Disinfection and pre-sterilization cleaning of surgical instruments and reusable medical devices

Authors: Rednenko V.V., Brikez J.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• disinfection table
• sink for processing instruments
• distilled water in a container
• containers with a solution of a chemical disinfectant with detergent properties:
  • "Disinfection of MI"
  • "Disinfection of dressings, PPE"
  • "Washing of MI"
• tweezers in a container with a working solution of a chemical disinfectant
• protective gloves (not sterile), mask, glasses
• brush, cotton-gauze swab
• surgical instruments: tweezers, scissors, clamp, needle holder
• gloves, mask, glasses

Clinical situation:     

• Disinfect and pre-sterilize surgical instruments after surgery. Pre-sterilization cleaning is combined with disinfection in one stage.

Order of the skill performance:

Preparatory stage:

• wash your hands (см. Hygienic hand washing)
  
• put on mask, glasses, gloves

Main stage:

• clean the MI from visual contaminations
  • open the container "Washing of MI", place the container lid near the container
  • immerse all MI in this container
    • open MI with locking parts, made several working movements with them in the solution
    • MI with channels, flush with disinfectant solution with a syringe
    • disassemble MI, consisting of several parts
  • if necessary, clean the MI from visual contamination manually using a cotton-gauze swab, place the used cotton-gauze swab into a container "Disinfection of dressing material, PPE"
• disinfect MI
  • open the container "Disinfection of MI", place the container lid near the container, place the press plate inside the container vertically beside one of the walls
  • place the washed MI into the container
  • press the MI with the press plate (layer of solution must be at least 1 cm above the plate) and close the container with a lid
  • withstand the exposure specified in the recommendations for the use of this disinfectant (say loudly *** minutes have passed)
  • open the container "Disinfection of MI", place the container lid on the container or next to it, put the press plate inside the container vertically against one of the walls
  • wash each instrument in the same solution and container
    • open MI with locking parts, made several working movements with them in the solution
    • MI with channels, flush with disinfectant solution with a syringe
    • disassemble MI, consisting of several parts
    • use a gauze for washing
    • use a brush to wash cavities and channels (except for rubber products)
  • remove the washed MI from the container (one at a time) and place them on a perforated tray (made of heat-resistant material)
• rinse MI
  • place the perforated tray with MI in the sink and rinse them under running water
    • metal MI for 3 minutes
    • polymer MI for 10 minutes
  • rinse the instruments on the perforated tray with distilled water for 30 seconds
• dry MI
  • place the perforated tray from the sink on a metal non-perforated tray (MI with locking parts, must be opened, collapsible MI, disassembled into component parts)
  • place the tray with MI in a dry oven
  • dry all instruments with hot air at a temperature of 85 * C until the moisture completely disappears (say loudly "Medical items are dried")
  • wait for the instruments to cool down (say loudly "Instruments are cold"
• check the quality of pre-sterilization cleaning
  • take a gauze pad and moisten it with azopyram working solution
  • wipe with this pad 1% of the total number of MI (but not less than 3 pcs.)
  • evaluate the color change of the pad and draw a conclusion about the quality of the pre-sterilization treatment

Final stage:

• remove gloves and place them in the container “Disinfection of dressings, PPE” (see practical skill«Removal contaminated gloves»);
  
• take off a mask and place it in the container “Disinfection of dressings, PPE”;
• take off glasses;
• wash your hands (см. Hygienic hand washing)