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Sterilization and maintenance of laparoscopic instruments

2021-7-4 18:53:34      点击:

With the increasing development of medical technology, gynecological laparoscopic surgery is more and more widely used in clinical practice, and the infection caused by this is also increasing, according to foreign investigations, the infection rate is generally around 8/100,000, and the infection rate in China is higher [1]. Because the instruments required by laparoscopic surgery are precise, expensive and frequently used in clinical patients, there is a risk of cross-infection. So the sterilization of laparoscopic instruments is particularly important. In addition, the success of laparoscopic surgery depends to a large extent on whether the instrument performance is good and whether the instrument is normal. Therefore, the maintenance of its equipment is also very important. The methods and management of sterilization of laparoscopic surgical instruments in our hospital in the past five years are introduced as follows.

Sterilization method of laparoscopic instruments

Since laparoscopic surgery has been carried out in our hospital, there are two sterilization methods for laparoscopic instruments: one is EA-625/EA-625+ desktop autoclaves (provided by Jiangsu Sanlai Medical Equipment Co., Ltd.), and the other is soaking sterilization with 2% enhanced glutaraldehyde.

1.1 Sterilization principle of desktop autoclave (1) Using gravity replacement principle, hot steam can discharge cold air from top to bottom through the lower vent in the autoclave, and the discharged cold air is replaced by saturated steam, and the latent heat released by steam can sterilize the goods. It is mainly used for sterilization of medical instruments and articles that are resistant to high temperature and humidity. (2) In the process of using a desktop autoclave to sterilize, the loading capacity shall not exceed 80% of the capacity in the cabinet, and the sterilized items must be exposed. The sterilization temperature reached 134℃ and the time was 10min. 3M 1250 indicator bar was used for monitoring during each sterilization to observe the degree of discoloration of the indicator bar to judge the sterilization effect. At the same time, the bacteria were used for biological monitoring every quarter, and the qualified rate of sterilization was 100%.

The immersion sterilizer used in our hospital is 2% enhanced glutaraldehyde sterilizer (Dianerkang brand provided by Shanghai Likang Sterilization Technology Co., Ltd.). The immersion time is 10h, and the main ingredients are high-purity medical glutaraldehyde and AED fortifier.

1.2.1 Functions and characteristics of glutaraldehyde This product is a classic sterilizer, can kill all kinds of microorganisms, does not corrode sterilizing items, little irritant, sterilization effect is less affected by organic matter and strong penetration, mainly applicable to a variety of precision instruments, heat resistant surgical instruments, endoscopy and other disinfection and sterilization [2]. The unalkalized glutaraldehyde has no spore killing effect, but when the glutaraldehyde disinfectant is adjusted to a pH of 8.0 with sodium bicarbonate, a strong spore killing effect can occur [1].

1.2.2 Method of use of glutaraldehyde One bag of activator must be added into the bucket to make enhanced glutaraldehyde with pH of 6-8, and another bag of corrosion inhibitor for rust prevention. The activated solution was used for 2 weeks. Sterilized laparoscopic instruments must be rinsed with sterile water before use to remove residual glutaraldehyde to avoid irritation to human organs.

(1) When autoclaved or soaked, the joint parts and accessories of the instrument should be disassembled so that the axial surface of each joint of the instrument can be penetrated or soaked by a certain concentration of saturated steam to ensure the sterilization effect. The lumen should not be twisted and should be kept smooth. (2) When soaking, all the instruments must be cleaned and dried to avoid water and organic matter being brought into the glutaraldehyde solution, which will lead to dilution or dissolution of glutaraldehyde and affect the sterilization effect. If the activated glutaraldehyde is not stored airtight, or the sterilization equipment is frequently used, or the ambient temperature is too high, and the storage time is long, the concentration of glutaraldehyde will decrease, and the color of the activated glutaraldehyde will change from light yellow to dark brown. When the solution is slightly yellow, it does not affect the sterilization effect. If the color is too dark, it should be discarded and renewed. In the process of glutaraldehyde use, we used the glutaraldehyde concentration indicator card produced by 3M Company in the United States to determine, in order to timely monitor the use of life.

Before laparoscopic surgery, HBV and HIV infection indicators must be tested before operation. For HBV or HIV infected persons or pathogen carriers, special endoscopy should be used and arranged to be done last. After use, all instruments should be soaked in 2% glutaraldehyde solution for 1h before cleaning and sterilization.

2 Equipment maintenance

(1) Laparoscopic instruments are precise, expensive and easily damaged, and we are kept and stored by special people and counters. (2) Before use, we should carefully check whether the instrument and its accessories are complete, pay special attention to whether the small parts are in good condition and matching, and it is strictly prohibited to knock the tubular instrument, so as to ensure the smooth operation. After the operation, add all the equipment in enzyme solution soak 5 min, 10 min ultrasonic washing, then scrub clean with clear water, immersed in 2% glutaraldehyde 30 min and then rinse clean with flowing water, the residual water wipe with dry cloth, cloth with paraffin oil evenly rub again and paraffin oil dishcloth wet should be moderate, if too wet paraffin oil too much on the instrument, It will affect the penetration of saturated steam and the effect of sterilization. If it is too dry, it does not play a lubrication and protection role on the surface of the instrument, which makes the instrument easy to rust, thus affecting the function of each joint and the smooth progress of the operation. (3) Detailed registration should be made after each operation to record the use of the instrument. (4) The commonly used instruments and instruments should be inspected daily, monthly inspection, detailed registration, the establishment of a registration record system, the discovery of problems, timely report and deal with

The above is a summary of the methods of sterilization and maintenance of laparoscopic instruments after laparoscopic surgery in our hospital. The purpose is to make the sterilization and maintenance of laparoscopic instruments further perfect and scientific, and make our aseptic technology level to a higher level.