Thermal methods of sterilization of medical instruments. Sterilization by boiling method. Dry heat cabinet. Medical autoclave. Sterilization of surgical instruments methods of sterilization of surgical instruments sterilization How surgeons disinfect
Sterilization of dressings and surgical linen. Sterilization by autoclaving - Very reliable way. Sterilize in an autoclave in Schimmelbusch containers. Most often, dressings and surgical linen, sometimes porcelain and glassware, enamel basins, etc. are sterilized under pressure. Before autoclaving, the material and linen are placed (not tightly) in bins, and if they are not available, in canvas bags or bags. The holes on the side wall of the bin are opened before loading the autoclave and closed after sterilization. The duration of sterilization depends on the pressure gauge readings: at 1 atm/126.8° - 30 minutes; at 2 atm./132.9° - 20 minutes.
Sterilization with flowing steam carried out either in a special Koch fluid-steam sterilizer, or using a pan or bucket with a lid. Water is poured into the vessel to 1/3 of its height, a lattice partition is inserted above the water level, onto which the materials to be sterilized are placed in fabric bags or bags. Having closed the vessel with a lid, in which there should be several small holes for steam to escape, turn on the heating. The beginning of sterilization is considered the moment when steam begins to come out from under the lid in a continuous stream; the steam temperature reaches 100°. The duration of sterilization is at least 30 minutes.
Sterilization by ironing linen and dressings are allowed only in cases where other methods cannot be used. Typically the iron temperature reaches 150°. First, lay out and iron the sheet on which the treatment will be carried out, then bend it with water required material and iron it on both sides, while moving the iron slowly 2-3 times in one place. The ironed linen is placed into a sterile bag or bag using sterile tweezers.
Preparing the surgeon's hands
Preparing the surgeon's hands. Since the hands of a veterinarian are constantly in contact with objects contaminated with microorganisms, hand preparation before surgery is particularly important. great value. The treatment of the surgeon’s hands consists of two stages:
2. treatment with antiseptic and tanning agents.
Hands are prepared using one of the following methods:
- Olivekov's method. Hands are first washed for 5 minutes hot water(40-50°) with a brush and soap. After this, wipe dry rough towel and treated for 3 minutes with swabs moistened with an alcohol solution of iodine 1:3000. Additionally, the subungual spaces and nail beds are treated with a 5% alcohol solution of iodine.
- Spasokukotsky-Kochergin method. Hands are washed in two basins with a 0.5% ammonia solution for five minutes. Then wipe with a towel and treat with 70° alcohol for five minutes. The subungual spaces are treated with a 5% iodine solution;
- Kiyashov's method is based on the use of a 0.5% ammonia solution, in which hands are washed with brushes for five minutes and dried with a towel. Completes the preparation of hands by treating with a 30% solution of zinc sulfate for three minutes, and the subungual spaces and nail beds with an additional 5% iodine solution.
When castrating a boar, hand treatment was carried out according to the Spasokukotsky-Kochergin method.
Sterilization of surgical instruments
Sterilization of surgical instruments. There is a cold and hot ways sterilization of instruments. Hot ones include: sterilization by boiling in water, filling and others; cold - sterilization in Karetnikov’s triple solution and others.
Sterilization by boiling in water. It is carried out in sterilizers. Washed instruments, syringes, needles and others are boiled for 30 minutes in distilled or boiled water.
To increase the sterilization effect, instruments are boiled in a 3% solution of bicarbonate of soda or a 0.25% solution of sodium hydroxide for 10-15 minutes.
Cold method of sterilization in triple Karetnikov solution. The solution consists of 20 grams of formolin, 3 grams of phenol and 1 liter of distilled water. Exposure 30 minutes.
Pre-sterilization of instruments. For emergency operations, it is necessary to sterilize instruments in advance. Preliminary sterilization can be carried out using the Andreev method. The tools are placed in a two-layer linen bag, which is tightly tied and dipped in a boiling 20% carbon dioxide solution for 15 minutes. After this, the bag is removed and hung to allow the solution to drain and dry.
Boiling instruments in a 20% carbon dioxide solution without subsequently wiping them does not cause corrosion. The instruments remain sterile for several months.
For this operation, sterilization by boiling in water is most acceptable.
Preparing the Operation Field
Preparation of the surgical field consists of mechanical cleaning, degreasing, antiseptic treatment, and isolation of the surgical field.
Mechanical cleaning includes washing with soap, removing hair by shaving or cutting. The size of the surgical field must be sufficient to ensure sterile conditions.
Prepare the surgical field using one of the following methods:
- Grossif-Filonchikov method. The degreased surgical field is “tanned” and aseptic with a 5% iodine solution immediately after mechanical cleaning, and then immediately before tissue incision. The interval between treatments should be at least five minutes;
-Mouse method is that after shaving, mechanical cleaning and degreasing, the surgical field is treated with 10% aqueous solution potassium permanganate.
During the operation, the field was prepared according to the Grossif-Filonchikov method.
Sterilization is carried out in two stages: the first stage is pre-sterilization treatment; the second is direct sterilization.
Pre-sterilization preparation includes disinfection, washing and drying. Due to the high risk of the spread of AIDS and the performance of operations on patients who have had hepatitis, the rules for pre-sterilization preparation have been changed and are equated to methods for processing instruments, providing a guarantee of the destruction of the human immunodeficiency virus. Instruments after purulent operations for anaerobic infection, patients who underwent within 5 recent years hepatitis, as well as the risk of AIDS, are treated separately from others. Immediately after the operation, instruments are immersed in disinfectants:
- - 3% chloramine solution for 40-60 minutes or 6% hydrogen solution:
- - peroxide - for 90 minutes, 0.5% polydez solution - for 60 minutes, combined instrument disinfectant - for 60 minutes.
After disinfection, the instruments are transferred to a cleaning solution (water, washing powder and hydrogen peroxide) at a temperature of 50°C for 20 minutes, then each instrument is washed with a brush in disassembled form and washed under running water. The stages and modes of cleaning instruments are presented in table. 1.
Table 1
Stages and modes of pre-sterilization cleaning of instruments combined with disinfection with incrasept 10 A
The quality of pre-sterilization treatment is checked by testing azopyram, phenolphthalein and benzidine samples for the presence of residual components detergent. blood and fat. At least 1% of the batch of instruments simultaneously subjected to processing is subject to control. The most convenient industrial indicator is sealed tubes containing powder - a mixture of sucrose and tartaric acid; at 180°C the powder becomes liquid.
In addition, quality control of pre-sterilization treatment is carried out by the Epidemiological Sanitation Center once a quarter. If the test is positive, the entire batch of instruments undergoes repeated pre-sterilization treatment.
The next stage is drying the instruments in a dry-heat oven at a temperature of 80°C for 20 minutes.
The choice of sterilization method depends on the type of surgical instruments to be sterilized.
Everything is common surgical instruments conditionally divided into four groups:
- 1) metal - cutting (scalpels, scissors, suture needles, etc.);
- 2) non-cutting: syringes, injection needles, clamps, etc.;
- 3) rubber and plastic: catheters, probes, drainages, etc.;
- 4) optical: laparoscopes, gastroscopes, cystoscopes, etc.
Sterilization of surgical metal instruments
and glass products are produced in the following ways:
Dry hot air sterilization- aerosterilization is carried out in dry-heat ovens. Disassembled instruments and syringes are placed in special metal mesh or packaged in kraft paper and sterilized at a temperature of 180-200°C for 1 hour. Products sterilized in kraft paper remain sterile for 3 days, and in open nets should be used immediately after sterilization. To check sterilization, the most convenient industrial indicator is sealed tubes containing powder - a mixture of sucrose and tartaric acid; at 180°C the powder becomes liquid.
For steam sterilization the instruments are placed in a Schimmelbusch box (Fig. 1). The container is tightly closed with a lid, which is attached to the body of the box with a hinge, and is closed with a lock. There are holes around the perimeter of the box that open and close using a movable metal belt, secured with a special lock. Bixes are loaded into autoclaves and sterilized at a pressure of 1.1 atm - 60 minutes, 1.5 atm - 45 minutes, 2 atm - 30 minutes. Shelf life in containers with a filter is 3 days. , without a filter - 24 hours. The material to be sterilized is placed loosely in the boxes so that steam freely penetrates to all contents.
Rice. 1.
Sterilization of disposable instruments is carried out in sealed bags using ionizing radiation (uluchi), ultraviolet rays and ultrasound. Currently, preference is given to sterilization with y-rays. For these purposes, the isotopes 60 Co and | 37 C are used. Sterilization must be carried out in compliance with safety measures in the factory. If the packages in which y-ray sterilization was carried out remain sealed, sterility is maintained for 5 years.
Sterilization boxes equipped with antibacterial filters (KSPF) are becoming widespread, in which the shelf life of sterile material can be increased to 1 month. If the box has been opened, the sterile material contained in it can only be used for that day.
Boiling as a method of sterilization is currently not used and refers to disinfection.
Sterilization of cutting and piercing instruments carried out in the factory by y-rays, gas and cold chemically using antiseptics. In dressing rooms, cutting and stabbing instruments are sterilized in dry-heat ovens.
Chemical sterilization methods include sterilization in the sterilization chambers of an air one- or two-chamber sterilizer with a capacity of 80 dm 3 or more with formalin vapor.
Formalin is placed at the bottom of the chamber at the rate of 10 g per 10 dm 3 chambers, sterilization time - 16 hours. Chemical gas method instruments that have an ebonite base are sterilized: telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments. Before gas sterilization, laparoscopic instruments are disinfected in a 3% aldezone solution by rinsing in one container. Then they are soaked in the second container for 1 hour and after that time are rinsed under running water to remove disinfectants.
Chemical sterilization is carried out using liquid antiseptics: a triple solution of 96% ethyl alcohol, a 6% solution of hydrogen peroxide, a combined disinfectant, alaminol, bionol, lysacin. The instrument is immersed in one of the listed disinfectants according to the instructions for their use.
Before sterilization, rubber tubes, catheters, drainages are washed with running water, kept for an hour in a 1% solution of chloramine, washed again with running water and dried. Then they are wrapped in gauze and sterilized at a pressure of 1 atm for 45 minutes.
Sterilization of gloves for reusable use is carried out after their pre-sterilization treatment. Used gloves are washed under running water and soap, disinfected in a 1% solution of chloramine or other antiseptics for 30 minutes, rinsed under running water, dried, checked for leaks, sprinkled with talcum powder, wrapped one pair at a time in gauze napkins, and placed in bags. and sterilized in an autoclave at a pressure of 1.1 atm for 30 minutes or 1.5 atm -1 5 minutes.
For surgical procedures, gloves are disinfected using one of the following methods:
- 1) in a 4.8% solution of pervomur - 20 minutes;
- 2) in a hydrogen peroxide solution at 50°C - 180 min;
- 3) in a 96% alcohol solution - 1 5 minutes;
- 4) in a 10% solution of roccala - 30 minutes;
- 5) in a 2% solution of chloramine - 2 hours.
After disinfection, gloves are washed twice in distilled water.
Sterilization of rubber and plastic products can be carried out in autoclaves with steam under a pressure of 1.1 atm - 30 minutes or 1.5 atm -1 5-20 minutes. Rubber and plastic disposable products are sterilized in the factory using ultraviolet rays.
Sterilization is the process of eliminating all forms of life, including infectious agents (fungi, bacteria, spores, viruses) that are present on surfaces and contained in liquids.
The following must undergo mandatory sterilization:
Objects that come into contact with the surface of wounds have contact with blood and injectable drugs
Diagnostic equipment that comes into contact with mucous membranes and can cause damage.
There are three main stages of sterilization:
Disinfection
Pre-sterilization cleaning
Sterilization
Sterilization is achieved through the use of thermal, chemical or radioactive treatment.
The quality of sterilization largely depends on the contact of the sterilizing agent with the surface of the instrument being sterilized. The choice of agent is related to the nature of the instrument that needs to be sterilized.
The sterilization process takes place in a special device called a sterilizer.
Sterilization methods
1) Thermal sterilization method
- Steam sterilization (autoclaving)
Heat treatment kills living organisms. This process is accelerated by adding moisture, but regular steam is not sufficient for sterilization. Pressure greater than atmospheric is required, which will allow raise the temperature of the steam to thermally destroy microbial life. Steam under pressure causes denaturation and coagulation of protein and its enzymes in cells.
The device in which steam sterilization occurs is called an autoclave. The entire autoclave sterilization cycle can take from 15 to 60 minutes, depending on the pressure, temperature and material of the instruments being sterilized.
Autoclavingsuitable for items that tolerate moisture, high blood pressure(from 1 to 3.5 atmospheres above external environment), and also high temperature(from + 121°C to + 148°C). For example, surgical instruments.
An excellent representative of devices for steam sterilization is a series of autoclaves Statim . Compact cassette sterilizers extend the life of fragile instruments.
- Air sterilization (dry heat oven)
Dry heat in the form of hot air is used mainly for sterilization of objects based on anhydrous oils, petroleum products and powders, which cannot be sterilized by steam and gas. The death of microbial organisms occurs due to oxidation and the slow process of protein combustion in cells. In the absence of moisture, higher temperatures are required during the sterilization process.
- Microwave sterilization
Under the influence of non-ionizing microwave radiation, hyperthermic conditions are created that disrupt the life processes of microorganisms. The cycle temperature is lower than with steam sterilization. The cycle time is much less - 30 seconds. Metal tools can be sterilized if placed under partial vacuum conditions in a glass container. This type of sterilizer is perfect for small volumes of sterilization.
2) Chemical method sterilization
- Gas sterilization
Ethylene oxide. Basic The sterilization cycle consists of five stages and takes approximately 2.5 hours, excluding aeration time. The gas reacts chemically with amino acids, proteins, DNA and prevents the proliferation of microbial organisms.
This sterilization methodSuitable for items that cannot withstand the high temperature and humidity required for steam sterilization. Due to the low temperature conditions (+30° to +60°C), this sterilization method is well suited for medical devices with built-in electronics. The disadvantage of this method is that it is easily flammable.
Formaldehyde.Gas kills microorganismsby protein coagulation in cells. This sterilization method is complex and less effective than other sterilization methods. Its use for sterilization has been largely abandoned in the United States, Canada and Australia, but it is still used in some countries in Europe and Asia.
- Plasma sterilization
Plasma isa state of matter other than solid, liquid, or gas. This state is achieved by creating a strong electric or magnetic field. Free radicals of hydrogen peroxide interact with cell membranes, enzymes, nucleic acids and disrupt the vital functions of microorganisms.
Main loop Plasma sterilization consists of four stages (vacuum creation, H2O2 injection, diffusion, plasma discharge). The process takes from 1 to 3 hours.
This sterilization method is suitablefor objects that cannot withstand the high temperature and humidity required for steam sterilization.
- Ozone sterilization
Ozone is form of oxygen. The sterilization process occurs through oxidation, the destruction of organic and inorganic substances. Ozone penetrates the cell membrane, causing it to explode. Ozone is an unstable gas, but can be easily generated from oxygen. Cycle time is up to 60 minutes depending on chamber size or load.
3) Radiation sterilization method
Is the most effective method sterilization, but is limited to commercial use only.
Ionizing radiationproduces ions that knock electrons out of atoms. These electrons strike an adjacent atom and either attach or knock an electron out of the second atom. Ionic energy is converted into thermal and chemical energy. This energy causes the death of microorganisms by destroying the DNA molecule, which prevents cell division and the spread of biological life. The main sources of ionizing radiation are beta particles and gamma rays.
Each method Sterilization has its own characteristics. When choosing one method or another, one should take into account possible side effects, especially when it comes to sterilizing various electronic devices.
Sterilization of surgical instruments is carried out by boiling, autoclaving and antiseptic substances. Non-cutting instruments are sterilized by boiling in a 1-2% solution of sodium bicarbonate, which prevents the oxidation of the metal and increases the boiling point. You can boil tools in distilled water. Instruments, washed with a brush and soap and dried after the previous operation, are lowered into water on a mesh in special metal vessels- sterilizers, the sizes of which vary depending on the number and size of instruments. Boiling time for tools is 30 minutes. If the instruments were previously used for purulent surgery, and especially if they were contaminated with anaerobic microbes or Pseudomonas aeruginosa, the boiling time increases to 45 minutes. or even boil them three times for 60 minutes. with water change. Such instruments are immersed in a saturated solution for several hours before boiling. boric acid(if contaminated with Pseudomonas aeruginosa) or into a lysoform solution. Boiling of instruments intended for “clean” and for purulent operations is carried out in separate sterilizers. Instruments can be sterilized by placing them in bags 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, instruments may be sterilized by burning. Having placed them in a metal tray, they are doused with alcohol, which is set on fire. But such sterilization deteriorates the instruments, and the method is not reliable.
Cutting instruments become dull when boiled in water, so they are sterilized using a cold method. After washing with a brush and soap, they are immersed in 96% alcohol for 2 hours. Lower concentrations of alcohol cause rust. You can use solutions of the following composition: carbolic acid - 3 parts, caustic soda - 15 parts, - 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 and rust may form, so their use can only be recommended in the absence of alcohol. The exposure is the same as for sterilization with alcohol. Sterilize 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°, the best method is dry air sterilization at a temperature of 200° for 30 minutes. The needles are boiled with mandrels or filled with water using a syringe. Otherwise, air remains in their lumen, which prevents the flow of water (air heated to t° 100° does not ensure sterility). New needles are cleaned of grease and cleaned three times for 20 minutes. boil in a 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. Store needles dry, with mandrins. Disassembled syringes and needles can be stored in 96% alcohol in special metal cases or in glass vessel. Sharing the same syringe and needle on multiple people can lead to the transmission of epidemic hepatitis, even if the instruments are boiled before each injection. A reliable means of prevention is a 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 a temperature of 45-50° (the needles are washed using a specially designated 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).
Stage 1 - 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. Personnel must wear rubber gloves when working.
Used but uninfected instruments are thoroughly washed with clean water using brushes in a separate sink for 5 minutes (instruments contaminated with blood are washed immediately, not allowing the blood to dry out) and then soaked for 15-20 minutes in one of the special cleaning solutions, heated up to 50vC. Syringes are processed in disassembled form.
Composition of washing solutions: solution A - perhydrol 20 g, washing powder (such as “News”, “Progress”, “Astra”, etc.) 5 g, water 975 ml; solution B - 2.5% hydrogen peroxide solution 200 ml, Novost washing powder 5 g, water 795 ml.
After soaking, the instruments are washed in the same solution with ruffs and brushes (locks, teeth, and notches are treated especially carefully), then rinsed with warm water for 5 minutes and rinsed in distilled water for 1 minute. After this, the instruments and syringes are placed in a dry air sterilizer at a temperature of 85 ° C to dry, after which they are ready for sterilization.
Instruments and syringes contaminated with pus or intestinal contents are first placed in enamel containers with a 0.1% diocide solution or a 5% Lysol solution for 30 minutes. Then, in the same solution, they are washed with brushes and brushes, rinsed with running water and dipped in one of the washing solutions, carrying out further processing according to the method described above.
After an operation performed on a patient with an anaerobic infection, instruments 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 then are the instruments prepared for sterilization in the same way as uninfected instruments. After 1 day (time for spore germination), they are subjected to autoclaving or boiling (fractional sterilization).
After use, puncture and injection needles are washed with a syringe with warm water and then with a 1% solution of sodium bicarbonate; the needle channel is cleaned with a mandrel and washed with a 0.5% solution ammonia and running water.
After this, the needle with the inserted mandrel is boiled for 30 minutes in a 2% sodium bicarbonate solution, and after 8-12 hours - again in distilled water 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 place it in a 5% Lysol solution for 1 hour, additionally washing the canal with Lysol using a syringe or a rubber bulb, and subject it to the same further treatment as needles not contaminated with pus.
Systems for transfusion of drugs or blood require careful handling to prevent post-transfusion reactions and complications. IN modern conditions use disposable transfusion systems that are factory sterilized. A reusable system immediately after blood transfusion or medicinal product disassemble - separate the glass parts, dropper and rubber tubes, rinse thoroughly with running water, kneading the rubber tube with your fingers (for better removal 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 mounted and packaged for sterilization.
Stage 2 - laying and preparation for sterilization. For sterilization in dry heat sterilizers, instruments are placed in metal boxes, laying them vertically in one layer. Disassembled syringes are wrapped in 2 layers of special thick paper. Box lids are sterilized nearby. IN lately Mostly, disposable syringes, factory sterilized, are used.
To sterilize with steam under pressure in steam sterilizers (autoclaves), 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 package.
The cylinder and piston of the syringe are placed separately in gauze napkins and wrapped in a piece of cotton fabric in the form of a bag, which is placed in sterilization box(biks). During mass sterilization of syringes in autoclaves (centralized sterilization), a special packing made of cotton fabric with pockets is used. Disassembled syringes are placed in the pockets, with needles and tweezers nearby. Each pack contains up to 5 syringes. The bundles are wrapped in a cotton diaper in the form of a bag and placed in a sterilizer.
Dry rubber gloves are sprinkled with talcum powder (outside and inside), lined with gauze napkins, wrapped in pairs in a napkin and placed in a separate box.
Assembled systems for blood transfusion, the strength of rubber tubes is checked, the tightness of their connection with glass parts and the compliance of the cannulas with the needle pavilions. The system is rolled up in the form of 2-3 rings, avoiding bending of the rubber tubes, wrapped in a large gauze napkin, then in a waffle towel and placed in boxes.
Stage III - sterilization. Sterilization of instruments, syringes (marked on the syringe with 200 °C), needles, and glassware is carried out in dry-heat sterilizer cabinets (Fig. 4). Items are placed freely on the shelves of the sterilizer in metal boxes (if removed covers) and turn on the heating. With the door open, bring the temperature to 80-85 ° C and dry for 30 minutes - remove moisture from internal surfaces cabinet and sterilized items. 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 reducing the temperature to 70-50 °C, open the cabinet door and close the metal boxes with instruments with sterile instruments. After 15-20 minutes (after the sterilizer has completely cooled), the chamber is unloaded.
When working with a dry-heat sterilizer, it is necessary to observe safety measures: the device must be grounded, after sterilization is completed, the cabinet door should be opened only when the temperature drops to 70-50 °C. Do not use a faulty device.
Sterilization of instruments, syringes, and blood transfusion systems can be done in a steam sterilizer (autoclave). The packaged items are placed in a sterilization chamber. If packages are placed in bins, their grilles must be open. Bixes or other packages are laid loosely 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 corresponding 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, close the holes in the containers.
Sterilization methods in dry heat and steam sterilizers should be considered as basic. The boiling sterilization method is used in small medical institutions where there is no centralized sterilization facility. They use stationary or portable electric boilers in which instruments, syringes, needles, glass objects, rubber drains, catheters, and gloves can be sterilized.
Distilled water is poured into the boiler; to increase the boiling point of water and destroy the bacterial shell, add 20 g of sodium bicarbonate per 1 liter of water (2% solution). A thin quilted layer of cotton wool and gauze is placed 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 instruments.
Disassembled tools are placed on special grids and lowered with hooks to the bottom of the boiler, leaving the handles of the hooks outside, and the boiler is covered with a lid. Sterilization time is 40 minutes from the moment the water boils. 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 instruments on a 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 adding sodium bicarbonate.
Instruments, 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 must be carefully processed and subsequently sterilized by boiling. They are boiled for 1 hour, removed from the boiler and left at room temperature for 12-24 hours (for spore germination), and then re-sterilized by boiling for 1 hour (fractional sterilization).
In emergency cases when it is impossible to ensure sterilization of instruments
none of the above 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, fire and explosion hazard (presence of oxygen, vapors narcotic substances in indoor air), therefore it is used in exceptional cases, strictly observing fire safety measures.
Cutting instruments (scalpels, scissors) during sterilization conventional methods become dull, so it is carried out practically without heat treatment. After pre-sterilization preparation, instruments are immersed in 96% ethanol for 30 minutes or in a triple solution for 3 hours. Only short-term boiling is allowed cutting tools. Scalpels are placed in a separate mesh, their blades are wrapped in gauze and boiled in distilled water without adding sodium bicarbonate for 10 minutes, then placed in 96% ethyl alcohol for 30 minutes.
Stage IV - storage of sterile material. Sterile material is stored in a special room. Storage of non-sterile and sterile materials in the same room is not allowed. The sterility of the material in the containers (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 containers for sterilization (for example, blood transfusion systems, rubber drains, syringes), they can be stored in these containers for up to 3 days. With centralized sterilization, syringes remain sterile for 25 days.
