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Pre-sterilization preparation and sterilization of dressings and surgical linen. Methods for sterilizing linen and dressings Preparation of surgical linen and dressings for sterilization

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?

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

The specified toolkit consists of the following components:

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

Video: Cleaning and disinfection of conventional medical instruments

Main stages of sterilization

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

1.Disinfection

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

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

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

  1. Low level. Indicated for disinfecting devices that come into contact with intact skin. The main means of this type of disinfection are preparations containing chlorine, phenol, ethyl or isopropyl alcohol, as well as iodophors. These drugs are not capable of destroying the products of proliferation of fungi and bacteria, as well as small viruses of a non-lipid nature. They cope well with the rest of the group of pathogenic microparticles.
  2. High level. 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.
  3. 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:

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

Immediately after use, contaminated work equipment is immersed in a special container, which is filled with a chemical disinfectant solution. The height of the liquid above the level of the instrument must be at least 1 cm. In case of significant contamination, cleaning is carried out twice. Disinfection ends with washing medical equipment under running water. If 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 of 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 such a technique they make special solutions- or use ready-made disinfectants. 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. Suitable for cleaning small amounts of surgical or laboratory equipment. The principle of sterilization is to place objects in a partial vacuum and expose them to microwaves. This manipulation takes only 30 seconds.
2) Chemical

There are several types:

  1. Plasma. Involves the use of 20 percent hydrogen peroxide.
  2. Ozone sterilization. Lasts about 60 minutes.
  3. Cleaning using vapors of 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 medical optics, 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.

  1. Dry sterilization method negatively affects the strength of glass and metal. Small dental devices also suffer: when exposed to temperatures above 160 C, they become dull and become brittle. Another negative aspect of this type of disinfection is the inability to control the quality of cleaning of objects.
  2. Today, the most efficient and high-quality means of disinfection is steam technique. It can be used to process instruments that are sensitive to high temperatures. Using 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, a safety valve is provided. 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:

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

Types of dressings and surgical linen

Dressing materials include gauze balls, tampons, napkins, bandages, turundas, cotton-gauze swabs. The dressing material is usually prepared immediately before sterilization, using special techniques to prevent individual strands of gauze from fraying. For ease of counting, the balls are placed in 50-100 pieces in gauze napkins, napkins and tampons are tied in 10 pieces. The dressing material is not reused; after use it is destroyed.

Operating linen includes surgical gowns, sheets, towels, and linens. The material for their production is cotton fabrics. Reusable surgical linen is washed after use, and separately from other types of linen.

Sterilization

Dressing material and linen are sterilized by autoclaving under standard conditions. Before sterilization, dressings and linen are placed in containers. There are three main types of bix styling: universal, targeted and specific styling.

Universal styling. Typically used when working in the dressing room and for minor operations. Bixes are conventionally divided into sectors, each of them is filled with a certain type of dressing material or linen: napkins are placed in one sector, balls in another, tampons in the third, etc.

Targeted styling. Designed to perform typical manipulations, procedures and minor operations. For example, placement for tracheostomy, catheterization of the subclavian vein, epidural anesthesia, etc. All instruments, dressings and linen necessary for the procedure are placed in the bix.

Type of styling. Typically used in operating rooms where necessary a large number of sterile material. In this case, for example, surgical gowns are placed in one bin, sheets in another, napkins in a third, etc.

Small quantities of dressing material in packages that have undergone radiation sterilization are used. There are also special sets of disposable surgical linen (gowns and sheets) made from synthetic fabrics that have also been subjected to radiation sterilization.

Treatment of surgeon's hands

Cleaning (washing) the surgeon's hands is a very important procedure. Exist certain rules hand washing.

The classical methods of hand treatment by Spasokukotsky-Kochergin, Alfeld, Furbringer and others are of only historical interest; they are not currently used.

Modern methods of treating surgeon's hands

The treatment of the surgeon's hands consists of two stages: hand washing and exposure to antiseptic agents.

Hand washing

The use of modern methods involves initial hand washing with soap or liquid detergents (in the absence of household contamination of hands).

Impact of antiseptics

Chemical antiseptics used to treat hands must have the following properties:

Have a strong antiseptic effect;

Be harmless to the skin of the surgeon’s hands;

Be accessible and cheap (since they are used in large quantities).

Modern methods hand treatment does not require special tanning (use film-forming antiseptics or antiseptics with a tanning element).

Hands are carefully treated from the fingertips to the upper third of the forearm. At the same time, a certain sequence is followed, which is based on the principle of not touching less clean skin and objects with the treated areas of the hands.

Main modern means Hand treatments include Pervomur, chlorhexidine, degmin (degmicide), Cerigel, AHD, Eurosept, etc.

First treatment of hands

Pervomur (proposed in 1967 by F.Yu. Rachinsky and V.T. Ovsipyan) is a mixture of formic acid, hydrogen peroxide and water. When the components are combined, performic acid is formed - a powerful antiseptic that causes the formation of a thin film on the surface of the skin, closing the pores and eliminating the need for tanning. Use a 2.4% solution prepared ex temporo.

Methodology: hand washing is carried out in basins for 1 minute, after which the hands are dried with a sterile napkin. The advantage of the method is its speed. Disadvantage: possible development of dermatitis on the surgeon’s hands.

Hand treatment with chlorhexidine

A 0.5% alcohol solution of chlorhexidine is used, which eliminates the need for additional exposure to alcohol for the purpose of tanning, as well as drying due to the rapid evaporation of the alcohol solution.

Methodology: hands are treated twice with a swab moistened with an antiseptic for 2-3 minutes. The relative disadvantage of the method is its duration.

Treatment with degmin and degmicide

These antiseptics belong to the group of surfactants (detergents).

Methodology: the treatment is carried out in basins for 5-7 minutes, after which the hands are dried with a sterile napkin. The disadvantage of the method is its duration.

Treatment with AHD, AHD-special, Eurosept

The active principles of these combined antiseptics are ethanol, polyol fatty acid ester, and chlorhexidine.

Methodology: the drugs are in special bottles, from which, when you press a special lever, a certain dose of drugs is poured onto the surgeon’s hands, and he rubs the solution into the skin of his hands for 2-3 minutes. The procedure is repeated twice. There is no need for additional tanning or drying. The method is practically free of drawbacks; it is currently considered the most progressive and widespread.

Despite existing methods hand treatment, currently Surgeons must perform all operations and manipulations in contact with the patient’s blood only wearing sterile gloves!

If minor manipulations are necessary or in critical situations, sterile gloves may be worn without prior hand treatment. When performing routine surgical operations, this should not be done, since any damage to the glove can lead to infection of the surgical wound.

Treatment of the surgical field

Sanitary and hygienic treatment is carried out first (washing in a bath or shower, changing bed and underwear). On the day of surgery, the hair in the area of ​​the surgical field is shaved (dry shaving). On the operating table, the surgical field is treated with chemical antiseptics (organic iodine-containing preparations, chlorhexidine, pervomur, AHD, sterile adhesive films). At the same time, they comply following rules:

Wide processing;

The sequence is “from the center to the periphery”;

Contaminated areas are treated last;

Repeated treatment during the operation (Filonchikov-Grossikh rule): skin treatment is performed before delimitation

sterile underwear, immediately before the incision, as well as before and after applying skin sutures.

Rules for preparing for the operation

In addition to knowing the basics of cleaning the surgeon’s hands, the surgical field, sterilizing instruments, etc., it is necessary to follow a certain sequence of actions before starting any surgical operation. Typically, preparation for surgery is carried out as follows.

The operating nurse is the first to prepare for the operation. She changes into a special operating suit, puts on shoe covers, a cap and a mask. Then, in the preoperative room, she cleans her hands according to one of the above methods, after which she enters the operating room, opens the bag with sterile linen (using a special foot pedal to open the lid of the box) and puts on a sterile gown, simultaneously putting both hands into its sleeves, without touching with either a robe or hands foreign objects, which can lead to a violation of sterility. After this, the sister ties the strings on the sleeves of the robe, and the nurse ties the robe at the back; his hands are unsterile, so he can only touch the inner surface of the robe and that part of it that ends up on the sister’s back and is subsequently considered unsterile.

In general, during the entire operation, the nurse's and surgeon's gown is considered sterile from the front to the waist. Sterile hands should not be raised above the shoulders and lowered below the waist, which is associated with the possibility of violating sterility with careless movements.

After putting on sterile clothes, the nurse puts on sterile gloves and sets a sterile table to perform the intervention: a small (or large) operating table is covered with four layers of sterile linen, then the sterile instruments and dressings necessary for the operation are laid out on it in a certain sequence.

The surgeon and assistants change clothes and treat their hands in the same way. After this, one of them receives from the sister’s hands a long instrument (usually a forceps) with a napkin moistened with an antiseptic, and treats the surgical field, changing the napkin with an antiseptic several times. The nurse then dresses the surgeon and assistant in sterile gowns, draping them over their outstretched sterile arms and tying the ties at the wrists. The orderly ties the gowns at the back.

After putting on sterile gowns, surgeons limit the operating field with sterile surgical linen (sheets, linens or towels), securing it with special linen clips or clips. The nurse puts sterile gloves on the surgeons' hands. Once again, the skin is treated and an incision is made, that is, the surgical operation begins.

Sterility control methods

All actions related to the processing and sterilization of instruments, linen and other things are subject to mandatory control. They control both the effectiveness of sterilization and the quality of pre-sterilization preparation.

Sterility control

Sterility control methods are divided into direct and indirect.

Direct method

A direct method of sterility control is bacteriological examination: a special sterile stick is carried out on sterile instruments (the skin of the surgeon’s hands or the surgical field, surgical linen, etc.), after which it is placed in a sterile test tube and sent to a bacteriological laboratory, where inoculation is carried out on various nutrient media and thus determine bacterial contamination.

The bacteriological method of sterility control is the most accurate. A negative point is the duration of the study: the culture result is ready only after 3-5 days, and the instruments must be used immediately after sterilization. Therefore, bacteriological research is carried out as planned and based on its results, the methodological errors at work medical personnel or defects in the equipment used. According to existing standards, which differ slightly for different types of instruments, bacteriological examination must be carried out once every 7-10 days. In addition, 2 times a year similar studies are carried out in all departments of the hospital by district and city sanitary and epidemiological services.

Indirect methods

Indirect control methods are used mainly when thermal methods sterilization. With their help, you can determine the temperature at which the treatment was carried out, without giving an exact answer to the question about the presence or absence of microflora. The advantage of indirect methods is the speed of obtaining results and the possibility of using them with each sterilization.

When autoclaving, an ampoule (test tube) with a powdery substance having a melting point in the range of 110-120 °C is usually placed in a biscuits. After sterilization, when opening the bix, the nurse first of all pays attention to this ampoule: if the substance has melted, then the material (instruments) can be considered sterile, but if not, the heating was insufficient and such material cannot be used, since it is unsterile. For this method, benzoic acid (melting point 120 °C), resorcinol (melting point 119 °C), and antipyrine (melting point 110 °C) are most often used. Instead of an ampoule, you can place a temperature indicator or a maximum thermometer in the Bix, which can also be used to determine what the temperature was during processing.

Similar indirect methods are used for sterilization in a dry-heat oven. However, here they use substances with a higher melting point (ascorbic acid - 190 °C, succinic acid - 190 °C, thiourea - 180 °C), and other temperature indicators or thermometers.

Quality control of pre-sterilization treatment

To control the quality of pre-sterilization treatment, chemicals are used to detect traces of unwashed blood or detergent residues on instruments. Reagents usually change color in the presence of appropriate substances (blood, alkaline detergents). The methods are used after treatment before sterilization.

To detect so-called occult blood, the benzidine test is most often used.

To detect traces of detergents, acid-base indicators are used, the most common is the phenolphthalein test.

Prevention of implantation infection

Implantation is the introduction of artificial, foreign materials and devices into the patient’s body for a specific therapeutic purpose.

Features of preventing implantation infection

Prevention of implantation infection - ensuring the strictest sterility of all objects introduced into the patient’s body. Unlike the contact route of infection, with implantation, almost 100% contagiousness is noted. Remaining in the patient’s body, where they exist favorable conditions(temperature, humidity, nutrients), microorganisms do not die for a long time and often begin to multiply, causing suppuration. At the same time, introduced into the body foreign body subsequently maintains the inflammatory process for a long time. In some cases, encapsulation of colonies of microorganisms occurs, which do not die and can become the source of an outbreak of a purulent process in months or years. Thus, any implanted body is a possible source of the so-called dormant infection.

Sources of implantation infection

What do surgeons “leave” in the patient’s body? First of all, the suture material. Almost no intervention can do without this. On average, during abdominal surgery, the surgeon places about 50-100 stitches.

A likely source of implantation infection are drainages - special tubes designed for the outflow of fluids, less often air (pleural drainage) or intended for the administration of drugs (catheters). Considering this route of infection spread, there is even the concept of “catheter sepsis” (sepsis is a severe general infectious disease, see Chapter 12).

In addition to suture material and drainages, the patient’s body contains prosthetic heart valves, blood vessels, joints, etc., various metal structures (staples, clips from suture devices, screws, knitting needles, screws and plates for osteosynthesis), special devices(vasa filters, coils, stents, etc.), synthetic mesh, homofascia, and sometimes transplanted organs.

All implants must of course be sterile. The method of sterilization depends on what material they are made of. Many prostheses have a complex design and strict special rules sterilization. If rubber drains and catheters can be sterilized in an autoclave or boiled, then some plastic products, as well as dissimilar materials, should be sterilized using chemical methods (in antiseptic solutions or a gas sterilizer).

At the same time, factory sterilization with γ-rays is now recognized as the main, practically most reliable and convenient method.

The main probable source of implantation infection remains the suture material constantly used by surgeons.

Sterilization of suture material

Types of suture material

Suture material heterogeneous, which is associated with its different functions. In one case, the strength of the threads is most important, in another - their resorption over time, in the third - inertness in relation to surrounding tissues, etc. During the operation, the surgeon selects the most suitable type of thread for each specific suture. There is a sufficient variety of types of suture material.

Suture material of natural and artificial origin

Suture materials of natural origin include silk, cotton thread and catgut. The origin of the first two species is well known. Catgut is made from the submucosal layer of the intestines of cattle. Suture material of artificial origin is currently represented by a huge number of threads created from synthetic chemical substances: nylon, lavsan, fluorlon, polyester, dacron, etc.

Absorbable and non-absorbable suture material

Absorbable sutures are used for suturing rapidly healing tissues in cases where high mechanical strength is not needed. This material is used to stitch muscles, fiber, and mucous membranes of the gastrointestinal tract, biliary and urinary tracts. In the latter case, the application of absorbable sutures avoids the formation of stones due to the deposition of salts on the ligatures. A classic example of an absorbable suture material is catgut. Catgut threads are completely absorbed in the body after 2-3 weeks. Extension of the resorption time, as well as an increase in the strength of catgut, is achieved by impregnation of threads with metals (chrome-plated catgut, less often - silver catgut), in this case the resorption time increases to 1-2 months.

Synthetic absorbable materials include dexon, vicryl, oxylon. Their resorption time is approximately the same as that of chrome-plated catgut, but they have increased strength, which allows the use of thinner threads.

All other threads (silk, nylon, lavsan, polyester, fluorine, etc.) are called non-absorbable - they remain in the patient’s body for life (except for removable skin sutures).

Suture material with different thread structure

There are braided and twisted suture materials. Wicker is more difficult to make, but is more durable. Recently, advances in chemistry have led to the possibility of using thread in the form of a monofilament, which has high mechanical strength with a small diameter. Monofilaments are used in microsurgery, cosmetic surgery, and operations on the heart and blood vessels.

Traumatic and atraumatic suture material

For many years, during a surgical operation, the operating nurse, immediately before applying a suture, threaded the appropriate thread into the detachable eye of a surgical needle. Such suture material is currently called traumatic.

In recent decades, atraumatic suture material has become widespread. At the factory, the thread is firmly connected to the needle and is intended for applying one seam. The main advantage of atraumatic suture material is the approximate correspondence of the diameter of the thread to the diameter of the needle (when using traumatic material, the thickness of the thread is significantly less than the diameter of the eye of the needle), thus, the thread almost completely covers the defect in the tissue after passing the needle. In this regard, it is atraumatic suture material that must be used for vascular and cosmetic stitches. Taking into account also the sharpness of disposable needles and ease of use, it should be assumed that in the near future atraumatic suture material will gradually completely replace traumatic ones.

Thread thickness

For ease of use, all threads are assigned numbers depending on their thickness. The thinnest thread is No. 0, the thickest is No. 10. In general surgical operations, threads from No. 1 to No. 5 are usually used. Thread No. 1, for example, can be used for stitching or ligating small vessels, placing gray-serous sutures on the intestinal wall. Threads No. 2 and 3 - for ligating medium-sized vessels, applying serous-muscular sutures to the intestine, suturing the peritoneum, etc. Thread No. 5 is usually used for suturing the aponeurosis.

When performing vascular operations, especially microsurgical interventions, even thinner threads are needed than thread No. 0. Such threads began to be assigned Nos. 1/0, 2/0, 3/0, etc. The thinnest thread currently used in ophthalmology and in operations on lymphatic vessels is No. 10/0. It should be noted that threads also differ in other properties: some glide better and are prone to unraveling, others spring back when tensioned, are more or less inert in relation to fabrics, more or less durable, etc.

Recently, threads with antimicrobial activity have become widespread due to the introduction of antiseptics and antibiotics into their composition (letilan-lavsan, fluorlon, etc.).

Metal clips, terminals, and clips made of stainless steel, titanium, tantalum and other alloys stand somewhat apart.

This type of suture material is used in special stitching machines.

Methods for sterilizing suture material

Currently, the main method of sterilizing suture material is radiation sterilization in the factory. This fully applies to atraumatic suture material: the needle and thread are placed in a separate sealed package, which indicates the size, curvature and type (piercing or cutting) of the needle, material, length and thread number. The suture material is sterilized, then it is delivered in packaging to medical institutions.

You can also sterilize just threads. In addition, pieces of thread can be placed in sealed glass ampoules with a special antiseptic solution, and spools of thread can be placed in special sealed containers with the same solution.

Classic methods sterilization of silk (Kocher method) and catgut (Sitkovsky method in iodine vapor, Gubarev and Claudius methods in alcohol and aqueous Lugol solutions) are currently prohibited for use due to their duration, complexity and not always sufficient effectiveness.

Sterilization of structures, prostheses, transplants

The method of sterilizing implants depends entirely on the material from which they are made.

Metal structures for osteosynthesis (plates, screws, screws, knitting needles) are sterilized together with metal non-cutting instruments in an autoclave or dry-heat oven.

More complex prostheses (heart valve prostheses, joints), consisting not only of metal, but also of plastic parts, are best sterilized by chemical methods - in a gas sterilizer or by soaking in antiseptic solutions.

Recently, leading manufacturers of prostheses have been producing them in sealed packages, sterilized by radiation.

Except various designs and prostheses, the source of implantation infection can be allogeneic organs removed from another organism during a transplantation operation. Sterilization of transplants is impossible, therefore, when harvesting organs, it is necessary to observe the strictest sterility: collection operations are performed in compliance with the same aseptic rules as conventional surgical interventions. After removal from the donor’s body and washing with sterile solutions, the organ is placed in a special sealed container, where it remains under sterile conditions until transplantation.

Cellulitis (pathogenesis, clinical picture, treatment).

Acute diffuse inflammation of the cellular spaces. Unlike abscess restriction

no inflammation occurs. It can be an independent disease or a consequence of other purulent diseases (carbuncle, abscess, sepsis).

According to the nature of the exudate, they distinguish: serous, purulent, purulent-hemorrhagic and putrefactive forms of phlegmon.

By localization: epifascial and subfascial. In some localizations, phlegmon has a special name.

Clinic: Painful swelling, diffuse redness of the skin quickly appears and spreads, high temperature (40°C and above), pain, and dysfunction appear.

Palpation determines a dense infiltrate (infiltrative stage). Then it softens and the symptom of fluctuation appears. The current often takes an unfavorable course.

Treatment. In the initial phase, you can use antibiotics, immobilization, plenty of fluids, a small plant-based diet, heart medications, and painkillers. When the process is limited and abscesses form, they are opened.

If phlegmon progresses, emergency intervention is indicated after a short

urgent preparation. A wide opening is performed and the phlegmon is drained. Then I loosely pack the wounds with tampons moistened with a hypertonic solution or KMnO4. Then the wound is treated according to the laws of purulent surgery in accordance with the course of the phases of the wound process.

It is permissible to carry out complete surgical debridement with the application of a primary suture.

on a purulent wound.

Sterilization of dressings and linen

Preparing dressings and linen for sterilization

In recent years, the issue of using disposable medical clothing and underwear has been very seriously discussed. There is a requirement from the Ministry of Health of the Russian Federation to switch to disposable clothing for surgical medical staff and underwear for postoperative patients.

The urgency of the problem is mainly due to quite high level wound infection in the postoperative period, and in most cases (85%) the source of microorganisms is the patient himself (50% of observations) and medical personnel (35%), as well as the steady increase in the incidence of infectious diseases among medical workers such as viral hepatitis B and C, HIV infections. Infection of personnel occurs through contact of skin and mucous membranes with various biological fluids and tissues of an infected patient.

To prevent infection of medical personnel, it is necessary to protect not only the skin, but also the entire body, and surgical underwear ( operating materials), designed to ensure the sterility of the surgical field, should not allow the penetration of microorganisms into the wound. Medical clothing and underwear do not meet these requirements.



The barrier capabilities of cotton surgical linen are extremely limited. It releases textile dust and small fibers, which, when saturated with biological fluids, become a good medium for the transfer and reproduction of microorganisms, and repeated treatments lead to even greater fiber disintegration. Disposable surgical underwear (Fig. 31) does not have these disadvantages. However, the level of provision of disposable medical clothing and underwear, according to experts, in Russia is only 0.32%.

Operating linen includes medical gowns, fasten at the back, sheets, towels, napkins, caps and masks.

The dressing material used in the operating room and for dressings is white absorbent gauze and cotton wool.

Gauze is folded into squares 1 m long and 70 - 80 cm wide. Napkins are prepared from it - large, medium and small. From one piece of gauze you can make 2 large, 4 medium and 6 small napkins. When making napkins, the edges of all cut pieces must be bent inward by 2 cm, folded in half along the transverse and then longitudinal thread. Wipes are used to protect the skin, dry the wound, and apply bandages.

Large, medium and small tampons are used to stop bleeding and remove blood and pus. The narrowest of them are turundas.

A large tampon is made from a large napkin with curved edges, which is folded in half twice. Then it is folded lengthwise so that one half is longer than the other.

The resulting strip is folded again - in half and the protruding edge is wrapped on a tampon.

A medium tampon is made from a medium napkin. To make it, fold the edge of the gauze 3-5 cm, fold it across, and then along..

A small tampon begins to be prepared by tucking one of the short edges of the gauze 1 - 2 cm, then tucking the longer edges inward with some overlapping of each other and folding them in half again in the longitudinal and transverse directions.

Turundas are prepared from strips of gauze or bandage 5 cm wide and up to 40 - 50 cm long. The end of the bandage is wrapped inward, and the edges are folded towards each other until they touch. To form a smooth edge, the folded strip is rolled in a taut state over the edge of the table, then it is folded again and again pulled over the edge of the table. The resulting strip is wound around three fingers, and the free edge is tucked inside the resulting ring.

To dry wounds from blood and pus, gauze balls are used, which are prepared from pieces of gauze 12 x 12 cm. They are folded towards the middle, wrapped around a finger and the free end is pulled into the middle of the resulting tube. They are placed in gauze bags of 50-100 pieces.

Cotton wool is prepared in the form of pieces measuring 33 x 20 cm or in the form of strips 30 cm wide and up to 1.5 meters long, rolled into a roll. Cotton tuffers are sometimes prepared from absorbent cotton wool by wrapping a piece of cotton wool on a wooden stick 15-20 cm long. Currently, they are rarely used.

Placing dressings and surgical linen in bins for sterilization

There are the following types of laying material in boxes.

Universal(sectoral) placement is used in surgical departments of small hospitals. All materials necessary to perform typical operations, often emergency ones, such as appendectomy, hernia repair, etc. (sheets, gowns, dressings, etc.) are placed in one box, and the sterilization container is divided into sectors; each of them contains different types of products and one internal indicator IKPS-VN/01 in the stacking of each sector.

Specialized(species) layout is used for operating rooms with a large volume of work. Only one type of material can be placed in each of the bins - only dressing gowns in one bin, sheets in the other, etc.

When sterilizing porous products (sheets, gowns, etc.), at least 3 IKPS-VN/01 “Medtest” indicators are placed in the sterilization box, placing them in the middle of the products being sterilized. When sterilizing gloves, indicators are placed in the palm part inside the glove. In other rubber products, indicators are placed where possible, but so that they are easily removed.

When sterilizing glass or metal products, indicators are attached to the inside of the package.

Focused stacking is used to perform, specifically, one of the large planned operations, for example, all the material necessary for pneumonectomy, gastric resection, etc. is stacked. In each type of bookmark, 1 internal indicator is placed inside, and in the bookmarks of one sterilization box there must be at least 3 indicators, one of which is located in the central bookmark and 2 in the side ones, close to the walls of the sterilization box.

Before packing, the nurse should check the integrity of the linen and fold it accordingly. The gowns are folded with the sleeves inward and not tightly rolled into a roll. The sheets are folded at the edges by 50 cm, then folded in four lengthwise and not rolled up tightly, starting from the non-folded end.

Towels and napkins are folded into four.

Linen is placed in bins so that each item, each bag or pack can be taken separately without touching the rest.

The bottom and walls of the bix are lined with a sheet, the ends of which are placed outside. Neatly folded linen is laid sectorally in a vertical position, moderately tightly, guided by the rule “... if a hand passes freely between the vertically laid layers of linen, the linen is laid correctly.”

The material is laid loosely to ensure free passage of steam. After the bix is ​​filled, the edges of the sheet lining it are folded inward.

Sterilization of dressings and linen is carried out in an autoclave. Sterilization mode: pressure 2 A, temperature – 132.9 o C, sterilization time 30 minutes.

Sterilization is a method that ensures the death of vegetative and spore forms of pathogenic and non-pathogenic microorganisms in the sterilized material.

Sterilization steps:

1. disinfection;

2. pre-sterilization cleaning (PSC);

3. sterilization.

Sterilization methods:

● thermal (steam, air, glass-perlene);

● chemical (gas, solutions of chemical compounds);

● radiation;

● plasma and ozone (group of chemicals)

In a clinical setting, the most common methods of sterilizing instruments and medical devices are:

● steam (autoclaving),

● air (dry-heat oven),

● chemical (gas, solutions of chemical compounds).

Sterilization should be carried out in strict accordance with the prescribed regime, make sure that the specified regime is implemented (direct and indirect control of sterility), and subsequently be guided by the terms for maintaining the sterility of the material and products.

Sterilization, steam method (autoclaving). Proper sterilization in an autoclave is possible with strict adherence to the rules for preparing the containers and loading them with appropriate products, for which you should:

● treat the inner surface of the bix with 70% alcohol and place a sheet on its bottom in such a way that its ends can then cover the contents of the bix;

● put sets of rubber products, dressings, and linen into the bin;

● wrap the instruments in a towel or diaper and place them in the bag;

● after loading the bix, place 5 indicators in it: 4 - along the inner side of the walls of the bix and 1 - in the center of the bix (indirect method of sterility control);

● fix a tag on the lid of the bin, on which to note: the type of material and the medical department for which instruments and materials are sterilized;

● close the lid of the box hermetically. For the old-style bix, move the metal belt-belt and thereby open the windows on its walls, which must be closed after sterilization is completed;

● after sterilization, put the date and signature of the nurse performing the autoclaving on the bix tag.

Various options for completing the bixes are possible: only one type of material, sets for a typical or specific surgical intervention.

Sterilization, air method. Reliable sterilization of instruments is possible with the correct use of craft bags and rational placement of products in a dry-heat oven, for which you should:



● put tools that have undergone disinfection and PSO into a craft bag;

● seal the craft bag along its top edge, or secure it with paper clips;

● indicate on the craft bag the contents, date of sterilization and sign the nurse performing the sterilization;

● all products can be laid out in one row on a metal mesh (reusable glass syringes - disassembled);

● put 5 indicators on the sterilizer mesh: 4 in the corners of the mesh and 1 in the center (indirect control method).

Sterilization, chemical method. Carried out under sterile conditions. The sterilization room must be equipped fume hood, bactericidal irradiator. The nurse works in sterile overalls, gloves, and a respirator.

Medical products that have undergone disinfection and PSO are immersed in a sterile container with a sterilant, and the lid is tightly closed. The log indicates the start time of sterilization. Upon completion of sterilization, honey. the products are removed from the solution with sterile tweezers or forceps, transferred to another sterile container with sterile water, washed, dried and placed in a container with a sterile diaper. The time of completion of sterilization is also recorded in the sterilization log.

The shelf life of sterile instruments is the same. Instrument sterility control is direct.

Sterility of materials, products, shelf life:

● closed boxes of a new type - 20 days;

● when a container of any sample is opened, the sterility of materials and products is maintained for up to 24 hours;

● Kraft bags, sealed - 20 days;

● craft bags with staples - 3 days.

Sterilization of medical devices must ensure the death of microorganisms of all types at all stages of development. Since microbial spores exhibit the greatest resistance to the overwhelming majority of sterilization agents (with the exception of ionizing radiation), sterilizing agents are those that have a sporicidal effect.



The following sterilization methods are used:

● thermal: steam, air, glass-perlene;

● chemical: gas, chemicals;

● radiation,

● plasma and ozone (a group of chemicals).

The choice of one or another method of sterilization of specific products depends on the characteristics of the product and the method itself - its advantages and disadvantages.

Products in packaging are sterilized in decentralized, centralized systems, or in industrial enterprises producing single-use medical devices. Products without packaging are sterilized only with a decentralized system in health care facilities.

The most common methods in health care facilities are steam and air sterilization methods.

Steam method- reliable, non-toxic, inexpensive, ensuring sterility not only of the surface, but of the entire product. It is carried out at a relatively low temperature, has a gentle effect on the processed material, allows you to sterilize products in packaging, thereby preventing the danger of recontamination (re-contamination with microorganisms).

The sterilizing agent in this method is saturated water steam under excess pressure.

Sterilization is carried out under the following modes:

● 141 ± GS at a pressure of 2.8 Bar - 3 min;

● 134 ± GS at a pressure of 2.026 Bar - 5 min;

● 126 ± GS at a pressure of 1.036 Bar - 10 min.

The steam method sterilizes products made of corrosion-resistant metals, glass, textile materials, rubber, and latex.

Sterilization boxes (boxes), parchment, wrapping papers: unimpregnated bag, wet-resistant bag, high-strength packaging, two-layer crepe.

In order for steam to penetrate well into various points of the sterilization chamber, between products and inside textile products, it is very important to comply with the loading standards of both the sterilizer and the bix.

The shelf life of sterile material depends on the type of packaging.

The steam method has significant shortcomings, causes corrosion of instruments made of non-corrosion-resistant metals: turning into condensate, it moistens the sterilized products, which worsens their storage conditions and increases the risk of recontamination.

Air method. The sterilizing agent is dry hot air. A distinctive feature of the method is that there is no moistening of the packaging and products, and an associated reduction in the period of sterility, as well as corrosion of metals.

Disadvantages of the method:

● slow and uneven heating of sterilized products;

● the need to use higher temperatures;

● inability to use rubber and polymer products for sterilization;

● inability to use all available packaging materials. The air method is carried out in air sterilizers under the following modes:

1. 200±ZvS - 30 min;

2. 180±3°С - 40 min;

3. 160±3°С - 120 min.

The effectiveness of air sterilization largely depends on the uniform penetration of hot air to the products being sterilized, which is achieved by forced air circulation at a speed of 1 m/s and compliance with the sterilizer loading standards.

Both steam and air sterilization methods are environmentally friendly.

Gas method carried out at 18-80°C. Products are sterilized in packages.

Gas sterilization uses ethylene oxide and its mixtures, formaldehyde.

In the gaseous state, ethylene oxide does not cause corrosion of metals and does not damage products made of leather, wool, paper, or plastics; it is a strong bactericidal, sporicidal and virucidal agent. Vapors have high penetration.

The disadvantage of ethylene oxide is its toxicity to personnel and explosion hazard if safety precautions are not followed. The sterilization process has a long cycle. Ethylene oxide is rarely used in health care facilities.

Formaldehyde It is not inferior in quality, and in some respects it is superior to ethylene oxide. For sterilization, as a rule, vapors of a 40% alcohol solution of formaldehyde are used. The sterilizing agent may be formaldehyde evaporating from paraform or formaldehyde.

Sterilization with solutions is an auxiliary method that is used when it is impossible to use others. Sterilization with solutions has the following disadvantages: products are sterilized without packaging, they must be washed after sterilization, which can lead to recontamination.

Advantages: universal availability, ease of implementation, etc.

Products to be sterilized by solutions are laid out freely in containers. For large lengths, the product is laid in a spiral, the channels and cavities are filled with solution.

After sterilization is completed, the products are immersed three times (if sterilized with hydrogen peroxide - twice) for 5 minutes in sterile water, changing it each time, then they are transferred with a sterile forceps to a sterile container lined with a sterile sheet.

Since products are sterilized with solutions without packaging, this method can only be used in a decentralized system.

Radiation method necessary for sterilization of products made from thermolabile materials. The sterilizing agent is ionizing y (gamma) and beta (beta) radiation.

For individual packaging, in addition to paper, polyethylene bags are used. Sterility is maintained in such packaging for years, but it is also limited. The expiration date is indicated on the packaging.

Radiation is the main method of industrial sterilization. It is used by companies producing sterile disposable products.

Stage 1 - preparation of material. The dressing material should be easily sterilized and not lose its properties. It is prepared from gauze and cotton wool, less often from viscose and lignin. For work, balls, napkins, tampons, turundas, and bandages are prepared from them. The gauze should be folded so that there is no free edge from which fabric fibers can fall off. Material is stored for future use, replenished as it is used. Before sterilization, it is placed as follows: balls - in gauze bags of 50-100 pieces, napkins are tied in 10 pieces. Surgical gowns, sheets, diapers, towels, caps, and shoe covers are used as surgical linen. They are made from cotton fabric. Robes, sheets, diapers, towels for sterilization are folded in the form of rolls, this makes it easy to unfold them when used. The dressing material is burned after use. Reusable laundry can be washed, but separately from other types of laundry.

Stage 2 - laying the material. Dressing material and surgical linen are sterilized in bins. Three types of bix styling are used:

Universal styling

Targeted styling

Type styling

Universal– arrange material and linen for one small, typical operation. This type of installation is used when working in dressing rooms and in small operations. Laying is done in sectors. Bixes are divided into sectors that are filled with a certain type of material or linen: napkins are placed in one sector, balls in another, tampons in the third, etc. Focused– arrange material and linen for a specific operation. For example, for appendectomy, gastric resection. The box contains a set of dressings and linen necessary for the operation. Species– lay a certain type of material or linen. This type of installation is used in operating rooms, where a large number of different operations are performed. Laying is carried out as follows - surgical gowns in one box, sheets in the other, napkins in the third, etc. Packing of the box is carried out as follows. Check the serviceability of the bix. Wipe the bottom, walls, and lid of the bin, first from the inside and then from the outside with 0.5% ammonia. On the side wall of the bix, a circular plate (tightness belt) is moved so as to open the side holes. The bix is ​​lined with a sheet folded in half, with its ends hanging outward. A sterility control indicator is placed at the bottom of the bix. Dressing material and linen are placed loosely in the bin, vertically, in sectors or in layers. Each item is placed so that it is easy to reach without disturbing the arrangement. An indicator for sterility control is also placed in the middle of the bix. The edges of the sheet lining the bix are folded one on top of the other. Another control indicator is placed on top, closer to the bix lock. Close the lid of the box with a lock. A tag - a passport - is attached to the handle of the bix. Stage 3 – sterilization. Dressings and linen are sterilized by autoclaving under standard conditions.

Step 4 – Sterile Material Storage. The side openings of the sterilized bix must be closed. Boxes with sterile material are stored separately from boxes with non-sterile material. After sterilization, you can store unopened biscuits for 3 days, after opening for 1 day. Unused bins are re-sterilized. CHECKING THE QUALITY OF STERILIZATION Sterility control can be carried out by direct and indirect (indirect) methods. Direct method– bacteriological, culture is carried out from sterile objects. It is produced as follows: in the operating room, the bix is ​​opened, small pieces of gauze moistened with an isotonic sodium chloride solution are passed over the linen several times, after which they are lowered into a test tube. The material taken in this way is sent for bacteriological examination. Bacteriological control is carried out once every 10 days. It is the most reliable method of sterility control. Indirect methods are used to directly control the sterility of the material. Thanks to them, you can evaluate the quality of sterilization of each bix. Indirect methods are based on placing thermal indicators into sterilized containers, which show whether the material being sterilized has passed a certain temperature regime. For indicators, substances with a certain melting point are used: benzoic acid (120°C), urea (132°C), thiourea (180°C). They are placed in ampoules. Indicators are placed along with the items being sterilized. Melting of the powder and its transformation into a solid mass indicates that the sterilization temperature was equal to or higher than the melting point of the control substance.

When sterilizing dressings in a bag, the linen is not placed tightly, the bag is tied with ribbons. The bag is lowered into another identical one and tied. If it is necessary to use the material, the bag is placed on a stool, the nurse unties the upper bag, spreads its edges and moves it downwards. The operating nurse unties the inner bag with sterile hands, opens it and removes the material.

Sterilization of dressings and surgical linen:

Stage 1 - pre-sterilization preparation of materials. Dressing materials include gauze bags, napkins, tampons, turundas, bandages, as well as surgical gowns, sheets, towels, masks, caps, shoe covers. They are used during operations and dressings to dry wounds, stop bleeding, and for drainage or packing of wounds. Dressing material is prepared from gauze and wattle, less often from viscose and lignin. The dressing material is prepared from gauze, previously cut into pieces. The gauze is folded so that its edges are tucked inwards and there is no free edge from which fabric fibers can fall out. The material is stored in reserve, replenished as it is consumed. To make it easier to count the material used during the operation, it is placed before sterilization in a certain order: balls - in gauze bags, napkins are tied in 10 pieces. Dressing material, except for bandages not contaminated with blood, is burned after use.

Operating linen includes surgical gowns, sheets, towels, masks, caps, shoe covers. The material for their manufacture is cotton fabrics - calico, linen. Reusable surgical linen must have a special mark and be washed separately from other linen in special bags. Robes should not have pockets or belts, and sheets should be hemmed. Robes, sheets, diapers, and towels for sterilization are folded in the form of rolls so that they can be easily unfolded when used.

Stage II - laying and preparing the material for sterilization. Dressing materials and surgical linen are placed in boxes. In the absence of bixes, sterilization in linen bags is allowed.

With universal placement, material intended for one small typical operation (appendectomy, herniotomy, phlebectomy, etc.) is placed in the bix.

When purposefully laid in the bix, they put necessary set dressings and surgical linen intended for a specific operation (pneumonectomy, gastrectomy, etc.). When laying by type, a specific type of dressing material or linen is placed in the bix (bix with gowns, bix with napkins, bix with balls, etc.).

This material is pre-folded into bins with the following calculation: the dressing material (gauze, bandages) is folded so that the edges are turned inward and there is no free edge from which fabric fibers can fall off. The material is stored for future use, replenishing its reserves as they are used up.

First, the serviceability of the bix is ​​checked, then an unfolded sheet is placed on the bottom of it, the ends of which are located from the outside. Dressing materials are placed vertically in sectors or in packs. The material is inserted loosely to allow steam access, indicators of the sterilization mode are placed in the middle, the edges of the sheet are wrapped, the bix is ​​closed with a lid and the lock is closed. Oilcloth tags are attached to the lid of the bin, which indicate the name of the materials, and after sterilization, the date and procedure and the name of the person who carried out the sterilization.

Stage III - sterilization. Dressing materials and surgical linen are sterilized in an autoclave for 40 minutes at a pressure of 2 atm. and temperature 132.9°C.

Stage IV - preservation of sterile material. Upon completion of sterilization and drying of the linen, the sterilization chamber is unloaded, the bins are removed, immediately closed and transferred to a special table for sterile material. The bixes are stored in locked cabinets in a special room.

Control of the sterility of the material and the sterilization regime in the autoclave is carried out by direct and indirect methods. The direct method is bacteriological; culture from dressings and linen or the use of bacteriological tests. Sowing is done in this way: in the operating room, the bix is ​​opened, small pieces of gauze moistened with an isotonic sodium chloride solution are passed over the linen several times, after which the pieces of gauze are immersed in a test tube, which is sent to the bacteriological laboratory. For bacteriological tests, test tubes with a known spore-bearing, non-pathogenic culture of microorganisms that die when certain temperature. The tubes are placed in a container, after sterilization is completed, they are pulled out and sent to the laboratory. The absence of microbial growth indicates the sterility of the material. The examination of cultures from dressings and linen is performed once every 10 days.

Indirect methods of monitoring the sterility of materials are constantly used during each sterilization. To do this, substances with a certain melting point are used: benzoic acid (120°C), resorcinol (119°C), antipyrine (110°C). These substances are available in ampoules. They are also used in test tubes (0.5 g each), closed with a gauze stopper. 1-2 ampoules are placed in the bix between layers of materials. Melting of the powder and its transformation into a solid mass indicates that the temperature in the mixture is equal to or higher than the melting point of the control substance. To control the sterilization regime in dry-heat sterilizers, powdered substances with a higher melting point are used: ascorbic acid (187-192°C), succinic acid(180-184°C), pilocarpine hydrochloride (200°C), urea (180°C).

Currently, a variety of sterility control indicators are used, which are manufactured in factories. Their use is based on the ability of chemicals to change their physicochemical and color characteristics at a certain temperature.

Sterilization of instruments:

Stage I - pre-sterilization preparation. Its purpose is thorough mechanical cleaning of instruments, syringes, injection needles, transfusion systems, removal of pyrogenic substances and destruction of the hepatitis virus.

The procedure for pre-sterilization preparation of instruments:

Disinfection;

Soaking in a soap-peroxide solution for 15 minutes. at T 50 °C.;

Wash for 30 seconds in a soap-peroxide solution using a cotton-gauze swab;

Rinse under running water for 30 seconds;

Rinse with distilled water;

Drying;

Tests for the quality of pre-sterilization preparation (tests for the presence of detergents, samples for the presence of blood residues, tests for the presence of fat residues.).

Stage II - laying and preparation for sterilization. After preliminary drying in air, the instruments are placed for drying in a dry-heat oven, which is heated to 80°C at open door. Then the cabinet door is closed and sterilization begins.

Stage III - sterilization. Sterilization of instruments, syringes, needles, and glassware is carried out in dry-heat sterilizers. After closing the cabinet door, the temperature is adjusted to 160 °C or 180 °C, maintaining it automatically. Sterilization lasts for 60 minutes at 180°C, or 150 minutes at 160°C. After turning off the heating system and reducing the temperature to 70-50°C, open the cabinet door, and close the lids of metal boxes with instruments with sterile instruments.

Sterilization of instruments that contain plastic parts (for example, cartridges with paper clips), syringes can be done in a steam sterilizer (autoclave). The packaged items are placed into the sterilization chamber. If the packages are placed in boxes, then their parts must be open. Surgical instruments and syringes are sterilized for 20 minutes at 2 atm. and temperature 132.9°C. The start time of sterilization is counted from the period of reaching the corresponding pressure. Rubber gloves, blood transfusion systems, rubber drainage tubes are sterilized at 1.1 atm. and temperature 120 °C for 45 minutes. or at 0.% atm. and a temperature of 110 °C for 180 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 in accordance with OST42-21-2-85 “Sterilization and disinfection of medical devices” is used.

Sterilization of instruments and items that are not subject to heat treatment(endoscopes, thoracoscopes, laparoscopes, devices or units of devices for artificial circulation, hemosorption), are carried out in a special gas sterilizer. Items to be sterilized are placed in a sealed sterilization chamber, which is filled with ethylene oxide. Exposure period is 16 hours at a temperature of 18°C. Sterilization can also be carried out with a mixture of ethylene oxide and methylene bromide at a temperature of 55°C for 6 hours.

Stage IV - preservation of sterile materials. Sterile materials are stored in a special room. It is not allowed to store non-sterile and sterile materials. The sterility of materials in containers (if they have not been opened slightly) is maintained for 48 hours, and if the material is additionally packaged in a cotton bag - 72 hours. With centralized sterilization, syringes remain sterile for 25 days.

Definition and classification of methods for sterilization of cutting, optical and general surgical instruments. Sterilization cutting tools carried out using the dry-air method at 180°C, wrapped in two layers of special paper.

Sterilization of instruments and optical devices (laparoscope, thoracoscope) can be carried out in an alcohol solution of Pervomuru, a 2.5% solution of glutaraldehyde for 360 minutes or a solution of the drug "Sidex" for 660 minutes. Sterilization of devices and instruments with chemical agents should be carried out in metal boxes with lids that prevent evaporation of the drug. With absence special dishes Sterilize in enamel or glass containers. The instruments are filled with solution so that it completely covers them and covered with a lid. IN in case of emergency When it is impossible to ensure sterilization of instruments using one of the indicated methods, sterilization of instruments by burning is used. 15-20 ml of alcohol is poured into a metal tray, several instruments are placed on the bottom and the alcohol is set on fire. The burning method is not reliable enough, fire and explosion hazard (presence of oxygen, vapors of narcotic substances in the indoor air). Therefore, it is resorted to in exceptional cases, strictly following fire safety rules.