1. Devices must be cleaned as soon as possible after use.
2. Carry out hand hygiene in accordance with the “hand hygiene” standard.
3. Wear gloves.
4. Prepare the workplace:
Container with disinfectant solution;
Container with distilled water;
Disinfectant;
Gloves;
Cotton-gauze swabs;
Sterile diaper.
5. Disassemble the device. Removable parts (hoses, moisture collectors, humidifier, tees, adapters, valve boxes and other parts depending on the brand of the device) are completely immersed in a container with a disinfectant solution approved for these purposes in the prescribed manner (for example, 3% peroximed for 60 minutes).
If the disinfection regime is not combined with pre-sterilization cleaning, additional pre-sterilization cleaning is carried out OST 42-21-2-85
6. Twice with an interval of 15-20 minutes. Wipe the outside of the device body with a napkin moistened with a disinfectant solution for these purposes (having detergent properties, for example 3% peroximed).
7. Remove the paper filter and place it in a container for disinfection of class “B” waste.
8. After exposure to the disinfection mode, rinse the removable parts of the device in the same solution; adapter, valve, tees, moisture collectors and other parts using a cotton-gauze swab for 25-30 seconds.
9. Throw the cotton-gauze swab into a container for disinfection of class “B” waste.
10. Rinse the removable parts of the device under running water, place it on a clean diaper and carry out azopyramic self-testing.
11. Rinse the removable parts of the device in a container with distilled water and place on a sterile sheet.
12. Remove used gloves and immerse them in a container with a disinfectant solution.
13. Carry out hygienic hand antiseptics in accordance with the “hand hygiene” standard. Wear clean gloves.
14. Assemble the device, attach all disinfected and dried removable parts.
15. Pour a disinfectant solution (0.5% chlorohexedine solution) into the moisture collector and connect the device for 60 minutes at a gas flow of 2 l/min.
16. Remove any remaining disinfectant solution. Blow through the apparatus with an oxygen flow of 8-10 l/min along a semi-closed circuit for 15 minutes.
Semester.
Topic: Fundamentals of anesthesiology. Local and general anesthesia.
Algorithms for practical activities.
KIT FOR CARRYING OUT NOVOCAINE BLOCKade
Goals: Carrying out novocaine blockade.
Indications: Various surgical interventions for therapeutic purposes
Contraindications: Intolerance to anesthetic, extensive traumatic surgery, patient age.
Complications: No
Equipment: Skin antiseptic, gloves, sterile tweezers, mask, syringe 20 g. , novocaine, 1%, 0.25%, needle (10-12 cm), sterile material, adhesive patch.
| № | Rationale | |
| 1. | Make sure this manipulation is necessary (assigned in the medical history). | |
| 2. | ||
| Prevention of V.B.I. | ||
| 3. | Infection safety | |
| 4. | Prevention of infection. | |
| 5. | Open the sterile table, use sterile tweezers in a bottle with 6% hydrogen peroxide (next to the sterile table), take a sterile tray, tweezers, scissors, cotton-gauze balls, and napkins. | |
| 6. | Igloo 10-12 cm. |
Prepare everything necessary for manipulation.
Take a bottle of novocaine 0.25%, 100 ml, alcohol or chlorhexidine, adhesive plaster, sterile gloves.
Goals: SET FOR SPINAL ANESTHESIA,
Indications: LUMBAL PUNCTURE.
Contraindications: Performing a lumbar puncture
Diseases, injuries of the skull and spine. Intolerance to novocaine drugs, severity of condition.
Equipment: Complications:
| № | Infection of the spinal cord membranes. | Rationale |
| 1. | lidocaine, trimecaine, bupivacaine, Skin antiseptic, iodine, gloves, sterile tweezers, mask, syringe 20 g. , novocaine, 0.25%, needle (10-12 cm), sterile material, adhesive patch, sterile tray, waste container. | Sequence of actions (stages) |
| 2. | Make sure this manipulation is necessary. (assignment in medical history). | Determination of indications for manipulation |
| 3. | Explain to the patient the meaning of the manipulation and the need to perform it. Calm him down. | |
| 4. | Psychological preparation of the victim | Infection safety |
| 5. | Put on the mask, wash your hands under running water and soap, and wipe dry. | Prevention of infection. |
| 6. | Hands are treated surgically and put on sterile gloves. | Compliance with aseptic requirements |
| 7. | Prepare everything necessary for manipulation (a bottle of lidocaine, trimecaine, bupivacaine, 10-20 ml, alcohol, iodine or chlorhexidine, sterile gloves, adhesive tape). | High-quality manipulation |
CARE OF ANESTHICAL RESPIRATORY EQUIPMENT
Target: Processing of anesthesia and respiratory equipment
Indications. Disinfection of the anesthesia machine.
Contraindications: Allergic reaction to chlorine-containing drugs.
Equipment: Rubber apron. Respirator (or 8-ply mask). Glasses. Cap. Rubber gloves, Enameled container with lid. A dark glass bottle with a ground-in stopper for a solution consisting of (20 ml of 30% perhydrol and 5 g of washing powder per 1 liter of hot water). Gauze swabs. A solution of 10% formaldehyde or 3% hydrogen peroxide solution. Bed sheet. Distilled water
| № | Sequence of actions (stages ) | Rationale |
| 1. | The nurse disconnects and disconnects individual metal parts of the device | Strict sequential execution of manipulation is the key to success |
| Wash these parts under running warm water. | Hygiene requirement. | |
| 2. | Then for 15-20 minutes it is immersed in a hot (50º C) solution, which is prepared at the rate of 20 ml of 30% perhydrol and 5 g of washing powder per 1 liter of hot water. | Compliance with instructions and aseptic standards |
| 3. | After the specified time, the soaked parts of the device are washed in the same solution with a swab and rinsed in running water. | Compliance with the requirements for the sequence of manipulations. |
| 4. | For the purpose of disinfection or sterilization, rubber parts, the body and frame of the adsorber, valve, are immersed for 1 hour in a 10% formaldehyde solution or a 3% hydrogen peroxide solution. | Compliance with sanitary and epidemiological requirements. |
| 5. | Then rinse twice in distilled water, wipe with a sterile sheet and store in a medical cabinet. | Quality of manipulation |
SOPs (standard operating procedure) provide medical workers with written step-by-step instructions and clear algorithms for implementation. The developed manual takes into account the regulatory framework, the specifics of the field of application, and the requirements for the procedure.
Purpose: Prevention of nosocomial infections, postoperative complications.
Disinfection equipment – devices and installations designed for disinfection, pre-sterilization cleaning ( hereinafter – PSO), sterilization.
Sterilization is the complete destruction of all types of pathogens, including spores, by affecting them with physical, chemical, thermal or mixed methods.
Application area: The rules apply to nursing and junior medical staff of clinical departments. Senior nurses supervise the cleaning process.
Requirements:
- Disinfectant.
- Detergent.
- Instructions for diluting these products.
- Containers for processing.
- Azopyram for pre-sterilization control of processing quality.
- Sterilization and pre-sterilization control logs.
High level disinfection of mechanical ventilation ( hereinafter referred to as mechanical ventilation), combined with pre-sterilization cleaning
The ventilator must be cleaned as soon as possible, but no later than 30 minutes after disconnection from the patient.
The main stages of processing of breathing equipment are:
Stage 1. Disassembling the device.
Stage 2. Cleaning the device + PSO (container No. 1).
Stage 3. High level disinfection ( hereinafter – TLD) the collapsible circuit of the device (tank No. 2).
Stage 4. hardware of the device.
Stage 5. Drying, storage.
1. Disassembling components, removing hoses, connecting elements, disconnecting the humidifier, water seal (water from the humidifier and water seal is disinfected). The breathing circuit of the devices is a hollow gas-conducting system that is in close contact with the air exhaled and inhaled by patients, face masks, tracheal tubes, tracheostomy cannulas, mouthpieces, connectors, adapters, tees, all kinds of connecting tubes, etc.
The breathing bag is also subject to disinfection and PSO.
2. All disassembled components, medical products ( hereinafter – IMN) are washed in container No. 1 with a working disinfectant solution (at least 3 minutes). You can use cotton gauze swabs for washing.
3. Medical devices are immersed in container No. 2 with a working solution of disinfectant for TLD, filling the channels and cavities. Detachable products are immersed disassembled, tools with locking parts are soaked open, making several working movements with these tools in the solution.
The volume of solution for treatment must be sufficient to ensure complete immersion of the medical device, and the volume of the solution above the products must be at least 1 cm.
The technological process of processing medical products, devices and equipment is regulated by the requirements of Chapter II of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” and includes sequential stages:
- disinfection;
- sterilization.
Processing and sterilization of anesthesia and respiratory equipment
The algorithm of actions is as follows:
- Disinfection of anesthesia-respiratory devices (hereinafter referred to as NDA), in accordance with the requirements of clause 2.7 of Chapter II and clause 6.6 of Chapter III of SanPiN 2.1.3.2630-10, is carried out taking into account the recommendations set out in the operating manual for the device of a specific model (see materials in the ES “Control in health care facilities” - ).
- Removable parts of the NDA are disinfected as medical products, taking into account the characteristics of the impact of chemical and physical agents on the materials from which the parts are made, using methods and techniques approved by the MU of the Ministry of Health of the Russian Federation dated December 30, 1998. No. 287-113 "Guidelines for disinfection of medical products"
- Regarding the treatment of breathing circuits, the requirements of SanPiN 2.1.3.2630-10 recommend the use of single-use circuits for no more than 72 hours for each patient, unless otherwise provided by the manufacturer.
Treatment of products that do not come into contact with the wound surface, blood, mucous membranes
Blood (in the patient’s body or injected into it) and/or injectable drugs and those not in contact with the mucous membrane during operation, according to clause 2.15 of Chapter II of SanPiN 2.1.3.2630-10, are not subject to sterilization. The exception is cases specified by the manufacturer in the operational documentation of the NDA.
Storage conditions
Storage conditions (packaging and terms) depend on the sterilization method used in the organization. Storage is allowed for no more than 3 days in a sterile sterilization box lined with a sterile sheet.
Installation of filters, removable parts of the device
Filling the humidifier reservoirs with sterile distilled water, installing filters and removable parts is carried out when preparing the NDA for use, in accordance with the instructions for use (paying attention to the number of treatment cycles specified by the manufacturer).
How are applicators (plastic) and attachments for low-frequency ultrasonic treatment apparatus for treating the respiratory system processed?
Reusable medical products that come into contact with the wound surface, blood and/or injectable drugs, which during operation come into contact with the mucous membrane and can cause damage to it, in accordance with the requirements established by Section II of SanPiN 2.1.3.2630-10 and taking into account the recommendations of product manufacturers medical purposes.
The choice of adequate methods and methods of disinfection and sterilization depends on the characteristics of the products being sterilized (material of manufacture and its properties):
- it is allowed to use disinfection by wiping for those medical products whose design features do not allow the use of the immersion method;
- disinfect and sterilize by physical (boiling, steam) or chemical methods (immersion in a disinfectant solution, sterilant) products made of rubber, latex and certain types of plastics;
- sterilize silicone rubber products using the air method, always drying them in an oven at a temperature of 850C until visible moisture disappears after pre-sterilization cleaning;
- sterilize using solutions of chemical agents, products in the construction of which thermolabile materials are used, using for these purposes solutions of aldehyde-containing, oxygen-containing and some chlorine-containing agents that exhibit a sporicidal effect.
In accordance with the established clauses 1.2 and clause 1.4 OST 42-21-2-85 "Sterilization and disinfection of medical devices. Methods, means and modes", the operational documentation for the product must describe the methods, means and modes of pre-sterilization cleaning, sterilization and disinfection in relation to a product or groups of products, taking into account their purpose, design features, as well as specifying the requirements for their resistance to means of pre-sterilization cleaning, sterilization and disinfection.
Those. The manufacturer's instructions for using a medical device must necessarily indicate and describe the sequence of procedures for processing the medical device and each product and instrument included in its configuration, or by listing them, if the methods of disinfection and sterilization for them are of the same type.
Should ventilator breathing circuits be sterile?
Types of ventilators and modifications of breathing circuits depend on the functional purpose, design features, perceived external influences, and operating mode of potential risk.
The manufacturer is obliged in the accompanying documentation to the equipment:
- provide an explanation of the IP classification of the values marked on medical devices and the purpose of the ventilator - for non-invasive (oxygen supply using a mask) or invasive (intubation) ventilation;
- provide the requirements for accessories supplied separately, indicating any limitations or negative effects, their main functional characteristics and level of safety;
- indicate the purpose of the accessories supplied with the device - disposable use or subject to reprocessing;
- indicate which part of the ventilator breathing circuit is contaminated by body fluids and exhaled gases, and the risk factors for reuse of the device and accessories;
- provide methods for cleaning, disinfection and sterilization in case of reprocessing of accessories and the risk of their reuse.
If the device, its parts and accessories are intended to be used by children, pregnant or lactating women, the instructions for use must contain information on the residual risks and precautions for the specified group of patients.
The breathing circuit to the ventilator may consist of tubes and connecting parts and include additional devices: humidifiers, gas analyzers, spirometers.
On the packaging of the breathing circuit by the manufacturer of the product in accordance with GOST R 51528-99 “Inhalation anesthesia systems. Part 2. Anesthetic circulation breathing circuits” should indicate:
- This product is for single use or can be reprocessed;
- processing methods and methods;
- number of reprocessing cycles;
- safety control methods for re-use.
Attention: when using a bacterial filter, the technical specifications for the operation of the ventilator must indicate that the breathing filter “Cannot be sterilized.”
Instructions for reprocessing must comply with GOST 17664-2012 “Sterilization of medical devices, information provided by the manufacturer for re-sterilization of medical devices.” Depending on the purpose of the ventilator - for non-invasive or invasive ventilation - and the possible risk of their repeated use:
- disinfection, PSO and sterilization of the circuit are required;
- Disinfection is sufficient.
The sterilization methods and modes specified in the operating manual must comply with MU 287-113 and OST 42-21-2-85:
- when sterilizing by autoclaving, the mode should not be lower than 110°C;
- When sterilizing using a chemical method, the water used to flush the breathing circuits must be sterile.
How to handle an Ambu-type resuscitation bag, the box in which it is stored, and resuscitation masks
Reusable breathing bags, breathing hoses, masks are products that do not come into contact with the mucous membranes of patients, therefore, after use and disconnection from the device, they must be cleaned, disinfected, dried and stored under conditions that prevent their secondary contamination.
Disinfection of anesthesia-respiratory devices and removable parts for them is carried out taking into account the recommendations set out in the operating instructions for the device of a specific model. For each type of device and removable parts for it, the manufacturer indicates specific methods, methods and modes of processing.
When choosing a disinfection mode, preference is given to modes based on the most resistant microorganisms between viruses or fungi of the genus Candida.
When the product (bag) is subject to:
- Pre-cleaning and washing by complete immersion in a detergent solution with an alkaline pH value (the hepatitis B virus is destroyed in an alkaline environment and is not sensitive to acidic pH values). The internal surfaces must be completely filled with cleaning solution. To wash the internal surfaces of the bag, shake it several times.
- Washing off detergent residues in running water.
- Immersion and exposure in a solution of an oxygen-containing product (in accordance with the recommendations of the product manufacturer and instructions for use of a specific disinfectant).
- Laundering. To preserve the functionality and service life of products, final rinsing is best done with prepared water (filtered, distilled).
When using autoclaving, products (masks, hoses) are subject to:
- Rinse under running water.
- Drying. Drying of products made from heat-resistant materials (latex, silicone) is carried out in accordance with the regime specified in the instructions for their use. Preferably dry in an oven at 85°C until visible moisture disappears.
For drying rubber and rubber-based latex products, a temperature range of 70–80°C is recommended, as higher temperatures significantly reduce their service life. Drying the hoses and breathing bag in a suspended state is applicable if no other method is possible and under aseptic conditions.
- Packaging.
- Autoclaving in the mode specified by the manufacturer.
Store the products in a container with a filter in which autoclaving was carried out for no more than 72 hours. The bag is stored in a sterile sheet, the diaper is stored in the box included in the storage kit for 24 hours (if there is no filter).
The technological process of processing products, devices and equipment for medical purposes is regulated by the requirements of Chapter II of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” and includes the sequential stages of disinfection, PSO and sterilization.
Disinfection of anesthesia-respiratory devices, in accordance with the requirements of clause 2.7 of Chapter II and clause 6.6 of Chapter III of SanPiN 2.1.3.2630-10, is carried out taking into account the recommendations set out in the operating manual for the device of a specific model. And the removable parts of the devices are disinfected as medical products, taking into account the characteristics of the impact of chemical and physical agents on the materials of the product, using methods and methods approved by the Ministry of Health of the Russian Federation dated December 30, 1998. No. 287-113 "Guidelines for disinfection, pre-sterilization cleaning and sterilization of medical devices"
Regarding the treatment of breathing circuits, the requirements of SanPiN 2.1.3.2630-10 recommend the use of single-use circuits for no more than 72 hours for each patient, unless otherwise provided by the manufacturer.
In accordance with the requirements of clause 2.19 and clause 2.31 of Chapter II of SanPiN 2.1.3.2630-10, sterilization of reusable medical devices (including removable parts of the device) made of heat-resistant polymer materials is carried out with saturated water steam in steam sterilizers (autoclaves) , from thermolabile materials - chemically. Medical products that do not come into contact with the wound surface, blood (in the patient’s body or injected into it) and/or injectable drugs and do not come into contact with the mucous membrane during operation, in accordance with clause 2.15 of Chapter II of SanPiN 2.1.3.2630-10, are not sterilized subject to Exceptions are cases specified by the manufacturer in the product’s operational documentation.
Storage conditions (packaging and terms) depend on the sterilization method used in the organization. Storage is allowed for no more than 3 days in a sterile sterilization box lined with a sterile sheet. Filling the reservoirs of humidifiers with sterile distilled water, installing filters and removable parts of the device are carried out when preparing anesthesia-respiratory equipment for use, in accordance with the instructions for use (paying attention to the number of treatment cycles specified by the manufacturer of the product).
Filling the reservoirs of humidifiers with sterile distilled water, installing filters and removable parts of the device are carried out when preparing anesthesia-respiratory equipment for use, in accordance with the instructions for use, paying attention to the number of product processing cycles specified by the manufacturer.