen peroxide. Antiseptic solutions are also used in the case when the instruments deteriorate from boiling. Gas sterilization is possible, carried out in special chambers and used to sterilize optical, highly precise and expensive instruments.
Sterilize surgical instruments with dry air (dry heat, in special thermostats) for 1.5 hours at a certain constant temperature.
In medical practice, they use the factory method of sterilization - gamma rays, ultraviolet rays, ultrasound (according to strictly defined methods).
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The processing of all instruments includes the sequential execution of two stages: pre-sterilization processing 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 the instruments. So, before, the processing of instruments after clean operations (dressings), purulent operations, operations in patients who had hepatitis and were at risk for AIDS was significantly different. However, at present, given the high risk of the spread of HIV infection, the rules for pre-sterilization preparation have been tightened and equated to methods for processing instruments that provide an unconditional guarantee of HIV destruction. It should be noted that instruments after purulent operations, operations in patients who have had hepatitis over the past 5 years, as well as at the risk of HIV infection, are treated separately from others. All pre-sterilization procedures must be performed with gloves!
Disinfection (disinfection).
Immediately after use, the instruments are immersed in a container with disinfectants (accumulator). In this case, they must be completely immersed in the solution. As disinfectants, a 3% solution of chloramine (exposure 40–60 min) or a 6% solution of hydrogen peroxide (exposure 90 min) is used. After disinfection, the instruments are washed with running water.
The washing up.
Tools are immersed in a special washing (alkaline) solution, which includes detergent (washing powder), hydrogen peroxide and water. Solution temperature 50 - 60 "C, exposure 20 min. After soaking, the tools are washed with brushes in the same solution, and then in running water.
Drying can be done naturally. Recently, especially during subsequent hot air sterilization, the instruments are dried in a dry oven at a temperature of 80 C for 30 minutes. After drying, the instruments are ready for sterilization.
actual 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, drains, enema tips, etc.)
optical (laparoscope, gastroscope, choledochoscope, cystoscope, etc.).
The main method for sterilizing non-cutting metal instruments is hot air sterilization in a dry oven or autoclave under standard conditions. Some types of simple instruments (tweezers, clamps, etc.) intended for single use can be sterilized by radiation.
Sterilization of cutting metal instruments.
Sterilization of cutting tools using thermal methods leads to their blunting and loss of the necessary properties. The main method of sterilizing cutting instruments is a cold chemical method using antiseptic solutions. The best sterilization methods are considered to be gas sterilization (in an ozone-air chamber) and radiation sterilization in the factory. The latter method has become widespread using disposable scalpel blades and surgical needles (atraumatic suture material).
From a functional point of view, surgical instruments are divided into ordinary metal, cutting, plastic and rubber, as well as optical. The main regulatory document for the processing of medical instruments is: “Industry standard. Sterilization and disinfection of medical devices. Methods, means, modes ("I 42-21 - 2-85. Order M3 of the USSR dated 10.06.85.). Taking into account the unfavorable epidemiological situation for AIDS, the OST was supplemented by order of the GUZO and TsGSEN No. 222/80 dated 06.27.00. SanPiN 2.1. 3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities" SanPiN 3.1.5.2826-10 "Prevention of HIV infection.
According to these documents, the following sequential stages of processing medical devices are assumed: disinfection, pre-sterilization cleaning and sterilization.
Disinfection is carried out in order to protect medical personnel from infection when processing instruments after surgery. Physical methods of disinfection (boiling, steam and air) are practically not used in a hospital due to bulkiness, lack of efficiency, or because of the rapid wear of tools. The following agents are used as chemical methods: a) 3% solution of chloramine - 60 min; b) 6% hydrogen peroxide solution - 60 min; c) 6% hydrogen peroxide solution + 0.5% detergent solution - 60 min; d) 4% formalin solution (for formaldehyde) - 60 min; e) 4% hydrogen peroxide solution - 90 min; f) preparation "Sydex" - 15 min. All instruments are filled with one of these solutions until they are completely immersed. After disinfection, they are washed with running water.
Pre-sterilization cleaning is carried out to remove protein, fat and mechanical contaminants, as well as drugs. During pre-sterilization cleaning, the following steps are performed sequentially: a) soaking for 15 minutes in a washing solution, which includes hydrogen peroxide 3% - 156 ml, detergent - 5 g and water to a volume of 1 l; b) individual washing of each product in the washing complex for 30 seconds; c) rinsing with running water after using detergents - at least 3 minutes; d) rinsing with distilled water to wash off salts; e) drying of tools until the moisture disappears completely.
actual sterilization. Previously used boiling retains its value only for disinfection or sterilization of instruments for individual use. If the previous steps are carried out during the sterilization of any instruments, regardless of their type, then with direct sterilization, various methods are used differentially depending on the type of instrument to be sterilized.
Ordinary metal instruments are sterilized in a dry oven or in a steam sterilizer (autoclave).
Sterilization of instruments in a dry-heat cabinet is carried out with hot air for 1 hour at a temperature of 180 C without packaging (open method). To control the quality of sterilization in a dry-heat oven, the following test indicators are used: hydroquinone (the indicator turns black) and thiourea (the indicator turns yellow to orange).
Sterilization in a steam sterilizer occurs as a result of exposure to water vapor. It consists of two metal chambers nested one inside the other and hermetically sealed with a front cover. Steam from the steam generator enters the outer chamber, from it into the inner chamber and then into the condenser. If the outlet valve of the inner chamber is closed, then the vapor pressure in the inner chamber begins to increase (maximum - up to 2 atm.). In parallel, the steam temperature rises to 132°C at 2 atm. Conventional metal surgical instruments are sterilized at a pressure of 2 atm. within 20 min. Modern steam sterilizers must be of a pass-through type, that is, they must have two front covers on opposite sides of the apparatus, and these covers must be located in different rooms for complete isolation of sterile and non-sterile material. In addition, steam sterilizers must be equipped with generators that create a pulsating vacuum to remove air from the sterilizer, which is a heat insulator and prevents effective sterilization. The instruments to be sterilized in a steam sterilizer are placed in Shimelbusch biscuits or biceps with a special bacterial filter, as well as in special bags for sterilization. Sterile instruments from a closed Shimelbush bix can be used within 3 days, from a closed bix equipped with a filter - within 20 days. After opening the bixes or packages, their contents should be used within 1 day, subject to all asepsis rules.
Packages for sterilization are of several types: a) crepe paper, which is wrapped in the form of an envelope (in the absence of violations of the integrity of the package, it retains the state of sterility of the contents for 3 days); b) paper packaging with a hot-melt adhesive strip and a sterilization indicator [class (unopened packaging keeps the contents sterile for 60 days); c) combined packaging, in which one side is made of laminated paper, and the other side is made of polyethylene film, has a hot-melt adhesive strip and a class I sterilization indicator (unopened packaging keeps the contents sterile for 1 year). Packaging bags for sterilization are produced by European companies Rexam (England), SPS - lab. (France), Steriking (Finland), etc. Open sterilization in a steam sterilizer should not be carried out!
There are chemical (cold) methods for sterilizing instruments: 6% hydrogen peroxide solution at 18°C for 6 hours, paraform or 16 "/formaldehyde solution in sealed chambers for 48 hours, 0.5% water-alcohol solution chlorhexidine for 5 minutes, sterilization in special chambers with ethylene oxide PO), as well as radiation sterilization.
Cutting metal instruments (scalpels, surgical needles, scissors, etc.) are sterilized by cold methods so that they do not become dull under the influence of hot steam. The most commonly used for this purpose is hydrogen peroxide or an alcohol solution of chlorhexidine. Scissors can be sterilized in a dry oven. Industrial radiation or ethylene oxide sterilization of scalpels and single-use atraumatic suture is optimal.
Plastic, rubber and optical instruments. Sterilization of rubber and plastic products is possible by the thermal method in a steam sterilizer under a pressure of 1.1 atm. within 45 min. At present, disposable gloves sterilized by industrial radiation are used, however, in extreme conditions, rubber gloves can be sterilized by autoclaving. For the chemical method of sterilization, formalin vapor, ethanol, ethylene oxide, etc. are used.
In addition to gas sterilization of optical instruments (endoscopes), a 0.5% alcohol solution of chlorhexidine, pervomur or sideks is used.
1.2.2. Sterilization of dressings and surgical linen. Dressings and underwear include large and small gauze napkins, gauze swabs, other special gauze and cotton products, as well as sheets, diapers and gowns. The set of material to be autoclaved is called a stack. Steam sterilization is carried out in Schimmelbusch cups, metal cups with filters, as well as in cotton sheets or diapers. Biks are supplied with labels, which should contain information about the contents of the biks and its belonging to one or another operating room or dressing room. The process of preparing dressings for surgery or dressing is divided into 3 stages.
I stage of pre-sterilization preparation of the material. The gauze cloth is cut into pieces of various sizes, depending on what is to be made - small napkins, large napkins, tampons, etc. The gauze should be soft and hygroscopic. The dressing is folded so that the free edges are tucked inside the napkins or tampons.
Stage II - laying and preparing the material for sterilization. There are 3 main types of bix styling. Universal stacking is usually used in dressing rooms and for small operations. At the same time, the material is placed in biks by sectors (in one sector - small napkins, and in the other - large napkins, in the third - tampons, etc.) so that you do not have to violate sterility when searching for one or another type of material. Targeted laying includes everything you need to perform typical manipulations, procedures and minor operations (laying for tracheostomy, for catheterization of the subclavian vein, for epidural anesthesia, etc.). All the necessary tools, dressings and underwear are placed in the bix. View stacking is used when working in large operating units. At the same time, one type of dressing material or linen is placed in the bix (in one - dressing gowns, in the other - sheets, in the third - napkins, etc.).
Currently, single-use surgical underwear made of non-woven material (sheets, diapers, gowns, caps and masks), as well as packages with gauze wipes of industrial radiation sterilization, is increasingly being used.
III stage - sterilization. Sterilization of linen is carried out by a steam method under pressure of 2 atm. at a temperature of 132°C for 20 min. Before loading into the autoclave, check whether the holes in the bix are open. After sterilization of the hole in the bix, in the process of removing it from the autoclave, it is closed with a metal rotating tape on the case of the bix and the date of sterilization is marked on it.
TREATMENT OF THE SURGEON'S HANDS
Processing (washing) the surgeon's hands is a very important procedure. There are certain rules for washing hands. Consistently it is necessary to carry out: mechanical and chemical (degreasing) treatment, exposure to antiseptic agents and tanning (closing the pores to maintain the sterility of the skin surface).
Modern methods of hand treatment do not require special tanning (film-forming antiseptics or antiseptics with a tanning element are used).
Mechanical and chemical processing
Mechanical and chemical treatment is carried out by washing hands under a tap with a brush and soap. Hands are thoroughly washed from the fingertips to the upper third of the forearm. At the same time, a certain sequence of processing is observed, which is based on the principle "do not touch the treated areas of the hands with less clean skin and objects."
The use of modern methods allows washing hands simply with soap or liquid detergents (in the absence of domestic hand contamination).
Each of us at least once in his life wondered about the sterilization of an instrument for surgical manipulations. Even if you took an ordinary needle to pick out a splinter and first wiped it on the edge of the T-shirt (at best, with a cotton swab 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 many thanks to them. I must also apologize to readers for the mistakes made. In my practice, methods are used 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, based on publicly available sources, therefore there are so many inaccuracies._______________________________________________________________________________
I must 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 *, sterilization itself. I want to be clear right now. The difference between disinfection and sterilization is that disinfection involves the destruction of pathogenic microbes (those that cause disease), while sterilization - the destruction of absolutely everything. [ Disinfection is the destruction of all microorganisms. Sterilization - the 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 of this does not change
Disinfection.
A freshly used instrument is contaminated with blood, pus, and other bodily 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 the fact that you become infected with some kind of muck. Therefore, the used instrument immediately after the operation is immersed in a bath with a disinfectant. In this case, it must be completely immersed in the solution. As disinfectants, a 3% solution of chloramine (exposure 40-60 minutes) or a 6% solution of hydrogen peroxide (exposure 90 minutes) * is used. 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 abundantly 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 the regional hospital.
The washing up.
Now our tool is not infected. But there is still “dirt” on it in the form of remnants of tissues, medicines. Now all this crap needs to be washed away. 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 that, the tools 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:After washing, the instrument must be dried. Drying can be done naturally. Recently, especially during subsequent hot air sterilization, the instruments are dried in a dry oven at 80°C for 30 minutes. After drying, the instruments are ready for sterilization.
Water- 978 ml.
Hydrogen peroxide (27.5%)- 17 ml. (!!! - It is such a high concentration that is made by diluting 33% perhydrol.)
washing powder- 5 y.
Those disinfectants and detergents that I described were used in medicine until recently, and for us they have one advantage - they are more or less available. Modern medicine has many specially designed products that combine the properties of disinfectants and detergents. Thus, two separate stages have merged into one, when the instrument is first immersed in a solution, sour, disinfected there, and then washed with a brush in it.
Sterilization.
So, our instrument is disinfected, clean and dried. Now he is ready for us to sterilize him. The methods for doing it are different. There are many classifications, but I personally like to divide them into two types: hot And cold. The choice of type of sterilization 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 this is only tweezers and a scalpel, then you are deeply mistaken. This includes rubber gloves (once they were reusable), and dressings, and optical equipment (for laparoscopic operations). The hot method is easier to use, more reliable, but how do you imagine frying delicate optics or plastic / rubber?In this regard, all instruments to be sterilized 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 by the hot method without any consequences. Stitching and cutting objects, when exposed to high temperatures, become dull very quickly and become unusable. Although if there is no other way out, then they can also be heat treated. Also, rubber gloves can withstand several cycles of hot sterilization.
Hot sterilization methods:
Roasting and boilingFiring is currently not used in the surgical clinic for the sterilization of instruments. The method can be used at home when it is impossible to use others. The firing of metal instruments is carried out with an open flame. Usually, a tool is placed on a metal tray, a small amount of ethyl alcohol is poured and set on fire. [ the alcohol ignition method does not stand up to scrutiny and cannot be used for sterilization]
Boiling has long been the main method of sterilizing instruments, but has rarely been used recently, since this method achieves a temperature of only 100 ° C, which is not enough to kill spore-bearing bacteria.
Tools are boiled in special electric sterilizers of various capacities. Opened instruments (disassembled syringes) are placed on a grid and immersed in distilled water (it is possible to add sodium bicarbonate - up to 2% solution).
The usual sterilization time is 30 minutes from the moment of boiling.
After the end of sterilization, the mesh with the instruments is taken out with the help of special sterile handles.
Steam sterilization under pressure (autoclaving)
In an autoclave (pressurized steam sterilization apparatus), water can be heated under increased pressure. This raises 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, underwear and other materials are loaded into the autoclave in special metal boxes - Schimmelbusch biks. Bixes have side holes that are opened before sterilization. The bix lid is tightly closed.
After loading the biks, the autoclave is closed with a hermetic lid and the necessary manipulations are performed to start its operation in a certain mode. The operation of the autoclave is controlled by the indicators of a pressure gauge and a 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.
At the end of sterilization, the bixes remain for some time in a hot autoclave to dry with the door slightly ajar. When removing the biks from the autoclave, the holes in the walls of the biks are closed and the date of sterilization is noted (usually on a piece of oilcloth attached to the biks). A closed bix keeps the items in it sterile for 72 hours.
Hot air sterilization (dry heat)
The active agent in this method of sterilization is heated air. Sterilization is carried out in special devices - dry-heat cabinets-sterilizers.
The instruments are placed on the shelves of the sterilizing 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 that, when the cabinet-sterilizer cools down to 50-70°C, the door is slightly opened and, upon final cooling, the chamber with sterile instruments is unloaded.
Sterilization in an autoclave and a dry oven is currently the main, most reliable way to sterilize surgical instruments.
In this regard, special central sterilization departments (CSO) are usually allocated in hospitals, 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 sterilizationAntimicrobial treatment can be carried out using ionizing radiation (gamma rays), ultraviolet rays and ultrasound. Gamma-ray sterilization has received the greatest use in our time.
The isotopes Co60 and Cs137 are used. The dose of penetrating radiation should be very significant - up to 20-25 μGy, which requires compliance with particularly strict security 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, with the integrity of the latter, lasts up to 5 years. The hermetic package makes it convenient to store and use the tools (you just need to open the package). The method is beneficial for the sterilization of simple disposable instruments (syringes, suture material, catheters, probes, blood transfusion systems, gloves, etc.) and is becoming more and more widespread. This is largely due to the fact that the properties of the sterilized objects are not lost at all during radiation sterilization.
Gas sterilization
Gas sterilization is carried out in special sealed chambers.
The sterilizing agent is usually: formalin vapor (formaldehyde tablets are placed on the bottom of the chamber [ paraform]) or ethylene oxide. Instruments laid on the grid are considered sterile after 6-48 hours (depending on the components of the gas mixture and the temperature in the chamber).
A distinctive feature of the method is its minimal negative impact on the quality of instruments, and therefore the method is used primarily for sterilization of optical, highly accurate 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 blunting of instruments, and therefore is used primarily for processing cutting surgical instruments.
Three solutions are mainly used for sterilization: triple solution *, 96 ° ethyl alcohol [ ethyl alcohol should be only 70 °, since it is this concentration that 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, the instruments are completely immersed in the open (or disassembled) form in one of the indicated solutions. When soaked in alcohol and a triple solution, the instruments are considered sterile after 2-3 hours, in hydrogen peroxide - after 6 hours.
I consider this method 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. For those interested in surgery, I can recommend it. The information is well organized, presented in an accessible form and not too specialized. About surgery in general.
Thanks for attention.
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 dressing gowns, 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.
Terms 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. Before boiling, such instruments are immersed for several hours in a saturated solution of boric acid (if contaminated with Pseudomonas aeruginosa) or in a solution of lysoform.
Boiling of instruments intended for "clean" and for purulent operations is carried out in separate sterilizers. Instruments can be sterilized in bixes or wrapped in sheets in an autoclave for 30 minutes. at a pressure of 2 am. Dry-air sterilization is also used in drying cabinets at t ° 180-200 ° for 40 minutes. In emergency cases, 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 a 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 treatment. 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 l. 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. The systems are mounted, placed in bixes or bags made of dense 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; a water-alcohol solution of chloramphenicol 1:1000 or one of the solutions used to sterilize cutting instruments. 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 a water tap and within 15-30 minutes. 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. The inner surface of the 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, rinsed until the water is clear, and dried 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 in 96% alcohol in jars with ground stoppers for storage. Before the operation, the required amount of silk is 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, reeled and fat-free 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 solution of sublimate 1:1000 (5 min.), as well as by the methods proposed for silk sterilization. Kapron and lavsan threads 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 - sheep intestines, and it does not tolerate boiling and autoclaving. Sterilization of catgut according to the Sitkovsky method: the catgut is degreased in ether for 12-24 hours, the threads are wiped with a swab dipped in a mercuric chloride solution 1: 1000, 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 cork 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 is achieved. 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.