How are surgical instruments disinfected? Sterilization of a veterinary instrument: basic methods

Methods for processing medical devices are strictly regulated by methodological guidelines, which are approved by the head of the Department of State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia.

Processing of tools and materials is carried out in order to prevent nosocomial infections in staff and patients. There are two types of treatment: disinfection and sterilization.

Disinfection of medical devices

Disinfection ensures the destruction of pathogenic and opportunistic pathogens - bacteria, viruses, fungi on the surface of the products themselves, as well as in their cavities and channels. Disinfection does not ensure the destruction of spore forms. Absolutely all products in contact with the patient are subjected to disinfection. After this type of cleaning, the instruments are either used for their intended purpose or subjected to further sterilization.

Disinfection is carried out by physical or chemical cleaning methods. The choice of method depends on the purpose and characteristics of the product.

Physical is more preferable as it is environmentally friendly, reliable and safe for personnel. Physical (thermal) methods of disinfection include:

boiling medical instruments in distilled water or with the addition of sodium carbonate;
steam (in an autoclave);
air (dry heat sterilizer).

For physical disinfection, the same devices are used as for sterilization, but in milder modes of operation.

Chemical disinfection is carried out by completely immersing the instruments in a special solution. Only the following groups of compounds are allowed to be used for disinfection: cationic surfactants, oxidizing agents, chlorine-containing agents, agents based on alcohols, hydrogen peroxide, aldehydes. The instructions of the Ministry of Health strictly regulate the use of disinfectants: their list, the concentration of the solution and the exposure time, the type of infection to be destroyed and the type of products to be cleaned. After disinfection, the product must be rinsed with running water. drinking water and wash off the remnants of dirt by mechanical means (brushes, ruffs, napkins).

Pre-sterilization cleaning

This type of cleaning is used after disinfection of products and their subsequent washing with running drinking water. The purpose of pre-sterilization treatment is to remove mechanical, protein and fatty contaminants, drug residues from products.

To clean instruments and materials before sterilization, chemical solutions strictly regulated by the Ministry of Health are used, indicating their concentration, temperature and holding time, cleaning method and type of products to be cleaned. If the selected solution has not only a detergent, but also a disinfectant property, then pre-sterilization cleaning may well be combined with disinfection.

Sterilization

Sterilization is carried out with the aim of the physical destruction of all non-pathogenic and pathogenic microorganisms on them, including spores.

Sterilization is subjected to all instruments and materials that have come into contact with the wound surface, have come into contact with the patient's blood or blood injected into it, as well as with injectable preparations; contact with mucous membranes or capable of damaging mucous membranes.

For this, chemical and physical (thermal) methods of sterilization are used. Choose a method depending on the properties of the sterilized products.

Physical (thermal) sterilization methods

The data is carried out using:

steam in autoclaves (steam method);
hot air in dry ovens (air method);
glass beads;
microwaves under partial vacuum.

Sterilization in a steam sterilizer

With this method of cleaning instruments, saturated steam under pressure of 0.05-0.21 MPa with a steam temperature of 110-135 ° C is used as a sterilizing agent. Cleaning is carried out in special medical autoclaves for sterilization. The principle of operation of the device: with increasing pressure, the boiling point of water increases. If at normal pressure water boils at 100 ° C, then with an increase in pressure by only 1 atm, already at 120 ° C. Under such conditions, microorganisms die within 30 minutes. If you increase the pressure by 2 atm, the water will boil at a temperature of 134 ° C, the microbes will die in 15 minutes.

Cleaning of instruments in an autoclave is carried out in three stages:

When is an autoclave used for sterilization?

An autoclave is used for sterilization:

Manicure tools.
Special and general surgical instruments.
glass.
Parts of devices made of corrosion-resistant materials.
Medical linen, dressing and suture material.
Rubber products (gloves, probes, catheters, tubes).
glass syringes.

Glass products, textiles, from corrosion-resistant materials, ligature suture material are treated with steam at a temperature of 134-126 ° C under a pressure of 0.21-0.14 MPa. Rubber products are cleaned at a temperature of 120-122 °C. Products made of plastics (polyethylene, PVC) are sterilized under milder conditions: a pressure of 0.11-0.05 MPa and a temperature of 121-110 °C.

Rubber gloves should be dusted with talc inside and out to prevent sticking. Between the gloves you need to lay paper or gauze. In addition, each pair of gloves should be wrapped separately.

Cleaning in the autoclave of products is carried out in biks - sterilization boxes. In addition, all products must be additionally packaged in:

double soft pack;
parchment;
unimpregnated bag paper;
heat-resistant bag paper;
crepe paper;
high-strength packaging paper.

If no filter or double soft packaging was used for sterilization, the products are considered clean for 3 days, if parchment, unimpregnated bag paper, heat-resistant bag paper, crepe paper, high-strength packaging paper or a sterilization box with a filter - 20 days.

Sukhozhar

Dry heat sterilization is used for products that cannot be exposed to wet steam or gas. The hot air circulating inside the instrument is used as a sterilizing agent. Sterilization mode in an air sterilizer: temperature from 160 to 200 °C, exposure time from 30 to 150 minutes. The higher the air temperature, the shorter the holding time required. At a temperature of 200 ° C, the products are processed for 30 minutes, 180 ° C - from 45 to 60 minutes, 160 ° C - 150 minutes. The choice of sterilization mode in the air sterilizer depends on the characteristics of the product. The time must be counted from the moment the air temperature inside the chamber reaches 180°C, and not from the moment the cabinet is turned on. The dry-heat cabinet for sterilization of medical instruments is equipped with a temperature indicator, a timer and a thermostat.

Dry high temperature air kills vegetative forms of microorganisms, as well as all spores. However, the breadth of application of this thermal sterilization method is very limited. The reason is the high duration of the cleaning process and the instability of many materials to such high temperatures(200 °C).

When is a dry oven used for sterilization?

Use a dry oven for sterilization:

Silicone rubber medical instruments.
Surgical instruments.
Gynecological instruments.
dental instruments.
glass syringes.
injection needles.
Parts of devices made of materials that are not resistant to corrosion.

The following types of packages can be used in the sterilization oven:

Wet-strength bag paper.
Crepe paper.
High-strength packaging paper.

It is also possible to sterilize in open trays without packaging.

Sterilization rules

Carrying out sterilization in dry-heat cabinets, the products are wrapped in one or two layers of packaging or placed in trays. After loading the material to be cleaned, turn on the device. After the air in the cabinet warms up to 90 ° C, the doors are closed. Sterilization is carried out directly. After the set time has elapsed, the device is turned off, and the air temperature is expected to drop to 90 ° C. Only then will it be possible to open the doors and pick up clean tools and materials. Thus, the whole process lasts at least two hours.

Products treated with air in the package are kept sterilized for 20 days. Products air-cleaned without packaging should be placed on a "sterile table" and used during the work shift.

Only dry products should be placed in a dry-heat cabinet for sterilization, therefore they are dried after pre-sterilization preparation in drying cabinets at a temperature of 85 ° C.

Sterilization will be of high quality only if the hot air in the chamber is distributed evenly, for this it is necessary to load the device correctly. Products must be laid horizontally, across the grooves of the shelves or cassettes. If the instruments are processed without packaging, they must not touch each other. You can not clutter up the chamber, it is necessary to place the instruments in such a way that air is freely supplied to each of them. It must be ensured that the ventilation grilles and purge windows are not blocked. So that bulky products do not interfere with the air flow, they must be placed on the upper metal grill. Products can be loaded and unloaded when the air temperature in the chamber drops to 50-40 °C.

Sterilization with glass beads

The cleanser is heated glass (glasperlene) balls. This method sterilizes dental equipment (diamond heads, burs, drills). Processing lasts 15-180 seconds.

Chemical sterilization

This cleaning method is used only if thermal methods of sterilization of this product are not possible. Chemical treatment is carried out on tools and materials made of thermolabile material with the condition of good access of the sterilizing agent to all cavities and surfaces of the object. The use of this cleaning method is limited, since the instruments cannot be sterilized in the package, which means that they cannot be stored after processing. In addition, after sterilization with chemical agents, the instruments must be washed, which is fraught with secondary contamination.

Features of processing products used for the provision of hairdressing and cosmetic services

Any procedure that may cause injury to the skin or mucous membranes must be carried out with sterile instruments. If the product is used repeatedly for these procedures, then it must be disinfected, pre-sterilized cleaning and sterilized. In modern hairdressing and beauty salons, chemical disinfection is usually used, combined with pre-sterilization cleaning, a dry-heat cabinet or an autoclave for sterilization is much less often used. manicure tools. The advantage of dry-heat cabinets is the destruction of spore forms, affordable price and large chamber volume, which allows you to sterilize a lot of instruments at once. The disadvantages are the huge energy consumption and the damage of tools under the influence of too high temperatures.

After sterilization, clean products can be stored in a UV sterilizer for 3 days or in trays with hermetically sealed lids.

Sterilization control

The sterilization control system includes:

Checking the parameters of the sterilization mode. For this, physical (use of instrumentation) and chemical (use of indicators) methods are used. Temperature regime checked with the help of thermometers, which are placed in the regulated points of sterilization devices. Using chemical indicators, you can accurately determine the time and temperature of the treatment.
Evaluation of processing efficiency. For this, bacteriological studies are used - biotests. A certain number of spores are placed in insulin vials (steam and air sterilizers) or on filter paper discs (air sterilizers).

Sterilization is considered effective if there is no growth of the inoculated test culture in combination with positive results of the sterilization regime check.

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 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 of 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).

Sterilization of surgical instruments

surgical autoclaving antiseptic

Sterilization of surgical instruments is carried out by boiling, autoclaving and antiseptic substances. Non-cutting instruments are sterilized by boiling in a 1-2% sodium bicarbonate solution, which prevents metal oxidation 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 - 30 min. 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 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 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 instruments become blunt when boiled in water, so they are cold sterilized. 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. The syringes are 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 blood injection begins with the preparation of rubber tubing. 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, as 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 - is carried out in a cold way. From boiling, they deteriorate, lose elasticity. Apply solutions of diiodide (biodide) mercury 1:1000, an aqueous-alcoholic solution of formaldehyde, an aqueous-alcoholic solution of chloramphenicol 1:1000 or one of the solutions used to sterilize 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 are thoroughly mechanically cleaned from 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 laryngoscope blades are washed with a 0.5% solution of ammonia and wiped several times with a cloth moistened with 96% alcohol. Metal parts - adapter tubes, forceps, dental spacers - are sterilized by boiling. 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, is carried out 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 for 20 minutes. or by boiling in distilled water - 30 minutes, or in a dry-air chamber at t ° 150-160 ° - 1 hour. Preparation for sterilization of soft suture material (silk, catgut, nylon, lavsan, hair) and its sterilization is carried out in the operating room.

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. The washed silk is wound on glass slides, coils or gauze rollers and immersed sequentially 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, the required amount of silk is boiled for 2 minutes. in a solution of sublimate 1: 1000.

Modifications of the Kocher method are often used.

1. Bakulev's method: silk in skeins is washed in a 0.5% solution of ammonia, dried and immersed in 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 mercuric chloride solution 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 are sterilized like silk, or autoclaved along with dressings and linens.

Catgut requires more complex sterilization due to the fact that it is made from extremely infected material - sheep intestines, 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 mercuric chloride solution 1: 1000, dipped in 2% water solution potassium iodide (No. 0-1 for 30 sec., 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, the 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 carried out 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, the catgut is stored in 96% alcohol, which is changed every 7-10 days.

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 disinfection methods (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 in sequence: 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 they are differentially used various methods depending on the type of sterilized instrument.

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 should 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. Sterilization open way should not be carried out in a steam sterilizer!

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. Currently, disposable gloves are used, sterilized by an industrial beam method, 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. Gauze cloth cut into pieces different 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.). Everything is put in Bix necessary tools, dressing material and underwear. 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, the hole in the bix is closed with a metal rotating tape on the case of the bix in the process of removing it from the autoclave 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. Exist certain rules hand washing. Consistently it is necessary to carry out: mechanical and chemical (degreasing) treatment, exposure to antiseptic agents and tanning (closing the pores to maintain the sterility of the skin surface).

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

Mechanical and chemical processing

Mechanical and chemical treatment is carried out by washing hands under a tap with a brush and soap. Hands are thoroughly washed from the fingertips to the upper third of the forearm. At the same time, a certain 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 with liquid detergents(in the absence of household contamination of hands).