Mode of sterilization of cutting instruments. Sterilization of surgical instruments methods of sterilization of surgical instruments sterilization. Sterilization of instruments with optics

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 running water and immersed 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% solution detergent (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).
After use, puncture, injection needles 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 they are placed for 1 hour in a 5% solution of Lysol, additionally washing the canal with Lysol with a syringe or a rubber bulb, and subjected to the same further processing as needles not contaminated with pus.
Systems for transfusion of medicinal substances or blood require careful processing to prevent post-transfusion reactions and complications. AT modern conditions use disposable transfusion systems that are sterilized at the factory. system reusable immediately after a blood transfusion or a drug, they are disassembled - the glass parts, a dropper and rubber tubes are separated, thoroughly washed with running water, kneading the rubber tube with your fingers (for better removal blood residue). Parts of the system are immersed for 2 hours in a heated to 60 ° C special solution 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, stretching 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 metal tray or grid. 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), use special styling, sewn from cotton fabric, with pockets. 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 sprinkled with talcum powder (outside and inside), laid with gauze napkins, wrapped in a napkin in pairs and placed in a separate bix.
Assembled blood transfusion systems tested for strength rubber tubes, the density of their connection with glass details and conformity of cannulas to 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. At open door bring the temperature to 80-85 ° C and dry for 30 minutes - remove moisture from the inner surfaces of the 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 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.
Instruments, syringes and needles contaminated with pus stool, after special pre-treatment 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 germination of spores), 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.

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).
After use, puncture, injection needles 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 they are placed for 1 hour in a 5% solution of Lysol, additionally washing the canal with Lysol with a syringe or a rubber bulb, and subjected to the same further processing 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, stretching 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 germination of spores), and then re-sterilized by boiling for 1 hour (fractional sterilization).

Sterilization of gloves.

With any method of processing, the sterility of the hands is violated, especially during long-term operations, since microbes can come out of the pores, folds, hair follicles, sweat and sebaceous glands - "self-infection". Therefore, after processing according to one of the methods listed above, put on sterile rubber gloves. Gloves are sterilized in various ways. Reliable sterilization is provided by autoclaving of gloves together with dressing material. Gloves are poured inside and out with talcum powder, wrapped one at a time in a gauze napkin and placed in a bix for sterilization. Gloves can be sterilized by boiling in water for 15 minutes or immersed in a mercuric chloride solution (1:1000) for 1 hour.
Wearing gloves are wiped with alcohol. Talc from the surface of gloves should not be allowed to enter the surgical wound, as this leads to the formation of inflammatory granulomas. If damaged, the gloves should be replaced immediately, otherwise the “glove juice” (sweat) will enter the wound. After the end of the operation, the gloves are thoroughly washed with warm water and soap, inside and out to remove blood, rubbed and dried. If the gloves are infected with pus (peritonitis, phlegmon), then after washing they are dipped in a disinfectant solution (lysol, sublimate), removed, washed hot water with soap, again immersed in a disinfectant solution for 30 minutes, washed and boiled for 20 minutes.
The integrity of gloves is checked before sterilization. The holes found are sealed with a small rubber patch using glue. When sterilized in an autoclave, gloves quickly become unusable: they lose strength and elasticity, are easily torn, and therefore it is sometimes better to use cold processing of gloves. In addition to sublimate, for this purpose, you can use a 2% solution of chloramine, 0.5% alcohol solution of formalin, iodine in a solution of alcohol and glycerin (iodine 2.5 g, alcohol and glycerin 4.0 ml each). To work in the dressing room, gloves can be sterilized in Sinitsyn's solution (boric acid - 5 g, sodium carbonate - 75 g, formalin - 100 g, phenol - 16.5 g, distilled water - 5000 g) for 3 hours or in 2% - nom solution of chloramine for 30 min. With careful pre-machining of gloves, all these agents provide reliable sterilization. In exceptional cases (mass treatment of the wounded) - Several operations can be performed in the same gloves (of course, if they are not associated with the treatment of anaerobic, putrefactive or heavily contaminated wounds). After each operation, the gloves are treated, without removing them from the hands, with gauze moistened with a fractional solution, then the gloved hands are washed in a basin with ammonia solution (the Spasokukotsky-Kochergin method), dried out and treated with alcohol.

41 . Sterilization of optical instruments.
Cystoscopes, ureteroscopes, cystolithotriptors and other optical instruments are thoroughly cleaned first assembled and then disassembled. Bulbs do not turn out of them. The metal parts of the instruments are boiled in distilled water, the elastic and optical parts are sterilized in formalin vapor. When boiling metal parts optical instruments care should be taken to ensure that they do not hit the bottom of the sterilizer when boiling. This can be easily avoided if boiling is carried out on specially made racks. This rack is removed after 30 minutes of boiling together with parts of the instrument, which, after drying, are placed in a steam-formalin cabinet and remain there until they are used.

The optical parts of the instrument are cleaned, washed in running water with a sponge and dried in air. After drying, the optical part up to the eyepiece (plastic part) is placed in a 95% ethanol solution, where it stays for an hour. If urogenital tuberculosis is suspected in the examined patient, instead of alcohol, the optics is placed in a 5% phenol solution for the same time.

Optical instruments can also be sterilized by immersing all parts, except for the handle with a cord, in a solution of oxycyanic mercury (1:1000) for 20 minutes. Optical tubes are immersed in the solution up to the funnel of the eyepiece. After cystoscopy of patients with suspected tuberculosis, optical instruments should be sterilized in a solution of mercury oxycyanide for at least 30 minutes.

Optical instruments can also be sterilized in steam-formalin cabinets. The duration of sterilization is at least 48 hours. After being removed from the chamber, they are immersed for 10-20 minutes in a solution of mercury oxycyanide (1: 1000) or a 95% solution of ethyl alcohol.

There is also this one.

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).

42. Silk sterilization.

Silk is used woven and twisted. Woven silk is stronger, but much more expensive. The thickness of the threads is determined by numbers (from No. 000 to No. 16).

Sterilize silk most often according to the Kocher method:

1. Wash skeins of silk 2-3 times in warm water with soap and dry with a sterile towel.

2. With sterile hands, silk is loosely wound on glass coils or glass slides with rounded edges and dipped for 12-24 hours (depending on thickness) in ether for degreasing.

3. From a can of ether with sterile instruments, skeins of silk are transferred for the same time to 70 ° alcohol.

4. The silk is boiled in a 1:1000 sublimate solution for 10 minutes. Boiling is carried out in a pre-boiled enamel pan.

5. After washing your hands and putting on a sterile gown, the silk is transferred from the sublimate solution to a jar with a ground stopper filled with 96 ° alcohol, where the silk is stored until used.

You can use ready-made silk only after sowing for sterility. In the absence of silk, it is replaced with linen or cotton threads. They are sterilized in the same way as silk.

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.

Sterilization of capron.

Kapron can be sterilized by boiling for 20 minutes. Lavsan sterilization. Lavsan threads can be sterilized by autoclaving, boiling, as well as diocide solution (1:1000-1:5000). Most types of modern suture material are factory sterilized by gamma irradiation. The sterility of the suture material is controlled by the bacteriological method.

There is such an option. 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.

Sterilization of catgut.

Catgut is a thread different thickness made from the serous and muscular layer of sheep intestines. Depending on the thickness, catgut is determined by numbers from No. 000 to No. 8. In tissues, catgut is completely absorbed after 2-3 weeks. To lengthen the resorption time, chrome-plated and formalin catgut is currently used. Due to the possibility of significant bacterial contamination of catgut, its sterilization requires special care. 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 cork 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, 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.

Sterilization of catgut in alcohol Lugol's solution.

1. Coils of catgut are immersed in air for 12-24 hours.

2. Ether is drained. Catgut is poured 2 times in 8 days with an alcohol Lugol solution (alcohol 96 ° 1000 ml, potassium iodide 10 g, pure iodine 10 g).

Catgut is subjected to bacteriological testing, and then stored in Lugol's solution.

Sterilization of catgut in aqueous Lugol's solution.

1. Coils of dry catgut are immersed in air for 12-24 hours.

2. The ether is drained and the catgut is poured 2 times in 8 days with an aqueous Lugol solution (distilled water 1000 ml, potassium iodide 20 g, pure iodine 10 g).

3. Catgut is poured with 96 ° alcohol for 4-6 days. Take seeding for sterility.

4. Store prepared catgut in 96° alcohol.

TOPIC 15.

ORGANIZATION OF WORK IN THE STERILIZATION. PREPARATION AND STERILIZATION OF CUTTING, OPTICAL, GENERAL SURGICAL INSTRUMENTS. STERILIZATION

SUTURE MATERIAL

Preparation and sterilization of instruments

Stage I- 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.

The order of pre-sterilization preparation of instruments:

Disinfection;

Soaking in a soap-peroxide solution for 15 minutes at a temperature of 50°C;

Washing for 30 seconds in a soap-peroxide solution using a cotton-gauze swab;

Rinse under running water for 30 seconds;

Rinse with distilled water;

Drying;

Tests for the quality of pre-sterilization preparation (tests for the presence of detergents, tests for the presence of blood residues, tests for the presence of fat residues).

Stage II– laying and preparation for sterilization. After pre-drying in air, the instruments are placed for drying in dry oven which is heated to 80°C at open doors. The cabinet doors are then closed and sterilization begins.

Stage III- sterilization. Sterilization of instruments, syringes, needles, glassware is carried out in dry heat cabinets. sterilizers. After closing the cabinet doors, the temperature is brought to +160 ° C or +180 °С, maintaining it automatically. Sterilization lasts 60 minutes at +180°C or 150 minutes at 160°C. After turning off the heating system and lowering the temperature to + 70-50 ° C, the cabinet doors are opened and metal boxes with tools are closed with lids with a sterile instrument.

Sterilization of instruments containing plastic parts(for example, staple cartridges), syringes can be made in a steam sterilizer (autoclave). Packed items are placed in the sterilization room. camera. If they are placed in bixes, then their parts must be open. Surgical instruments and syringes are sterilized for 20 minutes at 2 atm. and temperature +132.9 °C. Start time sterilization is counted from reaching the appropriate pressure. Rubber gloves, blood transfusion systems, rubber drainage tubes are sterilized at 1.1 atm. and a temperature of +120 °C for 45 minutes or at 0.5% atm. and temperature + 110 °C for 180 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 not used in accordance with OST 42-21-2-85 "Sterilization and disinfection of medical devices".

Sterilization of instruments and items not subject to heat treatment (endoscopes, thoracoscopes, laparoscopes, devices or blocks of apparatus for cardiopulmonary bypass, hemosorption), carried out in a special gas sterilizer. Items for sterilization are placed in a sealed sterilization chamber, which is filled with ethylene oxide. Exposure time - 16 hours at a temperature of 18 °C. Sterilization can also be carried out with a mixture of ethylene oxide and methylene bromide at a temperature of +55 ° C for 6 hours.

Stage IV– preservation of sterile materials. They are stored in a special room. It is not allowed to store non-sterile and sterile materials in the same room. The sterility of materials in biks (if they have not been opened) is maintained for 48 hours, and with additional packaging of the material in a cotton bag - 72 hours. With centralized sterilization, syringes remain sterile for 25 days.

Preparation of cleaning and disinfecting solutions

Modern means used for:

– Disinfection.

– Combination of disinfection and pre-sterilization tool processing, flexible and rigid endoscopes.

– Disinfection of laboratory glassware.

For disinfection are used:

1. Desactin 2.0 g per 1 liter for current cleaning(0.2% solution) 10.0 g per 1 liter for general cleaning(1.0% solution).

2. Neochlor 6 ml per 1 liter for current cleaning (0.05% solution) 29 ml per 1 liter for general cleaning (0.25% solution).

3. Chlorantoin 2.0 g per 1 liter for current cleaning (0.2% solution) 10.0 g per 1 liter for general cleaning (1.0% solution).

4. Diseffect 23 ml per 1 liter for current cleaning (2.3% solution) 38 ml per 1 liter for general cleaning (3.8% solution).

5. Maxisan 1.7 ml per 1 liter for current cleaning (0.17% solution) 2.5 ml per 1 liter for general cleaning (0.25% solution).

6. Septodor-forte 0.25 ml per 1 liter for current cleaning (0.025% solution) 2.0 ml per 1 liter for general cleaning (0.2% solution).

7. Corsolex plus (only for instruments) 30 ml per 1 liter (3% solution).

8. Corsolex Basic (only for instruments) 20 ml per 1 liter (2% solution).

9. Corsolex extra 15 ml per 1 liter for current cleaning (1.5% solution) 20 ml per 1 liter for general cleaning (2.0% solution).

10. Bacillocid rasant 2.5 ml per 1 liter for current cleaning (0.25% solution) 5.0 ml per 1 liter for general cleaning (0.5% solution).

11. Blanidas 2.0 g per 1 liter for current cleaning and tools (0.2% solution) 10.0 g per 1 liter for general cleaning (1% solution).

Samples for the quality of pre-sterilization treatment of instruments

The quality of pre-sterilization treatment is assessed by performing tests:

- for the presence of blood (benzidine, azopyram and amidopyrine tests);

- for the presence of detergents (phenolphthalein test);

– For the presence of fat (test with Sudan III).

Quality control of pre-sterilization treatment is carried out:

– SES and dez.station at least once a quarter,

- self-control centralized sterilization 1 time per day.

Check 1% of each item to be processed in one shift.

1.Azopyram test (for the presence of blood).

For 1 liter of solution: 100 g of azopyram, 1.0-1.5 g of aniline hydrochloride, 96% ethyl alcohol up to 1 liter.

Ready solution stored in a tightly closed vial in the dark at a temperature of +4 °C (in the refrigerator) 2 months, at room temperature (+18- +23 °C) no more than 1 month.

Yellowing of the reagent is acceptable without the formation of a precipitate.

The working solution is prepared before the sample is taken by mixing azopyram and 3% hydrogen peroxide in equal proportions. The working solution is suitable for 1-2 hours.

Do not test on hot instruments, store the solution in bright light, next to heating devices and at elevated temperatures.

Checking the working solution of azopyram: 2-3 drops of the solution are applied to the blood stain.

If after 1 minute appears purple coloring, the reagent is suitable for use.

If after 1 minute there is no color, the reagent is not suitable.

Sample setting: 2-3 drops of the reagent are applied to the instruments or wiped with a gauze cloth moistened with the reagent.

The test is positive if a purple color appears after 1 minute.

If the tools are contaminated with rust and chlorine-containing oxidizing agents, a brown color appears.

3-4 drops are added to the syringe, advanced several times with a piston to moisten the entire inner surface, the reagent is left for 1 minute. Then pour it on a gauze napkin. The needles are checking passing a reagent through them, squeezing it onto gauze napkins. Catheters are checked by filling their cavity with reagent completely from a clean syringe or pipette, leave for 1 minute. Then squeeze on a gauze napkin.

The quality of pre-sterilization treatment of endoscopes:

- check the instrumental channel, outer surface working part of the endoscope;

- in the hole "entrance" and "exit" is introduced to a small depth of cotton woolthe flagellum moistened with the reagent is left for 1 minute. outer surface wipe with a gauze napkin 5 × 5 cm moistened with a reagent.

2. Amidopyrine test (for the presence of blood).

The reagent is prepared before use. Mix 5% alcohol solution of amidopyrine, 30% solution acetic acid and 3% hydrogen peroxide solution in equal proportions.

The test is positive if a blue-violet color appears immediately or 1 minute after the application of the reagent. When setting azopyramic and amidopyrine samples, the color that appears later than after 1 minute is not taken into account.

3.Phenolphthalein test(for the presence of residues of alkali detergents).

Prepare a 1% alcohol solution of phenolphthalein.

The prepared solution is stored in a vial with a ground stopper in the refrigerator for 1 month.

The sample is positive if a pink color appears after treatment with the reagent. This indicates the presence of alkali residues from detergents.

4.Sudan III trial(for the presence of fat).

Solution preparation: 0.2 g of Sudan III, 0.2 g of methylene blue are dissolved in 70 ml of 96% ethyl alcohol heated in a water bath to 60 ° C, then 10 ml of 20-25% ammonia solution and 20 ml of distilled water are added. The finished solution is stored in a vial with a ground stopper in the refrigerator for 6 months. Sample setting: 3-5 ml of the reagent is applied to the instruments (inside the syringes), after 10 seconds the paint is washed off with water. yellow spots indicate the presence of grease. At a positive result any of the samples the entire lot of instruments is subject to reprocessing.

Sterilization methods for cutting, optical and general surgical instruments

Sterilization of cutting tools wrapped in two layers of special paper is carried out by dry heat method at a temperature of +180 °C. Sterilization of instruments and optical devices (laparoscope, thoracoscope) can be carried out in an alcohol solution of Pervomura, a 2.5% solution of glutaraldehyde for 360 minutes or in a solution of the drug "Sydex" for 60 minutes. Sterilization of devices and instruments chemicals should be carried out in metal boxes with lids to prevent evaporation of the drug. With absence special dishes sterilized in enameled or glassware. The tools are filled with a solution so that it completely covers them, and closed with a lid. In emergency cases, when it is impossible to ensure the sterilization of instruments by one of the indicated methods, sterilization of instruments by firing is used. 15-20 ml of alcohol is poured into a metal 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 oxygen, a pair of narcotic substances in the indoor air), therefore it is used in exceptional cases, strictly observing fire safety rules.

Types of suture material

Suture materials are classified into:

I. Absorbable:

a) animal origin (catgut, collagen);

b) plant origin- based on cellulose (occelon, caselon)

in) synthetic materials:

- based on polyglycolides (Polysorb, Vicryl, Dexon, Maxon);

– polydioxanone;

- polyurethane.

2. Materials that dissolve slowly: silk, polyamide (nylon).

3. Materials that are not absorbable:

a) polyesters (lavsan, surzhidak, mersilene, etibond);

b) polyolefins (surgipro, prolene, polypropylene, surgilen);

c) fluoropolymers (Gortex);

d) polyvinylidene (coralen);

e) metal wire, metal staples.

Suture sterilization methods

To connect tissues during the operation, threads of various origins, metal clips, brackets, and wire are used. There are more than 40 types of suture materials. Greatest silk, lavsan, kapron, catgut, metal clips are widespread. Absorbable threads and non-absorbable threads are used. Natural absorbable threads include catgut threads. Prolongation of the resorption of catgut is achieved by impregnating it with metals (chrome-plated, silver catgut). Synthetic absorbable threads are used - threads made of dexonate, vicryl, occilon, etc. To natural threads that do not dissolve, include threads made from natural silk, cotton, horsehair, synthetic ones - threads from nylon, lavsan, dacron, nylon, fluorolon, etc.

The suture material must meet the following basic requirements: have an accurate, even surface and not cause additional tissue damage, have good handling properties - slide well in tissues, be elastic (have sufficient stretch, prevent tissue compression and necrosis during their increasing edema), be strong in node; do not have hygroscopic properties and do not swell, be biologically compatible with living tissues and not give an allergic effect on the body. The destruction of the threads should coincide with the timing of wound healing.

Suppuration of the wound occurs much less frequently when using suture materials that have antimicrobial activity due to the antimicrobial drugs introduced into their structure (letilan-lavsan, fluorolon, acetate and other threads containing nitrofuran preparations, antibiotics, etc.). Synthetic threads containing antiseptic agents have all the advantages of suture materials and at the same time have an antibacterial effect.

Suture material can be sterilized by radiation in the factory. In ampoules, skeins of silk, catgut, nylon are stored at room temperature and used as needed.

The ligature material is sterilized with steam at a pressure of 2.0 atm. for 20 minutes or at 1.1 atm. within 45 minutes. Unused material can be re-sterilized once at 1.1 atm. within 45 minutes.

Express sterilization is possible in a 4.8% solution of pervomur attemperature 18-20 °C for 15 minutes in a closed enamel bowl.

Sterilization of catgut. Heat treatment catgut is not used. In the factory, it is sterilized with ionizing rays. Methods of sterilization of catgut by chemical methods provide for preliminary degreasing, for which folded catgut rings are placed in a sealed closed banks broadcast for 24 hours.

When sterilized according to Claudius the ether is drained from the can and the catgut rings are poured with Lugol's aqueous solution (pure iodine 10 ml, potassium iodide 20 ml, distilled water up to 1000 ml) for 10 days, then the Lugol solution is replaced with fresh one and the catgut is left in it again for 10 days. After that, Lugol's solution is replaced with 96% alcohol. After 4-6 days, they are sown for sterility.

Gubarev's method provides for sterilization of catgut with Lugol's alcohol solution (pure iodine and potassium iodide, 10 ml each, 96% ethanol up to 1000 ml). After degreasing, the ether is drained, and the catgut is poured with Lugol's solution for 10 days, after replacing the solution with a new catgut, the catgut is left in the latter for another 10 days. After bacteriological control, with favorable results, the use of materials is allowed.

Sitkovsky method. After degreasing under sterile conditions standard catgut threads are cut into 3 parts of 1.25 m long, wiped with a mercuric chloride solution 1:1000 and rolled into rings, which are dipped in a 2% aqueous solution of potassium iodide: for threads No. 0 - for 30 s, for No. 1 - for 1 minute, No. 2 - 2 minutes, No. 3 - 3 minutes, etc. (time in minutes corresponds to thread number). After impregnating the threads with potassium iodide, catgut rings are strung on thick threads and hung at a distance of 7-8 cm from the bottom. glass jar, on which crystalline iodine is poured at the rate of: in a jar with a capacity of 3 l - 40 g of iodine, with a capacity of 5 l - 60 g of iodine. Banks are hermetically sealed. The catgut exposure time varies depending on the thickness of the threads (No. 0, No. 1 are ready after 3 days, No. 2, No. 3, No. 4 - after 4 days, No. 5, No. 6 - after 5 days). After bacteriological control, the threads are suitable for use.

Ways to control sterility (duties during sterilization)

Sterility control methods are divided into direct and indirect.

direct method control is the result bacteriological research(most accurate method):

Methodology:

- a special sterile swab is carried out over sterile instruments, the skin of the surgeon's hands, the operating field, etc .;

- the swab is placed in a sterile test tube and sent to the bacteriological laboratory, where they are sown on various nutrient media.

Indirect Methods(used mainly in thermal sterilization methods: they determine the temperature at which the treatment was carried out, without giving an exact answer about the presence or absence of microflora), are used for each sterilization.

There are cold and hot methods for sterilizing instruments. Hot methods include: sterilization by boiling in water, flaming, etc. Cold methods include sterilization in Karetnikov's triple solution.

Sterilization by boiling in water. Proposed by Davidson and Coomer in 1881. It is carried out in sterilizers. The washed instruments are immersed in pre-boiled (10 minutes) water to remove carbon dioxide and oxygen and boiled for 30 minutes. Instruments are checked for suitability before sterilization. If they were covered with Vaseline, then wipe it off. Vaseline-lubricated needles are wiped and washed with ether or alcohol. The cutting part of the scalpel is pre-wrapped in gauze. Surgical needles are strung on a piece of gauze so that they do not get lost if there are a lot of instruments.

In order to increase the sterilization effect, the instruments are boiled in a 3% solution of bicarbonate of soda, or in a 0.25% solution of sodium hydroxide. At the end of sterilization, the instruments are immediately removed with the sterilizer grill, opening the lid so that the steam leaves the sterilizer without burning the hands and face. If it is necessary to re-sterilize, the water is not drained.

Instruments from the sterilizer grill are laid out on an instrument table covered in three rows with a sterile sheet or towel. The layout of the instruments is best done with Mikulich tongs or forceps. At the same time, a certain order is strictly observed - the same type of tools in one place and in a certain sequence characteristic of each operation. The gauze in which the scalpels were wrapped should be unrolled. The laid out tools are covered with a sterile sheet or towel.

Injection needles and syringes are sterilized in a separate sterilizer and only in water, since the presence of alkalis and other (preferably distilled) disinfectants can lead to inactivation medicines(for example, alkali inactivates novocaine). In this case, the needles and syringes are preliminarily thoroughly washed with running water and placed in cold water disassembled. The needles are sterilized with mandrin and placed in the sterilizer 10 minutes after the water boils in it.

Sterilization of instruments by flombing (burning), The disassembled instrument is laid out in a clean enameled basin or bath, poured required amount alcohol and light it. During the period of alcohol burning, it is advisable to turn the instrument over, since it cannot be sterilized well at the points of contact with the bottom.

This method is expensive and unsafe. In addition, prolonged firing releases steel, spoils stainless coatings, and dulls the cutting parts of tools. Therefore, flaming is used only when providing emergency surgical care, as well as for sterilizing enameled dishes, when other methods of sterilization are not possible due to lack of time.

Cold sterilization methods have a great practical value, because they allow to ensure sterility surgical instruments even in field conditions where it is not possible to apply reliable heat treatment.

Sterilization of instruments in Karetnikov's triple solution. The method was proposed in 1938. The solution consists of 20 g of formalin, 15 g of soda, 3 g of carbolic acid and 1 liter of distilled water. The duration of sterilization is 30 minutes. The method provides reliable sterilization of instruments, does not damage them, protects them from rust. With prolonged storage in jars with ground stoppers, the solution does not lose its bactericidal properties and remains transparent.

Similarly, you can sterilize instruments in a bactericide solution 1:3000 with soda 1% - 10 minutes: in rivanol (ethacridine lactate) 1:500 - 30 minutes; in 1% alcohol solution of brilliant green - 15 minutes.

Syringes are sterilized in Kitzler's solution, which consists of: 3 g of carbolic acid, 15 g of borax and 20 g of formalin per 1 liter of water. Sterilization time is 30 minutes.

During purulent operations, used instruments are wiped with wet gauze (gloved hands), then sterilized for 10 minutes in a 2% sodium carbonate solution with the addition of 0.5% lysol solution, wiped with a dry towel and dried. During operations associated with anaerobic processes, as well as in case of soil contamination of the instruments, they are immersed for 10 minutes in a Lysol solution and, after mechanical cleaning, are sterilized for 30 minutes in a 0.25% sodium hydroxide solution or in a 2% carbon dioxide solution with the addition of 0 5% Lysol, after which it is wiped in the usual way.

Tool storage. Injection needles can be stored in jars with a ground stopper in Nikiforov's liquid (alcohol and ether equally) or in Kitzler's solution. In this case, a mandrin should be inserted into each needle. dark spots or rust formed on tools can be removed using chalk with ammonia in a ratio of 2:1 or aqueous iron oxide powder.

Tools must be stored in a clean, dry room, tool cabinets always tightly closed. In order to avoid the appearance of rust on the instruments, it is desirable to have vessels half-filled with calcium chloride in the cabinets, which absorb moisture from the air well.

Do not store instruments together with iodine preparations. Rarely used tools should be lubricated with neutral fat - petroleum jelly or natural drying oil.

Rubber items are sterilized by boiling in distilled water. To do this, they are wrapped in cheesecloth (so as not to burn) and boiled for 30 minutes or cold in formalin vapor. Take an appropriate size glass vessel with a hermetic lid. A little formalin is poured into the bottom of the vessel. Then they hang catheters (bougie, other rubber instruments) from the lid or fix them on a special stand and tightly close the lid. Sterilization time is 24 hours. Used rubber products are mechanically cleaned before each sterilization with warm water and soap and soft brushes or a piece of gauze.

Rubber catheters and bougies can be sterilized by boiling in a 40% sodium chloride solution for 30 minutes or cold in formalin vapor, or in a 0.1% aqueous or 0.1% alcohol (alcohol 70 ° or 96 °) solution of decametoxine (wipe tissue for 3 minutes).

Sterilization of instruments with optics, which are used for endoscopy, are washed in soapy water and wiped with a cloth moistened with a 6% hydrogen peroxide solution with a 0.5% synthetic detergent solution (Rublenko M.V.. 1996).

Optical instruments can be sterilized in a solution of furacilin (1:5000) for 30-50 minutes. The optical system is wiped with ethyl alcohol or a 2.5% solution of gibitan (chlorhexidine bigljonate).

When sterilizing infusion systems, automatic syringes that have in their composition polymer materials, you should pay special attention to the nodes and elements that come into direct contact with the medicinal substance. Previously, these places are washed with a 3% hydrogen peroxide solution with a 0.5-1% solution of a synthetic detergent or a mixture equal parts 1% sodium bicarbonate solution and 1% ammonia solution. Further processing involves immersing the instruments in a solution of one of the following antiseptics: 0.5-2.5% gibitan (chlorhexidine bigluconate) (20-30 minutes), 0.1% diocide (30 minutes), 6% hydrogen peroxide (6 hours) , 4.8% pervomur (15 minutes), or 70 ° ethyl alcohol (2 hours). All antiseptics, except for hydrogen peroxide, are washed off with sterile water after sterilization.

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 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. Such instruments are immersed in a saturated solution for several hours before boiling. boric acid(when 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 drying cabinets at t° 180-200° for 40 min. 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, - 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. 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. 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 needles dry, with mandrin. Disassembled syringes and needles can be stored in 96% alcohol in special metal cases or in glass vessel. Using the same syringe and needle for more than one person can lead to the 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).

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