A process for improving flash sterilization

In reviewing OR policies and procedures for flash sterilization, staff members at Presbyterian Hospital of Dallas discovered that their process of biological monitoring and flash sterilization needed improvement, and they implemented changes to correct the process. These changes led to questions regarding biological indicators and the flash sterilization container systems being used. As a result, the overall time required for flash sterilization was increased to validate the sterilization process. AORN J 75 (Jan 2002) 127-133.     

消毒供应中心物流过程中的感染控制关键点

目的建立消毒供应中心物流过程医院感染控制关键点程序。方法采用制定关键点控制程序,贯彻实施关键点控制管理。结果消毒供应中心实施回收、清洗、包装、消毒灭菌、储存发放和物流控制等6个关键点管理,可以确保可靠的无菌物品质量。实施密封回收,可避免污染扩散;严格的清洗,可保证消毒与灭菌效果;正确的包装,不仅满足了灭菌要求,也便于储存和安全输送;合格的灭菌质量,保证医院感染控制的有效性;无菌储存发放及安全的物流控制,可有效防止无菌物品损坏和再污染。结论医院消毒供应中心实施物流过程感染控制程序,可明显提高供应室无菌物品管理质量。     

Understanding current steam sterilization recommendations and guidelines

PROCESSING SURGICAL INSTRUMENTS in preparation for surgery is a complex multistep practice. It is impractical to culture each and every item to determine sterility; therefore, the best assurance of a sterile product is careful execution of every step in the process coupled with an ongoing quality control program.PERIOPERATIVE STAFF NURSES and managers responsible for instrument processing, whether for a single instrument or multiple sets, must be knowledgeable with regard to cleaning; packaging; cycle selection; and the use of physical, chemical, and biological monitors. Nurses also should be able to resolve issues related to loaner sets, flash sterilization, and extended cycles. AORN J 88 (October 2008) 537-550. © AORN, Inc, 2008.     

综合性医院口腔门诊器械消毒供应中心集中式管理效果

目的:探讨综合性医院口腔门诊器械消毒供应中心集中式管理效果。方法:将口腔门诊所有器械统一经消毒供应中心人员按标准流程进行处理。结果:经消毒供应中心处理的器械清洗、包装、灭菌质量均高于口腔科自行处理的口腔器械,减少了口腔护士工作量,提高口腔护理质量。结论:口腔器械经消毒供应中心统一处理,能保证器械质量,有效控制医院内感染,保证患者安全。     

Nosocomial infections

Hospital-acquired infections cause significant morbidity, mortality and expense. Surveillance and control programs are necessary to reduce the rate of these infections. Measures to control infection include handwashing, sterilization, use of sterile disposable items, closed urinary drainage, intravenous catheter care, non-touch dressing technique, proper care of respiratory equipment and perioperative chemoprophylaxis.     

A Hospital-Wide Initiative to Eliminate Preventable Causes of Immediate Use Steam Sterilization

Instruments and implants sterilized by immediate use steam sterilization (IUSS), formerly called flash sterilization, can increase the patient’s risk for acquiring a surgical site infection. We implemented a hospital-wide initiative to determine the reasons that perioperative personnel use IUSS to sterilize items and then designed a program to reduce the hospital’s rates. Program initiatives included educating perioperative personnel, improving scheduling processes, holding vendor discussions, purchasing additional instrument sets, and transitioning from paper wrap to metal containers for instrument sets. In addition, we instituted a policy whereby nursing leaders are required to approve IUSS before it can be used and developed guidelines for immediate and rapid processing in the sterile processing department, and we monitor compliance daily and communicate results regularly to all team members. These efforts decreased our facility use of IUSS for implants from 10.22% in January 2008 to 0.09% in August 2012, and we decreased our use of IUSS for instruments from 79% in May 2010 to 7.5% in February 2012. We simultaneously implemented a process to reduce surgical site infection rates and saw an improvement in surgical site infection from 5.4% in the first quarter of 2010 to 1.4% in the fourth quarter of 2012.     

压力蒸汽对自动启闭式容器内物品灭菌效果监测

研制自动启闭式金属容器作为压力蒸汽灭菌物品包装,以解决手控开关容器二次污染问题。为证实其实际使用效果,采用下排气式和脉动真空式压力蒸汽灭菌器进行了试验观察。结果,经126℃下排气式压力蒸汽灭菌器灭菌处理20min,对自动启闭金属贮槽和消毒盒内的生物指示剂灭菌合格比例分别为24/30～28/30和23/30～26/30;化学指示卡及留点温度计均达到完全合格指标。经132℃脉动真空压力蒸汽灭菌器灭菌处理8min,对两种自动启闭金属容器内三种指示器材全部达到灭菌合格要求。结论,两种自动启闭金属容器不适合于下排气压力蒸汽灭菌器使用,在132℃脉动真空压力蒸汽灭菌器内灭菌8min可达到灭菌要求。     

Cost management: the implementation of the activity-based costing method in sterile processing department

This exploratory case study was performed aiming at implementing the Activity-based Costing (ABC) method in a sterile processing department (SPD) of a major teaching hospital. Data collection was performed throughout 2006. Documentary research techniques and non participant closed observation were used. The ABC implementation allowed for learning the activity-based costing of both the chemical and physical disinfection cycle/load: (dollar 9.95) and (dollar 12.63), respectively; as well as the cost for sterilization by steam under pressure (autoclave) (dollar 31.37) and low temperature steam and gaseous formaldehyde sterilization (LTSF) (dollar 255.28). The information provided by the ABC method has optimized the overall understanding of the cost driver process and provided the foundation for assessing performance and improvement in the SPD processes.     

两种包装医疗器械的灭菌及防污染效果比较

将装针头灭菌的铝制自动启闭消毒盒改装后．用于盛装医疗器械进行脉动真空压力蒸汽灭菌。对其灭菌效果与灭菌后无菌存放期进行了检测,并与双层棉布包装者比较。结果,２种包装医疗器械灭菌合格率均为 １００％。用改装铝盒装的器械,无菌存放期达２１ｄ,双层棉布包装者 １４ｄ。     

使用中持物钳放置无菌干罐中的效果检测

为了解使用中持物钳放置于无菌干罐中可维持钳部无菌的时间,连续按时进行细菌污染检测。结果,放置于无菌于罐中的使用中持物钳,在医院Ⅱ、Ⅲ类场所于4h内未检出有细菌污染;浸泡于含戊二醛2％（g/ml）的溶液中者,仅在2h内未检出有细菌污染。说明将使用中持物钳放置无菌干罐中的效果较好。     

医用油脂写滑石粉热力灭菌的研究

医用油脂和滑石粉,由于蒸汽不易穿透,较难用压力蒸汽灭菌法使之达到灭菌。目前我国医院中常用的下排气式压力蒸汽灭菌处理(121℃,30分钟)。很难保证上述物品全部达到灭菌要求,在压力蒸汽灭菌中,不得使用铝饭盒作为盛装容器,油脂类物品,容量愈大灭菌愈难。一般不宜超过50ml,并且应装在广口烧杯中。狭口三角烧瓶中的油脂,不易达到灭菌。干烤对于油脂类物品的灭菌,较为可靠,对于容量和容器的要求较宽。对凡士林纱布,温度应控制在150℃,以防焦化。     

大型压力蒸汽与臭氧消毒床垫的效果比较

目的比较大型压力蒸汽消毒法和臭氧消毒法对医院床垫的消毒效果。方法选择100张床垫,分为两组,各50张,采用压力蒸汽消毒法和臭氧消毒法,对两组床垫的表面细菌和深部载体定量菌的杀灭率进行对照研究。结果蒸汽消毒法对床垫表面细菌的杀灭率为99.92%,臭氧消毒法为94.86%,二者差异无统计学意义(P>0.05);蒸汽消毒法对床垫深部白色念珠菌的杀灭率为100%,高于臭氧法的98.03%(P<0.01)。结论两种消毒方法消毒效果肯定,但蒸汽消毒法穿透性能好、效率高、环保,值得推广。     

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.

     

MICROBIAL PERSISTENCE : II. CHARACTERISTICS OF THE STERILE STATE OF TUBERCLE BACILLI

The capability of tubercle bacilli to assume a long continued sterile state in the tissues when exposed to pyrazinamide and isoniazid is a highly specific drug-microbe phenomenon in which host participation is not critical. Although it is the pyrazinamide that possesses the sterilizing type of action, the role of the isoniazid is specific and essential. The isoniazid serves to convert a phenomenon that occurs irregularly with pyrazinamide alone into one that occurs with a high degree of uniformity. The observations suggest a competition between isoniazid and the pyrazinamide (or its parent nicotinamide) for a site or entrance in or on the tubercle bacilli and for sterilization, the isoniazid apparently must reach the site first. The rare failures to attain complete sterilization, appear to depend on the emergence of pyrazinamide-resistance which prevents the necessary dependent action of the two drugs. Populations already in the sterile state are nevertheless subject to a continued drug influence. Whether this represents a direct action on the sterile bacilli or an indirect effect produced by making the environment hostile to microbial revival, cannot be determined from the present observations.     

无菌水清洗法减低中段尿培养假阴性的效果观察

目的 比较高锰酸钾溶液清洗消毒法与无菌水清洗法对中段尿培养结果的影响. 方法采集2002年1月-2006年12月符合留取中段尿培养指征的住院患者的尿标本,将采用1:5000高锰酸钾溶液清洗、消毒法留取的尿样本列为消毒组(n=1572);将采用无菌反渗水(血透用)清洗法采集的尿标本列为清洗组(n=544);观察2组标本微生物培养阳性率及污染率的变化;培养出2种以上细菌定义为污染.结果 5年共入选830例尿路感染患者,收集中段尿标本2116例,共检出病原体53I株;消毒组和清洗组尿标本的微生物阳性检出率分别为20.04%和39.71%,2组比较差异显著;消毒组同一患者2次培养检出相同致病微生物的百分比为0.012%,清洗组则为0.105%,二者比较差异显著.但是同一患者2次培养检出不同和仅单次致病微生物的发生率比较差异不显著.消毒组的污染率(0.028%)显著高于清洗组(0.007%).结论 无菌水清洗留取中段尿在没有增加污染率的情况下,可显著提高尿培养致病微生物的阳性率;高锰酸钾溶液消毒法可能是导致培养高假阴性的原因.     

口含式雾化吸入器消毒与保存方法的选择

目的探讨口含式雾化吸入器有效的消毒、保存方法．减少雾化吸入器的污染。方法第1阶段：分两组分别采用流动水冲洗、含氯消毒剂浸泡的方法进行处理,消毒处理前后分别采样做细菌培养,比较两种方法的消毒处理效果。第2阶段：入选含氯消毒剂浸泡处理后细菌培养符合国家标准要求的雾化吸入器,再分两组分别采用原包装袋、无菌治疗巾进行保存,两组均在保存1、2、3d后采样做细菌培养．比较两种方法的保存效果。结果使用后的雾化吸入器存在严重的污染。流动水冲洗组达标率仅为82．2％．含氯消毒剂浸泡组达标率为100％,两组比较差异有统计学意义（P〈0．01）。含氯消毒剂浸泡后合格雾化吸入器采用原包装袋、无菌治疗巾保存3d后的达标率分别是80％和100％,两组比较差异有统计学意义（P〈0．01）。结论口含式雾化吸入器在含氯消毒剂浸泡处理晾干后置于铺有无菌治疗巾的治疗盘内保存是有效的消毒、保存方法。     

无菌水清洗法减低中段尿培养假阴性的效果观察

目的比较高锰酸钾溶液清洗消毒法与无菌水清洗法对中段尿培养结果的影响。方法采集2002年1月-2006年12月符合留取中段尿培养指征的住院患者的尿标本．将采用1：5000高锰酸钾溶液清洗、消毒法留取的尿样本列为消毒组（n=1572）;将采用无菌反渗水（血透用）清洗法采集的尿标本列为清洗组（n=544）;观察2组标本微生物培养阳性率及污染率的变化;培养出2种以上细菌定义为污染。结果5年共入选830例尿路感染患者,收集中段尿标本2116例,共检出病原体531株;消毒组和清洗组尿标本的微生物阳性检出率分别为20．04％和39．71％．2组比较差异显著;消毒组同一患者2次培养检出相同致病微生物的百分比为0．012％,清洗组则为0．105％,二者比较差异显著。但是同一患者2次培养检出不同和仅单次致病微生物的发生率比较差异不显著。消毒组的污染率（0．028％）显著高于清洗组（0．007％）。结论无菌水清洗留取中段尿在没有增加污染率的情况下,可显著提高尿培养致病微生物的阳性率;高锰酸钾溶液消毒法可能是导致培养高假阴性的原因。     

消毒剂使用期间抑菌、灭菌性能及污染监测

应用微生物检验法，对化学消毒剂在使用期间的抑菌、灭菌性能改变及污染情况进行了监测。结果：０２％醋酸洗必泰、器械消毒液抑菌性能较差，在口腔科门诊不宜广泛使用；０５％碱性戊二醛、０２％过氧乙酸、０５％碘伏，具有良好的灭菌性能；各种消毒剂随使用时间延长，其抑菌性能逐渐减弱，被污染情况逐渐加重，在第７天十分明显。建议：选用性能稳定的消毒剂，且消毒剂使用时间不宜超过３天，以预防医源性感染     

Preventing pregnancy with tubal ties

This article describes the tubal ligation method of female sterilization. This method, which uses different endoscopes through which the tubes can be cauterized or occluded by the application of clips, is 100% effective, has no major complications, and is easily adaptable to the day surgery center. Electrocoagulation is not used, and the procedure can be performed with general or local anesthesia, through a minilaparotomy incision or a conventional laparoscope. Equipment preparation for this procedure includes the KLI instrumentation, laparoscopic instrument tray, minor tray, laparoscopic light power tank/carbon dioxide tank, and fallopian tube ligation rings. Care must be taken when placing the patient in the lithotomy position. Postoperatively, the patient will have minimal discomfort and no restrictions need to be placed on activity. Failure rates, which are minimal, are attributable to application of a single tube, incomplete tubal occlusion, or application of the mesosalpinx and tuboperitoneal fistula. This tubal ligation does not damage the fimbriae of the proximal portion of the tube, thus theoretically permitting easier reconstruction or reanastomosis of the tube.     

山西省医疗机构消毒与灭菌质量调查

目的了解山西省医疗机构消毒与灭菌质量状况,改进医院消毒与感染控制措施。方法采用现场抽样和微生物检验的方法,对山西省直管不同规模医疗机消毒与灭菌质量进行了动态监测。结果 2009-2011年连续3年山西省直管医疗机构消毒效果合格率总平均为92.0%。省直综合医院消毒质量合格率为94.2%,专科医院消毒质量合格率为91.5%,民营医院消毒质量合格率为89.5%。医护人员手和内镜消毒效果合格率分别为77.7%和87.8%,无菌物品质量合格率为94.7%,压力蒸汽灭菌器灭菌效果合格率为98.4%。结论山西省直管医疗机构消毒质量总体较好,但无菌物品和压力蒸汽灭菌器质量堪忧。