I. Preparation of small animal surgical instruments and items
The instruments and other items used in surgery are of various types and nature, including metal products, glass, enamel, cotton fabrics, plastics, nylon, rubber products, etc., all of which may cause direct or indirect contact with the surgical creation of infection. Sterilization and disinfection methods are also many, should be based on the corrosion resistance of the items, anti-high-pressure and other selection of disinfection and sterilization.
1. Metal instruments
All surgical instruments should be clean and free of dirt and dust. First of all, it is necessary to check whether the number of instruments prepared is sufficient to ensure the needs of the surgical procedure. It is also important to pay attention to the performance of each instrument to ensure its proper use. For infrequently used instruments or new instruments, remove any protective oils or other protective agents from the surface with a warm detergent solution, and then rinse off any remaining detergent with plenty of water before use. Complicated instruments should be disassembled or semi-disassembled to facilitate adequate sterilization. For hemostatic forceps and needle forceps with elastic locks, the locks should be loosened to avoid affecting the elasticity. Sharp instruments should be wrapped in gauze to avoid dulling. Injection needles and suture needles should be placed in certain containers or inserted neatly and orderly in gauze blocks to prevent them from falling apart and causing inconvenience in use. In order to protect the sharpness of the surgical blades, it is best to wrap them in gauze and sterilize them by chemical immersion (autoclaving is not recommended). Each time the use of surgical instruments, can be wrapped in a larger cloth bag within the single, so more convenient sterilization and use.
The most common sterilization method for surgical instruments is autoclaving. In case of emergency or unconditional, can also be used to boil or chemical immersion sterilization method.
2. Glass, porcelain and enamel utensils
All of these supplies should be fully cleaned, fragile and fragile to use gauze properly wrapped and protected. Such vessels if the volume is small, can be used autoclave sterilization method, boiling method or chemical disinfectant immersion method (glassware do not sudden cold and heat, so as to avoid breakage). If the surgery requires glass syringes, should be cleaned syringe plug, the outer tube were wrapped in gauze to avoid misplaced or mutual collision. Sterilization of metal syringes, the first metal syringe clean, and its components disassembled, wrapped in sterile towels. Large quantities of syringes should be sterilized by autoclave, while small quantities are often sterilized by boiling. After sterilization, use the sterilized dressing forceps or tweezers to take out, aseptic state supporting the installation of the application. Large pieces of artifacts such as large square plate, enamel pots, etc., you can consider the use of alcohol flame cauterization sterilization method, that is, in a clean large-scale vessels poured into the appropriate amount of medical alcohol (95%), so that it covers the bottom of the plate, and timely ignition of combustion.
3. Rubber, latex, nylon and plastic supplies, including a variety of clinically used tubes and catheters, gloves, rubberized cloth, aprons and a variety of plastic products. Some are not resistant to high pressure, some even more can not withstand high heat, these supplies should be cleaned before sterilization, and fully rinsed with clean water for use. When sterilizing, the items should be wrapped in gauze. Latex products can be sterilized by autoclave steam, generally used only once, can also be used for chemical disinfectant soaking disinfection, but some disinfectants are prone to chemical reactions, such as the new cleaner can make the surface of the latex gloves sticky (does not affect the operation). Rubber products can be selected autoclave sterilization (very easy to age sticky, lose elasticity) or boiling sterilization, can also be used to disinfect chemical disinfectant solution immersion method to disinfect. Some special tubes and catheters, etc., can also be in a small closed container (such as desiccators) with formaldehyde fumigation method to disinfect. Many of these supplies are now single-use, which reduces the need for many of the tedious steps involved in sterilization, but the economic cost is higher, raising medical costs.
Plastic supplies such as plastic tubes, plastic film, etc. generally use chemical sterilization. Some medical units have the use of ethylene oxide gas sterilization device conditions, bacteria, spores, rickettsiae, viruses have a killing effect, can be used for instruments, instruments, dressings, rubber, plastics, etc. sterilization, will make a lot of surgical supplies disinfection and sterilization has become both convenient and simple
4. Dressings, surgical scarves, surgical gowns, hats, and masks, and other items
Dressings in the operation of the main refers to the hemostatic gauze. Hemostatic gauze for medical use made of skimmed gauze, according to the specific needs of the first cut into different sizes of square gauze block, like a handkerchief, and then folding method to fold, to the final cut edge of the raw edge completely folded in the internal until. And then a number of pieces of this hemostatic gauze with a small square cotton towel wrapped into a small package, easy to sterilize, easy to use. At present, clinical and teaching experiments with surgical towels, surgical caps and masks are mainly cotton fabrics, according to certain specifications in advance, respectively, the surgical towel, surgical gowns finishing, folding, and surgical caps, masks put into the folded surgical gowns, and then a large sheet of cloth will be surgical towels, surgical gowns, hats and masks wrapped up, ready to be sterilized. These supplies are generally autoclaved, at 126.6 ℃, after not less than 30min of sterilization, can fully meet the sterilization requirements. In the absence of high-pressure sterilizer, you can also use mobile steam sterilization method (using ordinary steamer, can be calculated from the water after boiling and send out a lot of steam, sterilized by 1 ~ 2h).
Sterilized items wrapped in a cloth sheet, small and scattered can be loaded into the storage tank, or wrapped in a small cloth sheet. Storage tank is made of metal materials made of special containers (see Figure 1-1). Before sterilization, the bottom and side windows of the reservoir are opened completely. The bottom and side windows are closed immediately after sterilization and removal from the autoclave. The tanks are guaranteed to be sterile for up to one week when closed. Recycling of the above supplies need to be washed, not adhering to the hair or other dirt, and then sorted according to different specifications, folded, sterilized and can be reused.
5. Suture materials
Sutures can be placed in the storage tank, surgical towels, surgical gowns package autoclave sterilization.
(B) sterilization and disinfection methods
Commonly used sterilization and disinfection methods are boiling sterilization, autoclaving and chemical sterilization method. In addition, there are mobile steam sterilization method, dry heat sterilization method and flame cauterization sterilization method, etc., but the application of less
1. Sterilization methods
Pre-sterilization, should check the instruments used, the practicality of supplies to ensure that the knife, scissors sharp, flexible shaft, a variety of pliers and forceps closed tightly, the locks open and close flexible. Sterilization of instruments and supplies to be cleaned with gauze wipe clean, and then wrapped in gauze bundled or with a lid container packed for sterilization.
(1)
Boiling sterilization method boiling sterilization method can be used in general with a lid clean aluminum lunch boxes, aluminum pots, iron pots and so on. The instruments to be sterilized in order into the sterilization container, add water to submerge all the instruments can be heated and boiled sterilization. After heating and boiling for 15~20min, it can kill the general bacteria, but it cannot kill the bacterial spores with strong resistance. For the suspected contamination of bacterial spores (tetanus bacillus, anthrax bacillus, necrosis bacillus, etc.) of the instruments or articles, must be boiled for more than 90min. Adding sodium bicarbonate to water to make it 2% alkaline solution can raise the boiling point of water to 102~105 ℃, which can not only strengthen the sterilization effect, but also prevent metal instruments from rusting (but on rubber products have damage). Plateau areas of low pressure, the boiling point of water is also low, the boiling time should be appropriately extended, the general altitude of every 300m above sea level, the need to extend the sterilization time of 2min. in order to save time and ensure the quality of sterilization, the pressure cooker can be used to carry out boiling sterilization, pressure cooker pressure can reach 1.3kg/cm2, the temperature of the water in the pot to reach 124 ℃ or so, 10min can be reached the purpose of sterilization.
Boiling sterilization method is suitable for heat-resistant, moisture-resistant items, such as metal, glass, rubber sterilization.
(2)
High-pressure steam sterilization method of high-pressure steam sterilization for the most common surgical applications, the effect of the most safe and reliable sterilization methods. High-pressure steam sterilizer portable, vertical, horizontal, etc., its volume size varies. The principle of sterilization is the use of steam accumulation in the container and generate pressure. Steam pressure increases, the temperature also increases. When the steam pressure reaches 0.1 ~ 0.137MPa, the temperature can reach 121 ~ 126 ℃, maintained for 30min, not only can kill all bacteria, and can kill the bacterial spores with strong resistance, to achieve the purpose of complete sterilization. The sterilized items can be used within two weeks.
Sterilization method for the first high-pressure sterilizer to add tap water to the specified position, and then the prepared surgical instruments wrapped in disinfection towels, in order to put the high-pressure sterilizer into the bucket, and then put the bucket into the high-pressure steam sterilizer to cover the lid, tighten the screws. Heating to a pressure of 0.0343MPa, the temperature of 108.4 ° C when you open the bleeder valve to let out the cold air, close the bleeder valve, continue to heat to a pressure of 0.1029MPa, the temperature of 121.3 ° C, maintained for 30min. and then stop the heating, venting to the barometer pointer to 0, open the lid to take out the sterilization of goods for standby. The method can kill all micro-organisms, including bacterial spores with strong resistance, used to withstand high temperatures, high pressure sterilization of goods, a variety of items required time, temperature and pressure are shown in Table 1-1.
Autoclave steam sterilization should pay attention to the following matters: ① need to be sterilized parcels should not be too large, do not pack too tightly, generally should be less than 55cm × 22cm × 33cm. ② parcels placed in the sterilizer, the package should not be too large. Put in the sterilizer package should not be too tight, too dense, so as not to impede the steam penetration, affecting the sterilization effect. ③ parcels should be placed in the middle of the sterilization effect of monitoring agent for monitoring, which is not to participate in the sterilization operation of the most important surgical personnel. Flammable and explosive substances such as iodoform, benzene, etc. are prohibited by autoclave sterilization. ⑤ Sharp instruments, such as knives, scissors, etc., should be used with caution, so as not to blunt. ⑥ of the sterilized items should be well marked, marked time, in order to use the identification.
Precautions for the use of autoclaves are as follows: ① autoclave pressure gauge must be accurate to ensure the safety of use. To be regularly inspected. ② autoclave added to the water should not be too much, so as not to boil the water to the barrel overflow, so that the disinfection of items soaked in water, and should not be too little, or can not form a certain steam pressure, affecting the sterilization effect. ③ The metal hose connected under the bleeder valve must be retained, must not be broken, otherwise the bleeder is not sufficient, the cold air retained in the barrel will affect the temperature rise, hindering the sterilization effect. ④ After sterilization should be immediately intermittent slow deflation, until the barometer pointer to 0, turn the lid to remove the contents in a timely manner, can not be left to cool naturally to reduce the pressure, so that the dry items will become wet, hindering the normal use. ⑤ Do not be too fast when deflating after sterilization. Especially when containing glass products or other fragile items, if the decompression is too fast, it will cause serious damage to the items. (6) should always determine the sterilization effect of autoclave, simple and easy method is the chemical indicator method. Commercially available 121 ℃ pressure steam sterilization chemical indicator card placed in the middle of the item to be sterilized. Sterilization indication card by the temperature change and become black, said in line with the sterilization conditions. If not black, that does not meet the sterilization conditions, should find out why and correct.
(3) flow steam sterilization method (steamer sterilization method) This method is used only in the absence of high-pressure steam sterilizer. Operation will be sterilized items in the steamer on the top of the grid, and keep a certain distance from the boiling water to prevent moisture. Time should be calculated from the boiling water on the steam, *** steam 1 ~ 2h. Generally used for dressings, surgical gowns, gloves sterilization.
Flow steam sterilization, with spores of bacteria is not easy to kill, need to use intermittent sterilization method to kill, each time 2h,*** continuous 3d, to achieve complete sterilization.
(4) flame cauterization sterilization method in urgent need, metal instruments can be used in this sterilization method. Operation, in the enamel or metal utensils poured into a little 95% alcohol, ignited with a long pliers holding the sterilized instruments in the flame on the grill, that is, to achieve the purpose of sterilization. Flame sterilization of instruments damage, non-emergency try not to use
2. Disinfection methods
(1) drug immersion disinfection method for sharp instruments, endoscopes and other items unsuitable for heat sterilization, can be used to disinfect the chemical solution immersion. Commonly used chemical disinfectants are the following.
①New Jieermei and Chlorhexidine: both are emerging surface-active antimicrobial agents, are cationic detergents, can adsorb bacterial membranes, change its permeability, so that the bacteria in the body of the important components of the escape and play a bactericidal effect. Chlorhexidine has a stronger bactericidal effect than Neosporin. Both immersion sterilization concentration of 0.1% solution, commonly used in soaking blades, scissors, needles, etc., immersion time of 30min, both of which have a certain degree of toxicity to the body's cells, the use of instruments should be rinsed first with sterile saline. Also note that this kind of cationic surfactant and alkali, soap, tincture of iodine, alcohol and other substances will fail after contact.
② Alcohol: commonly used concentration of 75%, the concentration is too low is not enough to make the bacterial protein coagulation denaturation, weakening the bactericidal effect; while the concentration is too high, the bacterial surface protein coagulation is too fast, hindering the role of the depth. Alcohol is often used for skin disinfection in surgery, and has the effect of deiodination. Disinfection of sharp instruments, immersion 30min ~ lh alcohol volatile, should be filtered once a week, and check its concentration to meet the requirements.
3 Mercury: commonly used concentration of 0.1% ~ 0.5%, used to soak cystoscopes, colloid catheters, etc., the time is 30min, before use must be rinsed with sterile saline to prevent the toxic effects of mercury on the body.
4 formaldehyde: can denature protein, not only strong bactericidal force, and can kill bacterial spores. But there is a strong irritating odor, and has a damaging effect on cells. Commonly used 10% formaldehyde solution, immersion plastic tubes, catheters and organic glass, etc., immersion time of 4 ~ 6h, when used with sterile saline rinse.
⑤Lysol: can be combined with bacterial protein and precipitation and kill bacteria. Insoluble in water, easily soluble in soap, so made of 5% coal phenol soap for spare, soak metal instruments need 1h, use should be thoroughly rinsed with sterile saline.
6 instrument solution (antirust disinfectant): the formula is 20g of carbolic acid, glycerol 266mL, 95% alcohol 26mL, sodium bicarbonate 10g, add distilled water to 1000mL. soak taxilife instruments for 30min disinfectant soak disinfection precautions: the application of chemical disinfectant soak instrument items, in the soak before the items to be cleaned and wiped off the oil and grease (organic lipids affect), disinfectant efficacy, the application of chemical disinfectant soak disinfection: the application of chemical disinfectant soak instrument items, the items to be clean and wipe off the oil (organic fat affect). (Organic fats and oils affect the disinfection efficiency), disinfected items must be completely immersed in the solution. There are axial joint instruments (such as scissors) should be open axial joints; empty lumen bottle air must be exhausted, inside and outside the lumen should be soaked in disinfectant. In the middle of soaking disinfection, such as adding items should be recalculated from the time of adding items. Because most of the chemical disinfectants on the human body has toxicity and erosive, so before the use of instruments, the need to use sterile saline will be attached to the liquid rinsed clean, so as to avoid tissue damage.
(3)
Formaldehyde steam fumigation disinfection method with a diameter of 24cm with a steam grid aluminum pot, steam grid under a measuring cup, add potassium permanganate 2.5g, and then add 40% formaldehyde 5mL, cover tightly fumigation 1h, that is, to achieve the purpose of disinfection. If the parts are large, you can use a large fumigator, you can refer to the above ratio to increase the dosage.
After the use of instruments and appliances, etc., must undergo a certain degree of treatment, in order to re-sterilize, disinfect, for the next operation. Processing method with the type of goods, the nature and degree of contamination varies. Metal instruments, glass, enamel items, after use must be cleaned, pay special attention to grooves, grooves, axial joints and other places of decontamination, metal instruments must be wiped with oil, rust, rubber and plastic pipelines should pay attention to the tube rinse, contact with some infected surgical supplies should be made special treatment.
(3) Precautions
①Since the chemical disinfectant can not enter the grease, can not kill the bacteria in the grease, therefore, the grease on the instruments should be wiped clean before immersion.
②Chemical disinfectants generally have a certain degree of irritation and toxicity, therefore, instruments or objects must be repeatedly rinsed with sterile saline or cool water before application, soak.
③Neosporin and Chlorhexidine dissociate into cationic active groups in aqueous solution, on the contrary, soapy water dissociates into anionic active groups in aqueous solution, the two will affect the effectiveness of the encounter, therefore, any contact with soapy water instruments, items must be washed with water and then disinfected by immersion. In addition, with potassium permanganate, alkali substances and other contraindications, should be used alone.
④All instruments and articles to be sterilized must be immersed in the liquid.
3. Preservation of sterile articles
(1) set up a sterile articles room for sterile articles, all articles should indicate the date of sterilization, name and name of the executor.
(2) Autoclaved items are valid for 7d, and need to be re-sterilized after the expiration date before use.
(3) boiling disinfection and chemical disinfection is valid for 12h, after the expiration date, must be re-sterilized.
(4) has opened the disinfection of the goods are limited to 24h storage operating room use.
(5) sterile dressing room should be 12 times a day to wipe the frame and the ground, 12 times a day ultraviolet light irradiation.
(6) sterile dressing room should be responsible for a person to do three: fixed, positioning, quantitative.
(7) The special infected animals contaminated dressings and instruments should be sterilized twice before returning to the sterile room.
The instruments in the operating room after sterilization should also pay attention to prevent recontamination. Transportation of sterilized surgical packages, auxiliary packages, etc., whether received from the supply room or the operating room turnover, should be applied to the sterilized trolley or tray, and must not be mixed with contaminated items or mixed use. Sterilization equipment kept in the operating room should be double-packed to prevent inadvertent contamination when opening the package. Small pieces of equipment should be packaged and sterilized, stored with the package. Store sterile equipment room, should be dry and dust-free, set up ventilation or ultraviolet disinfection device, minimize the access of personnel, and regular cleaning and disinfection.