脉动真空压力蒸汽灭菌湿包原因分析及对策

Phenomena of wet pack after pulsing vacuum steam sterilization:analysis and countermeasures

目的分析脉动真空灭菌器灭菌产生湿包的原因,探讨杜绝脉动真空灭菌器灭菌时产生湿包的对策。方法将采用棉布、无纺布、无纺布+皱纹纸、纸塑袋包装的基础护理包、同类专科器械、大小一致的手术室器械包和手术室布类包、外来器械,按不同待灭菌包种类,分别采取分类装载和混合装载的方式,利用科室2台灭菌器,选择织物程序按脉动真空灭菌器的正常操作流程运行一个灭菌周期。根据出锅时间及冷却时间的不同,观察湿包出现的部位、多少、种类;每天各选择2批次共8批次,连续监测7 d。结果 56批次共2 660个灭菌包,其中出现湿包32个。不同包装材质引起灭菌包出现湿包现象不同,纸塑包装最易湿包、双层无纺布次之、其次是无纺布+皱纹纸,棉布引起湿包发生现象最少;灭菌包不同材质,大小、重量可影响湿包产生,金属器械较布类易湿包,体积大、量重者容易湿包;不同的装载方式及冷却方式对湿包的产生有一定的影响,混合装载比分类装载更容易出现湿包;不同部位湿包产生不同,灭菌器最下层较上两层易湿包,灭菌包靠近灭菌器内腔壁容易湿包;冷却时间越短越容易湿包。结论加强消毒供应中心环节控制,规范器械物品干燥、包装、灭菌、卸载等流程操作,可有效控制湿包产生,防止因消毒供应中心灭菌物品不合格所致医院感染发生。

Objectve We will analyze the reason of wet pack appeared after pulsing vacuum steam sterilization.In order to bring forward the methods and of control to reduce the appearance of wet pack.Methods For the basic nursing pack packed by cotton or non-woven or non-woven＋crepe paper or paper-plastic bag,the similar specialized instrument, the same size of operating room surgical apparatus pack and operating room cloth pack, the foreign apparatus, we will take types of classified loading and mixed loading according to the different kinds of sterilization package, choose the fabric process taking addvantage of the two sterilization in the department, run a sterilization cycle according to the normal operating procedure of pulsing vacuum steam sterilization, observe the position, amount and variety of wet pack according to the different pan time and cooling-down time. We will choose 2 batch-totally 8 batch and contiously monitor 7 days everday.Results There were 32 wet packs appeared among the 56 batch-totally 2660 sterilization packages.Different materials have a variety of phenomena of wet pack.The first one is paper-plastic bag, next is non-woven, then the third is non-woven＋crepe paper, and the last is cotton.The material, size and weight could effect on the appearance of wet pack.The metallic apparatus is easier than mereery.The larger volume and the more weight,the easier of wet pack appeared.Different loading and cooling-down methods have an influence on wet pack.The mixed loading is easier than the classified loading.All of wet pack have all kinds of position.The lowest is easier than the two floors above it.And the sterilization package closing to the lining of sterilization is easier to the wet pack appeared. The shorter cooling-down time,the easier.Conclusion Strengthen the control of sterilized supply center and standard operation proceduce,such as drying equipment items,package,sterilization and unload,could effectively control the appearance of wet pack and prevent the hospital infection, for the unqualified sterilization items, from appearance.