Hauv tebchaws Russia, txhua lub koom haum koom nrog hauv kev kho mob yuav tsum ua haujlwm raws li cov qauv nruj, uas cov tshuaj tua kab mob kom raug thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob nyob hauv qhov chaw tseem ceeb.
Vim li cas ua raws tus qauv
Hnub no, ntau tus neeg, txawm tias nyob deb ntawm cov tshuaj, tau paub txog cov ntsiab lus xws li kab mob nosocomial. Nws suav nrog txhua yam kab mob uas tus neeg mob tau txais los ntawm nws txoj kev nrhiav kev pab los ntawm lub tsev kho mob, lossis lub koom haum cov neeg ua haujlwm hauv kev ua haujlwm ntawm lawv txoj haujlwm. Raws li kev txheeb cais, hauv cov tsev kho mob phais, theem ntawm cov teeb meem purulent-inflammatory tom qab kev ua haujlwm huv yog 12-16%, hauv cov chaw ua haujlwm gynecological, cov teeb meem tom qab kev ua haujlwm tsim hauv 11-14% ntawm cov poj niam. Tom qab kawm txog tus qauv ntawm qhov tshwm sim, nws tau pom tseeb tias txij li 7 mus rau 14% ntawm cov menyuam yug tshiab tau kis tus kabmob hauv tsev khomob maternity thiab menyuam lub chaw haujlwm.
Tau kawg, cov duab zoo li no tuaj yeem pom deb ntawmnyob rau hauv txhua lub koom haum kho mob thiab lawv qhov kev nthuav dav yog nyob ntawm ntau yam, xws li hom tsev kawm ntawv, qhov xwm txheej ntawm kev pab cuam, kev siv zog ntawm cov txheej txheem rau kev kis tus kab mob nosocomial, thiab nws cov qauv. Tawm tsam keeb kwm yav dhau los no, ib qho ntawm cov kev ntsuas tseem ceeb los tiv thaiv qhov tshwm sim thiab kis kab mob nosocomial yog kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob.
Cov ntaub ntawv tswj hwm
Nyob hauv lawv txoj haujlwm, txhua qhov chaw kho mob raug coj los ntawm cov lus pom zoo sau tseg hauv ntau cov ntaub ntawv tswj hwm. Cov ntaub ntawv tseem ceeb yog SanPiN (kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob tau hais qhia hauv ntu cais). Qhov kev hloov kho tshiab kawg tau pom zoo hauv xyoo 2010. Cov kev coj ua hauv qab no kuj hais txog kev txiav txim siab ua haujlwm ntawm cov tsev kho mob.
- FZ No. 52, uas tshaj tawm kev ntsuas rau kev nyab xeeb ntawm kev sib kis ntawm cov pejxeem.
- Order No. 408 (on viral hepatitis) of 1984-12-07.
- Order No. 720 (kom tiv thaiv HAI).
- xaj 1999-03-09 (ntawm kev txhim kho tshuaj tua kab mob).
OST "Sterilization thiab disinfection ntawm cov cuab yeej kho mob" No. Nws yog tus uas coj txhua lub tsev kho mob hauv lawv txoj haujlwm.
Ntxiv rau, muaj ntau cov lus qhia (MU), kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob uas tau txiav txim siab los ntawm qhov chaw.saib ntawm ntau yam tshuaj tua kab mob pom zoo rau lub hom phiaj no. Niaj hnub no, vim muaj ntau yam dis. txhais tau tias, cov lus qhia cuam tshuam kuj yog ib feem tseem ceeb ntawm cov ntaub ntawv uas ua haujlwm ntawm cov chaw kho mob raws li. Txog niaj hnub no, cov txheej txheem kev ntsuas ntsuas muaj peb theem sib law liag - tshuaj tua kab mob, PSO thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob.
Tshuaj tua kab mob
Kev tua kab mob yog ib txheej ntawm kev ntsuas, raws li qhov tshwm sim ntawm cov kab mob pathogenic tau raug rhuav tshem ntawm cov khoom ib puag ncig. Cov no suav nrog cov chaw (phab ntsa, pem teb, qhov rais, rooj tog tawv, khoom siv), cov khoom tu neeg mob (cov ntaub pua chaw, cov tais diav, cov khoom siv huv huv), nrog rau cov kua dej hauv lub cev, cov ntaub ntawv tus neeg mob, thiab lwm yam.
Nyob rau hauv kev txheeb xyuas qhov kis mob, cov dej num tau ua hu ua "focal disinfection". Nws lub hom phiaj yog kev puas tsuaj ntawm cov kab mob ncaj qha rau hauv qhov kev tsom xam. Muaj ntau hom tshuaj tua kab mob hauv qab no:
- tam sim no - nws tau ua hauv tsev kho mob txhawm rau tiv thaiv kev kis tus kabmob;
- kawg - ua tiav tom qab qhov kis kab mob cais tawm, uas yog, tus neeg mob tau mus pw hauv tsev kho mob.
Ntxiv rau, muaj kev tiv thaiv kab mob. Nws cov dej num yog nqa tawm tas li, tsis hais txog qhov muaj kev cuam tshuam ntawm kev sib kis. Qhov no suav nrog kev ntxuav tes, ntxuav qhov chaw ib puag ncig nrog cov khoom uas muaj cov kab mob bactericidal.
Txoj kev tua kab mob
Nyob ntawm cov hom phiaj, cov txheej txheem tshuaj tua kab mob hauv qab no tau siv:
- mechanical: nws hais ncaj qha rau kev cuam tshuam ntawm cov khoom siv - ntub tu, co lossis khob qhov rooj - nws tsis rhuav tshem cov kab mob kab mob, tab sis tsuas yog txo lawv tus lej ib ntus;
- lub cev: raug rau ultraviolet, kub lossis qis - qhov no, kev puas tsuaj tshwm sim yog tias qhov ntsuas kub thiab lub sijhawm raug raug soj ntsuam nruj me ntsis;
- tshuaj: kev puas tsuaj ntawm cov kab mob pathogenic nrog kev pab ntawm cov tshuaj - immersion, so los yog tshuaj tsuag ib yam khoom nrog ib tug tshuaj tov (yog cov feem ntau siv thiab zoo txoj kev);
- biological - nyob rau hauv rooj plaub no, siv cov antagonist ntawm cov kab mob ua kom puas tsuaj (feem ntau yog siv ntawm cov chaw tshwj xeeb bacteriological);
- combined - muab ntau txoj hauv kev tshuaj tua kab mob.
OST "Kev ua kom tsis muaj menyuam thiab tshuaj tua kab mob ntawm cov cuab yeej kho mob" 42-21-2-85 hais tias txhua yam khoom thiab cov cuab yeej siv uas tus neeg mob tau ntsib yuav tsum mus dhau ntawm cov txheej txheem tshuaj tua kab mob. Hauv cov chaw kho mob, siv lub cev lossis tshuaj tua kab mob rau qhov no. Tom qab nws ua tiav, cov khoom, nyob ntawm seb lawv lub hom phiaj, tau ua tiav, pov tseg lossis rov siv dua.
ua ntej sterilization tu
Kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob raureusable instruments yuav sterilized kuj muab rau pre-sterilization tu, uas yuav siv qhov chaw tom qab cov tshuaj tua kab mob ntawm cov khoom. Lub hom phiaj ntawm theem no yog qhov kawg kev tshem tawm cov khoom seem ntawm cov rog thiab cov kab mob protein, nrog rau cov tshuaj.
SanPiN tshiab, tshuaj tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob, uas suav nrog kev nthuav dav txaus, muab rau cov theem hauv qab no ntawm PSO.
- Rau 0.5 feeb, cov khoom raug ntxuav hauv dej kom tshem tawm cov tshuaj tua kab mob seem.
- Nyob rau hauv cov tshuaj ntxuav tes, rau kev tsim cov khoom siv uas pom zoo nkaus xwb, cov khoom tau tsau rau hauv tag nrho immersion. Nyob rau hauv cov kev tshwm sim uas lawv muaj ob peb qhov chaw ntawm cov khoom, nws yog ib qhov tsim nyog los disassemble thiab xyuas kom meej tias tag nrho cov kab noj hniav uas twb muaj lawm yog sau nrog ib tug tov. Ntawm lub tshuab ntxhua khaub ncaws kub ntawm 50º, lub sij hawm raug yog 15 feeb.
- Tom qab lub sijhawm dhau mus, txhua yam khoom raug ntxuav nrog ruff lossis gauze swab rau 0.5 feeb hauv tib txoj kev daws teeb meem.
- Yaug cov khoom hauv qab dej ntws. Lub sijhawm ntawm kev yaug yog nyob ntawm cov khoom siv ("Astra", "Lotus" - 10 feeb, "Progress" - 5, "Biolot" - 3).
- Yaug hauv dej distilled rau 30 vib nas this.
- Nyob hauv qhov cub cua kub.
Txhawm rau npaj cov tshuaj ntxuav, siv 5 g ntawm SMS ("Progress", "Astra", "Lotus", "Biolot"), 33% perhydrol - 16 g, lossis 27.5% - 17 g. kuj tau tso cai siv 6% (85 g) thiab 3% (170 g) peroxideshydrogen, dej haus - txog li 1 liter.
Tam sim no txhais tau tias siv tshuaj tua kab mob ua kom nws tuaj yeem ua ke cov tshuaj tua kab mob thiab cov txheej txheem PSO. Nyob rau hauv cov ntaub ntawv no, tom qab kawg ntawm qhov raug, ncaj qha nyob rau hauv lub des. kev daws, cov cuab yeej yog txhuam thiab tom qab ntawd tag nrho cov theem tom ntej ntawm PSO.
Quality control
SP, tshuaj tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob, uas tau pleev xim rau ib qib zuj zus, ua tib zoo saib xyuas kev tswj hwm ntawm txhua theem ntawm kev ua haujlwm. Ua li no, kev ntsuam xyuas tau ua tiav uas tswj qhov tsis muaj ntshav, lwm cov protein sib txuas ntawm cov khoom ua tiav, nrog rau qhov zoo ntawm kev ntxuav cov tshuaj ntxuav tes. Ib feem pua ntawm cov cuab yeej ua tiav yog raug tswj.
Kev kuaj phenolphthalein tso cai rau koj los soj ntsuam seb cov tshuaj ntxuav tes huv si uas tau siv ua ntej kom tsis muaj menyuam raug tshem tawm ntawm cov khoom. Txhawm rau muab tso rau ntawm lub qhov txhab, siv me me ntawm cov tshuaj npaj ua 1% ntawm phenolphthalein thiab tom qab ntawd so cov khoom uas lawv xav kuaj. Yog tias muaj xim liab liab tshwm, qhov zoo ntawm kev ntxuav ntawm cov tshuaj ntxuav tes yog suav tias yog tsis txaus.
Kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob xav tau kev tswj hwm ntawm txhua theem, thiab lwm qhov kev sim uas tso cai rau koj los ntsuas seb thawj theem tau ua tiav zoo li cas yog qhov kev sim azopyram. Nws ntsuas qhov muaj lossis tsis muaj cov ntshav thiab tshuaj tshuaj rau lawv. Txhawm rau nqa tawm, koj xav tau cov tshuaj azopyram,uas, thaum siav, tuaj yeem khaws cia rau 2 lub hlis hauv lub tub yees (ntawm chav tsev kub, lub sijhawm no txo qis rau ib hlis). Qee qhov turbidity ntawm cov reagent thaum tsis muaj sediment tsis cuam tshuam rau nws qhov zoo.
Rau qhov kev sim, tam sim ntawd ua ntej nws ua tiav, tib tus nqi ntawm azopyram thiab 3% hydrogen peroxide yog sib xyaw thiab siv rau cov ntshav rau kev kuaj xyuas. Cov tsos ntawm cov xim ntshav txhais tau hais tias cov reagent ua haujlwm - koj tuaj yeem pib sim. Ua li no, moisten ib lub swab nrog cov reagent npaj thiab so lub qhov chaw ntawm cov cuab yeej thiab cov cuab yeej. Nyob rau hauv cov khoom nrog hollow raws, ob peb tee ntawm cov reagent tau muab tso rau hauv thiab tom qab 1 feeb, qhov tshwm sim yog soj ntsuam, them nyiaj tshwj xeeb rau cov pob qij txha. Nyob rau hauv cov kev tshwm sim uas ib tug liab doog xim tshwm, maj mam tig mus rau hauv ib tug liab-lilac xim, lub xub ntiag ntawm cov ntshav yog ascertained. Cov xim brownish qhia tias muaj xeb, thiab ntshav qhia tias muaj cov tshuaj chlorine.
Txhawm rau ntsuas cov txiaj ntsig ntawm azopyram kom raug, ob peb lub ntsiab lus yuav tsum raug coj mus rau hauv tus account:
- tus qauv zoo tsuas yog txiav txim siab yog tias qhov staining tshwm nyob rau hauv thawj feeb tom qab siv cov reagent;
- kev daws teeb meem tsuas yog siv tau hauv thawj ob teev tom qab kev npaj;
- khoom yuav tsum nyob rau hauv chav tsev kub (ntawm qhov kub kub, tus qauv yuav tsis qhia);
- tsis hais txog qhov tshwm sim, cov khoom tau simntxuav nrog dej thiab rov raug rau presterization tu.
Yog tias tau txais txiaj ntsig zoo tom qab kuaj, tag nrho cov khoom siv rov kho dua kom txog thaum tau txais qhov tsis zoo.
Sterilization
Sterilization yog kauj ruam kawg hauv kev ua cov khoom lag luam uas muaj kev sib cuag nrog lub qhov txhab, mucous daim nyias nyias lossis ntshav, nrog rau cov tshuaj txhaj. Hauv qhov no, muaj kev puas tsuaj tag nrho ntawm txhua hom kab mob, ob qho tib si vegetative thiab spore. Ua txhua yam kev tswj hwm yog tswj xyuas kom meej los ntawm cov ntaub ntawv normative ntawm Ministry of He alth raws li kev txiav txim. Sterilization thiab tshuaj tua kab mob ntawm cov cuab yeej siv kho mob tau ua raws li qhov tshwj xeeb ntawm lub tsev kho mob thiab lawv lub hom phiaj. Cov khoom uas tsis muaj menyuam tuaj yeem khaws cia, nyob ntawm qhov ntim, txij li ib hnub mus rau rau lub hlis.
Sterilization Methods
Txoj kev tshuaj tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob muaj qee qhov sib txawv ntawm ib leeg. Sterilization yog ua los ntawm cov hauv qab no:
- thermal - huab cua, chav, glasperleny;
- tshuaj - roj lossis hauv cov tshuaj tov tshuaj;
- plasma lossis ozone;
- kub.
Hauv cov tsev kho mob, raws li txoj cai, chav dej, cua lossis tshuaj siv tau siv. Nyob rau tib lub sijhawm, qhov tseem ceeb tshaj plaws ntawm kev ua kom tsis muaj menyuam yog ua tib zoo saib xyuas cov txheej txheem tsim (lub sijhawm, kub, siab). Hom tshuaj tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob raug xaiv hauvnyob ntawm seb cov khoom uas lub workpiece yog ua.
Air method
Yog li, cov cuab yeej kho mob, cov khoom siv thiab cov khoom siv ua los ntawm cov hlau, iav thiab silicone roj hmab yog sterilized. Cov khoom yuav tsum tau qhuav kom huv si ua ntej kom tsis muaj menyuam.
Qhov siab tshaj qhov sib txawv ntawm qhov ntsuas kub nrog txoj kev ua kom tsis muaj menyuam yuav tsum tsis pub tshaj 3 ° C.
| Kub | sijhawm | Control |
| 200° | 30 feeb | |
| 180° | 60 feeb | YHydroquinone, thiourea, tartaric acid |
| 160° | 150 feeb | Levomycetin |
Steam method
Cov txheej txheem chav dej yog nyob deb ntawm kev siv dav tshaj plaws, uas cuam tshuam nrog lub voj voog luv luv, muaj peev xwm siv nws los ua kom tsis muaj menyuam cov khoom ua los ntawm cov khoom tsis muaj cua sov (linen, suture thiab hnav khaub ncaws khoom, roj hmab, yas, latex khoom). Sterility nyob rau hauv txoj kev no yog tiav los ntawm kev siv cov chav nkag nyob rau hauv lub siab tshaj. Qhov no tshwm sim hauv chav sterilizer lossis hauv autoclave.
| siab | Kub | sijhawm | Control |
| 2,0 | 132° | 20 feeb | Y IP-132, urea, nicotinamide |
| 1, 1 | 120° | 45 feeb | YIC-120, benzoic acid |
| 2, 1 | 134° | 5 feeb | Urea |
| 0, 5 | 110° | 180 feeb | Antipyrine, resorcinol |
Kev sib txawv hauv cov qauv siab tau tso cai txog li 2 kg / m², thiab qhov kub thiab txias - 1-2 °.
YGlasperlen sterilization
Txoj kev txhawb nqa ntawm cov tsev kho mob tau txhim kho tau zoo nyob rau xyoo tas los no thiab qhov no tau sau tseg hauv qhov tseeb SP (kev tua kab mob thiab ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob). Ib txoj kev ua kom tsis muaj menyuam tshiab uas tau siv dav hauv cov chaw kho mob yog glasperlene sterilization. Nws muaj nyob rau hauv immersing lub instrumentation nyob rau hauv nruab nrab ntawm iav granules rhuab mus rau 190 - 330 °. Txoj kev ua kom tsis muaj menyuam yuav siv sijhawm feeb, thiab tom qab ntawd cov cuab yeej siv tau npaj txhij. Qhov tsis zoo ntawm txoj kev no yog tias nws tsuas tuaj yeem ruaj ntseg cov cuab yeej me me xwb, yog li nws yog siv feem ntau hauv cov chaw kho hniav.
Kev tua kab mob, kev ntxuav ua ntej ua kom tsis muaj menyuam, ua kom tsis muaj menyuam ntawm cov cuab yeej kho mob yog qhov tseem ceeb tshaj plaws hauv kev ua haujlwmcov tsev kho mob niaj hnub. Kev noj qab haus huv ntawm ob tus neeg mob thiab cov neeg ua haujlwm kho mob yuav nyob ntawm seb ua tib zoo npaum li cas txhua qhov kev ntsuas uas tau teev tseg hauv cov kev cai pom zoo los ntawm Ministry of He alth ntawm Lavxias Federation tau ua.
