四大名著之首蒸汽灭菌的常见错误
Most mistakes regarding the programming and operation of typical steam sterilizers are related to the basic principles of steam sterilization.
常见蒸汽灭菌柜的大多数程序和操作错误都与蒸汽灭菌的基本原理有关。
1. Containers with clod valves, empty glass bottles with tightened screw caps or cured aluminum foil are placed in the sterilizer.
灭菌柜中放入关闭阀门的容器、旋紧瓶盖或紧扣铝盖的空玻璃瓶。
As a result, steam cannot directly contact the inside surfaces and sterilization does not occur. This problem can be resolved by assuring that all items in the sterilizer have a way for the steam to get in and the air to get out. If there is uncertainty about whether an item’s configuration, t-up, packaging, or orientation will allow adequate steam penetration, a thermocouple, chemical and/or biological indicator can be placed inside the item to be certain.
教研员工作总结
这样， 蒸汽就不能直接接触到内表面，不能进行灭菌。 这一问题可通过确保灭菌柜中的物品有蒸汽进入和空气排出的通道来解决。 如果不确定物品的配置、设置、包装或方位是否允许充分的蒸汽穿透，那么可以通过在物品内部放置热电偶、化学和/或生物指示剂来确定。
2. Pouched and/or heavily wrapped items are tightly packed in the chamber.
袋装和/或严密包裹的物品紧实地装载在腔室内。
As a result, air may remain trapped in the items after the preconditioning pha and prevent sterilization. Items should not be overwrapped, and sufficient space should be maintained between load items. The preconditioning vacuum and pressure puls must be t correctly to attain complete air removal from the load. Typically, four (or more) preconditioning vacuum puls should be programmed to reach at least 28 in (711 mm) Hg vacuum ((1.0 psia or 6.9 kPa (absolute)) to assure sufficient air removal for worst ca loads. Some very den loads may require a short (2 to 5 min) hold pha at peak preconditioning vacuum to allow time for trapped air to be removed. Preconditioning pres
sure puls should be programmed for 3 to 5 psig ((21 to 34.5 kPa (gauge)). Higher pressures t for prevacuum pressure puls can result in an excessive amount of superheat and difficulties with temperature stabilization during the first few minutes of the exposure pha.
这样， 预调节阶段后空气可能仍然滞留在物品中，阻碍了灭菌。 物品不应过度包裹，且应在物品间留有足够的空间。 预调节真空和压力脉动必须正确地设定，以完全排除装载内的空气。 通常， 应该程序设定达到 28 in (711 mm)汞柱((1.0 psia or 6.9kPa (绝对压力))真空且四次(及以上)预真空脉动，以确保最差装载情况下空气排除充分。 有些非常密集的装载在预调节真空峰值时可能需要一段较短（ 2-5min）的保持时间，从而排除滞留的空气。 预调节真空脉动应设定为 3~5 psig ((21~34.5 kPa (表压))。 预调节压力脉动可能造成暴露阶段前几分钟时的过热和温度稳定困难。
3. Heavier items are placed on top shelves.
妈妈错了
较重的物品置于货架顶层。
Water droplets and/or stains are obrved on the outside of wrappers of items placed on the mid to lower shelves after the sterilization cycle is complete. Becau the items are not dry, they cannot be aptically removed from the sterilizer. Condensation is the natural result of steam contact with the cooler surfaces of the load. The condensate will fall from shelf to shelf. The denr the load item, the more condensate is created. Therefore, place heavier items on the bottom shelf. In addition, consider placing a cotton sheet or lint free towels on each sterilizer loading cart shelf prior to loading to allow the condensate to be absorbed. This also aids in drying. As the condensate wicks into the sheet or lint free towels, the condensate surface area is greatly incread and evaporates much more rapidly during the drying pha than the same amount of condensate in a droplet or a puddle.西游记人物图片
电话卡挂失灭菌循环结束后， 置于中间和低层的物品包装外表面可以看到水滴和/或污迹。 由于物品不是干燥的，不能从灭菌柜中无菌地取出。 冷凝是蒸汽接触物品冷表面时的自然结果。冷凝水会从货架上滴下。物品的放置越密， 产生的冷凝水越多。 因此， 将更重的物品放置于低层。 另外，在装载前考虑在各灭菌装载货架上放置纯棉布或无绒毛巾来吸收冷凝水。
这也有助于干燥。由于冷凝水浸入棉布或无绒毛巾，冷凝水表面积大大增加， 与同量冷凝水滴相比干燥阶段的气化速率也大大提高。
4. Load is too den or items are positioned incorrectly in the load.
装载过于密集或物品在装载中摆放位置不对。
As a result, wet or damp items are obrved at the end of the cycle. Wrapped items positioned so that condensate is allowed to collect will not be dried. Items should be positioned so that the condensate is allowed to flow downward. Items (wrappers, pouches, filters, or other porous biological barriers) that remain wet at the end of cycle cannot prevent contamination of the load when removed from the sterilizer. As the load cools outside the sterilizer, the water in the wrapper will be drawn into the wrapped item. Any contamination that is prent in the environment can be drawn through the sterile barrier along with the water. There are numerous other possible caus for wet loads.The most common are:
网建
因此， 循环结束时发现物品变得潮湿。 放于会收集冷凝水的位置的包裹物品不会被干燥。 物品的放置应允许冷凝水向下流动。 物品（包裹、 呼吸袋、过滤器或其它多孔生物滤膜） 由于在循环结束时仍是湿的，在从灭菌柜取出时不能避免装载的污染。由于在灭菌柜外冷却，包裹上的水会浸入到被包裹的物品中。 任何环境中的污染源都可能随水一起穿过无菌屏障。 还有许多其它原因可能会造成装载潮湿，最常见的是：
a. Insufficient drying vacuum level or time programmed
程序设计干燥真空水平或时间不够
b. Rubber or plastic items in pouches (i.e., rubber stoppers, plastic tubing) may require additional drying (a puld air or heated puld-air drying process is recommended for the items)创意社区
袋装的橡胶或塑料制品（如橡胶塞、塑料管）可能需要额外的干燥（ 对于这些物品，推荐采用脉动空气或脉动热空气干燥工艺）
英语朗读文章c. Wet steam
湿蒸汽
While there is no single solution to eliminating wet loads, it’s likely that experimenting with drying time, repositioning items, reducing load density, modifying cycle ttings, and investigating steam quality will resolve the problem.
由于没有哪个方案一定能有效消除装载潮湿，很可能通过试验干燥时间、重新放置物品、降低装载密度、改进循环设置和调查蒸汽质量可以解决这个问题。
