I. Water washing
(1) Put the endoscope into the cleaning tank:
1. Rinse thoroughly under flowing water, scrub the body of the mirror with gauze repeatedly and wash the operation part at the same time;
2. Remove the biopsy inlet valve, the suction device button and the button of sending air and water, and brush the biopsy orifice and the light-conducting hose of the suction device pipe thoroughly with a cleaning brush. Attractor tube of the light-conducting hose, when brushing, the brush head must be seen at both ends and the dirt on the brush head must be washed;
3. Install the full pipeline irrigator, the pipeline plug, the waterproof cap and the attractor, and use the attractor to repeatedly suction the biopsy orifices;
4. Connect the full pipeline irrigator to the 50 ml syringe, and suction the fresh water into the air-supply and water-supply pipelines;
5. Suck the water of biopsy orifices and wipe off the mirror by using the attractor. orifice and dry the mirror.
(ii) Rinse and dry the removed suction button, air and water delivery buttons and biopsy inlet valve with water.
(iii) After use, endoscopic accessories such as biopsy forceps, cytobrush, incisional knife, guidewire, lithotripter, mesh basket, contrast catheter, and foreign body forceps, etc., are placed in clean water, and the inner surface of the forceps flap and the joints are cleaned with a small brush, rinsed, and wiped dry.
(d) Cleaning gauze should be used in a single-use manner, and the cleaning brush should be sterilized once used.
II. Enzymatic washing
(I) The configuration and soaking time of the multi-enzyme washing solution is in accordance with the product instructions.
(B) the dry endoscope in the enzyme wash tank, with injection suction multi-enzyme wash 100 ml, rinse the gas and water pipeline, with the suction device will contain enzyme wash into the biopsy orifice, the operation of the Department of multi-enzymatic wash with a wipe.
(c) After wiping dry the accessories, all kinds of buttons and valves soaked with multi-enzyme wash solution, accessories also need to be cleaned in the ultrasonic cleaner for 5-10 minutes.
(iv) Multi-enzyme wash should be replaced after cleaning one endoscope.
Three, cleaning
(a) After soaking the endoscope with multi-enzyme wash solution, thoroughly rinse each tube with a water pistol or syringe to remove the multi-enzyme wash solution and loose dirt in the tube, and at the same time rinse the outer surface of the endoscope.
(ii) Flush each tube with a 50-mL syringe to expel water from the tube so as not to dilute the disinfectant.
Four, disinfection
When 2% alkaline glutaraldehyde is used for immersion or sterilization, the cleaned and wiped endoscope should be placed in the disinfection tank and fully submerged in the disinfectant, and the orifices should be filled with disinfectant with a syringe. The operating section of a non-totally immersed endoscope must be wiped with water and then disinfected by wiping with 75% ethanol. When 2% alkaline glutaraldehyde is used to sterilize endoscopes that need to be sterilized, the immersion time is as follows:
Gastroscopes, enteroscopes, and duodenoscopes should be immersed for not less than 10 minutes;
Bronchoscopes should be immersed for not less than 20 minutes;
Tuberculous bacilli and other specially infected patients should be immersed for not less than 45 minutes after use;
Endoscopes that need to be sterilized When 2% alkaline glutaraldehyde is used for sterilization, it must be immersed for 10 hours;
When 2% alkaline glutaraldehyde is used for sterilization of gastroscopes, enteroscopes, duodenoscopes, bronchoscopes, and other endoscopes that need to be sterilized which are no longer to be continued in use on the same day, the time of disinfection should be extended to 30 minutes;
When automatic cleaning and disinfecting of instruments is used, the endoscopes should be cleaned prior to disinfecting the instruments used.
V. Endoscopes should be rinsed and dried after disinfection in accordance with the following methods and steps:
1. Before endoscopes are taken out of the disinfection tank, cleaning and disinfecting personnel should change their gloves, and inject air into each lumen from the syringe to get rid of disinfectant.
2. The endoscope is placed in the rinsing tank, and the outer surface of the endoscope is cleaned with gauze under running water, and the orifices are rinsed by repeated suction of water.
3. Clean the outer surface of the endoscope with gauze, pump the water from each orifice cleanly, remove all kinds of special tubes and buttons for cleaning, and replace them with all kinds of diagnostic attachments before they can be used for the next patient.
4. Bronchoscope after the above operation, but also need to use 75% ethanol or clean compressed air and other methods for drying.
Sterilization of endoscopic accessories:
Endoscopic accessories: such as biopsy forceps, cytobrush, incision knife, guidewire, lithotripter, mesh basket, contrast catheter, foreign body forceps, etc. should be sterilized once used, and sterilized by pressure steam or 2% glutaraldehyde immersion for 10 hours.
Disinfection of other objects:
1. Mouth cushions, curved trays, dressing cylinders, etc. should be sterilized by pressure steam.
2. Disinfection of water bottles and connectors should be sterilized by soaking in 500mg/L chlorine-containing disinfectant for 30 minutes, thoroughly rinsing the residual disinfectant with water, drying and preparing for use, and the water in the water bottles should be sterilized water, which should be replaced every day.
3. Disinfection of suction bottles and tubes: after the examination, clean the suction bottles first and then soak them in 500mg/L chlorine disinfectant for 30 minutes, brush them clean and dry them.
4. Cleaning tanks, enzyme washing tanks, rinsing tanks are sufficiently scrubbed, and then wiped with chlorine disinfectant with an effective chlorine content of 500mg/L. The disinfecting tanks must be changed when replacing the disinfectant. Disinfectant tanks must be thoroughly scrubbed when replacing the disinfectant.
5. The organizer box is brushed and cleaned after daily use, and then wiped with chlorine disinfectant with an effective chlorine content of 500mg/L. The disinfectant must be used before the start of the daily treatment. Before the start of the daily diagnosis and treatment work, the disinfectant endoscopes to be used on that day must be disinfected again. If 2% glutaraldehyde immersion is used, the disinfection time is not less than 20 minutes, rinsing, drying, before being used for patient consultation.
Other chemical disinfection methods are formaldehyde fumigation, ethylene oxide sterilization. Formaldehyde fumigation has the following disadvantages: ① condensation polymerization of white sticky material will damage the instruments; ② sterilization delay; ③ a strong irritating odor; ④ poor penetration. Therefore, most hospitals in China use glutaraldehyde fumigation disinfection method instead of the traditional formaldehyde fumigation. Traditional chemical methods can cause slow corrosion of surgical instruments as well as poisoning threat to the operator, so it has been phased out in major hospitals.
Physical disinfection methods are also:
(1)Ultraviolet light disinfection: mainly used for disinfection of oral mirrors and endoscopy storage cabinets, irradiation for 5-10 minutes, can inactivate HEsAg.
(2)Pressure steam sterilization is mainly used for various valves and biopsy forceps of rigid endoscopes and fibre endoscopes.
(3)Low-temperature plasma sterilization device is being accepted by many large domestic hospitals. Imported brands to the U.S. Johnson and Johnson's 100S type of the main, the more excellent domestic brands are Chengdu old Ken, Beijing White Elephant and other brands.
Low-temperature plasma disinfection mechanism: low-temperature plasma there are many electrons, ions, reactive groups and excited state molecules with very high chemical activity of the particles
, so that many of the need for a high activation energy of the chemical reaction can take place, so that the conventional method is difficult to remove the pollutants can be transformed or decomposed. Under the action of an applied electric field, a large number of high-energy electrons generated by dielectric discharge bombard the pollutant molecules,
converting the energy into the internal energy of the ground state molecules, and a series of processes, such as excitation, ionization, and dissociation, so that the gas is in an activated state. When the electron energy is low, it produces reactive radicals,
Activated pollutant molecules are removed after plasma directed chain chemical reaction. When the average electron energy exceeds the chemical bonding energy of the pollutant molecules, the molecular bonds are broken and the pollutants are decomposed. In this process,
occurred a series of complex physical and chemical reactions, so that the complex macromolecular pollutants into simple small molecules of safe substances,
or so that the toxic and hazardous substances into non-toxic and harmless or low toxicity and low harm of the material. The occurrence of these reactions depends mainly on the average energy of electrons, electron density, gas temperature, the concentration of pollutant gas molecules and the ****existing gas composition.
No residual toxicity:
The end products of hydrogen peroxide plasma sterilization are water and oxygen, completely free of harmful substances, so it is safe for medical workers and patients, and will not cause environmental pollution.
The choice of sterilization method should be based on the hospital's surgical volume and equipped with sterilization equipment from the best consideration.