Cleaning, disinfection and sterilization of endoscopic instruments and endoscopic instruments

1. Cleaning method of endoscopic instruments and laparoscopic instruments Cleaning is an important link in disinfection and sterilization, and more than 90% of the pathogens can be removed by cleaning the instruments. At present, there are two ways to clean laparoscopic instruments: manual cleaning and ultrasonic automatic cleaning machine. So we use the manual cleaning method, the procedure is: enzyme bubble ª² cleaning disinfection, cleaning, drying, sterilization. After the operation, the laparoscopic instrument was soaked in enzyme cleaning agent for 30min immediately. Because the enzyme can quickly decompose protein and organic matter, the residual blood, organic matter and mucus will not solidify and adsorb on the instrument, so as to be easy to clean. All dismountable parts should be removed and placed separately. Each casing core should be pulled out and soaked fully. Then carefully clean each part with flowing tap water, the instrument with the lumen application of high pressure water gun injection water rinse, and then wash repeatedly with a soft brush, to both ends see the brush head shall be subject to, completely remove all tissue debris, while removing other organic matter. After cleaning, the components, joints and forceps blades are opened, and the pneumoperitoneum tubes and instruments with lumen are fully dried by injection of 95% ethanol, and then placed horizontally or hung in a cool and dry special storage cabinet for reserve.

Pay attention to cleaning to prevent the absence of the accessories of the laparoscopic instruments, because the laparoscopic instruments are sophisticated and complex, many instruments are equipped with small accessories, so in the disassembly and cleaning, the scrub tank is best covered with a filter screen, in order to prevent the loss of the flush into the sewer. In addition, the connection between the cold light source and the camera lens should not be discounted in the process of cleaning and disinfection, and the Angle of circling should be obtuse to avoid damage to the optical fiber.

2, my department commonly used disinfection and sterilization methods :¢Å glutaraldehyde immersion method 2% basic glutaraldehyde disinfectant is a kind of highly effective broad-spectrum disinfectant. Glutaraldehyde disinfectant has no corrosive effect on endoscopic devices and no aggregation effect on proteins, and is suitable for all endoscopic devices.

When disinfecting, the joints and parts of the instruments must be soaked completely, and the lumen should be filled with disinfectant. Before and after each use, at least soak 2% glutaraldehyde for 30min, for special infection, soak 60min, soak 10h can kill the bud to achieve sterilization.

The glutaraldehyde fumigation method was used in our hospital to replace the traditional formaldehyde fumigation. Use glutaraldehyde steam disinfection cabinet. Steam disinfection of glutaraldehyde should be maintained for 3-5 hours. Instruments and other items should be thoroughly wiped with sterile distilled water after removal, otherwise residual glutaraldehyde will damage human tissues and may cause iatrogenic pelvic adhesions. There are many leads of laparoscopic tubes, such as single and bipolar electrocoagulation lines, carbon dioxide pneumoperitonite tubes, flue suction tubes, etc. Because these wires cannot withstand high temperature, we used glutaraldehyde fumigation method, biological monitoring once a week, and bacterial culture once a month.

(3) High pressure steam sterilization method is commonly used in the card sterilizer sterilization, its advantages are: the equipment exposed to high temperature time is short (the whole sterilization process in 6-8 minutes), protect the equipment, prolong the service life; High pressure steam penetration, sterilization effect is more reliable; Small sterilization chamber, good heat uniformity; The sterilizer box itself is a good vehicle to prevent re-contamination before use; There is no need to store more devices, and it is safe and reliable. The use of pulse forced exhaust method sterilization, sterilization effect is more reliable; The sterilizer is small in size, light in weight and wide in application environment. At the same time, the bacteria were used for biological monitoring every week, and the qualified rate of sterilization was 100%. Although this method is the safest and most reliable sterilization method at present, laparoscopic instruments are highly precise instruments, many parts are not resistant to high temperature, and the cost is too high. If high pressure is used, the service life of the instruments will inevitably be shortened. Therefore, we are limited to a few instruments, such as the relatively less precise all-metal gripper, Trocar, rinse suction rod and so on.

(4) Disinfection of laparoscopic surgical instruments for the operation of hepatitis B patients, a very small number of emergency operations or laboratory results have not returned to the laparoscopic surgical instruments according to the infection operation for disinfection. Follow the principle of disinfection - cleaning - disinfection, first with 1/2000 chlorine-containing disinfectant or with 2% glutaraldehyde immersion for 60 minutes (note that metal instruments must be added rust inhibitor), and then according to the conventional method of cleaning, disinfection.

¢É Disinfection and sterilization of laparoscopic accessories, such as pneumoperitoneal puncture needle, puncture device, cannula, disassembled surgical forceps, etc., all need to be completely disassembled and cleaned after autoclave sterilization; Conductors and pneumopitoneum tubes that cannot be soaked and sterilized by high temperature and high pressure can be sterilized by glutaraldehyde steam. Fiber guide beam and camera and other valuable accessories in order to avoid the impact of disinfection and sterilization of its performance and life, disposable aseptic protective sleeve can be used to ensure the aseptic state of the wire.

When using instruments sterilized by glutaraldehyde immersion, a large amount of sterile distilled water must be rinsed repeatedly (not less than 3 times), especially in each lumen, to prevent the toxic effects of residual chemicals after disinfection.

4. Strengthen the monitoring of disinfection and sterilization effect. Test the concentration of glutaraldehyde before use, change it once a week, carry out biological monitoring on the sterilized instruments regularly, and deal with any problems in time.

The glutaraldehyde disinfection cabinet is managed by special personnel, cleaned regularly, and Bacillus solanum is cultivated weekly. The card sterilizer is managed by a special person, regularly inspected, the sterilization instruction card is placed when using, and the thermophilic fatty bacteria are cultured weekly. If any problem is found, deal with it in time.