手術(shù)器械物品等的準(zhǔn)備與滅菌

手術(shù)器械物品等的準(zhǔn)備與滅菌手術(shù)器械物品等的準(zhǔn)備與滅菌第1頁有彈性鎖扣止血鉗等要將其松開。（一）金屬器械1.滅菌前準(zhǔn)備足夠數(shù)量，良好性能，清潔。手術(shù)刀片、縫針、注射針頭等散碎小物品應(yīng)另包后單獨(dú)放置。手術(shù)器械、物品等準(zhǔn)備與滅菌用布包好或裝入特制袋內(nèi)。手術(shù)器械物品等的準(zhǔn)備與滅菌第2頁2.滅菌方法

高壓蒸汽滅菌

化學(xué)浸泡消毒

煮沸滅菌法手術(shù)器械物品等的準(zhǔn)備與滅菌第3頁（二）玻璃、瓷、搪瓷類器皿注射器盡可能使用一次性，玻璃注射器應(yīng)將內(nèi)栓抽出并與外筒對應(yīng)編號1.滅菌前準(zhǔn)備洗凈易碎品用紗布等包裹手術(shù)器械物品等的準(zhǔn)備與滅菌第4頁2.滅菌方法高壓蒸汽滅菌化學(xué)消毒劑浸泡消毒煮沸滅菌酒精火焰燒灼滅菌（大方盤等）手術(shù)器械物品等的準(zhǔn)備與滅菌第5頁（三）橡膠、尼龍和塑料類制品1.滅菌前準(zhǔn)備盡可能選取一次性制品非一次性制品洗凈，紗布等包好塑料制品不可高壓滅菌，橡膠制品不可重復(fù)高壓手術(shù)器械物品等的準(zhǔn)備與滅菌第6頁2.滅菌方法煮沸滅菌高壓蒸汽滅菌化學(xué)浸泡消毒環(huán)氧乙烷或甲醛熏蒸消毒手術(shù)器械物品等的準(zhǔn)備與滅菌第7頁（四）縫合材料腸線等可吸收性縫合材料為已消毒物品。其余縫合材料應(yīng)準(zhǔn)備足夠數(shù)量，可疏松地纏繞在線板上，但不可重復(fù)高壓滅菌。手術(shù)器械物品等的準(zhǔn)備與滅菌第8頁（五）敷料、創(chuàng)巾、手術(shù)衣帽、口罩廣泛使用一次性制品止血巾、創(chuàng)布等可自行制作回收使用時(shí)，應(yīng)充分洗凈高壓蒸汽滅菌，包裹不宜大、包扎不宜緊、排列不宜密手術(shù)器械物品等的準(zhǔn)備與滅菌第9頁FoldingofaGownforSterilizationHoldthegownsothattheoutsideisfacingawayfromyou.Placetheoutsiderightandlefttiesintothewhitetab.手術(shù)器械物品等的準(zhǔn)備與滅菌第10頁手術(shù)器械物品等的準(zhǔn)備與滅菌第11頁Foldthegowninhalflengthwisetwicemakingsurethattheinsideofthegownisshowing.手術(shù)器械物品等的準(zhǔn)備與滅菌第12頁手術(shù)器械物品等的準(zhǔn)備與滅菌第13頁Liethegownonatableandfoldinhalflengthwiseagain.Thenfoldendtoendtwice.手術(shù)器械物品等的準(zhǔn)備與滅菌第14頁Thegownisfoldedinsuchawaythatthetopoftheinsideofthegownispresentedwhenthesterilepackisunwrapped.手術(shù)器械物品等的準(zhǔn)備與滅菌第15頁Instrumentsareloadedintoanultrasoniccleanerforwashingpriortosterilization（六）高壓蒸汽滅菌手術(shù)器械物品等的準(zhǔn)備與滅菌第16頁Theproperarrangementofsurgicalpacksforsteamsterilization.Allpacksareorientedvertically，andasmallamountofspaceseparatesthepacks。0.1~0.137MPa121.6~126.6oC30min手術(shù)器械物品等的準(zhǔn)備與滅菌第17頁Allinstrumentsmustbedoublewrappedinlinenorspecialpaperorplacedinaspecialmetalboxequippedwithafilterbeforesterilization手術(shù)器械物品等的準(zhǔn)備與滅菌第18頁Thewhitestripesonthetapechangetoblackwhentheappropriateconditions(temperature)havebeenmet.手術(shù)器械物品等的準(zhǔn)備與滅菌第19頁Colorindicatorsarealsoincludedontheoutsideandinsideofequipmentsterilizedinpaperpackages.手術(shù)器械物品等的準(zhǔn)備與滅菌第20頁（七）煮沸滅菌法

非手術(shù)室條件下使用。清潔常水煮沸3~5min，去除沉淀，將器械放入，第二次水沸后15min，可將普通細(xì)菌殺死，細(xì)菌芽孢則需60min。2%NaHCO3液可使水沸點(diǎn)提升到102~105oC，并可預(yù)防金屬生銹，但對橡膠制品有損害。手術(shù)器械物品等的準(zhǔn)備與滅菌第21頁（八）化學(xué)藥品消毒新潔爾滅

0.1%皮膚、粘膜，浸泡器械。0.1%

新潔爾滅1000ml，5g醫(yī)用亞硝酸鈉，用于長久浸泡器械。物品上不可有有機(jī)物存在，不可與肥皂、碘酊、高錳酸鉀和堿類藥品混用。手術(shù)器械物品等的準(zhǔn)備與滅菌第22頁酒精

70~75%，浸泡器械，尤其是有刃器械，30min以上。煤酚皂常見于環(huán)境消毒甲醛10%，金屬器械、塑料薄膜、橡膠制品、各種導(dǎo)管，浸泡，30min以上40%，用于熏蒸消毒。手術(shù)器械物品等的準(zhǔn)備與滅菌第23頁聚乙烯酮碘

0.75%，皮膚、粘膜消毒。0.1%，口腔消毒。1%，陰道消毒。0.5%，鼻腔、咽、陰道噴霧消毒。手術(shù)器械物品等的準(zhǔn)備與滅菌第24頁IsopropylAlcohol(70%)ADVANTAGES:Causesproteindenaturation,celllysis,andmetabolicinterruption.Degreasestheskin.DISADVANTAGES:Ineffectiveagainstbacterialsporesandpoorlyeffectiveagainstvirusesandfungi.手術(shù)器械物品等的準(zhǔn)備與滅菌第25頁ChlorhexidineGluconate

ADVANTAGES:RapidactionResidualactivityisenhancedbyrepeateduseLesssusceptibletoorganicinactivationthanprovidoneiodineDISADVANTAGES:

Occasionalskinsensitivity.

Inactiveagainstbacterialspores

Activityagainstvirusesandfungiisvariableandinconsistent手術(shù)器械物品等的準(zhǔn)備與滅菌第26頁P(yáng)ovidoneIodineADVANTAGES:Bactericidal,viricidal,andfungicidalDI