骨科手术器械含有大量空心工具，包括空心钻头、套筒、关节镜器械等，空心器械清理困难，其中若有骨质残留，常规消毒灭菌后是否能再用？
参考文献：Smith K, Araoye I, Gilbert S, Waites K,
Camins B, Conklin M, Ponce B. Is retained bone debris in cannulated
orthopedic instruments sterile after autoclaving? Am J Infect Control.
2018 Sep;46(9):1009-1013. doi: 10.1016/j.ajic.2018.02.024. Epub 2018 Apr
13. PMID: 29661627.骨科常用的手术器械，如空心钻头、套筒、关节镜器械等，由于清洗较为困难，较难判断是否清理干净，因此容易残留骨碎屑。对上述空心器械残留的骨碎屑，通过常规消毒灭菌后是否能有效灭菌，是否能在后续手术中继续使用，尚无定论。对上述问题，国外的学者进行了相关研究，结果发表在American Journal of Infection Control期刊上。在常规清洁和消毒后，空心手术器械可能会残留生物碎屑。清洁后残留的碎屑被认为是无菌的，但该假设并没有实验依据。这项研究的目的是确定高压灭菌后在空心手术器械中发现的残留生物碎屑的无菌性。 （Cannulated surgical instruments may retain biologic debris after routine cleaning and sterilization. Residual debris after cleaning is assumed to be sterile; however, there is no experimental basis for this assumption. The purpose of this study was to determine the sterility of retained biodebris found within cannulated surgical instruments after autoclave sterilization.）
用15个空心钻头钻猪肩胛骨，以产生一个骨塞，该骨塞在灭菌前暴露于蜡样芽孢杆菌，铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌的混合物中，持续60、120或180分钟。对钻头进行标准的高压灭菌。然后将“灭菌”的骨塞在溶液中孵育，并在血琼脂上划线。
（Fifteen cannulated drill bits were used to drill pig scapulae to create a plug of bone that was exposed to a mixture of Bacillus cereus, Pseudomonas aeruginosa, and methicillin-resistant taphylococcus aureus for 60, 120, or 180 minutes prior to sterilization. The drill bits were autoclave sterilized using standard settings. The “sterilized” bone cores were then incubated in solution and streakplated on blood agar.）
所有3个阳性对照实验细菌均为阳性。两个阴性对照对污染细菌呈阳性。从180分钟实验组中的1个实验组钻头中回收了蜡状芽孢杆菌菌株。脉冲场凝胶电泳证实回收的蜡状芽孢杆菌菌株与实验接种菌相同。 （All 3 positive controls were positive for the experimental bacteria. Two negative controls were positive for contaminant bacteria. A B. cereus strain was recovered from 1 of the experimental group drill bits in the 180-minute group. Pulsed-field gel electrophoresis confirmed that the recovered B. cereus strain was identical to the experimental inoculate.）标准高压灭菌后，空心钻头中残留的生物碎屑可能不是无菌的。此外，手术器械再处理的延迟可能会增加残留物污染的风险。（Retained biodebris in cannulated drills may not be sterile after standard autoclave sterilization. In addition, delay of surgical instrument reprocessing may increase the risk of resistant contamination.）
本站仅提供存储服务，所有内容均由用户发布，如发现有害或侵权内容，请
点击举报。
