|
|
发表于 2011-1-14 09:32:37
|
显示全部楼层
回复 17# 欢乐天空
2009年4月1日CSSD管理规范中“重复使用的诊疗器械、器具和物品直接至于封闭的容器中、由CSSD及中回收处理……”，由此应该可以理解为，使用科室不应在科室作初步清洗等处理。
但美国2008年发布的〈Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008〉中第36页讲到cleaning的重要性时有这样一段话“Cleaning is the removal of foreign material (e.g., soil, and organic material) from objects and is normally accomplished using water with detergents or enzymatic products. Thorough cleaning is required before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes. Also, if soiled materials dry or bake onto the instruments, the removal process becomes more difficult and the disinfection or sterilization process less effective or ineffective. Surgical instruments should be presoaked or rinsed to prevent drying of blood and to soften or remove blood from the instruments.
Cleaning is done manually in use areas without mechanical units (e.g., ultrasonic cleaners or washer-disinfectors) or for fragile or difficult-to-clean instruments.”
这是在指南的描述性段落中表明应在“使用区域”进行手工清洗的观点。
同时在指南后面的大纲性建议时又指出“Clean medical devices as soon as practical after use (e.g., at the point of use) because soiled materials become dried onto the instruments. Dried or baked materials on the instrument make the removal process more difficult and the disinfection or sterilization process less effective or ineffective. Category IB.”由此可以看出，美国消毒灭菌指南中是建议在使用区域尽快进行初步冲洗的。
那么这是不是说明我国的规范不合理呢？首先，我国的自我防护意识强吗？防护装备有吗？其次，我们的使用点有专用的器械初步冲洗设备吗？如专用清洗池等等。到底是应该在使用点先初步冲洗还是不冲，由CSSD来集中处理，需要我们大家因地制宜，共同思考，而不是机械地执行某个规范，或者迷信某个指南。如使用科室不具备初步冲洗的条件，是不是供应室根据各个科室使用情况增加回收的频率？或者有人说的使用保湿剂？但也有人认为使用保湿剂可能会加快器械锈蚀？或者有条件的医院，设置专用的初步冲洗设备以及配备必要的防护装备，也参照美国指南在使用点作初步冲洗？这些问题都有待我们做进一步研究和探讨。
|
|
楼主: dearhang
