Brief introduction of disinfection supply room routine

Directory 1 pinyin 2 location and layout 3 nature and tasks of each district 3. 1 polluted area 3.2 general work area 3.3 clean area 3.4 sterile area 4 supply mode 5 supply scope 6 disinfection supply room (department) work system 7 monitoring items 1 pinyin xiā o dú ng yú sh yú b ā n chá nggu

2 location and layout 1. The position of disinfection supply room (department) should be close to the ward, which is convenient for receiving and dispatching and clinical practice. Conditional hospitals can consider setting up special passages or conveyor belts for the transportation and recycling of goods when they are newly built.

2. The surrounding environment is clean and there is no pollution source. The outdoor ground should be bricked or afforested as much as possible to form a relatively independent area.

3. The terrain should be more than 4m above the ground, with good lighting and air circulation to avoid harmful gases and all kinds of dust falling.

4. The scale of the building should be adapted to the clinical departments, and the building area of the conditional hospital can be calculated as 0.50.7m2 per kloc-0/bed. There should be piping systems for cold water, hot water and distilled water or pure water. The working area and living area of the supply room (department) of a grade hospital should be strictly separated.

5. Indoor buildings shall meet the hygiene requirements, and materials with easy cleaning and disinfection, corrosion resistance and few joints shall be selected, and the walls shall be smooth and free from falling particles. Floor drains shall be equipped with anti-fouling and anti-rodent devices. Doors and windows should be made of materials with good sealing performance.

6. The room layout is reasonable, and the polluted area, general work area, clean area and sterile area are strictly divided. Recovery, cleaning, packaging, sterilization, storage and distribution should take a mandatory route and not retrograde. Conditional hospitals can use Shuang Ye cleaning and disinfecting machine, automatic ultrasonic cleaning machine and Shuang Ye pressure steam sterilizer as isolation screens for polluted areas, clean areas and sterile areas. Each area is in charge of by a special person, so as to be divided into four parts: the studio is separated from the living room; Separate the recovery of dirt from the placement of clean items; Primary washing is separated from fine washing; No, sterilization is separate from sterilization.

3. Nature and tasks of each district 3. 1 Designated persons and special vehicles are fixed in the polluted areas to recycle the used pollutants, and classify, pretreat and clean them. The area should not be too large. Generally, there are sewage recycling room, disposable goods treatment room and washing room (divided into primary washing area and fine washing area). The design of rooms in polluted areas requires that negative pressure can be formed.

(1) The recovered articles are unpacked and classified in a fixed special room, soaked and disinfected in an appropriate and effective way, and then sent to the washing room.

(2) When recycling in disposable goods, it must be registered. Infusion devices and syringes can only be transferred to the recycling station designated by the local health administrative department after being destroyed or disinfected and treated harmlessly, and both parties shall register and sign it to show their responsibility. Other disposable goods should be burned after use (pay attention to environmental protection and avoid re-pollution).

(3) The washing process consists of primary washing (rough washing) and fine washing. The cleaning of syringes and infusion sets must adopt four steps: decontamination, pyrogen removal, detergent removal and fine cleaning.

(4) The initial washing is to wash off the dirt attached to the articles with a suitable detergent by mechanical or manual operation, and then rinse off the residual detergent with ordinary water. Incomplete decontamination will directly affect the sterilization effect, and removing residual blood stains is a necessary measure to ensure the sterilization quality.

(5) After the first washing of syringes and infusion sets, pyrogens must be removed, because pyrogens cannot be removed during sterilization and must be inactivated during washing. The Ministry of Health of the People's Republic of China (1993) notified No.59 document to promote the use of "three-effect pyrogen inactivator" to eliminate pyrogen. This method is simple and safe, and can effectively remove pyrogen (the specific operation can be carried out according to the manufacturer's product manual).

(6) Instruments or appliances that have been treated with inactivating agent according to the procedure can enter fine washing after washing the residual liquid medicine with ordinary water. Fine washing can use fresh flowing distilled water or pyrogen-free pure water. The four steps of washing: decontamination, pyrogen removal, detergent and fine washing, cannot be changed or simplified at will.

(7) The recycling vehicle must be dedicated and cleaned and disinfected after each use. Do not enter other areas or use them for other purposes.

3.2 General work area This area mainly includes dressing rooms, glove handling rooms, offices and warehouses, as well as dressing rooms, duty rooms, study rooms and bathrooms in living areas.

3.3 Clean area is also called sterilization preparation area. The work in this area is to inspect, equip, properly package and disinfect sterilized items. All articles entering the clean area must be dry articles that have passed the qualified decontamination process. There are disposable sterile medical supplies storage warehouse, instrument room, assembly room, microcomputer room, unloading storage room and disinfection and sterilization room in the clean area. The temperature in the clean area should be kept at 1820℃ and there should be enough illumination brightness (> 25W/m2). The air in this area should be a positive pressure area.

(1) packaging materials: packaging materials or containers used in clean areas should be clean and dry, which is conducive to the penetration of air and steam discharged during sterilization and can prevent re-pollution after sterilization. Wrapping cloth, therapeutic towel, etc. Usually made of double-layer plain cloth, it must be cleaned and decontaminated before reuse. If packing in containers, choose containers that can block microorganisms, facilitate vapor permeation, have sieve holes and can be closed. The lunch box containers sold in the market, whether covered or not, can not be used as the packaging of sterilized items.

The renewal of medical materials is the new development of disinfection supply, and the selection of packaging materials is an important link to prevent particle pollution. At present, the packaging bag made of polyester-polypropylene composite transparent film and special paper can be heat-sealed. The required sterilization equipment is put into the bag in advance, sealed with a heat sealing machine, and then sterilized. There is also a kind of pressure steam medical packaging paper, which has small pores, strong toughness, strong penetration of steam during sterilization and high retention rate of bacteria after sterilization. Hospitals can choose according to specific conditions.

(2) Packaging method: separate the plate to be disinfected from the pot with a towel or cloth to allow steam to circulate. All kinds of condoms and dressing condoms should not be too large, generally not exceeding 30cm×30cm×25cm, and the weight should not exceed 5kg. The appearance of packaged goods should be neat, clean and flat, with four corners symmetrical, and the exposed corner is in the middle of the bag. The wrapping cloth is moderately elastic, sealed with chemical indicator tape, and marked with the sterilization validity period and operator code. Articles after fine washing should be sent to the sterilization room for sterilization as soon as possible (12h), and should not be left for a long time to prevent pollution and pyrogen generation.

(3) Assembly requirements: the environment of the assembly room should be relatively clean, and it is best to install an air purifier in a conditional hospital. Indoor relative humidity should be kept at 35% ~ 50%, and there are good lighting conditions to facilitate operation. A light source and a magnifying glass should be set at the appropriate position of the console to facilitate the inspection of the quality of injection needles and surgical sutures. Operating table and ground should always be kept clean and wiped with effective disinfectant 1 ~ 2 times a day. Clean the air filter regularly and strictly restrict people from entering the room.

3.4 Sterile area This area is a separate isolation area. The indoor air should be kept at positive pressure, the temperature should be kept at 18 ~ 22℃, the relative humidity should be ≤ 50%, and there should be enough lighting equipment (> 25W/m2). Personnel entering the sterile area should dress neatly, wash their hands and change shoes.

(1) The packaging of aseptic goods should be complete, the cloth should be dry, the water content should not exceed 3% (it is dry to the touch and cannot be used as aseptic goods when wet), and the chemical indicator should change color evenly, which meets the requirements and standards.

(2) Sterilized articles that fall to the ground or are placed in unclean places are regarded as contaminated and cannot be used as sterile articles.

(3) The storage room for sterile articles shall be highly clean, and an air purification device shall be installed. Access to the sterile area is limited to the personnel responsible for transporting and distributing sterile items, and non-sterile items are not allowed to enter.

(4) Purchased disposable sterile articles must be removed from the outer packaging, and can only enter the sterile article storage room after passing pyrogen detection and sterility test.

(5) The sterilized aseptic package should be marked with the expiration date of 7 ~ 14d, which can be shortened in hot and humid areas in summer. Expired items should be repackaged and disinfected before use. Once the aseptic package is disassembled, it should be repackaged and sterilized even if it is not used.

(6) Sterilized articles should be placed in sterile lockers or four-grid racks 20 cm above the ground, 50 cm above the ceiling and 5 cm above the wall. Placed according to sterilization order, short-term development first, then long-term development.

(7) Shelves for placing sterile items should be wiped and disinfected regularly, and the ground should be scrubbed with a disinfected wet mop every day. Indoor air should be disinfected according to regulations, and the installation and use of ultraviolet lamps should refer to physical disinfection and sterilization methods. Ceiling, air conditioning vents, air filters, etc. Must be cleaned frequently.

(8) The distribution of sterile articles should be distributed in principle. Transport vehicles should use fully enclosed trolleys and be strictly separated from pollution recovery vehicles. Use special person, special car and special route. Distribution personnel are not allowed to touch the contaminated items, and the distribution vehicles should be effectively disinfected every day to distribute the remaining items. They are not allowed to enter the sterile goods storage room again and need to be disinfected again.

(9) When the department personnel directly exchange items in the disinfection supply room, the trays, containers and hands of the staff transporting contaminated items must be properly handled before receiving sterile items. Conditional hospitals can set up isolated distribution windows in sterile goods storage places, and all departments have fixed windows. The delivery window has two doors and is equipped with ultraviolet disinfection lights. Sterile items needed by the department are put into the inner doors and windows, and the sterile items are taken out from the outer doors and windows. You can't open two windows at the same time, that is, one window opens and the other window closes automatically.

(10) The indoor relative humidity of sterile goods storage room should be controlled at ≤ 50%, and dehumidifiers can be used for dehumidification in humid areas in the south.

4 mode of supply 1. Centralized supply? Concentration is to recycle all the items that need disinfection and sterilization in the hospital to the disinfection supply room for processing. So that disinfection, cleaning, packaging, sterilization, storage, testing and distribution are all completed by experienced professionals, forming a standardized and effective disinfection and sterilization circulation system, reducing iatrogenic pollution and facilitating the management and quality control of hospital infection. ?

2. Fixed supply? Disinfection supply room distributes certain items (such as infusion sets, syringes, treatment kits, dressing change bowls, treatment towels, etc.) according to the needs of various departments. ), and according to the fixed base, send sterile items to the department every day. Items supplied by the department to the disinfection supply room should be kept by special personnel to prevent them from being expired or lost. The head nurse of disinfection supply room has the right to inspect and assess the base regularly. ?

3. Temporary supply? Departments that need special items should contact in advance to prepare. Items borrowed from the disinfection supply room should be filled in in detail, first-aid items should be returned within 24 hours, and general items should be returned within 3 days. ?

4. Items prepared by the department itself and sterilized in the disinfection supply room should be properly packaged as required, indicating the type of items and the name of the department, and sent to the disinfection supply room within the specified time. The sterilizer will register to check whether the package meets the requirements, and only those that are qualified can be sent to the disinfection room and retrieved in time after disinfection.

Scope of supply The disinfection supply room provides disinfection and sterilization items for diagnosis, treatment, teaching and scientific research. For clinical and medical departments in hospitals. The specific classification is:?

Category I: articles used for treatment, examination and intravenous and intramuscular injection, such as infusion sets, syringes of various specifications, needles, tees, connecting pipes and various intravenous catheters. ?

The second category: all kinds of treatment kits and all kinds of catheters, such as trachea catheter, stomach tube, drainage tube, catheter, anal canal, gloves and all kinds of treatment kits. ?

Three categories: various dressings, such as therapeutic towels, wrapping cloth, gauze, cotton balls, cotton swabs, gauze balls, etc. ?

Disinfection supply room is responsible for the sterilization and disinfection of all kinds of articles and instruments needed by various departments in the hospital. All kinds of articles in hospital laboratories and animal laboratories should be sterilized by themselves. In order to ensure safety, all kinds of aqua should be disinfected with a special sterilizer, not together with other items in the disinfection supply room.

6 disinfection supply room (department) working system 1. The staff in this room should be familiar with disinfection and sterilization operation technology, and their clothes and hats should be clean and tidy. Workers in polluted areas should wear isolation gown and take off isolation gown when leaving the room. You must wash your hands and change your shoes before entering the sterile area. ?

2. According to the work nature and tasks of each room, the staff should be reasonably staffed, with good quality and quantity, and the responsibility should be implemented to people. Regular physical examination, anyone suffering from infectious diseases and mental illness shall not work in the supply room. ?

3. Insist on clinical receiving and dispatching, earnestly fulfill the receiving and delivery procedures, regularly check the general ledger and subsidiary ledger of the supplier, input them into the computer for archiving in time, and ensure that the accounts are consistent with the contents, and have a perfect monthly report system. ?

4. Disinfection supply room should exchange items on time every day. Each ward should prepare the items to be exchanged according to the name, quantity and specifications, and make preliminary treatment, that is, all kinds of used items should be disinfected with effective disinfectants before they can be exchanged, and the items used should not be accompanied by liquid medicine, blood, tape, etc. Prevent pollution. ?

5. Specially polluted articles should be stored in clean paper bags when exchanged, marked "Contaminated" and then transported. After being disinfected by effective disinfectant or pressure steam, it can be cleaned, packaged and disinfected together with other articles. ?

6. The person who replaces the goods will pick it up and sign it in person to avoid mistakes. Unused sets should be replaced in the sterile supply room on the morning of the due date. ?

7. The treatment towels, gauze and gloves supplied to the department are only used for treatment and shall not be used for other purposes, so as to keep the treatment towels and gloves clean. ?

8. First-aid equipment should be provided regularly, and a certain number of exercises should be kept to ensure the supply at any time. ?

9. Ensure safe work and observe various inspection systems. Every day, each group has a special person to check the doors and windows, water, electricity and gas, and handle the problems in time when found.

10. Keep the room clean, tidy and dust-free, with minor cleaning twice a day, major cleaning once a week 1 times, air disinfection in each workshop 1 ~ 2 times a day, and air disinfection in sterile room twice a day.

7 monitoring project 1. Normal water? It shall be odorless, colorless, clear and transparent, with no volatile matter exceeding 0.5%, and the conductivity test shall be above 500kω·m per month 1 time. ?

2. distilled water? It should be odorless, colorless, transparent, free of chloride, sulfate, calcium salt, ammonia, easy oxides, heavy metals and carbon dioxide, without pyrogen reaction, with pH value of 5.0 ~ 7.0, per week 1 time.

3. What is the sterilization effect of pressure steam? See physical disinfection and sterilization methods.

4. Monitoring of ethylene oxide sterilization

(1) process monitoring: check the concentration, temperature, humidity, duration of ethylene oxide and the nature of sterilized articles according to the operating procedures and various necessary conditions for sterilization. And record the tank number, expiration date, operator name or code, etc. ?

(2) Chemical monitoring: For each pot, the chemical indicator card is placed in the center of the sterilized article, and the basic magnesium hydroxide is generated by the reaction of ethylene oxide and magnesium salt, which makes the indicator card discolor, so as to infer whether it meets the sterilization requirements.

(3) Biological monitoring: the indicator bacterium is Bacillus subtilis variant Aspergillus Niger spore (ATCC9372), and the bacterial infection amount of each bacterial slice is 5× 105 ~ 5× 106. Under the conditions of 54℃ 2℃ and relative humidity 60% 65438 00%, the bacteria were infected at 600+. During detection, the indicator bacteria piece is placed in the center of the object to be sterilized, and after being sterilized by ethylene oxide, the indicator bacteria piece is taken out and cultured in the nutrient broth tube. If the culture result is aseptic growth and the same batch of bacterial slices (not sterilized) are bacterial growth, it shows that the sterilization purpose has been achieved. The newly installed and maintained ethylene oxide sterilizer should be tested with 565,438+00 pieces of budding bacteria in each sterilization cycle at the initial stage of operation until the sterilization effect is established. In routine use, two pieces of budding bacteria are used for detection in each sterilization cycle.

5. Dry heat sterilization detection Dry heat sterilization is important to do a good job in process detection, that is, whether the sterilization temperature and required time meet the required standards. Sterility test can also be used to verify the reliability of dry heat sterilization.

Chemical detection: the use method of chemical indicator card and indicator tape for dry heat sterilization is the same as that for pressure steam sterilization. ?

Biological detection: Bacillus subtilis var. Taking Aspergillus Niger spores as biological indicator bacteria, the sterilization effect of dry-hot sterilization cabinet was determined. ?

6. pyrogen detection? 2% and 0.5% of each batch of sterile infusion sets, intravenous syringes and disposable infusion sets were taken for pyrogen detection. Limulus test is commonly used and the result may not be positive. ?

7. particle detection? It should be carried out under clean conditions. Mainly used for intravenous injection. A special particle counter should be used, with no more than 20 particles larger than 1 0 μ m and no more than 2 particles larger than 25μm per1ml of the liquid to be tested. ?

8. What is the disinfection effect of ultraviolet surface?

(1) indicator bacteria: Escherichia coli (8099 or ATCC25922) and Bacillus subtilis var. Niger spore (ATCC9372). ?

(2) Physical index: The ultraviolet radiation intensity of ordinary 30W straight tube ultraviolet lamp at 2025℃ at room temperature and 220V at 253.7nm (vertical position of 1m) should be ≥70/μW/cm2. When the voltage is 220V and the room temperature is 20 ~ 25℃, the ultraviolet radiation intensity of 253.7nm (perpendicular to 1m) should be ≥200μW/cm2.

(3) Physical detection: measure the ultraviolet intensity (μW/cm2) of the lamp tube at the vertical position of 1m with an ultraviolet intensity tester with the central wavelength of 253.7nm (within the calibration period).

(4) Biological monitoring: carrier quantitative disinfection test was adopted. ?

9. Monitoring of air, object surface and employees' hands? In order to ensure the environmental quality of the disinfection supply room, the air, the surface of objects and the hands of staff should be monitored regularly (at least 1 time per month). The specific standards are as follows: ① The number of bacteria in the air of sterile area is ≤ 200 cfu/m3; ② The number of bacteria in the air in the clean area is ≤ 500 cfu/m3; ③ The number of bacteria on the surface of the object is less than or equal to 5 cfu/m2；; (4) The number of bacteria in workers' hands is ≤ 5 cfu/m2; ⑤ No microorganism can be detected in sterile articles and disposable sterile medical articles.

10. Monitoring of disinfectants in use?

(1) sampling time: use the disinfectant used before replacement. ?

(2) Sampling method: Under aseptic conditions, suck 65438±0ml sample solution with sterile straws, and add it into 9ml diluent to mix well. ?