Cleaning process of surgical instruments
(I) Treatment of general surgical instruments
General surgical instruments are non-infected surgical instruments, such as thyroid, hernia, intervertebral disc and other surgical instruments.
Handling method: remove blood stains under running water of postoperative instruments → enzyme immersion for more than 2min (or + ultrasonic shock) → thorough rinsing under running water → sorting and drying (fine, sharp instruments should be separated) → checking → oiling → packing or sorting and storing them in the instrument cabinet.
(2) The treatment of general infected surgical instruments
General infected surgical instruments refer to the incision of cavities (e.g., stomach, intestines, pancreas, appendix, etc.), radical treatment of tumors, haematoma incision, tuberculosis foci removal, as well as for patients infected with syphilis, AIDS, viral hepatitis, the implementation of the operation of the instruments.
Processing method: soak postoperative instruments in chlorine disinfectant for 30min → flow of water to brush clean → sorting and drying → checking → oiling → sorting and preserving in the instrument cabinet.
(3) Treatment of special infected surgical instruments
Special infected surgical instruments refer to gas gangrene, anthrax, tetanus surgical instruments.
Handling method: soak the postoperative instruments in chlorine disinfectant for 30min→preliminary rinsing→packaging→autoclaving→thoroughly brushing with brush in flowing water→classification and drying→checking→oiled→packaging→again autoclaving and preserving the sterile instruments
in the cabinet for spare.
(D) endoscopic surgical instruments
Processing methods: unloading of movable endoscopic components, optical leads of the connecting accessories, channel valves, etc. → open the clamping part of the washing surface with flowing water to wash the blood stains, a small brush gently scrubbing → high-pressure water gun rinsing of the joints, the internal lumen channel, to remove the hidden blood stains or organic matter → immersed in the enzyme (cavity mirror special cleaning agent) in the dilute liquid 2min, fully remove organic matter→rinse again with flowing water→wipe dry→high-pressure oxygen or compressed air to blow dry the water of each part→special lubricant is sprayed directly on the surface of the instrument, axial joints, internal cavities, and spring parts, and then the lens paper is wiped to remove the surface oil stains→preserve it in the cabinet of the special instrument. In case of HBsAg-positive patients, postoperative instruments should be immersed in 0.33% glutaraldehyde dilution (2% glutaraldehyde 1 part, plus 5 parts of water) for 15min, and then cleaned according to the above method.
Surgical instruments, endoscopes, general diagnostic and therapeutic supplies disinfection and sterilization requirements
(a) All surgical instruments and items that enter the human body tissues or sterile organs are all autoclaved or enter the sterile room through a surgical incision of endoscopes and their accessories, such as laparoscopes, arthroscopes, ventriculoscopes, cystoscopes, hysteroscopes, etc. should be sterilized to achieve sterilization level before use.
(ii) contact with unbroken skin of the general diagnostic supplies such as sphygmomanometer, stethoscope can be cleaned on the basis of ethanol wipe disinfection, sphygmomanometer cuff if blood, body fluids contaminated should be cleaned on the basis of a disinfectant soak containing 500mg/L chlorine for 30 minutes and then cleaned.
(3) contact with unbroken mucous membranes of the apparatus such as dilator, cotter, tongue forceps, tongue depressor, thermometer, etc., after use, first clean and decontaminated, disinfected, wiped dry, high-temperature-resistant appliances such as dilator, cotter, tongue depressor with high-temperature sterilization, the thermometer in the clean based on the chlorine-containing disinfectant immersion disinfectant for 30 minutes after rinsing with water to wipe dry for spare parts.
(d) through the pipeline indirectly with the superficial body cavity mucosal contact apparatus such as oxygen wetting bottle, ventilator, anesthesia apparatus, nebulizer, gastrointestinal pressure reducer, suction, drainage bottle, etc. can be cleaned on the basis of high-temperature-resistant can be used to high-pressure sterilization, do not tolerate high temperatures can be cleaned with 500mg/L chlorine-containing agent immersion for 30 minutes, rinsed with clean water to dry and standby, the strict requirements of a disinfection of one use, the application of a sterile water. Wetting solution should be sterile water, such as continuous use of wetting solution can be replaced every day, and weekly replacement of the apparatus used for disinfection.
(E) Where the body's natural channels and luminal mucosal contact with the endoscope and its accessories, such as laryngoscopes, tracheoscopes, bronchoscopes, gastroscopes, sigmoidoscopes, proctoscopes, etc., can be used in peracetic acid, glutaraldehyde, Manfrotto gold and other high-efficiency disinfectants.
(F) endoscopic accessories that enter the broken mucosa should also be sterilized to the level of sterilization, such as biopsy forceps, high-frequency electric knife.
(vii) oral equipment in accordance with the degree of its harm to different treatments, surgical instruments and other instruments that penetrate the oral soft tissue or bone tissue, do not penetrate the oral soft tissue but have contact with the soft tissue of the instruments must be sterilized, oral examination instruments such as forceps, tongue depressor, mouth mirrors, probes, curved discs and so on, disposable supplies can be used.
(viii) all kinds of medical equipment sent to the equipment section for repair, need to use chlorine-containing agents to disinfect the treatment before repair, the staff should be strictly hand-sterilized after the repair.
Manual cleaning of surgical instruments
I. Manual cleaning is applicable to the cleaning of precision, complex instruments and the preliminary treatment of heavy organic contamination instruments.
Two, commonly used surgical instruments manual cleaning process
1, dress code, good personal occupational protection.
2, rinse: the rusty instruments rust, rust-free with flowing water rinse. The disassembled parts and screws are disassembled and cleaned separately, and the pincers with lumens such as nucleus pulposus pincers and vertebral plate biting pincers are rinsed with flowing water while alternating between closing and loosening.
3, ultrasonic cleaning: the instruments with blue basket, placed in the ultrasonic cleaning machine ultrasonic washing 8min, the machine for the multi-enzyme cleaner, ultrasonic machine with a cover to prevent aerosols and noise pollution, the instruments should be placed in the liquid 2cm below the surface.
4, scrubbing: with a plastic brush under the water surface of the teeth of the instruments, groove, and the internal and external surfaces of the instruments to prevent the splashing of aerosols and droplets of water, the teeth of the instruments groove and internal and external surfaces of clean to be clean to prevent the splashing of aerosols and droplets of water, the teeth and groove and internal and external surfaces of the instruments should be clean to be clean. The teeth, grooves and internal and external surfaces of the instruments should be cleaned without stains and rust, and the joints and crevices should be opened and repeatedly brushed.
5, rinsing: rinse with running water or soak under the water surface to prevent splashing water droplets, there should be no detergent residue.
6, disinfection: acidic oxidation potential water disinfection flow rinse or soak for 2 minutes.
7, final rinse: rinse with purified water water.
8, lubrication: the instruments will be immersed in lubricating antirust agent solution for 30s, pay attention to prevent re-contamination of the instruments.
9, drying: drying with drying oven at 70~90℃ for 20min. To achieve the instruments without scale, no dirt, no rust, flexible joints.
Three, lumen instrument manual cleaning process
1, dress code, good personal occupational protection. 2, disassembled after running water rinse. 3, multi-enzyme cleaner soak. 4, brushing the lumen brush, high-pressure water gun rinsing lumen. 5, multi-enzyme cleaner plus ultrasonic washing for 8 minutes. 6, high-pressure water gun rinsing the lumen. 7, acidic oxidation potential of the water running rinse or soak for 2 minutes to disinfect. 8, with purified water to disinfect. 9, with purified water to disinfect. 10, with purified water, with purified water, with purified water, with purified water, with purified water, with purified water, with purified water. 8、Rinse with purified water. 9、Pressure air gun and drying oven at 70~90℃ for 20min.
Four, notes:
1, manual cleaning water temperature should be 1 5 ℃ ~ 30 ℃. Removal of dry solid stains should be soaked with enzyme cleaner, then brushing or scrubbing. The brushing operation should be carried out under the water surface to prevent aerosols.
2. Tube lumen instruments should be rinsed with a pressure water gun, and removable parts should be disassembled and cleaned. Should not use wire ball type utensils and decontamination powder and other supplies, should be selected to match the brushing utensils, supplies, to avoid wear and tear of the instruments. Cleaning utensils, cleaning pool should be cleaned and disinfected every day.