Слайд 13
The preliminary consists in damp wiping of horizontal surfaces and all subjects, preparation of tool tables at the beginning of the working day.
The current cleaning is carried out to operating time, incidentally fallen subjects, removal of the used dressing gather from a floor.
Final cleaning is carried out at the end of the working day. It consists in washing and damp wiping of window sills, heaters, furniture and a floor with application antiseptics. After cleaning the room is irradiated with ultra-violet light, including wall or ceiling irradiators for 60 minutes.
Clear-out is carried out once a week (the fixed day). The equipment with use of disinfecting solutions is processed by wall antiseptics.
There are superpure organs transplantation, operational for performance of operations, the burn patients having the huge area of entrance gate for an infection. It is necessary to carry the operational to them:
- with a laminar stream of air (air arrives via the bacterial filter);
- baroperatsionnye-pressures chamber with an elevated pressure (on surgeons - special hermetic suits, on the head device for breath).
- with the abakterilny environment
Control of the mode of sterility of the operational block is exercised by bacteriological researches of air operational once a month.
It is necessary for the prevention of contact infection, what everything that adjoins to a wound, was sterile. It is reached by sterilization of surgical tools, operational linen, dressing and surgical linen, hands of the surgeon, an operational field.
Slaid 14
Preventive measures of contact and implantation infections
Sterilization is achieved by means of physical and chemical methods.
Physical - thermal and ray sterilization - boiling, the sterilization by steam under pressure, dry heat sterilization, gamma-radiation.
Chemical - the sterilization by ethylene oxide, the treatment by acetic acid, the chemical therapeutic treatment. Sterilization in the autoclave (water steam) is fulfilled with 120-132° C, pressure - 1,1 atm/sm2 during 45 min. The ray sterilization - is by ionic radiation of high energetic power. They use beta- and gamma-radiations. The ultra-ionic sterilization is also possible - the sterilizer is filled with some antiseptic, which under the influence of ultrasonic waves sterilizers surgical instruments.
The chemical sterilization: ethylen oxide possesses a bacterial effect. By means of gas sterilization they treat the instruments of which cannot be treated in autoclaves or air sterilizators. They use ethylen oxide for sterilization of catheters, gloves, endoscopes, apparatuses for the artificial blood-circulated room.
Slaid 15 Sterilization of dressing, operational linen.
Gauze balls, tampons, napkins, bandage, turunda, wadded and gauze tampons belong to dressing. Dressing is prepared usually just before sterilization, using special receptions for prevention of fall of separate threads of a gauze. For convenience of calculation balls stack on 50-100 pieces. Dressing isn't reused and after application is burned.
Requirements to dressing: to be biologically and chemically intact, to possess good hygroscopicity, to be minimum loose, soft, elastic, not to injure fabric, it is easy to be sterilized and not to lose the properties, to be cheap in production.
Surgical dressing gowns, sheets, towels belong to operational linen and podkladny. Material for their production are cotton fabrics. The operational linen of repeated application after use passes washing, and separately from other types of linen.
Ways of laying in the steam sterilizer: the linen and dressing keeps within the steam sterilizer so that it was possible to take any them them, without having affected another for what the sector of the steam sterilizer (universal laying) is allocated for each subject, or the steam sterilizer is filled with a certain type of material (specific laying); purposeful laying - keeps within the steam sterilizer the dressing and operational linen, tools intended for one typical operation (a kateterization of a subclavial vein, for peridural anesthesia, a trakheostomiya).
Slaid 16
Dressing and linen will be sterilized in the autoclave at 132 °C; 2 atm – 20 minutes. Before sterilization dressing and linen keeps within packings for sterility preservation.
Slaid 17
Sterility preservation term the windows of steam sterilizers – 3 days; steam sterilizers with the anti-bactericidal filter – 21 days. If the steam sterilizer opens for a capture of part of material, the left material is considered rather sterile during a shift (6 hours).
The term of preservation of sterility of packing with a double layer of nonwoven fabric – 3 months, a layer of krepirovanny paper with a layer of nonwoven fabric – 2 months, a kraft-package – 3 days.
Slaid 18
The sterilization of instruments.
In air sterilization procedure is carried out during 60 min with t° - 180°C.
Instruments made of corrosion-resistant metals or of plastics are sterilized in the 6% solution of hydrogen peroxide with temperature 180°C during 360 min. Instrument are sterilized also in the solution of 3 components (2 % formaline, 0,3 % phenol, 1,5 % sodium bicarbonate) during 45 min.
Syringes are sterilized in dry-hot case with temperature - 180°C during 60 min.
Endoscopes, catheters, cistoscopes are sterilized by means of glutar dialdehyde and sodium hypochloride, the duration of treatment is 45-180 min.
Slaid 19
Sterility quality control
Distinguish visual, physical, chemical, bacteriological types of control.
Slaid 20
- Visual control. Check correctness of use of packing materials, level of loading of packings and sterilizing cameras, validity of the chosen sterilization method.
Slaid 21
- Physical control. Estimate indicators of instrumentations of the sterilizing equipment: the maximum thermometers, manometers and the level of a deviation of indicators from standards.
Slaid 22
- Chemical control. Carry out by means of chemical test indicators. Today it is necessary to use test indicators of 4 generations which allow to control all parameters of sterilization (pressure, temperature, time). Distinguish test indicators for control out of packing and in packing.
Internal indicators are placed in packing on 3 levels – at uniform laying (at the mixed bookmark – in each type of the sterilized material place the additional test). Internal test indicators allow to control sterilization parameters in packing. External test indicators control sterilization parameters in the sterilizing camera and are placed in certain points of the camera.
Test indicators are estimated directly after the end of sterilization (external test indicators) and after packing opening (internal).
Rules of a laying of the test indicator in sterilizing packings:
- in uniform laying test indicators are put on three levels (a bottom, the middle, top).
- in the combined laying test indicators are put on 3 levels and in addition in the middle of each type of material.
In soft laying of small volume is admissible to put one test indicator in the middle.
Slaid 23
Bacteriological control (direct control method) is exercised by crops of dabs taken from various sites of the sterilized material, tools, skin of hands of the surgeon. For the operational block, intensive care units of research on quality of sterilization 1 time in 10 days, for other regime offices – once a month is carried out; 2 times a year similar researches are conducted by SEA – sanitary-epidemiological station.
Slaid 24
Among contact ways of transfer of an exogenous infection the main place is taken by the direct method of a kontamination which is carried out directly through hands of members of surgical crew.
Disinfections of surgeon’s hands
Disinfections of hands are a good removal of microorganisms from the hands. And such a case they use the tannage of skin, which prevents the penetration of microorganisms onto the surface of the skin. The principal of surgical treatment: care of hands, care of nails, the mechanical cleaning is with soap and a brush during 2- 5 min, then disinfections. A disinfectant must be:
exterminate the micro flora quickly;
exterminate microbes in the juice of gloves;
possess a cumulative effect - hands must be free from microorganisms even in the intervals of disinfections;
not irritate the skin.
Slaid 25
The most often now in use of mechanical cleaning and disinfection.
Modern ways of processing of hands
Processing by "Pervomur" is a peroxide of hydrogen + formic acid. Processing assumes washing of hands flowing water with soap, then in a basin with "Pervomur" - 1 minute; the hlorgeksidiny – 0,5% spirtovy solution of 2-3 minutes; degminy, degmitsiny (cleaners) – 5-7 minutes;
the tserigely – film-forming antiseptics from group of cleaners; the evrosepty – the operating beginning – ethanol хлоргексидин – 2-3 minutes.
Slaid 26
Any of the existing methods of processing of hands doesn't provide an absolute aseptichnost therefore all operations, manipulations
Slaid 27
are carried out by surgeons in sterile gloves.
Slaid 28
Processing of the operational field Way of Grossikha-Filonchikov (1904-1908) it is based on a skin tanning which provides an obturation of output channels of glands: grease and stalemate also creates an obstacle for an exit of microbes to a surface (4-fold greasing of skin of 10% iodine solution) 1) in 5-10 minutes prior to operation, 2) before a section, 3) before suture, 4) after their imposing. This method excluded washing of an operational field soap and a brush therefore for mechanical cleaning used gasoline. ]
Slaid 29
The antiseptics - system of measures, is directed on reduction of quantity and destruction of microbes in a wound or the patient's organism.
Slaid 30
Depending on the nature of the used methods 4 types of antiseptics differ: