Dekontaminacja, czyli proces niszczenia biologicznych czynników chorobotwórczych poprzez mycie, dezynfekcję i sterylizację, ma szczególne znaczenie dla zapobiegania zakażeniom szpitalnym. Jakie czynniki decydują o tym, czy jest przeprowadzana w sposób prawidłowy i skuteczny?
Według norm ustalonych przez Polski Komitet Normalizacyjny kontrola procesów sterylizacji w szpitalach powinna się odbywać regularnie. Jej celem jest dostarczenie dowodu na to, że procedury dekontaminacji przebiegają w prawidłowy sposób, a poddany sterylizacji sprzęt jest bezpieczny w użytkowaniu. Brak kontroli skuteczności sterylizacji może skutkować wystąpieniem zakażenia.
Kontrolę należy przeprowadzać z uwzględnieniem czynników fizycznych, chemicznych i biologicznych.
Kontrola fizyczna polega na monitorowaniu parametrów działania sterylizatora na podstawie wydruku z urządzenia. Parametry te są mierzone za pomocą termometrów, manometrów, zegarów i mierników. Ich obserwacja pozwala na bieżące kontrolowanie jakości i prawidłowości pracy sterylizatora.
Wskaźniki biologiczne pozwalają na określenie skuteczności biobójczej procesu sterylizacyjnego. Po przeprowadzeniu kontroli biologicznej sterylizowany sprzęt może zostać przekazany do użytku. Kontrola chemiczna skuteczności sterylizacji jest przeprowadzana przez użytkownika końcowego za pomocą wewnętrznych wskaźników chemicznych. Odbywa się ona przed klinicznym zastosowaniem sprzętu. W przypadku uzyskania nieprawidłowego wyniku sprzęt powinien trafić do ponownej sterylizacji.
Należy zwrócić uwagę, że w szpitalnych sterylizatorniach są stosowane różne metody sterylizacji. Kontrola każdej z nich uwzględnia inne krytyczne parametry.
W przypadku stosowania do sterylizacji pary wodnej parametry te obejmują: czas, temperaturę, wodę dostarczoną jako nasyconą parę wodną, formaldehyd i jego stężenie.
Jeżeli sterylizacja przeprowadzana jest za pomocą tlenku etylenu, parametry obejmują: czas, temperaturę, wilgotność względną oraz stężenie tlenku etylenu.
W procesie sterylizacji z użyciem pary nadtlenku wodoru do kontrolowanych parametrów należą czas, temperatura, stężenie nadtlenku wodoru oraz plazma (jeżeli się ją wykorzystuje).
Rzetelna, regularna kontrola jakości sterylizacji ma duże znaczenie dla bezpieczeństwa zdrowotnego pacjentów. Z tego względu zarówno sama sterylizacja, jak i pozostałe etapy dekontaminacji powinny się odbywać na najwyższym poziomie, z zastosowaniem profesjonalnych standardów postępowania.
Źródło: J. Włodarczyk-Rajska, Kontrola skuteczności sterylizacji, w: Forum Zakażeń 2017; 8(3): 215-217.
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