牙科手机灭菌规范化流程临床应用的探讨

目的检验牙科手机腔管内灭菌效果。方法采用卫生部核准的进口口腔器械专用消毒灭菌系统,通过规范化程序对5．4万支牙用手机进行灭菌处理,随机抽样178支牙用手机进行腔管内病原微生物及乙肝表面抗原测定。结果所有手机腔管内均未检出病原微生物及乙肝表面抗原。结论该系统通过规范化操作可以做到手机腔管内灭菌。     

Importance of considering injured microorganisms in sterilization validation

Disinfection or sterilization treatment by heating, irradiation, or chemicals can cause injury to microorganisms at sublethal levels. Microbial injury is the inability to grow under conditions suitable for the uninjured microorganisms. This inability of injured microorganisms to grow is explained in terms of more complex or different nutritional requirements or in terms of increased sensitivity to environmental conditions such as incubation conditions (time or temperature) or to chemical agents such as halogen compounds. Injured microorganisms can be distinguished from those that are dead or mutated by their ability to regain normal physiological activity when placed in appropriate conditions for cultivation. The return to normal physiological function has been termed repair. The extent and severity of sublethal injury, the mechanisms of injury, and the mechanisms and degree of recovery vary with the sterilization procedures, the species, the strains, the condition of the microorganism, and the methods of repair. Injury to spore formers has been detected at different stages of the spore cycle. The sites of injury include damage to enzymes, membrane disruption, and/or damage to DNA or RNA. Information on the sublethal injury and recovery of microorganisms is very important in evaluating sterilization/disinfection procedures. This paper supplies academic as well as practical information dealing with the repair, and detection of injured microorganisms for performing reproducible sterilization validation.     

Air-borne disease

Respiratory protection is a factor which worries nursing professionals who take care of patients susceptible of transmitting microorganisms through the air more as every day passes. This type of protection covers the use of surgical or hygienic masks against the transmission of infection by airborne drops to the use of highly effective masks or respirators against the transmission of airborne diseases such as tuberculosis or SARS, a recently discovered disease. The adequate choice of this protective device and its correct use are fundamental in order to have an effective protection for exposed personnel. The authors summarize the main protective respiratory devices used by health workers, their characteristics and degree of effectiveness, as well as the circumstances under which each device is indicated for use.     

包装器具对手术器械包灭菌质量的影响

目的 探讨合适的手术器械包装器具,提高手术器械灭菌质量.方法 将选定的手术器械包1 000个随机分成两组,对照组(500个)和实验组(500个).对照组用传统的有孔打包盘作为包装器具包装灭菌,实验组用打包篮筐作为包装器具包装灭菌,观察两组手术器械包灭菌质量.结果 生物监测和包外化学指示标签全部合格,对照组手术器械包湿包率为8%、包内化学指示卡变色合格率96%,实验组手术器械包湿包率为0.04%、化学指示卡变色合格率100%,两者比较具有显著性差异(P＜0.01).结论 打包篮筐包装手术器械包的灭菌质量比打包盘包装手术器械包的灭菌质量好.     

宝鸡市口腔器械消毒效果调查

目的了解宝鸡市口腔医疗机构消毒工作现状,以便加强口腔器械的消毒与灭菌管理。方法采取现场检查和随机抽样检测的方法,对全市医疗机构的口腔器械消毒、灭菌质量进行了监测。结果 2006-2010年连续5年共采集口腔器械样本392份,总平均合格率为84.44%。无菌器械灭菌效果平均合格率为83.7%,医护人员手消毒质量平均合格率为81.0%。除牙托和一次性托盘无菌合格率为100%之外,其他器械都存在不合格现象,牙钻手机灭菌合格率均在80%以下。结论宝鸡市医疗机构口腔器械消毒与灭菌质量存在问题较多,无菌器械灭菌合格率较低,应重点加强监督管理。     

Implementing AORN Recommended Practices for Sterilization

Any hospital or facility in which surgery and other invasive procedures are performed should have accommodations for cleaning, decontaminating, disinfecting, and sterilizing instruments, equipment, and other essential supplies that are used for patient procedures. Sterilization is essential to reducing or preventing the risk of surgical site infections. This is a collaborative process and should include all health care providers who handle these instruments, including perioperative nurses. The revised AORN “Recommended practices for sterilization,” which became effective June 15, 2012, includes updates on sterilizing single-use items, inspecting critical items before sterilization, using low-temperature hydrogen peroxide vapor sterilization methods, and immediate use steam sterilization. This RP document is the first AORN document to be evidence rated and accepted for inclusion in the Agency for Healthcare Research and Quality National Guideline Clearinghouse.     

Degradation in peritoneal dialysis fluids may be avoided by using low pH and high glucose concentration.

OBJECTIVE: When glucose is present in a medical fluid, the heat applied during sterilization leads to degradation. The glucose degradation products (GDPs) give rise to bioincompatible reactions in peritoneal dialysis patients. The extent of the degradation depends on a number of factors, such as heating time, temperature, pH, glucose concentration, and catalyzing substances. In the present work, we investigated the influence of pH and concentration in order to determine how to decrease the amounts of GDPs produced. DESIGN: Glucose solutions (1%-60% glucose; pH 1-8) were heat sterilized at 121 degrees C. Ultraviolet (UV) absorption, aldehydes, pH, and inhibition of cell growth (ICG) were used as measures of degradation. RESULTS: Glucose degradation was minimum at an initial pH (prior to sterilization) of around 3.5 and at a high concentration of glucose. There was considerable development of acid degradation products during the sterilization process when the initial pH was high. Two different patterns of development of UV-absorbing degradation products were seen: one below pH 3.5, dominated by the formation of 5-hydroxy-methyl-2-furaldehyde (5-HMF); and one above, dominated by degradation products absorbing at 228 nm. 3-Deoxyglucosone (3-DG) concentration and the portion of 228 nm UV absorbance not caused by 5-HMF were found to relate to the in vitro bioincompatibility measured as ICG; there was no relation between 5-HMF or absorbance at 284 nm and bioincompatibility. CONCLUSION: In order to minimize the development of bioincompatible GDPs in peritoneal dialysis fluids during heat sterilization, pH should be kept around 3.2 and the concentration of glucose should be high. 5-HMF and 284 nm UV absorbance are not reliable as quality measures. 3-DG and the portion of UV absorbance at 228 nm caused by degradation products other than 5-HMF seem to be reliable indicators of bioincompatibility.     

SMALL SCALE PRODUCTION OF TOTAL PARENTERAL NUTRITION INFUSIONS

The lay-out of a small-scale production facility for the preparation of total parenteral nutrition infusions is presented. Its concept and the configuration of the production equipment and the operational procedures are explained. The cleaning and sterilization process are also described.     

包装器具对手术器械包灭菌质量的影响

目的 探讨合适的手术器械包装器具,提高手术器械灭菌质量.方法 将选定的手术器械包1 000个随机分成两组,对照组(500个)和实验组(500个).对照组用传统的有孔打包盘作为包装器具包装灭菌,实验组用打包篮筐作为包装器具包装灭菌,观察两组手术器械包灭菌质量.结果 生物监测和包外化学指示标签全部合格,对照组手术器械包湿包率为8%、包内化学指示卡变色合格率96%,实验组手术器械包湿包率为0.04%、化学指示卡变色合格率100%,两者比较具有显著性差异(P＜0.01).结论 打包篮筐包装手术器械包的灭菌质量比打包盘包装手术器械包的灭菌质量好.

Abstract：

Objective To Explore suitable packaging equipment of operation instrument to improve sterilization quality of operation instrument Methods A total of 1 000 packages operation instruments were randomly divided into two groups,traditional packaging tray with holes was used to package and sterilize in control group,packaged basket was used to package and sterilize in experimental group.The sterilization qualities of the two groups'operation instruments were observed.Results Biology monitoring and chemical indicators labeling were all qualified,the packet rate of operation instrument was 8%, the passing rate of discoloration of the chemical indicator card was 96% in control group,the wet packet rate of operation instrument was 0.04%, the passing rate of discoloration of the chemical indicator card was 100% in experimental group,there was significant difference between the two groups (P<0.01).Conclusions Sterilization quality of packaged baskets as packaging equipment is better than that of packaging tray as packaging equipment.     

包装器具对手术器械包灭菌质量的影响

目的 探讨合适的手术器械包装器具,提高手术器械灭菌质量.方法 将选定的手术器械包1 000个随机分成两组,对照组(500个)和实验组(500个).对照组用传统的有孔打包盘作为包装器具包装灭菌,实验组用打包篮筐作为包装器具包装灭菌,观察两组手术器械包灭菌质量.结果 生物监测和包外化学指示标签全部合格,对照组手术器械包湿包率为8%、包内化学指示卡变色合格率96%,实验组手术器械包湿包率为0.04%、化学指示卡变色合格率100%,两者比较具有显著性差异(P＜0.01).结论 打包篮筐包装手术器械包的灭菌质量比打包盘包装手术器械包的灭菌质量好.     

Reduced risk for peritonitis in CAPD with the use of a UV connector box.

A common route for peritoneal infection is the bag transfer connecting site. To investigate possible reduction of such transfer infections with the use of a bag transfer set (UV-XD, Travenol, Baxter, Minneapolis), this study sampled patients using a transfer set with or without UV light sterilization. Calculations excluded peritonitis due to penetrating tunnel infection or defective peritoneal dialysis bag (4 episodes in 2 patients). The study included 51 patients with a median age of 62 years (range 25-81). Five were switched from manual connection (Travenol, Type II) to UV-XD, and each suffered from at least 2 peritonitis episodes during 9-24.5 months prior to the change to UV-XD. In this patient group, the incidence of peritonitis fell significantly from 1 peritonitis/4 to 1/21 months. The bag transfer set was used without UV light in 35 patients for a total of 178 months, producing an incidence of 1 episode/7.7 treatment months. These patients had significantly more peritonitis than 35 patients who used the UV light for a total of 416 months (1 episode/21 months). In 19 patients who used both techniques, there was less risk for peritonitis when UV light was used (p = 0.001). We conclude that the UV-XD device is simple to handle and may reduce the incidence of peritonitis, especially if the box is used in tandem with UV light sterilization.     

Thioethers in urine of sterilization personnel exposed to ethylene oxide.

Biological monitoring of exposure to ethylene oxide (EO) was carried out in 31 hospital workers in the sterilization facilities of five hospitals. The excretion of total thioethers was determined in the urine of sterilization workers. An occupational nonexposed group served as a control (n = 31). The air EO level was not monitored routinely, however, peak concentrations of EO up to 200 p.p.m. were detected mainly when the sterilization chambers were open. Our results show a significant difference in urinary thioether excretion between the exposed and control groups (P less than 0.001). Sterilization workers seem to absorb significant quantities of EO. We feel that other alternative and more sensitive methods for detecting thioether metabolites of EO should be carried out to confirm our results.     

Fouling-free ultrafiltration for humic acid removal

Membrane fouling is a serious concern that significantly affects the membrane filtration process. In this study, an ultrafiltration (UF) membrane was developed with surface auto-regeneration potential by immobilizing a photocatalyst [titanium dioxide nanoparticles (TiO₂ NPs)] on a hybrid polyvinylidene fluoride (PVDF) membrane to reduce fouling. The combination of photocatalysis and UF, namely, photocatalytic UF, induced the surface auto-regeneration potential to the membrane. The photocatalytic process was initiated after UV light reached the TiO₂ NPs through a quartz window in the membrane containing cell. The membrane, with an optimized distribution of TiO₂ NPs (3.04 g m⁻²), could completely regenerate itself during photocatalytic UF [with 2 mg L⁻¹ humic acid (HA)] without experiencing membrane fouling during 90 min of filtration. The impact of temperature, an important factor for increasing the kinetic rate of the photocatalyst, was also studied. The results showed that an increase in temperature did not affect the photocatalytic process, but increased the permeate flux, which was attributed to the decrease in kinematic viscosity of the water. Finally, four consecutive photocatalytic UF cycles demonstrated the stability of the membrane for a fouling-free UF process.

Membrane fouling is a serious concern that significantly affects the membrane filtration process.     

The new era of flash sterilization

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FLASH STERILIZATION was developed for use in the OR for emergent need and immediate use of an instrument that was dropped on the floor, forgotten, or unanticipated.

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ISSUES AND CONCERNS regarding flash sterilization practice run the gamut from overuse to misuse to increased risk for infection transmission to increased costs for the health care facility.

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SERIOUS CONSEQUENCES of surgical infection and national demands for patient safety highlight the need for added vigilance in the practices of flash sterilization. Today, state of the art products and equipment can help address some of the challenges historically associated with the flash sterilization process. AORN J 86 (July 2007) 58-68. © AORN, Inc, 2007.

     

Grossesses survenues après électro-coagulation et section tubaire par laparoscopie

Between 1970-1975 the authors performed 3160 laparoscopic tubal electrocoagulations and divisions on women desiring permanent sterilization. While the literature reports a failure rate of 0.2% on sterilizations performed with such a procedure, in the series considered there were 16 pregnancies, i.e., a failure rate of 0.51%. However, 7 patients were already pregnant at the time of tubal sterilization, bringing the failure rate down to 0.28%. Of these 9 unwanted pregnancies 6 were ectopic. The result of this investigation induced the authors to modify their sterilization procedure, and to use only wide electrocoagulation with the bipolar forceps.     

流程再造在硬式内镜管理之作用

目的提高医院消毒供应中心硬式内镜及器械管理质量。方法选拔内镜专职护士,将手术配合、污染回收、清洁消毒、包装灭菌、储存发送的流程进行再造。抽取内镜及器械流程改造前707例和流程改造后956例,比较流程改造前后内镜及器械合格率差异。结果流程再造后与流程再造前硬式内镜及器械的综合管理质量相比较差异有统计学意义。结论流程再造实现了手术室供应中心内镜专职护士对硬式内镜及器械的专职管理,实现了手术室消毒供应中心硬式内镜及器械使用、清洗、消毒、灭菌等技术的规范化、专业化、科学化。     

Sterilization: would your facility pass a standards audit?

PROPER STERILIZATION of reusable medical instruments, supplies, and devices and maintaining the sterility of these items until they are used are critical aspects of infection control. To minimize risk, perioperative managers should perform sterilization audits to test their facilities.THIS ARTICLE guides the reader through a systematic, comprehensive, sterilization audit that evaluates facility design, personnel training, and processing procedures. AORN J 87 (January 2008) 176-182. © AORN, Inc, 2008.     

单斜晶型钒酸铋可见光催化杀菌的研究

目的观察单斜晶型钒酸铋新型光催化抗菌材料在可见光条件下的杀菌效果。方法采用液相合成法制备单斜晶型钒酸铋光催化杀菌剂,采用悬液定量杀菌试验方法进行杀菌效果观察。结果本研究所制备的光催化剂样品均为单斜晶型钒酸铋,其吸收带边可达550 nm。在常温可见光照射下,用含500 mg/L单斜晶型钒酸铋光催化剂稀释液中加入大肠杆菌,经60 min光照,大肠杆菌存活率下降了81%;经90 min光照,大肠杆菌全部被杀灭。结论单斜晶型钒酸铋新型光催化抗菌材料在可见光照射下具有较强的杀菌效果。     

Efficacy of the pasteur oven as sterilization equipment in dental offices

This study was aimed at assessing the efficacy of the use of the Pasteur oven as sterilization equipment in dental offices through biological monitoring. For this assessment were taken into account how adequately the material is loaded into the equipment; time/temperature used; and preventive maintenance of the oven. The data were collected in 101 dental offices in the Central District of GoiPnia, in the State of Goiás, through observation, interviews and performance of tests with biological indicator. The results showed a lack of standardization of some of the procedures recommended by the Ministry of Health for sterilization of items in the oven, and positive results of the biological test in 46 (45.5%) of the tested cycles. The intervening factors with most significance regarding sterilization problems were: absence of an accessory thermometer to control the cycles' temperature and non-observance of the time/temperature relations recommended for the sterilization cycle through dry heat.     

自体单株毛囊显微移植手术的配合及护理

通过对14例患分别进行了头发、眉毛、阴毛种植手术诹得较好效果。配合与护理要点包括：物品准备；加强术中心理护理。取发后、种植前询问病人是否去卫生间、饮水或适当活动肢体，消除长时间卧床的疲劳；所有分离种植毛囊的器械、物品禁忌化学消毒；分离和移植过程中，头皮及毛囊小体必须保存在低温、湿润的环境内等。