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【双语文章】器械表面变色/残留并非是因清洁不彻底造成的(下篇)

2017-07-04 14:39:21 新华手术器械有限公司 阅读

器械表面变色/残留并非是因清洁不彻底造成的

Staining/residues on medical instruments are not always caused by lack of hygiene


(接上篇)


合成树脂(树脂/纤维)再处理过程中产生的残留

Residue formation from the reprocessing of Ferrozell (Resin/fabric)


到目前为止还有一个有待解决的问题是,残留可能出现在一些带手柄的器械上,这类手柄由含有结构填充物的酚醛树脂制成。此类材料对酸、碱和温度很敏感,会在器械表面及灭菌器舱内壁上产生褐色残留。


A further problem not adequately addressed up to now are residues that can occur because of instruments with handles made of phenol resin with fabric filler. This material is sensitive to alkalinity, acidity and the effect of heat. The brownish residues caused by Ferrozell precipitate out onto instruments and predominantly in the sterilization chamber.


即使可以假定这类残留不存在卫生方面风险,但是我们不能判断是否存在毒理学方面的风险。因此,在对器械的循环处理过程中应尽可能快的去除和修复此类合成树脂再处理造成的残留物。由于这类材料对器械再处理过程中很多有效参数是高度敏感的,因此应尽可能用耐受性好的材料彻底替换掉合成树脂材料。


It is safe to assume that these depositions pose no hygiene risk, however we have no information on their toxicology risk. Instruments with residues caused by the reprocessing of Ferrozell should be removed from circulation and repaired as quickly as possible. Because of their high sensitivity to the effective parameters of instrument reprocessing devices made of Ferrozell should be completely swapped for more durable materials where at all possible.


日常工作中最常见的腐蚀类型

The most common types of corrosion found in daily practice


除了上述提到状况,还有一些医疗器械的表层变化更具危害性,从卫生安全角度来讲是需要立刻清除掉的。例如,点状腐蚀、摩擦腐蚀、缝隙腐蚀和应力腐蚀,本文将重点关注这几类腐蚀。


In addition to these there are surface alterations on medical devices that are far more critical and therefore from a hygiene point of view must be immediately removed. Here we have for example pitting corrosion, fretting corrosion, crevice corrosion and stress corrosion. Our article will concentrate on these.


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这些腐蚀中最常见的类型是点状腐蚀。其产生的主要原因是器械接触过氯化物或长时间与血液、分泌物接触所致。可通过最后冲洗阶段用去离子水彻底冲洗并且缩短器械使用后与处理前的时间来避免产生点状腐蚀。为了确保病人的安全,出现腐蚀的器械应立即从器械处理循环中剔除并且由制造厂商进行检修。


Pitting corrosion is the most well-known of these. It is elicited mainly by chloride or longer contact of blood and secretions on instruments. It can be prevented for example by using fully demineralized water in the final rinse of reprocessing and by keeping the time as short as possible between using the instruments for operations and reprocessing them. In order to guarantee patient safety, the instruments showing corrosion must be of course immediately be removed from instrument circulation and overhauled by the manufacturer.


点状腐蚀的卫生风险在于点状腐蚀会产生锈渍,而锈渍会扩散到整个再处理循环过程中。随后传染给更多的器械,甚至扩散清洗消毒器和灭菌器里,自然也会进一步殃及到患者。


The hygiene risk here is that rust can form in the pits and that this can then be distributed as flash rust throughout the whole reprocessing process. As well as reaching all the instruments it also spreads in the WDs and sterilisers and therefore naturally also as far as a patient.


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金属器械有摩擦的部位会产生摩擦腐蚀,摩擦腐蚀会对器械表面造成严重磨损并损坏钝化层。在摩擦区域非常容易产生血渍或其他残留污渍,从而导致锈蚀。为防止这种情况发生,可在清洗/消毒后将器械冷却到室温,然后使用合适的润滑油对器械进行保养。出现磨损的器械应立即从器械处理循环中剔除并且由制造厂商进行检修。


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Fretting corrosion happens where metal is subjected to friction, which greatly roughens the surface and damages the protective passive layer. Then blood or other residues can be deposited and corrode the instrument. To prevent this it is essential to allow instruments to cool down to room temperature after cleaning/disinfection and sterilization and then to maintain them adequately using suitable lubricants and instruments oils. Affected instruments should be immediately sorted out and be given to the manufacturer for repairs.



如今缝隙腐蚀已经变得越来越普遍。缝隙腐蚀主要出现在新器械因设计原因具有的狭缝区域/铰接区域,特别是硬质合金金属的嵌入端,如解剖剪刀和持针器。如果处理不当,锈渍会从缝隙中转移。未被去除的有机残留物常常会被误认为是缝隙腐蚀。


For some time now crevice corrosion has been becoming more common. It is found mainly on new instruments with narrow grooves/joints necessary for the design, especially on carbide metal insertions, for example in dissection scissors and needle holders. If not treated properly rust comes out of the gap and is often falsely confused with organic residues.


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应力裂缝腐蚀也是非常普遍的。器械再处理时经受了很大的拉伸力,例如在铰接器械的缝隙部位,常常发生此类腐蚀。


Stress cracking corrosion is another common type of corrosion. It often occurs because of the way an instrument is assembled, through high tensile stress e.g. at seams of jointed instruments.


铰接器械在张开状态下清洗消毒,并且确保至少有一个棘齿在卡合下灭菌以避免额外的拉力是很重要的。受损器械应立即从清洗消毒处理循环中剔除并更换新的器械,检修后也不能再使用。


This is why it is important to clean and disinfect jointed instruments in the open position and during sterilization to make sure that at the most only one notch is closed, to prevent additional tension. Damaged instruments should be removed from instrument circulation immediately and interchanged for new ones. Repair is not possible here.


为了充分评估风险因素,有必要将无机污物辨别出来,同时使用半定量或蛋白质测试等试验方法将来自有机污物的风险因素排除。


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In order to appreciate adequately the risk factor it is necessary to identify inorganic deposits and rule out hygiene risks from organic residual soil using semi-quantitative or alternatively protein tests.


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欲知更多此类信息和对器械的专业处理方法请参考器械清洗消毒工作小组撰写的"红皮书",也可从www.a-k-i.org免费下载电子版。


For further information on this and many other topics about professional instrument reprocessing please see the Red Brochure by the Working Group Instrument Reprocessing, as a free down load at www.a-k-i.org.


最后我们想指出的是,如果基于实际卫生方面的风险而关闭消毒供应部门是完全合乎情理的。但最合理的是先要根据当地个体情况做出正确的评估,随后再采取合适的应对方案。


To conclude we would like to point out that CSSD closures due to actual hygiene risks are completely justified. But it is preferable to make a correct evaluation of the individual situation in situ and to come up with a suitable reaction.


如果消毒供应中心确实存在卫生安全方面的不足,那么众所周知,应把病人的安全放在首位,关闭器械再处理部门绝对是合理的决策。


If there really are hygiene deficits in the central sterilizing department, then the well-being and care of the patients obviously comes first and closure of the reprocessing department would be an absolutely logical consequence.


转自“消毒供应频道”