Text: Xing Shiling, Fu Baojing, Sheng Mengyu, Bai Sumei, Zhang Shuo, Zhang Mengli
Reviewer/Gong Xiangli Ma Huizhen, Disinfection Supply Department, Strategic Support Force Characteristic Medical Center (formerly 306 Hospital).
Edited by Liu Yan/Cui Yan, Medical Science Popularization Center
Did you know about World Sterilization Science Day?
The World Federation of Sterilization Science (WFHSS) has designated April 10 as "World Sterilization Science Day" every year, aiming to promote the scientific knowledge of the reprocessing process of reused instruments and related sterilization in sterilization supply centers, and promote communication and trust.
April 10, 2024 is the 8th World Sterilization Science Day, and today we're going to take you through the supply of sterilization.
The disinfection supply center is an important department for the prevention and monitoring of hospital infection, as well as an important department for safe medical security, and is responsible for the cleaning, disinfection, sterilization and supply of sterile items for all reused diagnosis and treatment instruments, appliances and articles in various departments in the hospital. The work includes dozens of processes such as recycling, sorting, cleaning, disinfection, drying, inspection and maintenance, packaging, sterilization, storage, and distribution.
As a special department of the hospital, clinical care is for patients, while we care for equipment. In the work, only each process is interlocking to ensure the cleaning and sterilization quality of each instrument package, so as to ensure that the qualified rate of sterile items issued reaches 100%, ensure that medical workers have no worries when fighting on the front line, and then ensure the safe development of medical diagnosis and treatment activities in the hospital.
Disinfection supply center area division
The disinfection supply center area is divided into decontamination area, inspection and packaging area, sterilization area, and sterile goods storage area.
(1) Decontamination area: The area where reused diagnostic and treatment instruments, appliances and articles are recycled, sorted, cleaned and disinfected, is a contaminated area. There is a special passage in the decontamination area, and the elevator leads directly to the operating room, which is convenient for rapid recovery and improves the turnover rate of instrument use.
(2) Inspection packaging and sterilization area: The area for inspection, assembly, packaging and sterilization (including dressing making, etc.) of the decontaminated diagnostic and treatment instruments, appliances and articles is a clean area.
(3) Sterile goods storage area: the area for storing, keeping and distributing sterile goods, and the clean area. There is a clean elevator in the sterile area that leads directly to the operating room, which is convenient to ensure the supply in a timely and rapid manner.
Sterilization supply center instrument handling
Next, we will lead you into the decontamination area of the disinfection supply department to see how the equipment and item bags are recycled, cleaned, disinfected, packaged, sterilized, stored and distributed after use.
First stop: Decontamination Zone
(1) Recycling: The staff of the disinfection supply center should bring the clean sewage truck to the clinical department for recycling in a closed manner according to the specified time and route, and make a handover and record with the department.
(2) Classification: The contaminated items recovered by the clinical department will be classified according to the different materials, properties, precision and pollution status of the equipment.
(3) Cleaning: The staff of the disinfection supply center are "fully armed", rinsing the instruments under running water, and sometimes brushing them on their bodies with brushes to remove obvious blood and pollutants, and then choose the appropriate cleaning and disinfection methods according to the material and precision of the instruments, including mechanical cleaning, manual cleaning, and ultrasonic cleaning. Regardless of the cleaning method, it will go through the whole process of rinsing, enzymatic washing, rinsing, disinfection, final rinsing, lubrication, and drying.
(4) Disinfection: Adopt moist heat disinfection method.
(5) Drying: It is advisable to use special drying equipment for drying treatment.
Second stop: Packing area
Inspect and maintain each piece of equipment, utensils and articles after drying, check the cleanliness, integrity and functional goodness of the equipment through visual inspection or a magnifying glass with a light source, and put a protective cover suitable for the size of the precision instrument, and select the appropriate packaging material for packaging. There are as few as one or two pieces in a package of equipment, and nearly 100 pieces as much as possible, and it is necessary to strictly implement the check system in order to achieve the name, quantity, and performance of the equipment.
Third stop: sterilization area
Sterilization refers to the process of using physical or chemical methods to kill all microorganisms on an object, including bacterial spores, viruses and fungi, to achieve a sterile level. In the diagnosis and treatment, everything from a pair of suture scissors to a large surgical instrument bag for surgery must be disposed of by sterilization.
(1) Packaging materials: different "coats" determine the "life limit" of different materials. The validity period of ordinary cotton cloth material should be 14 days, the validity period of sterile items packaged in medical disposable paper bags should be 30 days, the validity period of disposable medical crepe paper and medical non-woven materials should be 180 days, the validity period of disposable paper-plastic bag materials should be 180 days, and the validity period of rigid containers should be 180 days.
(2) Sterilization methods: The commonly used sterilization methods in hospital disinfection supply centers mainly include pressure steam sterilization, ethylene oxide sterilization, hydrogen peroxide low-temperature plasma sterilization, etc. Only after passing the physical, chemical and biological tests can you enter the terminal - sterile goods storage area.
Fourth stop: sterile goods storage area
After the instruments are processed, we will move on to the next step - sterile goods storage, we continue to walk into the sterile goods storage area of the disinfection supply center, and take everyone to see how the sterile bags and items are stored and distributed.
After passing the sterilization, all kinds of items and instrument bags enter the sterile goods storage area of the terminal, and under the careful care of the staff, the instruments are quietly placed on the clean and tidy shelves waiting to be "called" at any time. In order to ensure normal use, the staff will manage us in accordance with the requirements of the specification.
(1) When entering the sterile room, dress as required, and wash hands or disinfect hands properly before touching the sterile bag.
(2) Storage: (1) After passing the sterilization, the sterile bag needs to be cooled for > 30 minutes before it can be unloaded, and the unloading should be carefully checked for wet bags, broken bags, dirty bags, etc., and whether the six information cards are complete (sterilizer code, sterilizer number, batch number, sterilization chemical indicators, sterilization date and expiration date). (2) The sterile bag should be classified and stored in the sterile goods storage area, with a fixed position and clear identification. (3) The ambient temperature < 24 °C, the humidity < 70%, the shelves are ≥ 20 cm from the ground, 50 cm from the ceiling, and 5 cm from the ≥≥ wall.
(3) Distribution: (1) The name, quantity, completeness and validity period of the sterile package, the issuance time, and the receiving department must be strictly checked, and both parties must sign after confirmation. (2) A transfer cart with guardrails must be used when transporting sterile instrument packages. (3) When moving or carrying the sterile instrument bag, adopt the correct handling technique: hold both hands at both ends of the instrument bag, translate and handle gently, and do not stand upside down or flip. (4) The principle of distribution should be first-in, first-out, and the dropped package, broken package, and wet package are unqualified and must be repackaged and sterilized.
Consumption and supply is no trivial matter, every instrument is related to the life of the patient, and the disinfection supply department will also keep pace with the times, and escort the clinic with more standardized, professional and refined management.
(Some of the pictures come from the Internet)