All surgical instruments according to the characteristics of the materials used and other qualities can be divided into three groups: metal (cutting and non-cutting), rubber and plastic,
optical. Sterilization of non-cutting metal instruments
The main method of sterilization is hot air sterilization in a dry heat cabinet or in an autoclave under standard conditions. Sterilization of cutting metal instruments
The main method of sterilization of cutting instruments is a cold chemical method using antiseptic solutions. Recently, in dressing rooms, cutting instruments, as well as non-cutting ones, are sterilized in a dry-heat cabinet, which leads to some decrease in their sharpness, but ensures absolute sterility.
The best methods of sterilization are gas sterilization and especially 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 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.
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. 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 flow of water. 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.
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, aqueous-alcoholic solution of formaldehyde, aqueous-alcoholic solution of levomycetin 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, immersed in a 2% aqueous solution of potassium iodide (No. 0-1 for 30 seconds, No. 2- 5 for 1 min., No. 6 for 2 min.), and then the catgut wound into rings is placed in a suspended state in a jar with a ground and paraffin-filled stopper at a distance of 6-7 cm from the bottom, where dry iodine is located (in a 3-liter jar - 40 g, in a 5-liter jar - 60 g). Periodically, the jars are slightly shaken for uniform access of iodine vapor to all skeins of catgut. Catgut is considered sterilized No. 0-1 - after 3 days, No. 2-4 - after 4 days, No. 5-6 - after 5 days and after sowing is placed in dry sterile jars with ground stoppers.
Claudius method: for 14 days, 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.
Stage 1 - pre-sterilization preparation. Its purpose is the thorough mechanical cleaning of instruments, syringes, injection needles, transfusion systems, the removal of pyrogens and the destruction of the hepatitis virus. Personnel must wear rubber gloves.
Used, but non-infected instruments are thoroughly washed with running water with brushes in a separate sink for 5 minutes (instruments contaminated with blood are washed immediately, preventing the blood from drying out) and then soaked for 15-20 minutes in one of the special washing solutions heated up to 50vs. Syringes are processed disassembled.
Composition of washing solutions: solution A - perhydrol 20 g, washing powder (type "News", "Progress", "Astra", etc.) 5 g, water 975 ml; solution B - 2.5% hydrogen peroxide solution 200 ml, washing powder "News" 5 g, water 795 ml.
After soaking, the tools are washed in the same solution with ruffs, brushes (locks, teeth, notches are especially carefully treated), then rinsed with warm water for 5 minutes and rinsed in distilled water for 1 minute. After that, the instruments and syringes are placed in a dry-air sterilizer at 85 °C to dry, after which they are ready for sterilization.
Tools and syringes contaminated with pus or intestinal contents are first placed in enameled containers with a 0.1% diocide solution or 5% Lysol solution for 30 minutes. Then, in the same solution, they are washed with ruffs, brushes, rinsed with running water and dipped in one of the washing solutions, carrying out further processing according to the method described above.
Instruments after an operation performed on a patient with an anaerobic infection are soaked for 1 hour in a special solution consisting of a 6% hydrogen peroxide solution and a 0.5% detergent solution (washing powder), then washed with a brush in the same solution and boiled for 90 minutes . Only after that, the instruments are prepared for sterilization in the same way as uninfected instruments. After 1 day (time for germination of spores), they are subjected to autoclaving or boiling (fractional sterilization).
Puncture, injection needles after use are washed with a syringe with warm water, and then with 1% sodium bicarbonate solution, the needle channel is cleaned with a mandrin, washed with 0.5% ammonia solution and running water.
After that, the needle with the inserted mandrin is boiled for 30 minutes in a 2% sodium bicarbonate solution, and after 8-12 hours it is re-distilled for 40 minutes and dried, after which the needle channel is dried by blowing with ether or alcohol using a syringe or rubber pears. Needles contaminated with pus are thoroughly washed, their lumen is washed with running water; then it is placed for 1 hour in a 5% Lysol solution, additionally washing the canal with Lysol with a syringe or a rubber bulb, and subjected to the same further treatment as needles not contaminated with pus.
Systems for transfusion of medicinal substances or blood require careful processing to prevent post-transfusion reactions and complications. In modern conditions, one-time systems for transfusion, sterilized in the factory, are used. The reusable system is dismantled immediately after a blood or drug transfusion - the glass parts, a dropper and rubber tubes are separated, washed thoroughly with running water, kneading the rubber tube with your fingers (for better removal of blood residues). Parts of the system are immersed for 2 hours in a special solution heated to 60 ° C, containing 1% sodium bicarbonate solution and 1% ammonia solution. Then the parts of the system are washed with running water and boiled in distilled water for 30 minutes, washed again with water, kneading the rubber tubes, and boiled again for 20 minutes in distilled water. The system is then assembled and packaged for sterilization.
Stage 2 - laying and preparation for sterilization. For sterilization in dry heat sterilizers, the instruments are placed in metal boxes, stacking them vertically in one layer. Unassembled syringes are wrapped in 2 layers of special thick paper. Lids from boxes are sterilized side by side. Recently, disposable syringes, sterilized at the factory, have been mainly used.
For steam sterilization under pressure in steam sterilizers (autoclaves), the instruments are wrapped in a waffle towel or cotton cloth in the form of a bag and placed on a metal tray or mesh. For specific typical operations, a set of instruments is prepared in advance (for example, for operations on the lung, heart, bones, blood vessels), placed on a special mesh and wrapped in a sheet in the form of a bag.
The cylinder and plunger of the syringe are placed separately in gauze and wrapped in a piece of cotton fabric in the form of a bag, which is placed in a sterilization box (bix). For mass sterilization of syringes in autoclaves (centralized sterilization), a special packing made of cotton fabric with pockets is used. Disassembled syringes are placed in pockets, along with needles and tweezers. Each package contains up to 5 syringes. The styling is wrapped in a cotton diaper in the form of a bag and placed in a sterilizer.
Dry rubber gloves are sprinkled with talc (outside and inside), laid with gauze napkins, wrapped in a napkin in pairs and placed in a separate bix.
Assembled systems for blood transfusion are checked for the strength of rubber tubes, the tightness of their connection with glass parts and the compliance of cannulas with needle pavilions. The system is rolled up in the form of 2-3 rings, without bending the rubber tubes, wrapped in a large gauze napkin, then in a waffle towel and placed in bixes.
Stage III - sterilization. Sterilization of instruments, syringes (with a mark on the syringe of 200 VC), needles, glassware is carried out in dry-heat sterilizing cabinets (Fig. 4). Items are loosely placed on the shelves of the sterilizer in metal boxes (with the covers removed) and heating is turned on. With the door open, the temperature is brought to 80-85 ° C and dried for 30 minutes - moisture is removed from the inner surfaces of the cabinet and objects to be sterilized. Then the door is closed, the temperature is brought to the set temperature (180 °C), maintaining it automatically, and sterilized for 60 minutes. After turning off the heating system and lowering the temperature to 70-50 ° C, open the cabinet door and close the metal boxes with the lids with sterile tools. After 15-20 minutes (after complete cooling of the sterilizer), the chamber is unloaded.
When working with a dry heat sterilizer, safety measures must be observed: the device must be grounded, after sterilization, the cabinet door should be opened only when the temperature drops to 70-50 °C. It is forbidden to use a defective device.
Sterilization of instruments, syringes, blood transfusion systems can be done in a steam sterilizer (autoclave). Packed items are placed in the sterilization chamber. If the packages are placed in bixes, then their grids must be open. Bixes or other packages are laid freely so that the steam is distributed evenly.
Surgical instruments and syringes are sterilized for 20 minutes at 2 atm, which corresponds to a temperature of 132.9 °C. The start time of sterilization is counted from the moment the appropriate pressure is reached. Rubber gloves, blood transfusion systems, rubber drainage tubes are sterilized at 1.1 atm (steam temperature 120 °C) for 45 minutes. When unloading the autoclave, the holes in the bixes are closed.
Sterilization methods in dry heat and steam sterilizers should be considered as basic. The method of sterilization by boiling is used in small medical institutions where there is no centralized sterilization. Stationary or portable electric boilers are used, in which instruments, syringes, needles, glass objects, rubber drains, catheters, gloves can be sterilized.
Distilled water is poured into the boiler, to increase the boiling point of water and destroy the bacteria shell, add 20 g of sodium bicarbonate per 1 liter of water (2% solution). A thin quilted layer of cotton wool with gauze is laid at the bottom of the boiler so that the salts that fall out in the form of scale settle on it, and not on the tools.
The disassembled tools are placed on special nets and lowered with hooks to the bottom of the boiler, leaving the handles of the hooks outside, and the boiler is closed with a lid. Sterilization time - 40 minutes from the moment of boiling water. At the end of sterilization, the mesh with instruments is picked up with hooks, allowed to drain and transferred to a special table covered with a sterile sheet folded in 4 layers. The operating nurse lays out the instruments on the large operating table.
Syringes and needles are sterilized separately from instruments, disassembled (by boiling in distilled water without adding sodium bicarbonate), for 45 minutes. Syringes and needles for spinal puncture and intravenous infusions are boiled in double-distilled water without the addition of sodium bicarbonate.
Tools, syringes and needles contaminated with pus, feces, after special pre-treatment, are sterilized by boiling for 90 minutes in a separate boiler.
Instruments, syringes and needles used in patients with gas gangrene are subject to careful processing and subsequent fractional boiling sterilization. They are boiled for 1 hour, removed from the boiler and left at room temperature for 12-24 hours (for spores to germinate), and then re-sterilized by boiling for 1 hour (fractional sterilization).
In emergency cases, when it is impossible to ensure the sterilization of instruments
none of these methods, use the burning method. 15-20 ml of alcohol is poured into a metal basin or tray, several tools are placed on the bottom and the alcohol is set on fire. The burning method is not reliable enough, it is fire and explosive (the presence of oxygen, narcotic vapors in the indoor air), therefore, it is resorted to in exceptional cases, strictly observing fire safety measures.
Cutting instruments (scalpels, scissors) become dull during sterilization by conventional methods, so it is carried out with little or no heat treatment. After pre-sterilization preparation, the instruments are immersed in 96% ethyl alcohol for 30 minutes or in a triple solution for 3 hours. Only short-term boiling of cutting instruments is allowed. Scalpels are placed in a separate grid, their blades are wrapped with gauze and boiled in distilled water without adding sodium bicarbonate for 10 minutes, then stirred in 96% ethyl alcohol for 30 minutes.
Stage IV - storage of sterile material. Sterile material is stored in a special room. It is not allowed to store non-sterile and sterile materials in the same room. The sterility of the material in bixes (if they have not been opened) is maintained for 48 hours. If the materials were placed in linen packages (towels, sheets, diapers) and placed in biks for sterilization (for example, blood transfusion systems, rubber drains, syringes), they can be stored in these bixes for up to 3 days. With centralized sterilization, syringes remain sterile for 25 days.
ü Stage 1. Disinfection.
Target: Protect yourself from infection with blood-borne infections.
Ø Disassembled instruments are placed in a reservoir with water, where it should be until disinfection.
Ø Disinfection is carried out in another container, either by a physical method (boiling in distilled water for 30 minutes) or chemical (placed in 3% chloramine en 30 minutes or 4% H 2 O 2 for 20 minutes).
Ø Rinse the tools with running water until the smell of the disinfectant disappears.
Ø Disinfect the accumulator (boiling for 30 minutes or filling it with dry lime chloride 200.0 per 1 liter for 60 minutes).
ü Stage 2. Pre-sterilization cleaning (PSC).
Target: Removal of protein, fat and mechanical impurities, drug residues from the instrumentation.
Ø Immerse the tools in a warm washing complex (40-50 0 С depending on the detergent) for 15 minutes.
Ø Rinse with a brush, cotton-gauze swab or brush each tool in the washing complex for 0.5 min.
Ø Rinse with running water for 3-10 minutes.
Ø Rinse each instrument with distilled water for 0.5 min.
Ø Dry with hot air at t 0 80-85 0 С until moisture disappears completely.
Ø Carry out quality control of PSO (see OSD).
ü Stage 3. Sterilization.
Target: Destruction of spore forms of microbes.
Dry heat method:
Ø The tools are laid out equally on a tray.
Ø Withstand 60 min. at 180 0 C.
Ø Use during the work shift.
Autoclaving:
Ø Pack the tools in cotton cloth or crepe paper.
Ø Hold for 20 min. at 2 atm.
Chemical method:
Ø Immerse in 1 of the solutions:
v 6% H 2 O 2 for 180 min. at 50 0 С.
v 1% deoxon-1 for 45 min. at 20 0 С.
Ø Rinse in 2 sterile containers with water for 5 minutes. in each.
Ø Wrap in a sterile sheet and store in a sterile container.
Ø Use within 3 days.
Result evaluation:
Operational field processing (OP):
Sequencing: The preparation of the OP consists of sanitary and hygienic treatment of the skin before surgery and special treatment on the operating table.
ü For planned surgery:
Ø On the eve of the operation, carry out a complete sanitary and hygienic preparation of the skin (bathroom, shower, partial sanitization, taking into account the patient's condition).
Ø Change of bed and underwear.
Ø On the day of the operation, treat the skin with an antiseptic, dry it, dry shave in the direction of hair growth, treat with ethyl alcohol.
ü For emergency surgery:
Ø Carry out partial sanitization of the skin.
Ø Treat the skin with an antiseptic, dry, dry shave in the direction of hair growth, treat with alcohol.
ü On the operating table:
Ø Widely process the OP twice from the center to the periphery.
Ø Treat the OP at the site of the skin incision.
Ø Limit OP to sterile linen.
Ø Repeat the treatment of the OP at the site of the skin incision.
Ø Treat the OP before suturing.
Ø Treat the OP after suturing.
ü According to OST 42-21-2-85: 1% stodonate, 1% stodinol, 1% stodpiron, 0.5% chlorhexidine digluconate, AHD, AHD-2000, AHD-special, lizanin-OP-Red.
Ø Notes:
v If the operation is performed under local anesthesia, then after anesthesia it is necessary to additionally treat the skin with an antiseptic.
v Use skin-staining antiseptics to treat OP, they help distinguish treated areas from untreated areas of the field.
v To isolate the skin of the OP, you can use a special sterile diaper (protector) Emakryl.
Result evaluation: can only be tested bacteriologically.
Sterilization control.
ü Direct method:
Ø Bacteriological method. Directly responsible whether there is a microbe or not on the surface we are checking. A smear is taken, sowing on the ps. This method is used to control the SIR in medical institutions, because it does not allow you to determine whether the item can now be used (sterile or not).
ü Indirect method:
Ø With the help of indicators. They change color. When bookmarking light- 120 0 C slightly sandy– 132 0 C light brown– 180 0 C dark brown(almost black).
Ø With the help of chemicals. They are soldered in ampoules, placed in biks. Upon reaching the desired t 0, the substance melts and changes color. Benzoic acid at 120 0 С until sterility it is gray-blue, and after that it is plum-colored. Urea at 132 0 С before sterilization pink, after cherry color. Thiourea, succinic or tartaric acid at 180 0 C white before sterilization, yellow-green after. The control substance must be selected with the desired melting point.
Ø With the help of thermo-time indicators. Self-adhesive oilcloth, which is attached to the packaging or bix, and then attached to the journal, where sterilization is recorded. ITPS-120– in an autoclave, light green before sterilization, black after. ITPS-132– autoclaved, pink before sterilization, purple-brown after. ITSV-180- dry-heat cabinet, before sterilization blue, after dark gray (almost black).
Putting on a sterile gown:
ü To myself. M / s d.b. in a mask and cap, sterile bix d.b. on a stand, ready to go. - Prepare your hands. – Open the bix lid with the foot pedal, do not lower your hands below the waist. – Check the sterility indicator. – Using the tongs for linen, bend the lining sheet so that it covers the edges of the bix from the outside. - Remove the dressing gown from the bix, take it from the side with the other hand, without touching the instrument and return the instrument to the sterile tray. - Take the upper part with your hand and release it so that it turns around without touching anything. - Turn the inside towards you. - Put both hands into the sleeves at the same time. - The nurse takes the inside of the gown, without touching the outside, straightens it and ties the ribbons. - M / s ties up the sleeves, wrapping the ribbons around the wrist, does not tuck the ends behind the cuffs of the robe to the body. – The m/s takes out a belt from his right pocket and gives it to the nurse so that she can tie it without touching the m/s’s hands and dressing gown. The nurse ties the belt at the back.
ü To the doctor. M / s d.b. in a sterile gown and gloves. - He takes out a sterile gown from the bix with tongs for linen. - He turns it with the outer side towards himself, and the inner side towards the doctor so that he can put both hands into the sleeves. - Throw a robe over your shoulders. - An operating nurse is tying up from behind. - The doctor takes out the belt and gives it to the nurse so that she does not touch the dressing gown with her hands. The nurse is tying her robe. - M / s gives gloves.
Putting on sterile seals:
ü To myself. M / s d.b. in a mask, cap, sterile gown and with prepared hands. – Open the bix lid by pressing the pedal, remove the package of gloves and put it on a sterile table. - Using sterile tweezers, open the package, unfold. - With your left hand, take the right glove by the lapel of the cuff from the inside. - Put on a glove on your hand without straightening the cuffs. - We put 4 fingers of the hand in gloves under the cuffs of the left glove. - Put on a glove. – Unscrew the cuffs on the sleeves of the dressing gown.
If fingers fall out of place, they can be corrected when both hands are gloved.
Remove gloves like this so that the skin does not touch the contaminated surface of the gloves.
ü To the doctor. M / s d.b. in a sterile gown and gloves, the doctor d.b. in a robe. - Place 4 fingers under the cuffs of the gloves, stretch and give to the doctor so that the cuffs of the gloves cover the cuffs of the gown. - Use a ball of alcohol to treat the gloves on your hands.
Types of gloves:
o Synthetic. - Latex.
ü Powdered. - Powder free.
ü Diagnostic. - Surgical.
ü Sterile. - Non-sterile.
All gloves d.b. durable, non-allergic, chemically resistant, comfortable (elastic, with good sensitivity.
Means for disinfection and sterilization:
ü Lysoformin-3000. It is used for disinfection and sterilization of medical devices. IMN is immersed for 1 hour. For disinfection 1,5, 0,75, 2%, for sterilization 8%.
ü Blanisol. For PSO medical devices, endoscopes 1% solution. Can be added to Lysoformin-3000 in order to enhance its properties.
ü Desoform. For disinfection medical devices from any material 1, 3, 5%.
ü Lizanol. Cutaneous antiseptic.
ü Chlorapin. Processing everything. In tablets and granules.
ü Amidine. Cutaneous antiseptic. For the treatment of hands, OP, injection sites, medical gloves, shoes.
Covering the sterile table for the dressing room:
Equipment: Bix with 5 sterile sheets; Bix with sterile oilcloth; sterile tray with instruments; tongs for linen; 2 forceps; 2 toes.
Algorithm:
ü Cover the table with sterile oilcloth in 1 layer in the direction Push.
ü Use the foot pedal to open the bix cover. Check indicator. Use tongs to bend the lining sheet.
ü Take out with tongs 1 sheet. Expand to 1 layer. Over the oilcloth so that it covers the table legs but not touching the floor.
ü 2 sheets in 2 layers. So that she hung from the edge of the table by 20-25 cm.
ü 3 sheets in 2 layers. So that hung from the edge of the table by 10 cm.
ü 4 sheets same way like 3.
ü 5 sheets in 1 layer. So that covered the edge of 2 sheets.
ü Forceps impose on the edges of 5 sheets at the corners of the table.
ü Raise sheet for forceps and fold accordion at the far end of the table in the direction from myself to myself. The last direction to yourself. Put forceps rings to each other.
ü Capturing heels 2 layers 4 sheets and 1 layer 3. Add up accordion over forceps. Tsapki we put rings to each other.
ü We put everything necessary for dressing on the surface. We take hoes and overlap. We take forceps and overlap.
The processing of all instruments includes the sequential execution of two stages: pre-sterilization processing and sterilization itself. The type and volume of pre-sterilization treatment is determined by the degree of infection of the instruments, and the method of sterilization primarily depends on the type of instruments.
a) Pre-sterilization preparation
Pre-sterilization preparation consists of disinfection, washing and drying. All types of instruments are exposed to it.
The type and volume of pre-sterilization treatment in the recent past was determined by 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 in the AIDS risk group was significantly different. However, at present, given the high risk of the spread of AIDS, the rules for pre-sterilization preparation have been tightened and equated to methods of processing instruments that provide an unconditional guarantee of the destruction of the human immunodeficiency virus. It should only 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 AIDS, are processed separately from others.
All pre-sterilization procedures must be performed with gloves!
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
funds use a 3% solution of chloramine (exposure 40-60 minutes) or 6% hydrogen peroxide solution (exposure 90 minutes). After disinfection, the instruments are washed with running water.
the washing up
Tools are immersed in a special washing (alkaline) solution, which includes detergent (washing powder), hydrogen peroxide and water. Solution temperature 50-60°C, exposure 20 minutes. After that, the tools are washed with brushes in the same solution, and then in running water.
Drying
Drying can be done naturally. Recently, especially during subsequent hot air sterilization, the instruments are dried in a dry oven at 80°C for 30 minutes. After drying, the instruments are ready for sterilization.
The choice of sterilization method primarily depends on the type of surgical instruments.
b) Actually sterilization
All surgical instruments according to the characteristics of the materials used and other qualities can be divided into three groups:
- metal (cutting and non-cutting),
- rubber and plastic,
- optical (Fig. 2.7).
SURGICAL INSTRUMENTS
t
syringes, needles, clamps, tweezers, hooks, zoids, plates, screws, rods, etc.
scalpels, scissors, surgical needles, amputation knives, etc.
catheters, probes, drains, enema tips, etc.
laparoscope, gastroscope, choledochoscope, cystoscope, etc.
Rice. 2.7
The main types of surgical instruments
Sterilization of non-cutting metal instruments
The main method of sterilization is hot air sterilization in a dry heat cabinet or in an autoclave under standard conditions. It is also possible to use boiling. However, it is not recommended to boil instruments after operations for anaerobic infections and in the hepatitis risk group. Some types of simple instruments (tweezers, clamps, probes, etc.) intended for single use can be sterilized by radiation.
Sterilization of cutting metal instruments
Sterilization of cutting instruments using thermal methods leads to their blunting and loss of properties necessary for the surgeon.
The main method of sterilization of cutting instruments is a cold chemical method using antiseptic solutions.
Recently, in dressing rooms, cutting instruments, as well as non-cutting ones, are sterilized in a dry-heat cabinet, which leads to some decrease in their sharpness, but ensures absolute sterility.
The best methods of sterilization are gas sterilization and especially radiation sterilization in the factory. The latter method has become widespread using disposable scalpel blades and surgical needles (atraumatic suture material).
Sterilization of rubber and plastic instruments
The main method of sterilization of rubber products is autoclaving. With repeated sterilization, the rubber loses its elastic properties and cracks, which is some disadvantage of the method. Boiling rubber products for 15 minutes is also acceptable.
Single-use plastic products, as well as catheters and probes, are subjected to radiation factory sterilization.
Special mention should be made of the sterilization of gloves. Recently, disposable gloves that have undergone radiation factory sterilization have been most commonly used. With repeated use, the main method of sterilization is autoclaving in a gentle mode: after pre-sterilization treatment, the gloves are dried, sprinkled with talc (prevents sticking), wrapped in gauze, placed in bix and autoclaved at 1.1 atm. within 30-40 minutes or
- 5 atm. - 15-20 minutes.
After putting on sterile gloves, they are usually treated with a ball of alcohol to remove talc or other substances from the surface that prevent rubber from sticking.
Sterilization of optical instruments
The main method of sterilizing optical instruments that require the most gentle treatment with the exception of heating is gas sterilization. All instruments for laparoscopic and thoracoscopic interventions are processed in this way, which is associated with their complex design and high cost.
When sterilizing fibrogastroscopes, choledochoscopes, colonoscopes, it is also possible to use cold sterilization using chemical antiseptics (ethyl alcohol, chlorhexidine, sidex - a two-component preparation based on glutaraldehyde).
It should be especially noted that the best way to prevent contact infection is to use disposable instruments that have undergone radiation factory sterilization!
