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How to sterilize medical instruments


Sterilization of instruments and medical devices

Sterilization of medical devices consists of 3 stages: disinfection, pre-sterilization treatment and sterilization.

Disinfection subject to all instruments and devices used during operations and surgical procedures. All used instruments, syringes, needles, catheters, probes, etc. are immersed in a container with a 3% solution of chloramine or a 0.5% solution of deoxone, where they are washed by washing the gaps of the needles, and then immersed in the same solution for 60 minutes . For the same purpose, they also use a 0.5% solution of bleach, a 6% solution of hydrogen peroxide and other drugs (see the section “Antiseptics”).

Pre-sterilization treatment (second stage of tool processing, OST-42-21-2-85) carried out after disinfection and laundering of the disinfectant residues with clean running water. Its purpose is the removal of protein, fat, mechanical impurities and drug residues.

Various means are used for pre-sterilization treatment: solutions containing hydrogen peroxide and a detergent (Lotus, Lotus-machine, Astra, etc.), which are prepared before use. To reduce the corrosive effects of these drugs, it is advisable to use a corrosion inhibitor - 0.14% sodium oleate.

Detachable products are subjected to disassembled processing, and when soaked, they are completely immersed in the solution so that all gaps and cavities are filled. The washing is carried out using a ruff, tampons, tissue napkins, the channels are washed with a syringe.

Manual pre-sterilization treatment steps:

Rinsing under running water - 0.5 min.

Soaking in a washing complex at a temperature of 40-55 gr. C - 15 minutes

Washing in a washing complex with a ruff - 0.5 min.

Rinsing products under running water: a) after using “Biolot” - 3 minutes, b) after using “Progress” and “Marichki” - 5 minutes, c) after using “Astra”, “Lotus” - 10 minutes.

Rinsing with distilled water –0.5 min. or boiling

within 5 minutes in a special container.

Drying with hot air at a temperature of 80 - 85 gr. S. gr. C until the moisture disappears completely in the air sterilizer with the vent open.

Currently, there are tools that allow disinfection and pre-sterilization cleaning of instruments in one step using drugs: lysetol, vircon, pyroxymed, etc. The use of these tools allows you to make the process of processing tools less time-consuming and reduce processing time.

Quality of pre-sterilization treatment controlled by samples: for the presence of blood residues using an amidopyrine test. For this purpose, benzidine and orthotoluidine samples can also be used. To determine the residual alkaline components of detergents, a phenolphthalein sample is used. Using an azopyram test, you can determine both the presence of blood on the instruments and the components of the detergents.

Azopyram test. For the test, a 1.0 - 1.5% solution of aniline hydrochloride in 95% alcohol is used. Before the test, a working solution is prepared by mixing equal volumes of azopyram and 3% hydrogen peroxide. Prepared working solution (shelf life 1 - 2 hours) is applied to objects. A sample is considered positive if the color of the reagent changes within the first minute. Purple appears first. The transition from violet to pink-lilac indicates blood traces, and the appearance of brownish staining indicates incomplete removal of detergent, chlorine-containing oxidizing agents, and rust (extract from instructive recommendations on quality control of pre-sterilization cleaning of medical devices using azopyram reagent No. 28- 6/13 dated 05/26/88).

Amidopyrine test. When stating an amidopyrine test, the presence of residual quantities of blood indicates the immediate, or no later than 1 minute, the appearance of a blue-green staining of the reagent. Staining that occurs later than 1 minute later is not taken into account (guidelines for pre-sterilization cleaning of medical devices No. 28-6 / 13 of 06/08/82).

Phenolphthalein sample carried out using a 1% alcohol solution of phenolphthalein. The solution is applied with a gauze napkin to the product, or 2-3 drops of the solution are applied to the product. The result is evaluated within 2 minutes. With a positive test, the color of the reagent will change from pink to raspberry.

With positive samples, the pre-sterilization treatment is repeated.

The method of sterilization depends on the type of surgical instrument or product.

Sterilization of metal instruments. Metal instruments are sterilized in an autoclave, or in a dry oven. A chemical method is used to sterilize cutting tools. Instruments equipped with optics (fibrogastroduodenoscopes, bronchoscopes, cystoscopes, colonoscopes, etc.) are sterilized in gas sterilizers or use chemical antiseptics such as chlohexidine bigluconate and others for this purpose.

Sterilization of rubber products and polymeric materials. Dry rubber gloves are autoclaved. Before sterilization, inside and out, they are sprinkled with talcum powder to protect against bonding. A gauze or paper is placed between the gloves, each pair of gloves is wrapped separately in gauze or paper and, in this form, is placed in a beaks. Sterilization mode at a steam temperature of 120 g. C, pressure 1.1 atm. - 45 minutes.

Other products made of rubber and polymeric materials are also sterilized. Chemical control: benzoic acid with fuchsin, IP 120 g C.

Order of the Ministry of Health of the USSR No. 720 of 07/31/78 and No. 408 of July 12, 89