{"id":54,"date":"2013-01-24T19:13:31","date_gmt":"2013-01-24T17:13:31","guid":{"rendered":"http:\/\/medfam.ro\/medlex\/?p=54"},"modified":"2013-01-24T19:35:37","modified_gmt":"2013-01-24T17:35:37","slug":"norma-tehnica-din-06032003-privind-efectuarea-sterilizarii-si-pastrarea-sterilitatii-dispozitivelor-materialelor-sanitare","status":"publish","type":"post","link":"https:\/\/medfam.ro\/medlex\/norma-tehnica-din-06032003-privind-efectuarea-sterilizarii-si-pastrarea-sterilitatii-dispozitivelor-materialelor-sanitare\/","title":{"rendered":"Norma tehnica din 06\/03\/2003"},"content":{"rendered":"

\u00a0Norma tehnica din 06\/03\/2003<\/strong><\/p>\n

Publicat in Monitorul Oficial, Partea I nr. 194bis din 26\/03\/2003\u00a0<\/strong>privind efectuarea steriliz\u0103rii \u015fi p\u0103strarea sterilit\u0103\u0163ii dispozitivelor<\/strong>\u00a0materialelor sanitare<\/strong><\/p>\n

\u00a0 \u00a0Art. 1. – INTRODUCERE<\/span><\/p>\n

Sterilizarea este opera\u0163iunea prin care sunt eliminate sau omor\u00e2te microorganismele, inclusiv cele aflate \u00een stare vegetativ\u0103, de pe obiectele inerte contaminate, rezultatul acestei opera\u0163iuni fiind starea de sterilitate (conform EN 556 = starea unui produs liber de microorganisme viabile). Probabilitatea teoretic\u0103 a existen\u0163ei microorganismelor <= 10-6<\/sup>.<\/p>\n

Conform normelor EN ISO 9001 \u015fi 9002, precum \u015fi a normelor EN 46001 \u015fi 46002, „sterilizarea face parte din categoria procedurilor speciale, ale c\u0103rei rezultate nu pot fi verificate integral prin controlul final al produsului, efectuat a posteriori, trebuind s\u0103 fie supus\u0103 valid\u0103rii, supravegherii bunei func\u0163ion\u0103ri, precum \u015fi asigur\u0103rii unei p\u0103str\u0103ri corespunz\u0103toare a materialelor sterilizate. Sunt necesare at\u00e2t controlul permanent al opera\u0163iunilor, c\u00e2t \u015fi respectarea permanent\u0103 a procedurilor stabilite, pentru asigurarea conform\u0103rii la exigen\u0163ele specificate”.<\/p>\n

Ob\u0163inerea st\u0103rii de „sterilitate”, precum \u015fi men\u0163inerea ei (p\u00e2n\u0103 \u00een momentul utiliz\u0103rii), reprezint\u0103 o obliga\u0163ie de rezultat, unit\u0103\u0163ile sanitare fiind obligate s\u0103 creeze sistemele de calitate bazate pe normele care se refer\u0103 la cerin\u0163ele sistemelor de calitate.<\/p>\n

Unit\u0103\u0163ile sanitare trebuie s\u0103 garanteze acela\u015fi nivel de securitate a pacien\u0163ilor at\u00e2t \u00een cazul utiliz\u0103rii de dispozitive medicale achizi\u0163ionate de pe pia\u0163\u0103, sau sterilizate \u00een unitatea sanitar\u0103.<\/p>\n

Dispozitivele \u015fi materialele de unic\u0103 folosin\u0163\u0103 nu vor fi niciodat\u0103 reprocesate \u00een vederea reutiliz\u0103rii.<\/p>\n

Dispozitivele medicale care, prin modul de proiectare, sau prin natura materialului din care sunt construite, nu suport\u0103 nici un tip de sterilizare, trebuie s\u0103 fie supuse unei dezinfec\u0163ii adecvate, al c\u0103rei efect s\u0103 fie bactericid (EN 1040), fungicid (EN 1275), virulicid \u015fi sporicid.<\/p>\n

Termenii „produs sterilizant” sau „sterilizare chimic\u0103” sunt utiliza\u0163i pentru o gam\u0103 restr\u00e2ns\u0103 de compu\u015fi chimici (formaldehida, glutaraldehida) care, \u00een condi\u0163ii controlate, pot distruge sporii bacterieni.<\/p>\n

Toate dispozitivele medicale \u015fi materialele care urmeaz\u0103 a fi sterilizate trebuie cur\u0103\u0163ate prin metode fizice \u015fi dezinfectate chimic \u00eenainte de a fi supuse unui proces de sterilizare standardizat.<\/p>\n

Toate instrumentele chirurgicale, materialele textile \u015fi alte obiecte sau solu\u0163ii care p\u0103trund \u00een \u0163esuturile sterile sau sistemul vascular, inclusiv instrumentele stomatologice, trebuie s\u0103 fie sterile (instrumente\/obiecte critice).<\/p>\n

Organizarea activit\u0103\u0163ilor propriu-zise de sterilizare, precum \u015fi activit\u0103\u0163ile conexe (sp\u0103larea, decontaminarea \u015fi \u00eempachetarea, stocarea \u015fi livrarea) va \u0163ine cont de necesitatea respect\u0103rii circuitelor, a evit\u0103rii golurilor de control pe parcursul realiz\u0103rii lor \u015fi a utiliz\u0103rii altor spa\u0163ii dec\u00e2t cele anume desemnate, serviciul central de sterilizare trebuind s\u0103 aib\u0103 un caracter unitar geografic pentru toate etapele men\u0163ionate.<\/p>\n

La organizarea activit\u0103\u0163ii serviciului central de sterilizare vor fi avute \u00een vedere:<\/p>\n

– circuitul de colectare, recipientele \u015fi mijloacele de transport a dispozitivelor murdare, nesterile<\/p>\n

– diminuarea \u00eenc\u0103rc\u0103turii microbiene \u015fi eliminarea \u00eenc\u0103rc\u0103turii organice \u015fi a biofilmului1<\/sup>)<\/a> de pe dispozitivele medicale<\/p>\n

___________<\/p>\n

1<\/sup>) Biofilm = ansamblul de produse organice av\u00e2nd incluse microorganisme (bacterii Gram negative) capabile s\u0103 secrete produse macromoleculare, pe suprafa\u0163a unor materiale. Acesta se constituie \u00een decurs de 3 ore de la utilizarea dispozitivului, \u00eentr-un mediu contaminat. Ne\u00eendep\u0103rtat, constituie o protec\u0163ie pentru bacteriile remanente, permi\u0163\u00e2ndu-le s\u0103 elibereze toxine, responsabile de producerea \u015focului septic. Bifilmul permite bacteriilor s\u0103 reziste la tratamentele de sterilizare \u015fi dezinfec\u0163ie. Majoritatea procedurilor obi\u015fnuite de pretratare nu elimin\u0103 \u00eenc\u0103rc\u0103tura de endotoxine, fiind necesare un pretratament \u015fi o cur\u0103\u0163are riguroase, utiliz\u00e2ndu-se detergen\u0163i enzimatici, \u00eenaintea oric\u0103rui alt tratament.<\/p>\n

 <\/p>\n

– controlul condi\u0163iilor de mediu, verificarea st\u0103rii de func\u0163ionare a aparaturii<\/p>\n

– spa\u0163iul curat pentru inventarierea \u015fi \u00eempachetarea dispozitivelor medicale<\/p>\n

– sterilizarea propriu-zis\u0103 \u015fi sistemul de control al procesului<\/p>\n

– procedurile de control \u015fi marcare a produselor finite<\/p>\n

– tratarea neconformit\u0103\u0163ilor<\/p>\n

– \u00eenregistrarea \u015fi arhivarea datelor privind parcursul procesului, \u00een vederea asigur\u0103rii trasabilit\u0103\u0163ii (ISO 8402), care este un element de sistem de calitate \u015fi este parte component\u0103 a materiovigilen\u0163ei2<\/sup>)<\/a><\/p>\n

___________<\/p>\n

2<\/sup>) Obliga\u0163ia de a declara incidentele sau riscurile de producere a unor incidente legate de utilizarea dispozitivelor medicale; incidentele pot fi legate de sterilizarea acestora.
\n– circuitul de stocare, distribu\u0163ie, transport la utilizatori<\/p>\n

– instruirea personalului<\/p>\n

– echipamentul de protec\u0163ie a personalului, diferen\u0163iat pe etape de proces<\/p>\n

Pentru fiecare etap\u0103 SPCIN va elabora protocoale de procedur\u0103, con\u0163in\u00e2nd instruc\u0163iuni clare \u015fi bine definite, iar personalul serviciului central de sterilizare va fi certificat.<\/p>\n

Circuitele vor fi stabilite \u00een a\u015fa fel \u00eenc\u00e2t s\u0103 asigure securitatea personalului, a mediului \u015fi integritatea dispozitivelor medicale.<\/p>\n

Controlul mediului este important, \u00eentruc\u00e2t permite s\u0103 se:<\/p>\n

– evalueze problemele existente<\/p>\n

– remedieze defec\u0163iunile<\/p>\n

– supravegheze \u015fi corecteze condi\u0163iile de desf\u0103\u015furare a procesului de sterilizare \u015fi a activit\u0103\u0163ilor conexe.<\/p>\n

Pentru aceasta vor fi \u0163inute sub observa\u0163ie \u015fi verificate:<\/p>\n

– calitatea aerului, apei \u015fi a fluidelor utilizate<\/p>\n

– starea de igien\u0103 a suprafe\u0163elor<\/p>\n

– modul de func\u0163ionare a echipamentelor de sterilizare<\/p>\n

– modul de func\u0163ionare a echipamentelor de control, m\u0103sur\u0103 \u015fi testare<\/p>\n

– \u0163inuta \u015fi formarea profesional\u0103 a personalului<\/p>\n

\u00cen unit\u0103\u0163ile de asisten\u0163\u0103 medical\u0103 sterilizarea se poate realiza prin: metode fizice – abur sub presiune (sau abur la temperatur\u0103 \u015fi presiune ridicat\u0103\/sc\u0103zut\u0103), c\u0103ldur\u0103 uscat\u0103, metode chimice – oxid de etilen\u0103, „sterilizan\u0163i” chimici: formaldehid\u0103 \u015fi abur la temperaturi joase \u015fi presiune subatmosferic\u0103.<\/p>\n

\u00cen stadiul actual al datelor \u015ftiin\u0163ifice, sterilizarea cu vapori de ap\u0103 satura\u0163i sub presiune trebuie s\u0103 fie metoda de elec\u0163ie, dac\u0103 dispozitivul medical suport\u0103 aceast\u0103 procedur\u0103.<\/p>\n

Art. 2. – CUR\u0102\u0162AREA (DECONTAMINAREA\/PREDEZINFEC\u0162IA), DEZINFEC\u0162IA \u015eI PREG\u0102TIREA MATERIALULUI MEDICO-CHIRURGICAL (instrumente, echipamente)<\/p>\n

2.1. Decontaminarea\/pre-dezinfec\u0163ia\/cur\u0103\u0163area este primul tratament care se aplic\u0103 dispozitivelor medicale av\u00e2nd scopurile urm\u0103toare:<\/p>\n

– diminueaz\u0103 popula\u0163ia de microorganisme<\/p>\n

– previne uscarea produselor biologice<\/p>\n

– u\u015fureaz\u0103 procesele ulterioare<\/p>\n

– contribuie la protec\u0163ia personalului care-l manipuleaz\u0103, dezasambleaz\u0103, etc.<\/p>\n

– contribuie la protec\u0163ia mediului \u00eempotriva contamin\u0103rii<\/p>\n

\u2022 Se desf\u0103\u015foar\u0103 \u00een dou\u0103 etape:<\/p>\n

– faza de pretratament, realizat\u0103 prin imersia dispozitivelor utilizate, \u00een solu\u0163ie de detergent – dezinfectant (cu ac\u0163iune de deta\u015fare a murd\u0103riei grosiere de pe substrat \u015fi ac\u0163iune bactericid\u0103)<\/p>\n

– faza de cur\u0103\u0163are completeaz\u0103 procesul din faza de pretratament de \u00eendep\u0103rtare a substan\u0163elor proteice, av\u00e2nd rolul de a:<\/p>\n

* elimina murd\u0103ria, \u00eendeosebi materiile organice<\/p>\n

* preveni formarea unui biofilm<\/p>\n

* reduce \u00eenc\u0103rc\u0103tura microbian\u0103 ini\u0163ial\u0103<\/p>\n

Mecanismele de ac\u0163iune \u00een aceast\u0103 faz\u0103 de pretratament – cur\u0103\u0163are sunt:<\/p>\n

– fizico-chimic\u0103, prin detergentul care poate fi:<\/p>\n

\u2022 neutru<\/p>\n

\u2022 alcalin<\/p>\n

\u2022 enzimatic<\/p>\n

– mecanic\u0103 (jet de ap\u0103, periaj, etc)<\/p>\n

– termic\u0103 (temperatura apei)<\/p>\n

Nu se utilizeaz\u0103 produse pe baz\u0103 de aldehide, deoarece acestea au capacitatea de a fixa proteinele de suport.<\/p>\n

Aceast\u0103 faz\u0103 realizeaz\u0103 \u00eendep\u0103rtarea germenilor patogeni prezen\u0163i \u00een propor\u0163ie de p\u00e2n\u0103 la 95-98% \u015fi evitarea transmiterii lor altor bolnavi, personalului medico-sanitar, sau mediului de spital. Doar un obiect bine cur\u0103\u0163at va putea fi sterilizat, \u00een termen absolut.<\/p>\n

Dezinfec\u0163ia dispozitivelor medicale completeaz\u0103 cur\u0103\u0163area (decontaminarea) \u015fi realizeaz\u0103 distrugerea germenilor patogeni \u00een propor\u0163ie de 99,99% existen\u0163i pe instrumentar, echipamente.<\/p>\n

2.2. Cur\u0103\u0163area (decontaminarea) instrumentarului, echipamentelor trebuie realizat\u0103 imediat dup\u0103 utilizarea acestora, c\u00e2t mai aproape de locul utiliz\u0103rii.<\/p>\n

2.3. Pentru anumite obiecte: termometre, t\u0103vi\u0163e renale, garou, cuve, etc. cur\u0103\u0163area urmat\u0103 de dezinfec\u0163ia chimic\u0103 poate fi suficient\u0103.<\/p>\n

Pentru alte obiecte acest tratament va fi completat prin sterilizare fizic\u0103 (instrumente) sau sterilizare chimic\u0103 (echipament termosensibil: endoscoape).<\/p>\n

2.4. Preg\u0103tirea \u00een vederea steriliz\u0103rii a materialului medico-chirurgical utilizat cuprinde 7 etape distincte:<\/p>\n

– cur\u0103\u0163are\/decontaminare (predezinfec\u0163ie), cu cele 2 subetape<\/p>\n

– cl\u0103tire<\/p>\n

– dezinfec\u0163ie<\/p>\n

– cl\u0103tire<\/p>\n

– uscare<\/p>\n

– lubrefiere<\/p>\n

– verificare a integrit\u0103\u0163ii instrumentelor \u015fi \u00eempachetare \u00een vederea steriliz\u0103rii dac\u0103 este necesar<\/p>\n

2.4.1. Cur\u0103\u0163area\/decontaminarea instrumentarului chirurgical\/Pre-dezinfec\u0163ie (\u00een blocul operator, \u00een sec\u0163ii de spital, cabinete medicale, s\u0103li de tratament)<\/p>\n

Se poate realiza manual sau automat cu ajutorul unor echipamente automate de cur\u0103\u0163are.<\/p>\n

Metoda: cur\u0103\u0163are manual\u0103<\/p>\n

Imediat, la sf\u00e2r\u015fitul interven\u0163iei chirurgicale sau efectu\u0103rii pansamentului, instrumentarul folosit se imerseaz\u0103 \u00eentr-un produs etichetat \u015fi avizat ca detergent, detergent enzimatic sau detergent-dezinfectant sau produs de cur\u0103\u0163are-decontaminare pentru instrumentar, \u00een concentra\u0163ia recomandat\u0103 de produc\u0103tor (gama pe care produc\u0103torul instrumentului le recomand\u0103, compatibile cu materialul din care sunt fabricate). Concentra\u0163ia de lucru a produsului utilizat \u00een aceast\u0103 etap\u0103 trebuie s\u0103 acopere spectrul de ac\u0163iune virulicid (inactivarea VHB \u015fi HIV).<\/p>\n

Este de preferat ca \u00een aceast\u0103 etap\u0103 s\u0103 fie utiliza\u0163i dezinfectan\u0163i eticheta\u0163i \u015fi aviza\u0163i ca „dezinfectant pentru instrumentar” cu propriet\u0103\u0163i de cur\u0103\u0163are \u015fi aviza\u0163i de c\u0103tre Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei conform legisla\u0163iei \u00een vigoare.<\/p>\n

Prin folosirea \u00een aceast\u0103 etap\u0103 a unui produs etichetat ca detergent, detergent enzimatic, sau detergent-dezinfectant, sau produs de cur\u0103\u0163are-decontaminare pentru instrumentar, exist\u0103 pericolul contamin\u0103rii personalului ce efectueaz\u0103 aceast\u0103 opera\u0163ie, cu agen\u0163i patogeni transmisibili. Utiliz\u00e2nd \u00een aceast\u0103 etap\u0103 un dezinfectant cu propriet\u0103\u0163i de cur\u0103\u0163are, etichetat ca dezinfectant pentru instrumentar, este eliminat acest risc.<\/p>\n

___________<\/p>\n

*) Materialul nu se refer\u0103 la practica farmaceutic\u0103<\/p>\n

 <\/p>\n

Aten\u0163ie la eticheta produsului utilizat!<\/p>\n

Sunt produse chimice etichetate „Cur\u0103\u0163are \u015fi decontaminare”, „Detergent dezinfectant” care con\u0163in pe l\u00e2ng\u0103 agen\u0163i de spumare cel pu\u0163in un principiu activ recunoscut cu propriet\u0103\u0163i bactericide, fungicide folosite \u00eenainte de dezinfec\u0163ie.<\/p>\n

Pentru dezinfec\u0163ie se utilizeaz\u0103 dezinfectante anume destinate „Dezinfec\u0163iei instrumentarului”, care sunt avizate de Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei \u015fi care se folosesc \u00een mod obligatoriu dup\u0103 decontaminare (cur\u0103\u0163are).<\/p>\n

Protocol de lucru:<\/p>\n

– se perie cu grij\u0103, insist\u00e2nd asupra articula\u0163iilor \u015fi canelurilor utiliz\u00e2nd o perie moale din nailon;<\/p>\n

– instrumentarul se demonteaz\u0103 complet<\/p>\n

– se cur\u0103\u0163\u0103 canelurile cu o compres\u0103<\/p>\n

– se cur\u0103\u0163\u0103 bine toate p\u0103r\u0163ile scobite, jgheaburile, cavit\u0103\u0163ile, cu ajutorul unei seringi<\/p>\n

Metoda: cur\u0103\u0163are automat\u0103 \u00een ma\u015fini de cur\u0103\u0163at automat\u0103 cu program de dezinfec\u0163ie\/baie cu ultrasunete (EN 15883-1)<\/p>\n

Se pot folosi ma\u015fini de sp\u0103lat automate cu program de dezinfec\u0163ie inclus pentru instrumente, avizate de Ministerul S\u0103n\u0103t\u0103\u0163ii\/Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei.<\/p>\n

Dezinfec\u0163ia \u00een ma\u015fina de cur\u0103\u0163at automat\u0103 cu program de dezinfec\u0163ie inclus se realizeaz\u0103 la o temperatur\u0103 \u015fi un timp de expunere care variaz\u0103 \u00een func\u0163ie de fabricant:<\/p>\n

– 75\u00b0C, 20 minute sau 80\u00b0C, 10 minute (sunt distruse formele vegetative ale bacteriilor inclusiv Mycobacteriile dar nu \u015fi VHB);<\/p>\n

– 93\u00b0C, 10 minute (sunt distruse formele vegetative ale bacteriilor inclusiv Mycobacteriile);<\/p>\n

– 105\u00b0C, 1 minut (sunt distruse formele vegetative ale bacteriilor inclusiv Mycobacteriile) sau 105 \u00b0C, 5 minute sau 105 \u00b0C, 7 minute (sunt distruse formele vegetative ale bacteriilor inclusiv Mycobacteriile precum \u015fi sporii de Bacillus antracis).<\/p>\n

Utilizarea ma\u015finilor automate pentru dezinfec\u0163ia instrumentelor au avantajul c\u0103 reduc expunerea personalului la substan\u0163ele chimice toxice, iar timpul de contact cu dezinfectantul poate fi standardizat.<\/p>\n

2.4.2. Cl\u0103tire riguroas\u0103 sub jet de ap\u0103 potabil\u0103<\/p>\n

2.4.3. Dezinfec\u0163ie<\/p>\n

Atunci c\u00e2nd opera\u0163iunea de cur\u0103\u0163are-decontaminare se face manual ea este urmat\u0103 \u00een mod obligatoriu de etapa de dezinfec\u0163ie.<\/p>\n

Se utilizeaz\u0103 obligatoriu un dezinfectant etichetat ca dezinfectant pentru instrumentar \u015fi avizat de Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei \u00een concentra\u0163ia recomandat\u0103 de produc\u0103tor (se va alege un dezinfectant anticoroziv).<\/p>\n

Concentra\u0163ia de lucru a solu\u0163iei de dezinfectant trebuie s\u0103 acopere spectrul de ac\u0163iune: bactericid (inclusiv Mycobacterium .terrae – prin testul cantitativ al suspensiei), fungicid, virulicid (inactivarea VHB \u015fi HIV).<\/p>\n

Solu\u0163ia de dezinfectant se pune \u00een cuve\/recipiente cu capac.<\/p>\n

Instrumentarul este imersat \u00een solu\u0163ia de dezinfectant \u00een concentra\u0163ia recomandat\u0103 de produc\u0103tor, av\u00e2nd grij\u0103 ca solu\u0163ia dezinfectant\u0103 s\u0103 \u00eel acopere pe perioada de timp recomandat\u0103 de produc\u0103tor.<\/p>\n

La sf\u00e2r\u015fitul timpului de dezinfec\u0163ie se extrag instrumentele.<\/p>\n

2.4.4. Cl\u0103tire. Se cl\u0103tesc instrumentele cu ap\u0103 din abunden\u0163\u0103.<\/p>\n

2.4.5. Uscare cu un prosop curat sau aer comprimat.<\/p>\n

2.4.6. Se lubrefiaz\u0103 instrumentarul care necesit\u0103 acest tratament.<\/p>\n

2.4.7. Se verific\u0103 integritatea instrumentului.<\/p>\n

2.4.8. Se \u00eempacheteaz\u0103 instrumentarul \u00een vederea steriliz\u0103rii, pe o suprafa\u0163\u0103 curat\u0103.<\/p>\n

2.14. Reguli generale:<\/p>\n

Cur\u0103\u0163area\/decontaminarea instrumentelor \u015fi aparatelor medico-chirurgicale este urmat\u0103 \u00een mod obligatoriu de dezinfec\u0163ia acestora cu un dezinfectant etichetat \u015fi avizat ca dezinfectant pentru instrumentar, de Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei \u015fi preg\u0103tirea lui \u00een vederea steriliz\u0103rii. Este obligatoriu s\u0103 se efectueze \u00eentr-o \u00eenc\u0103pere\/spa\u0163iu special destinat cu dot\u0103rile corespunz\u0103toare.<\/p>\n

Personalul care efectueaz\u0103 aceast\u0103 opera\u0163iune va respecta precau\u0163iile universale.<\/p>\n

Personalul care efectueaz\u0103 aceast\u0103 opera\u0163iune trebuie s\u0103 poarte echipament de protec\u0163ie: halat, m\u0103nu\u015fi, sor\u0163 de cauciuc, ochelari de protec\u0163ie, etc.<\/p>\n

Protocolul privind cur\u0103\u0163area (decontaminarea) urmat\u0103 \u00een mod obligatoriu de dezinfec\u0163ia \u015fi preg\u0103tirea materialului medico-chirurgical \u00een vederea steriliz\u0103rii chimice sau fizice va fi afi\u015fat la loc vizibil.<\/p>\n

2.15. Responsabili:<\/p>\n

Asistenta medical\u0103 responsabilizat\u0103 cu preg\u0103tirea, cur\u0103\u0163area (decontaminarea) \u015fi dezinfec\u0163ia instrumentarului medico-chirurgical.<\/p>\n

2.16. Evaluare:<\/p>\n

Medicul \u015fef de sec\u0163ie \u015fi asistenta \u015fef\u0103 sau medicul de cabinet controleaz\u0103 respectarea tehnicii de cur\u0103\u0163are\/decontaminare (de preferat a fi utilizat un dezinfectant etichetat ca dezinfectant pentru instrumentar \u015fi avizat de Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei, cu propriet\u0103\u0163i bune de cur\u0103\u0163are \u00een cazul \u00een care aceast\u0103 opera\u0163iune se face manual) urmat\u0103 de dezinfec\u0163ie \u015fi preg\u0103tire a instrumentarului, echipamentului.<\/p>\n

Eficacitatea procedurii de cur\u0103\u0163are\/decontaminare urmat\u0103 de dezinfec\u0163ie se verific\u0103 prin prelevare de probe \u015fi investigare bacteriologic\u0103.<\/p>\n

Art. 3. – \u00ceMPACHETAREA MATERIALULUI DE STERILIZAT<\/p>\n

3.1. Va fi utilizat numai material pentru \u00eempachetare avizat de Ministerul S\u0103n\u0103t\u0103\u0163ii\/Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei \u015fi \u0163in\u00e2nd cont de recomand\u0103rile produc\u0103torului.<\/p>\n

3.2. Materialele care se sterilizeaz\u0103 pot fi \u00eempachetate \u00een:<\/p>\n

– cutii metalice (pentru sterilizarea cu aer cald).<\/p>\n

– cutii metalice perforate (pentru sterilizarea cu abur sub presiune).<\/p>\n

– casolete perforate cu colier (pentru sterilizarea cu abur sub presiune).<\/p>\n

– h\u00e2rtie special\u0103 pentru \u00eempachetarea instrumentarului sau materialului textil fabricat\u0103 special pentru sterilizarea cu abur sub presiune (EN 868-2).<\/p>\n

– pungi\/role h\u00e2rtie plastic fabricate special pentru sterilizarea cu aer cald sau oxid de etilen\u0103 cu indicatori fizico-chimici de temperatur\u0103.<\/p>\n

– pungi\/role h\u00e2rtie plastic fabricate special pentru sterilizarea cu abur sub presiune sau abur \u015fi formaldehid\u0103 la temperaturi joase presiune subatmosferic\u0103, cu indicatori fizico-chimici de temperatur\u0103.<\/p>\n

3.3. Pungile\/rolele h\u00e2rtie plastic achizi\u0163ionate trebuie s\u0103 fie sudate cu trei r\u00e2nduri de benzi a c\u00e2te 10 mm fiecare (conform standardelor Europene).<\/p>\n

Pungile\/rolele h\u00e2rtie plastic de diferite dimensiuni, cu sau f\u0103r\u0103 pliu, dup\u0103 ce au fost \u00eenc\u0103rcate cu instrumentar (truse) sau material textil (pentru o procedur\u0103) \u015fi indicator fizico-chimic „integrator” trebuie sudate\/lipite la cap\u0103tul de acces.<\/p>\n

Sudarea se realizeaz\u0103 cu ajutorul unui aparat special dedicat acestei opera\u0163ii.<\/p>\n

Se pot folosi \u015fi pungi care la cap\u0103tul de acces au sistem autocolant pentru lipirea pachetului.<\/p>\n

Pungile h\u00e2rtie plastic cu instrumentar, material moale (truse) se a\u015feaz\u0103 \u00een co\u015furi\/navete metalice \u00een pozi\u0163ie vertical\u0103, ordonate ca \u015fi c\u0103r\u0163ile \u00een bibliotec\u0103. Co\u015furile\/navetele metalice astfel \u00eenc\u0103rcate se introduc \u00een incinta sterilizatorului.<\/p>\n

3.4. H\u00e2rtia special\u0103 pentru \u00eempachetarea instrumentarului, m\u0103nu\u015filor sau materialului textil.<\/p>\n

Ambalarea se realizeaz\u0103 obligatoriu \u00een dou\u0103 straturi de h\u00e2rtie special\u0103, astfel \u00eenc\u00e2t materialul de sterilizat s\u0103 fie bine \u00eenchis, f\u0103r\u0103 solu\u0163ii de continuitate; dup\u0103 plierea celui de al doilea strat acesta se \u00eenchide cu band\u0103 adeziv\u0103 cu indicator fizico-chimic de virare a culorii.<\/p>\n

3.5. Materialul ambalat \u00een h\u00e2rtie special\u0103 sau pungi h\u00e2rtie plastic se a\u015feaz\u0103 \u00een co\u015furi\/navete metalice. \u00cen func\u0163ie de m\u0103rimea pachetului, \u00een co\u015furi\/navete se a\u015feaz\u0103 un singur pachet sau dou\u0103, dar nesuprapuse pentru a permite p\u0103trunderea agentului de sterilizare \u00een interiorul pachetelor.<\/p>\n

3.6. Dup\u0103 ambalarea materialului de sterilizat \u00een h\u00e2rtie special\u0103 sau pungi h\u00e2rtie plastic \u015fi a\u015fezare \u00een co\u015furi\/navete, manipularea pachetelor se face numai prin intermediul acestora.<\/p>\n

3.7. \u00cen cutiile metalice perforate sau nu, casoletele perforate cu colier se introduce materialul de sterilizat (trusa) \u015fi indicatori fizico-chimici „integratori” adecva\u0163i, pentru controlul eficacit\u0103\u0163ii steriliz\u0103rii sau alt indicator fizico-chimic, se \u00eenchide capacul. Se lipesc dou\u0103 buc\u0103\u0163i de band\u0103 adeziv\u0103 cu indicator chimic adecvat \u00een vederea fix\u0103rii capacului.<\/p>\n

Pot fi folosite \u015fi cutii metalice perforate prev\u0103zute cu valve sau filtre; utilizarea \u015fi \u00eentre\u0163inerea acestora se face conform instruc\u0163iunilor produc\u0103torului.<\/p>\n

3.8. Casoletele perforate cu colier se \u00eencarc\u0103 cu o anumit\u0103 cantitate de material textil, \u00een func\u0163ie de dimensiune (vezi tabelul 1).<\/p>\n

Aprecierea \u00eenc\u0103rc\u0103rii casoletelor cu textile: se c\u00e2nt\u0103re\u015fte con\u0163inutul casoletei, care trebuie s\u0103 corespund\u0103 urm\u0103toarelor norme de greutate pe casolet\u0103:<\/p>\n

 <\/p>\n

Tabelul 1<\/p>\n

\n\n\n\n
\u250c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2510
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0DIMENSIUNILE\u00a0CASOLETEI\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Greutatea\u00a0normal\u0103\u00a0a\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2524\u00eenc\u0103rc\u0103rii\u00a0de\u00a0textile\u00a0(g)\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u03a6\u00a0(mm)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00cen\u0103l\u0163imea\u00a0(mm)\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0140\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0105\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0191\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0190\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0145\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0492\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0240\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0165\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0895\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0290\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0180\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a01426\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0340\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0250\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02724\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0390\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0300\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a04301\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2514\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2518<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

Exist\u0103 cutii metalice perforate echipate cu valve sau filtre; utilizarea acestora se face conform instruc\u0163iunilor produc\u0103torului.<\/p>\n

3.9. Utiliza\u0163i numai cutiile metalice perforate sau casoletele perforate cu colier \u00een perfect\u0103 stare (nedeformate, capacul s\u0103 se \u00eenchid\u0103 etan\u015f, colierul s\u0103 se muleze perfect pe corpul casoletei)<\/p>\n

Nu utiliza\u0163i cutii metalice neperforate pentru sterilizarea la autoclav.<\/p>\n

3.10. H\u00e2rtia special\u0103 \u015fi pungile h\u00e2rtie plastic folosite la \u00eempachetare NU se reutilizeaz\u0103.<\/p>\n

3.11. Standardizarea \u00eenc\u0103rc\u0103turii incintei<\/p>\n

Indiferent de tipul de sterilizator utilizat \u00eenc\u0103rcarea incintei trebuie s\u0103 respecte anumite reguli pentru a asigura uniformizarea procesului, astfel<\/p>\n

– materialele de sterilizat se a\u015feaz\u0103 astfel \u00eenc\u00e2t contactul cu agentul sterilizant s\u0103 fie c\u00e2t mai u\u015for de realizat<\/p>\n

– materialele de sterilizat se \u00eempacheteaz\u0103 lejer pentru a permite p\u0103trunderea agentului de sterilizare \u00een pachete. Nu se admit pachete cu dimensiuni mai mari de 30\/30\/50 cm<\/p>\n

– greutatea unui pachet trebuie s\u0103 fie mai mic\u0103 de 5 Kg<\/p>\n

Respecta\u0163i recomand\u0103rile produc\u0103torului aparatului privind cantitatea de material de sterilizat cu care se poate \u00eenc\u0103rca aparatul la un ciclu de sterilizare, pentru a func\u0163iona la parametrii proiecta\u0163i.<\/p>\n

Art. 4. – STERILIZAREA<\/p>\n

Vor fi folosite numai aparate de sterilizare autorizate de autoritatea central\u0103 \u00een domeniul s\u0103n\u0103t\u0103\u0163ii (Ministerul S\u0103n\u0103t\u0103\u0163ii\/Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei).<\/p>\n

Presiunile, temperatura \u015fi timpul de sterilizare cuprinse \u00een cele ce urmeaz\u0103 reprezint\u0103 valori de siguran\u0163\u0103 pentru eficacitatea steriliz\u0103rii \u00een func\u0163ie de aparat.<\/p>\n

La \u00eenc\u0103rcarea incintei de sterilizare l\u0103sa\u0163i spa\u0163ii \u00eentre pachete \u015fi \u00eentre pachete \u015fi pere\u0163i pentru a permite circularea \u015fi p\u0103trunderea \u00een \u015fi printre pachete a agentului de sterilizare.<\/p>\n

L\u0103sa\u0163i \u00een incinta de sterilizare rafturile cu care este echipat aparatul.<\/p>\n

Nu supra\u00eenc\u0103rca\u0163i \u00eenghesuind cutiile metalice, casoletele, co\u015furile\/navetele \u00een incinta de sterilizare.<\/p>\n

Citi\u0163i cu aten\u0163ie instruc\u0163iunile de utilizare \u015fi cartea tehnic\u0103 a aparatului pentru a folosi temperatura, presiunea \u015fi timpul de sterilizare recomandat de produc\u0103tor pentru tipurile de materiale de sterilizat ambalate.<\/p>\n

Afi\u015fa\u0163i la loc vizibil instruc\u0163iunile de utilizare pentru fiecare sterilizator.<\/p>\n

Este interzis\u0103 utilizarea sterilizatoarelor cu bile de cuar\u0163 pentru sterilizarea instrumentelor utilizate \u00een cabinetele de stomatologie.<\/p>\n

Art. 4. . – STERILIZAREA LA STERILIZATOR CU AER CALD (PUPINEL, ETUV\u0102)<\/p>\n

4.1.1. La sterilizatorul cu aer cald se sterilizeaz\u0103 sticl\u0103ria \u015fi instrumentarul care nu suport\u0103 sterilizarea cu aburi sub presiune (o\u0163el ne-inoxidabil: cromat).<\/p>\n

Sterilizatorul cu aer cald este total contraindicat pentru materiale textile, lichide \u015fi cauciuc.<\/p>\n

4.1.2. Sterilizarea<\/p>\n

4.1.2.1. Ciclul complet de sterilizare la sterilizatorul cu aer cald cuprinde urm\u0103toarele faze:<\/p>\n

– faza de \u00eenc\u0103lzire a aparatului: intervalul de timp \u00eentre pornirea aparatului \u015fi \u00eenceperea cre\u015fterii temperaturii; durata – \u00een func\u0163ie de aparat.<\/p>\n

– faza de laten\u0163\u0103 (omogenizare): intervalul de timp \u00een care are loc propagarea \u015fi cre\u015fterea temperaturii pentru atingerea temperaturii de sterilizare \u00een cutiile metalice\/pachetele din co\u015furi; durata \u00een func\u0163ie de aparat, de natura \u015fi cantitatea materialului de sterilizat.<\/p>\n

– faza de sterilizare: durata depinde de temperatur\u0103<\/p>\n

– 180\u00b0C, 1 or\u0103 sau<\/p>\n

– 160\u00b0C, 2 ore<\/p>\n

– faza de r\u0103cire: durata \u00een func\u0163ie de aparat, de natura \u015fi cantitatea, materialului de sterilizat.<\/p>\n

Un ciclu complet de sterilizare dureaz\u0103 \u00eentre 4 – 5 ore.<\/p>\n

4.1.2.2. Cutiile metalice cu instrumentar se introduc \u00eenchise \u00een incinta sterilizatorului cu aer cald.<\/p>\n

4.1.2.3. \u00cen func\u0163ie de solu\u0163iile tehnice ale sterilizatorului cu aer cald (cu sau f\u0103r\u0103 ventilator, cu termocuplu \u00een incinta de sterilizare pentru monitorizarea temperaturii, etc.) pot fi acceptate temperaturi \u015fi timpi de sterilizare indica\u0163i de produc\u0103torul aparatului.<\/p>\n

4.1.2.4. Timpul de sterilizare se m\u0103soar\u0103 din momentul atingerii temperaturii de sterilizare \u00een interiorul \u00eenc\u0103rc\u0103turii.<\/p>\n

Nu deschide\u0163i niciodat\u0103 sterilizatorul cu aer cald \u00een timpul perioadei de sterilizare pentru a introduce noi pachete.<\/p>\n

4.1.3. Durata men\u0163inerii sterilit\u0103\u0163ii<\/p>\n

Durata men\u0163inerii sterilit\u0103\u0163ii materialelor ambalate \u00een cutii metalice este de 24 de ore de la sterilizare, cu condi\u0163ia men\u0163inerii cutiilor metalice \u00eenchise.<\/p>\n

Durata men\u0163inerii sterilit\u0103\u0163ii materialelor ambalate \u00een pungi h\u00e2rtie-plastic sudate este de 2 luni de la sterilizare, cu condi\u0163ia men\u0163inerii integrit\u0103\u0163ii lor \u015fi a manipul\u0103rii acestora numai prin intermediul co\u015fului.<\/p>\n

4.1.4. La \u00eencheierea ciclului complet de sterilizare<\/p>\n

4.1.4.1. La \u00eencheierea ciclului de sterilizare nu deschide\u0163i niciodat\u0103 sterilizatorul cu aer cald \u00eenainte ca temperatura s\u0103 fie sub 50\u00b0C. La extragerea pachetelor din sterilizatorul cu aer cald folosi\u0163i m\u0103nu\u015fi din bumbac.<\/p>\n

4.1.4.2. Verifica\u0163i indicatorii de eficien\u0163\u0103 ai steriliz\u0103rii:<\/p>\n

– virarea culorii la benzile adezive cu indicator fizico-chimic.<\/p>\n

– virarea culorii la indicatorii fizico-chimici „integratori”: se poate verifica pentru materialele ambalate \u00een pungi h\u00e2rtie plastic prin transparen\u0163a plasticului. Pentru materialele ambalate \u00een cutii metalice, verificarea se face de c\u0103tre utilizatori, la deschiderea acestora. \u00cen situa\u0163ia \u00een care virajul nu s-a realizat, materialul se consider\u0103 nesterilizat \u015fi nu se utilizeaz\u0103.<\/p>\n

4.1.4.3. Lipi\u0163i o etichet\u0103 pe capac\/banderol\u0103 pentru a identifica dispozitivele medicale \u015fi materialele sterilizate. Se noteaz\u0103 data, ora, sterilizatorul cu aer cald la care se va efectua sterilizarea, persoana care efectueaz\u0103 sterilizarea.<\/p>\n

4.1.4.4. Nota\u0163i \u00een caietul de sterilizare: data, con\u0163inutul cutiilor (pachetelor), temperatura la care s-a efectuat sterilizarea, durata, rezultatele indicatorilor chimici, semn\u0103tura persoanei responsabilizate cu sterilizarea, observa\u0163ii.<\/p>\n

4.1.5. Evaluarea eficacit\u0103\u0163ii steriliz\u0103rii la sterilizatorul cu aer cald:<\/p>\n

4.1.5.1. Evaluarea pentru fiecare ciclu:<\/p>\n

Se cite\u015fte temperatura termometrului (dac\u0103 aparatul este echipat) sau temperatura afi\u015fat\u0103 pe monitor. Temperatura se noteaz\u0103 \u00een caietul de sterilizare.<\/p>\n

Se cite\u015fte virarea culorii indicatorului fizico-chimic de pe cutie.<\/p>\n

Se cite\u015fte virarea culorii indicatorului „integrator” pentru sterilizatorul cu aer cald, care controleaz\u0103 timpul \u015fi temperatura. Ex. tuburi Browne. Indicatorul integrator plasat \u00een interiorul cutiilor metalice indic\u0103 dac\u0103 au fost \u00eendeplinite condi\u0163iile pentru o sterilizare eficient\u0103 – temperatura atins\u0103 \u00een interiorul pachetului \u015fi timpul de expunere.<\/p>\n

4.1.5.2. O dat\u0103 pe lun\u0103<\/p>\n

Se controleaz\u0103 fazele procesului de sterilizare realiz\u00e2nd graficul timp\/temperatur\u0103 al unui ciclu de sterilizare complet, cu aparatul \u00eenc\u0103rcat cu cantitatea de material recomandat\u0103 de produc\u0103tor.<\/p>\n

Gradientul de temperatur\u0103 \u00een timpul perioadei de sterilizare (precizia de termostatare): \u00b1 1\u00b0C.<\/p>\n

Se utilizeaz\u0103 indicator biologic cu Bacillus subtillis pentru controlul eficacit\u0103\u0163ii steriliz\u0103rii. Pot fi utiliza\u0163i indicatori biologici cu Bacillus subtillis prepara\u0163i industrial, comercializa\u0163i, care con\u0163in 106<\/sup> UFC sau prepara\u0163i \u00een laborator. Se utilizeaz\u0103 pachete-test (cutii metalice sau cutii de sering\u0103) cu 2 flacoane\/tuburi de indicatorul biologic \u015fi se plaseaz\u0103 cel pu\u0163in un pachet-test \u00een mijlocul incintei sterilizatorului cu aer cald, odat\u0103 cu celelalte pachete pentru sterilizat. Se realizeaz\u0103 ciclul complet de sterilizare. La sf\u00e2r\u015fitul ciclului, indicatorii biologici se extrag din cutie \u015fi se incubeaz\u0103 48 ore la 56\u00b0C, la laborator. Pentru indicatorii biologici comercializa\u0163i, citi\u0163i cu aten\u0163ie \u015fi respecta\u0163i instruc\u0163iunile produc\u0103torului. Laboratorul va emite un buletin de analiz\u0103 cu rezultatul constatat.<\/p>\n

4.1.5.3. La 6 luni<\/p>\n

Se efectueaz\u0103 verificarea aparatului \u00een prezen\u0163a tehnicianului de la o societate autorizat\u0103. Se controleaz\u0103 termostatul \u015fi dac\u0103 aparatul atinge temperatura corect\u0103 \u00een cutii, utiliz\u00e2nd un termometru maximal.<\/p>\n

Art. 4. . – STERILIZAREA CU ABUR SUB PRESIUNE – AUTOCLAV\u0102<\/p>\n

4.2.1. Sterilizarea la autoclav\u0103 se realizeaz\u0103 \u00een sta\u0163ia central\u0103 de sterilizare sau punct de sterilizare la autoclav\u0103 ata\u015fat blocului operator \u015fi accesibil pentru toate serviciile sau ata\u015fat laboratorului clinic.<\/p>\n

4.2.2. Principiul steriliz\u0103rii cu abur sub presiune a\u015fa cum se realizeaz\u0103 \u00een autoclav\u0103 este de a expune fiecare articol direct la contactul cu aburul la temperatura \u015fi presiunea pentru timpul specificat. Aburul ideal pentru sterilizare este abur uscat saturat 100% (absen\u0163a condensului).<\/p>\n

4.2.3. Sunt admise a se utiliza 2 tipuri de autoclave:<\/p>\n

4.2.3.1. Sterilizatorul cu abur sub presiune cu pre \u015fi post vacuumare.<\/p>\n

Sterilizarea la sterilizatorul cu abur sub presiune cu pre \u015fi post vacuumare este cea mai bun\u0103 metod\u0103 de sterilizare a instrumentarului chirurgical din o\u0163el inoxidabil \u00eempachetat \u015fi singura metod\u0103 posibil\u0103 pentru sterilizarea materialului moale (textile), cauciucului, sticl\u0103riei. Este folosit \u015fi \u00een decontaminarea de\u015feurilor din laborator (de\u015feuri infec\u0163ioase).<\/p>\n

4.2.3.2. Sterilizatorul cu abur sub presiune f\u0103r\u0103 post vacuumare. Este folosit pentru sterilizarea mediilor de laborator, lichidelor \u00een flacoane, instrumentar ne\u00eempachetat. Timpul de p\u0103trundere al aburului este prelungit datorit\u0103 elimin\u0103rii incomplete a aerului.<\/p>\n

4.2.4. Pot fi utilizate programe de sterilizare pentru instrumentar ne\u00eempachetat folosind autoclave amplasate \u00een imediata apropiere a s\u0103lilor de opera\u0163ie. Temperatura este 134\u00b0C.<\/p>\n

Sterilizarea instrumentarului ne\u00eempachetat se poate face numai \u00een caz de urgen\u0163e medico-chirurgicale, c\u00e2nd instrumentarul disponibil este insuficient, iar utilizarea acestuia se face imediat (f\u0103r\u0103 stocare).<\/p>\n

4.2.5. Sterilizarea<\/p>\n

4.2.5.1. Ciclul complet de sterilizare la sterilizatorul cu abur sub presiune cuprinde urm\u0103toarele faze:<\/p>\n

a) Faza de pretratament \u015fi pre\u00eenc\u0103lzire (prevacuumare):<\/p>\n

Pretratamentul const\u0103 din mai multe secven\u0163e de admisie de abur \u015fi evacuare, realizat printr-un num\u0103r de varia\u0163ii de presiune – purj\u0103ri – (+ 0,8 – + 1 atm.\/- 0,8 – – 1 atm.) \u015fi are drept scop s\u0103 \u00eendep\u0103rteze aerul din materialul de sterilizat concomitent cu umezirea acestuia necesar\u0103 \u00eenaintea fazei de sterilizare.<\/p>\n

\u00cen situa\u0163ia autoclav\u0103rii solu\u0163iilor apoase \u00een recipiente deschise, \u00eendep\u0103rtarea aerului se realizeaz\u0103 printr-un curent de abur.<\/p>\n

b) Faza de sterilizare:<\/p>\n

Timpul de sterilizare se m\u0103soar\u0103 din momentul atingerii temperaturii de sterilizare \u00een interiorul \u00eenc\u0103rc\u0103turii. \u00cen func\u0163ie de temperatura, presiunea aleas\u0103, timpul de sterilizare dureaz\u0103 un num\u0103r de minute.<\/p>\n

Pentru sterilizatoarele cu abur saturat la presiune \u00eenalt\u0103 (cu pre \u015fi post vacuumare) cu programe prestabilite sau programate op\u0163ional, faza de sterilizare se declan\u015feaz\u0103 \u00een momentul \u00een care traductorul de temperatur\u0103 din incinta de sterilizare semnalizeaz\u0103 o temperatur\u0103 egal\u0103 sau mai mare cu temperatura specificat\u0103 a programului selectat. Varia\u0163ia temperaturii de sterilizare admis\u0103 este de \u00b1 1,5\u00b0C.<\/p>\n

Pentru procesarea lichidelor pot fi folosite sterilizatoare cu abur saturat la presiune \u00eenalt\u0103 cu programe de sterilizare a lichidelor, la care temperatura de sterilizare este m\u0103surat\u0103 \u00een incinta de sterilizare \u015fi \u00een recipient prin traductori (senzori de temperatur\u0103); condi\u0163ia de \u00eencepere a timpului de sterilizare este ca ambele traductoare, cel din incinta de sterilizare \u015fi cel din recipient, s\u0103 ating\u0103 temperatura de sterilizare programat\u0103.<\/p>\n

 <\/p>\n

Tabelul 2 Parametrii procesului de sterilizare \u00een func\u0163ie de tipul materialului de sterilizat<\/p>\n

\n\n\n\n
\u250c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2510
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Presiune\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Durata\u00a0fazei\u00a0de\u00a0sterilizare\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Materialul\u00a0de\u00a0sterilizat\u2502(bari\/\u00a0\u00a0\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524Temperatura\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Kgf\/cm2<\/sup>)\u2502Autoclave\u00a0cu\u00a0abur\u00a0saturat\u2502Autoclave\u00a0tip\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0la\u00a0presiune\u00a0\u00eenalt\u0103\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0ISM2\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Sticl\u0103rie,\u00a0cauciuc,\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a01,3\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a015\u00a0min\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a030\u00a0min\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0125\u00b0C\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502plastic\u00a0termostabil\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a01,01\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a020\u00a0min\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0121\u00b0C\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a01,2\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a030\u00a0min\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0123\u00b0C\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Instrumentar\u00a0\u015fi\u00a0textile\u00a0\u2502\u00a0\u00a02\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a05-10\u00a0min\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a030\u00a0min\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0134\u00b0C\u00a0\u00a0\u00a0\u2502
\n\u2514\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2518<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

c) Faza de post-tratament (postvacuumare):<\/p>\n

Este destinat\u0103 normaliz\u0103rii \u00een ce prive\u015fte temperatura \u015fi umiditatea materialului de sterilizat. Toate tipurile de material de sterilizat, cu excep\u0163ia lichidelor sunt expuse unui vacuum mai sc\u0103zut de – 0,7 bari pentru o anumit\u0103 perioad\u0103 de timp.<\/p>\n

Dup\u0103 faza de postvacuumare textilele pot s\u0103 aib\u0103 o cre\u015ftere \u00een greutate de aproximativ 1%, ceea ce reprezint\u0103 o umiditate normal\u0103 \u00een timpul procesului de sterilizare la sterilizatoarele cu abur saturat la presiune \u00eenalt\u0103, cu pre \u015fi post vacuumare. Pentru autoclavele rom\u00e2ne\u015fti tip ISM2, dup\u0103 faza de postvacuumare textilele pot s\u0103 aib\u0103 o cre\u015ftere \u00een greutate de sub 5%.<\/p>\n

Posttratamentul la sterilizarea solu\u0163iilor apoase \u00een recipiente deschise sau ventilate const\u0103 dintr-o perioad\u0103 de r\u0103cire natural\u0103, timp \u00een care presiunea \u015fi temperatura scad \u00eencet p\u00e2n\u0103 c\u00e2nd temperatura lichidului este sub punctul s\u0103u de fierbere; procesul este accelerat prin aplicarea unui vacuum u\u015for \u00een incint\u0103, atunci c\u00e2nd presiunea din incinta de sterilizare este apropiat\u0103 de presiunea atmosferic\u0103.<\/p>\n

Egalarea presiunii de la vacuum se produce prin admisia aerului atmosferic din mediu, printr-un filtru ce \u00eempiedic\u0103 p\u0103trunderea bacteriilor \u00een incinta de sterilizare.<\/p>\n

4.2.6. La \u00eencheierea ciclului complet de sterilizare<\/p>\n

4.2.6.1. Nu deschide\u0163i niciodat\u0103 sterilizatorul cu abur sub presiune \u00eenainte ca temperatura s\u0103 fie sub 100\u00b0C. La extragerea pachetelor din sterilizatorul cu abur sub presiune folosi\u0163i m\u0103nu\u015fi din bumbac.<\/p>\n

4.2.6.2. Cutiile, casoletele, co\u015furile, navetele cu pachetele sterilizate se depoziteaz\u0103 temporar pe o suprafa\u0163\u0103 special destinat\u0103 materialului steril \u015fi se aranjeaz\u0103 \u00een dulapuri special destinate depozit\u0103rii materialului steril.<\/p>\n

4.2.6.3. La extragerea materialului sterilizat din sterilizatorul cu abur sub presiune se efectueaz\u0103 urm\u0103toarele verific\u0103ri:<\/p>\n

a) Se verific\u0103 parametrii fizici:<\/p>\n

Pentru autoclavele care au sistem de \u00eenregistrare automat\u0103 a ciclului de sterilizare (diagram\u0103) se efectueaz\u0103 analiza acesteia:<\/p>\n

– prin compararea cu diagrama tip furnizat\u0103 de produc\u0103tor<\/p>\n

– prin analiza diagramei urm\u0103rind presiunea \u015fi temperatura atins\u0103 \u00eenregistrat\u0103 pentru fiecare faz\u0103 a ciclului \u00een func\u0163ie de programul ales.<\/p>\n

Pentru autoclavele care nu au sistem de \u00eenregistrare automat\u0103 a ciclului de sterilizare, pe tot parcursul ciclului complet de sterilizare se urm\u0103re\u015fte pe panoul de comand\u0103 \u015fi se noteaz\u0103 temperatura \u015fi presiunea atins\u0103 pentru fiecare faz\u0103 a ciclului. \u00cen aceast\u0103 situa\u0163ie este obligatoriu s\u0103 se foloseasc\u0103 indicatori bilogici (bacteriologici).<\/p>\n

b) Se verific\u0103 vizual integritatea pachetelor ambalate \u00een h\u00e2rtie special\u0103 sau pungi h\u00e2rtie plastic. Se \u00eenchide imediat colierul casoletelor.<\/p>\n

c) Se verific\u0103 indicatorii fizico-chimici de eficien\u0163\u0103 ai steriliz\u0103rii:<\/p>\n

– virarea culorii benzilor adezive cu indicator fizico-chimic de lipite pe cutii, casolete, pachetele ambalate \u00een h\u00e2rtie special\u0103 sau imprimate pe punga h\u00e2rtie plastic.<\/p>\n

– virarea culorii la indicatorii „integratori” plasa\u0163i \u00een interiorul fiec\u0103rui pachet sau \u00eentr-un pache\u0163el-test \u00een fiecare co\u015f verific\u00e2ndu-se temperatura, timpul \u015fi satura\u0163ia vaporilor:<\/p>\n

Se poate verifica pentru materialele ambalate \u00een pungi h\u00e2rtie plastic prin transparen\u0163a plasticului.<\/p>\n

Pentru materialele ambalate \u00een cutii metalice verificarea se face prin verificarea pache\u0163elui-test ata\u015fat la fiecare co\u015f.<\/p>\n

\u00cen situa\u0163ia \u00een care virajul nu s-a realizat, materialul se consider\u0103 nesterilizat \u015fi nu se utilizeaz\u0103.<\/p>\n

d) Se efectueaz\u0103 controlul umidit\u0103\u0163ii textilelor.<\/p>\n

Atunci c\u00e2nd la autoclav\u0103 se sterilizeaz\u0103 textile, se utilizeaz\u0103 o casolet\u0103-test care se plaseaz\u0103 \u00eentre celelalte casolete \u00een mijlocul \u00eenc\u0103rc\u0103turii.<\/p>\n

Casoleta-test se preg\u0103te\u015fte astfel: \u00een func\u0163ie de dimensiunea acesteia se realizeaz\u0103 o \u00eenc\u0103rc\u0103tur\u0103 cu textile \u015fi se plaseaz\u0103 teste de tifon \u00eemp\u0103turit cu o greutate de cca. 20 g \u00een casolet\u0103 \u00een pozi\u0163iile: sub capac, la mijloc \u015fi la fund, pe axul casoletei. Testele se c\u00e2nt\u0103resc la balan\u0163a electronic\u0103 \u00eenainte de a fi puse \u00een casolete \u015fi dup\u0103 scoaterea de la sterilizare din autoclav\u0103.<\/p>\n

Diferen\u0163a de greutate exprimat\u0103 \u00een procent reprezint\u0103 cre\u015fterea umidit\u0103\u0163ii textilelor \u00een cele trei puncte investigate.<\/p>\n

Pentru aparatele la care uscarea se realizeaz\u0103 \u00een condi\u0163ii bune, testele, indiferent de pozi\u0163ia lor \u00een casolet\u0103 indic\u0103 valori sub 5% (pentru autoclavele rom\u00e2ne\u015fti) sau 1% (pentru noile tipuri de autoclave). \u00cen caz c\u0103 aceast\u0103 norm\u0103 de umiditate este dep\u0103\u015fit\u0103 este obligatorie verificarea func\u0163ion\u0103rii autoclavei.<\/p>\n

e) Filtrul de la supapa de admisie a aerului atmosferic se schimb\u0103 dup\u0103 recomand\u0103rile produc\u0103torului aparatului.<\/p>\n

Sunt de preferat filtrele de unic\u0103 utilizare. Eficien\u0163a filtrului poate fi de 99,998% pentru particule de ordinul de m\u0103rime 0,3\u00b5 (0,0003 mm).<\/p>\n

Nu se permite func\u0163ionarea autoclavelor f\u0103r\u0103 filtru sau cu filtru carbonizat.<\/p>\n

f) Cutiile, casoletele, co\u015furile, navetele cu pachetele sterilizate se eticheteaz\u0103 (banderoleaz\u0103) not\u00e2ndu-se data, ora, sterilizatorul cu abur sub presiune la care s-a efectuat sterilizarea, persoana care a efectuat sterilizarea.<\/p>\n

g) Nota\u0163i \u00een caietul de sterilizare: data, num\u0103rul autoclavei atunci c\u00e2nd sunt mai multe, con\u0163inutul pachetelor din \u015farj\u0103 \u015fi num\u0103rul lor, num\u0103rul \u015farjei, temperatura \u015fi presiunea la care s-a efectuat sterilizarea, ora de \u00eencepere \u015fi de \u00eencheiere a ciclului (durata), rezultatele indicatorilor fizico-chimici, semn\u0103tura persoanei responsabilizate cu sterilizarea \u015fi care elibereaz\u0103 materialul steril; se ata\u015feaz\u0103 diagrama ciclului de sterilizare (acolo unde se efectueaz\u0103 \u00eenregistrarea automat\u0103), rezultatul testului Bowie & Dick, observa\u0163ii, data la care s-a efectuat \u00eentre\u0163inerea \u015fi verificarea aparatului.<\/p>\n

4.2.7. Verificarea calit\u0103\u0163ii penetr\u0103rii aburului<\/p>\n

Se realizeaz\u0103 zilnic, \u00eenainte de efectuarea primei steriliz\u0103ri, cu ajutorul testului Bowie & Dick pentru verificarea calit\u0103\u0163ii penetr\u0103rii aburului.<\/p>\n

Se confec\u0163ioneaz\u0103 un pachet-test compus din prosoape de bumbac de 30\/30 cm, care se pun unul peste altul realiz\u00e2nd o \u00een\u0103l\u0163ime de 27,5 cm; \u00een mijlocul acestora se plaseaz\u0103 h\u00e2rtia test Bowie & Dick de aceea\u015fi dimensiune cu prosopul (care are imprimat un model geometric). Se ambaleaz\u0103 etan\u015f \u00eentr-un c\u00e2mp operator, se \u00eenchide cu band\u0103 adeziv\u0103 cu indicator chimic de virare a culorii.<\/p>\n

Pachetul-test astfel confec\u0163ionat se plaseaz\u0103 singur \u00een mijlocul incintei autoclavei.<\/p>\n

Se realizeaz\u0103 un ciclu de sterilizare complet (cu pre \u015fi postvacuumare) la temperatura de 134 \u00b0C, timp de 3,5 minute.<\/p>\n

La sf\u00e2r\u015fitul ciclului complet de sterilizare se extrage din pachet testul \u015fi se interpreteaz\u0103 rezultatul. Dac\u0103 ciclul a fost eficient (absen\u0163a aerului rezidual sau a pungilor de aer) schimbarea culorii modelului geometric imprimat este uniform\u0103. Dac\u0103 penetrarea aburului nu a fost uniform\u0103, au existat pungi de aer, culoarea benzilor este neuniform\u0103 (apar pete mai clare). \u00cen aceast\u0103 situa\u0163ie sterilizarea nu a fost eficient\u0103, sterilizatorul nu trebuie utilizat \u015fi se apeleaz\u0103 la tehnician pentru verificare.<\/p>\n

Testul Bowie & Dick se comercializeaz\u0103 sub forma foi imprimate sau de pachete test gata confec\u0163ionate de diferi\u0163i produc\u0103tori.<\/p>\n

Testul Bowie & Dick trebuie utilizat:<\/p>\n

– zilnic, dac\u0103 la autoclav\u0103 se sterilizeaz\u0103 textile<\/p>\n

– cel pu\u0163in o dat\u0103 pe s\u0103pt\u0103m\u00e2n\u0103 la autoclavele care sterilizeaz\u0103 instrumentar<\/p>\n

– dup\u0103 fiecare repara\u0163ie a autoclavei.<\/p>\n

4.2.8. Indicatori biologici pentru controlul eficacit\u0103\u0163ii steriliz\u0103rii<\/p>\n

Sunt admi\u015fi indicatorii biologici cu forme diferite de condi\u0163ionare:<\/p>\n

4.2.8.1. Indicatori biologici cu Bacillus stearothermophyllus impregna\u0163i pe supor\u0163i de bumbac sub form\u0103 de peticele sau fire de a\u0163\u0103 \u00een concentra\u0163ii de 106<\/sup> UFC.<\/p>\n

Ace\u015ftia se pun \u00een interiorul unei cutii-test. Cutia-test se introduce \u00een autoclav\u0103 odat\u0103 cu materialul de sterilizat \u015fi se realizeaz\u0103 ciclul complet de sterilizare. La sf\u00e2r\u015fitul ciclului, indicatorul biologic este trimis la laborator, unde este extras, \u00eens\u0103m\u00e2n\u0163at \u015fi incubat; citirea se face la 7 zile.<\/p>\n

4.2.8.2. Indicatori biologici cu Bacillus stearothermophyllus impregna\u0163i pe suport \u015fi condi\u0163ionat \u00eempreun\u0103 cu mediul de cultur\u0103 \u00eenfiolat. La sf\u00e2r\u015fitul ciclului se sparge fiola prin presiune asupra tubului exterior \u015fi se incubeaz\u0103. Citirea se face la 24 sau 48 ore.<\/p>\n

Se recomand\u0103 citirea cu aten\u0163ie a prospectului \u015fi respectarea recomand\u0103rilor produc\u0103torului.<\/p>\n

4.2.8.3. Controlul bacteriologic al steriliz\u0103rii la autoclav cu indicator tip „Stearotest 120”.<\/p>\n

Pentru controlul steriliz\u0103rii la autoclav\u0103 la temperatura de 120 \u00b0C cu o durat\u0103 de 30 minute, se pot utiliza produse tip „Stearotest 120”.<\/p>\n

Acest produs este o suspensie de spori de Bacillus stearothermophyllus \u00een solu\u0163ie nutritiv\u0103, cu indicator de pH. Con\u0163inutul fiolelor de „Stearotest 120” este limpede de culoare violet.<\/p>\n

Mod de utilizare:<\/p>\n

a) fiolele de tip „Stearotest 120” se introduc \u00een autoclav\u0103 la diferite niveluri printre dispozitivele medicale \u015fi materialele supuse steriliz\u0103rii la 120 \u00b0C. Se efectueaz\u0103 sterilizarea la parametri indica\u0163i de c\u0103tre produc\u0103tor (de ex. 120 \u00b0C, timp de 30 min);<\/p>\n

b) dup\u0103 sterilizare fiolele sunt a\u015fezate \u00eentr-un incubator de 56 \u00b0C<\/p>\n

c) citirea rezultatelor:<\/p>\n

– men\u0163inerea aspectului (culoare, transparen\u0163\u0103) nemodificat arat\u0103 o sterilizare corect\u0103;<\/p>\n

– virajul la galben al indicatorului de pH \u015fi o u\u015foar\u0103 opalescen\u0163\u0103 a con\u0163inutului indic\u0103 o sterilizare sub parametrii de eficien\u0163\u0103 optim\u0103 (au r\u0103mas spori viabili s-au cultivat \u015fi au modificat aspectul produsului).<\/p>\n

Produsul tip „Stearotest 120” nu este indicat pentru controlul steriliz\u0103rii la autoclav\u0103 la temperaturi mai mari de 120 \u00b0C.<\/p>\n

Modificarea culorii violet a produsului la nuan\u0163e de violet ro\u015fcat p\u00e2n\u0103 la galben, chiar la scoaterea fiolelor din autoclav\u0103, indic\u0103 dep\u0103\u015firea temperaturii de 120 \u00b0C. Aceast\u0103 modificare de culoare se datoreaz\u0103 degrad\u0103rii chimice a substratului din cauza temperaturii ridicate. Asemenea fiole nu mai este necesar s\u0103 fie incubate, deoarece sporii din fiol\u0103 au fost distru\u015fi.<\/p>\n

4.2.9. Durata men\u0163inerii sterilit\u0103\u0163ii<\/p>\n

Durata men\u0163inerii sterilit\u0103\u0163ii materialelor ambalate \u00een cutii metalice perforate sau casolete cu colier este de 24 de ore de la sterilizare, cu condi\u0163ia men\u0163inerii cutiilor, casoletelor \u00eenchise.<\/p>\n

Durata men\u0163inerii sterilit\u0103\u0163ii materialelor ambalate \u00een pungi h\u00e2rtie-plastic sudate este de 2 luni de la sterilizare, cu condi\u0163ia men\u0163inerii integrit\u0103\u0163ii ambalajului.<\/p>\n

Durata men\u0163inerii sterilit\u0103\u0163ii materialelor ambalate \u00een h\u00e2rtie special\u0103 (ambalaj \u00een dou\u0103 straturi de h\u00e2rtie, f\u0103r\u0103 solu\u0163ii de continuitate) este de 1 lun\u0103 de la sterilizare.<\/p>\n

4.2.10. Evaluarea eficacit\u0103\u0163ii steriliz\u0103rii:<\/p>\n

4.2.10.1. Pentru fiecare ciclu:<\/p>\n

Pe tot parcursul ciclului complet de sterilizare se urm\u0103re\u015fte pe panoul de comand\u0103 \u015fi se noteaz\u0103 temperatura \u015fi presiunea atins\u0103 pentru fiecare faz\u0103 a ciclului sau se analizeaz\u0103 diagrama.<\/p>\n

Se cite\u015fte virarea culorii indicatorului pentru temperatura de pe banda adeziv\u0103 (ex. 3M).<\/p>\n

Se cite\u015fte virarea culorii indicatorului „integrator” pentru sterilizatorul cu abur sub presiune, care controleaz\u0103 timpul, temperatura \u015fi satura\u0163ia vaporilor.<\/p>\n

4.2.10.2. Zilnic:<\/p>\n

Se controleaz\u0103 calitatea penetr\u0103rii aburului cu ajutorul testului Bowie & Dick.<\/p>\n

Controlul cu indicator biologic (Bacillus stearothermophyllus) pentru autoclavele din sta\u0163iile centrale de sterilizare sau pentru autoclavele care nu sunt echipate cu dispozitiv automat de \u00eenregistrare (diagrama).<\/p>\n

4.2.10.3. S\u0103pt\u0103m\u00e2nal:<\/p>\n

Se controleaz\u0103 calitatea penetr\u0103rii aburului cu ajutorul testului Bowie & Dick.<\/p>\n

4.2.11. \u00centre\u0163inerea (mentenan\u0163a) autoclavelor<\/p>\n

Cu periodicitatea recomandat\u0103 de produc\u0103torul aparatului se efectueaz\u0103 de c\u0103tre tehnician autorizat verificarea func\u0163ion\u0103rii acestuia.<\/p>\n

Orice defec\u0163iune ap\u0103rut\u0103 la autoclav\u0103 necesit\u0103 interven\u0163ia tehnicianului autorizat.<\/p>\n

Dup\u0103 interven\u0163ia pe aparat se efectueaz\u0103:<\/p>\n

– verificarea parametrilor aparatului urm\u0103rind \u00eenregistr\u0103rile de temperatur\u0103 \u015fi presiune (pe panoului frontal sau diagram\u0103)<\/p>\n

– testul Bowie & Dick pentru verificarea calit\u0103\u0163ii penetr\u0103rii aburului<\/p>\n

– controlul umidit\u0103\u0163ii textilelor.<\/p>\n

4.2.12. \u00cen toate sta\u0163iile centrale de sterilizare sau punctele de sterilizare echipate cu sterilizatoare cu abur sub presiune:<\/p>\n

– Vor fi respectate Normele specifice de protec\u0163ie a muncii \u00een domeniul s\u0103n\u0103t\u0103\u0163ii (Ord. MMPS nr. 411\/1998<\/a>).<\/p>\n

– La amplasarea, dotarea, exploatarea, \u00eentre\u0163inerea, verificarea \u015fi repararea aparatelor, utilajelor \u015fi instala\u0163iilor de sterilizare se vor respecta \u015fi prescrip\u0163iile tehnice ISCIR C 1-85, instruc\u0163iunile produc\u0103torului, m\u0103surile de electro-securitate \u00een vigoare, precum \u015fi prevederile de prevenire \u015fi stingere a incendiilor.<\/p>\n

– Vor fi utilizate numai aparate autorizate de Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei.<\/p>\n

– La fiecare loc de munc\u0103 se vor elabora \u015fi afi\u015fa instruc\u0163iuni tehnice specifice privind exploatarea aparatelor, precum \u015fi m\u0103surile ce trebuie luate \u00een caz de avarii, \u00eentreruperi sau deregl\u0103ri.<\/p>\n

– Asistenta medical\u0103 responsabilizat\u0103 cu sterilizarea va fi instruit\u0103 \u015fi acreditat\u0103 (autorizat\u0103) s\u0103 lucreze cu vase sub presiune.<\/p>\n

Art. 4. . – METODE RECOMANDATE PENTRU INACTIVAREA AGENTULUI ETIOLOGIC A BOLII CREUTZFELDT-JAKOB<\/p>\n

Boala Creutzfeld-Jakob este cauzat\u0103 de prioni. Ace\u015ftia sunt extrem de rezisten\u0163i la metodele uzuale de inactivare.<\/p>\n

Se recomand\u0103 urm\u0103toarele tehnici de sterilizare\/dezinfec\u0163ie:<\/p>\n

Metoda de preferat pentru tratamentul materialului contaminat este sterilizarea la abur pentru cel pu\u0163in 30 minute la 134 \u00b0C c\u00e2nd utiliz\u0103m sterilizatorul cu abur sub presiune f\u0103r\u0103 postvacuumare.<\/p>\n

C\u00e2nd utiliz\u0103m sterilizatorul cu abur sub presiune cu pre \u015fi postvacuumare este eficient tratamentul de 18 minute la 134 \u00b0C – 138 \u00b0C.<\/p>\n

Temperatura de 121 \u00b0C nu este eficient\u0103.<\/p>\n

Alternativ\u0103: imersia \u00een hidroxid de sodiu 1N (solu\u0163ie caustic\u0103) pentru 1 or\u0103 la temperatura camerei, urmat\u0103 de sterilizarea la abur sub presiune cu pre \u015fi postvacuumare la 121 \u00b0C timp de 30 minute poate fi utilizat\u0103 pentru instrumente, echipamente critice \u015fi semi-critice.<\/p>\n

Instrumentele, echipamentele non-critice (ex.: masa de autopsie, paviment) pot fi dezinfectate cu orice dezinfectant nediluat sau hipocloritul de sodiu \u00een dilu\u0163ie mai mare de 1:10 sau hidroxid de sodiu 1N la temperatura camerei, timp de 15 minute. Ace\u015fti dezinfectan\u0163i trebuie utiliza\u0163i pentru ca echipamentele sau instrumentele non-critice sau suprafe\u0163ele s\u0103 nu fie implicate \u00een transmiterea bolii Creutzfeldt-Jakob.<\/p>\n

Art. 4. . – STERILIZAREA APEI PENTRU SP\u0102LAREA CHIRURGICAL\u0102<\/p>\n

Se efectueaz\u0103 \u00een autoclav\u0103 pentru sterilizarea apei, potrivit instruc\u0163iunilor de utilizare din cartea tehnic\u0103 a acestora, la o presiune de sterilizare de 1,5 bari \u015fi un timp de sterilizare de 30 minute.<\/p>\n

Conductele pentru aducerea apei sterile de la autoclave la sp\u0103l\u0103toare trebuie s\u0103 \u00eendeplineasc\u0103 urm\u0103toarele condi\u0163ii:<\/p>\n

a) distan\u0163a maxim\u0103 de la autoclav la punctul de distribu\u0163ie nu va dep\u0103\u015fi 20 m<\/p>\n

b) sunt admise numai conducte f\u0103r\u0103 mufe<\/p>\n

c) eliminarea oric\u0103rei posibilit\u0103\u0163i de contaminare a apei sterile prin stagnarea \u00een sistemul de distribu\u0163ie (cu interzicerea coturilor \u00een „U” sub nivelul conductei)<\/p>\n

d) apa steril\u0103 pentru sp\u0103larea chirurgical\u0103 se prepar\u0103 \u00een ziua utiliz\u0103rii ei.<\/p>\n

Art. 4. . – STERILIZAREA LA STERILIZATOARE CU OXID DE ETILEN\u0102<\/p>\n

4.5.1. Sterilizarea cu oxid de etilen\u0103 se utilizeaz\u0103 numai atunci c\u00e2nd nu exist\u0103 alt mijloc de sterilizare adecvat pentru obiecte, echipamente termosensibile.<\/p>\n

Aceast\u0103 tehnic\u0103 de sterilizare este delicat\u0103 \u015fi erorile de procedur\u0103 pot duce fie la accidente prin sterilizare ineficient\u0103, fie la accidente toxice la personal sau pacien\u0163ii la care se utilizeaz\u0103 materialul sterilizat cu oxid de etilen\u0103.<\/p>\n

4.5.2. Sterilizarea cu oxid de etilen\u0103 se va efectua numai \u00een sta\u0163ia central\u0103 de sterilizare, special echipat\u0103 \u015fi deservit\u0103 de personal calificat, instruit \u015fi acreditat s\u0103 lucreze cu sterilizatoare cu oxid de etilen\u0103.<\/p>\n

4.5.3. Sterilizarea cu oxid de etilen\u0103 nu trebuie niciodat\u0103 utilizat\u0103 pentru sterilizarea materialului medico-chirurgical \u00een urgen\u0163\u0103, deoarece acesta trebuie supus tratamentului de desorb\u0163ie.<\/p>\n

Nu va fi sterilizat cu oxid de etilen\u0103 materialul medico-chirurgical a c\u0103rei compozi\u0163ie nu este cunoscut\u0103.<\/p>\n

4.5.4. Toxicitatea oxidului de etilen\u0103<\/p>\n

Oxidul de etilen\u0103 este un gaz inodor, a c\u0103rui prezen\u0163\u0103 nu este perceput\u0103 \u00een aer.<\/p>\n

El este toxic:<\/p>\n

Prin inhalare: oxidul de etilen\u0103 poate provoca irita\u0163ia c\u0103ilor respiratorii \u015fi depresia sistemului nervos central la personalul care efectueaz\u0103 sterilizarea.<\/p>\n

Prin contact: oxidul de etilen\u0103 poate provoca reac\u0163ii de irita\u0163ie \u015fi apari\u0163ia de vezicule pe piele \u015fi mucoase la personalul care efectueaz\u0103 sterilizarea.<\/p>\n

Pe cale parenteral\u0103: materialul supus insuficient tratamentului de desorb\u0163ie utilizat la bolnavi poate cauza fenomene hemolitice, stenoze traheale, colaps cardiovascular \u015fi fenomene alergice.<\/p>\n

Prin reac\u0163ie cu diferi\u0163i compu\u015fi chimici:<\/p>\n

Echipamentul medical constituit din p\u0103r\u0163i de PVC (policlorur\u0103 de vinil) sterilizat ini\u0163ial cu radia\u0163ii ionizante sau raze gamma nu va fi resterilizat cu oxid de etilen\u0103, deoarece PVC elibereaz\u0103 compu\u015fi toxici – etilen clorhidrin\u0103.<\/p>\n

Inflamabil, pericol de explozie:<\/p>\n

Oxidul de etilen\u0103 \u00een amestec cu aerul este exploziv pornind de la concentra\u0163ia de 3% (\u00een volum).<\/p>\n

Este interzis a se fuma \u00een \u00eenc\u0103perile unde se utilizeaz\u0103 oxidul de etilen\u0103. Aceste \u00eenc\u0103peri trebuie ventilate \u00een permanen\u0163\u0103 direct cu aer proasp\u0103t (din exterior).<\/p>\n

4.5.5. Materialul medico-chirurgical care se sterilizeaz\u0103 cu oxid de etilen\u0103:<\/p>\n

4.5.5.1. Obiecte din material plastic care sunt termosensibile \u015fi pentru care se cunoa\u015fte perioada de timp necesar\u0103 desorb\u0163iei; cu excep\u0163ia obiectelor din PVC sterilizate ini\u0163ial prin radia\u0163ii ionizante \u015fi radia\u0163ii gamma.<\/p>\n

4.5.5.2. Instrumente din materiale compozite, termosensibile (se deterioreaz\u0103 prin sterilizare la abur sub presiune).<\/p>\n

4.5.5.3. Materiale fragile (efectele personale noi ale bolnavilor cu aplazie medular\u0103, etc.)<\/p>\n

4.5.6. Sterilizare<\/p>\n

4.5.6.1. Ciclul complet de sterilizare cuprinde urm\u0103toarele faze: vacuumare ini\u0163ial\u0103, pre\u00eenc\u0103lzire, \u00eendep\u0103rtarea aerului cu umidificarea obiectelor, sterilizare (expunere la gaz), vacuumare final\u0103, purjare de aer \u015fi ventilare, aerare (desorb\u0163ie).<\/p>\n

Parametrii programelor automate de sterilizare sunt:<\/p>\n

a) temperatura de 37 \u00b0C, presiune subatmosferic\u0103, timp de sterilizare 180 minute. Durata procesului 4 – 8 ore.<\/p>\n

b) temperatura de 55 \u00b0C, presiune subatmosferic\u0103, timp de sterilizare 60 minute. Durata procesului 2 – 5 ore.<\/p>\n

Se admit \u015fi al\u0163i parametrii ai programelor automate de sterilizare pe care \u00eei recomand\u0103 produc\u0103torul aparatului: ex. temperatura de 42 \u00b0C, timp de sterilizare 150 minute, etc.<\/p>\n

Se recomand\u0103 a se citi cu aten\u0163ie instruc\u0163iunile de utilizare \u015fi cartea tehnic\u0103 a aparatului pentru a folosi temperatura (presiunea) \u015fi timpul de sterilizare recomandat de produc\u0103tor pentru materialele de sterilizat \u00eempachetate.<\/p>\n

4.5.6.2. Verificarea eficien\u0163ei steriliz\u0103rii:<\/p>\n

Vor fi citite \u015fi interpretate diagramele \u00eenregistrate ale ciclului complet de sterilizare: se cite\u015fte temperatura, presiunea, presiunea negativ\u0103 (vidul) \u015fi durata.<\/p>\n

Indicatorii fizico-chimici, martori ai trecerii prin procesul de sterilizare, special fabrica\u0163i pentru sterilizarea cu oxid de etilen\u0103.<\/p>\n

Pentru fiecare ciclu se folosesc teste biologice (bacteriologice) cu spori de Bacillus subtillis.<\/p>\n

4.5.6.3. Nota\u0163i \u00een caietul de sterilizare: num\u0103rul \u015farjei \u015fi con\u0163inutul pachetelor, data \u015fi ora de debut \u015fi sf\u00e2r\u015fit a ciclului, temperatura la care s-a efectuat sterilizarea, rezultatele indicatorilor fizico-chimici \u015fi biologici, numele \u015fi semn\u0103tura persoanei responsabilizate cu sterilizarea, observa\u0163ii, data la care s-a efectuat \u00eentre\u0163inerea \u015fi verificarea aparatului. Data final\u0103 a desorb\u0163iei va fi notat\u0103 pe fiecare ambalaj.<\/p>\n

4.5.6.4. Desorb\u0163ie<\/p>\n

Materialele sterilizate cu oxidul de etilen\u0103 nu pot fi utilizate dec\u00e2t dup\u0103 ce con\u0163inutul \u00een gaz a sc\u0103zut sub 2 ppm (2 mg\/Kg), valoare fixat\u0103 prin consens.<\/p>\n

Pentru a ajunge la aceste rezultate se utilizeaz\u0103 un spa\u0163iu ventilat, cu o temperatur\u0103 de cel pu\u0163in 20 \u00b0C, care nu este utilizat \u00een alte scopuri \u015fi \u00een care este interzis\u0103 sta\u0163ionarea personalului. Perioada de timp necesar\u0103 desorb\u0163iei este \u00een func\u0163ie de compozi\u0163ia materialelor sterilizate.<\/p>\n

Pentru sterilizatoarele cu oxidul de etilen\u0103 care nu au inclus \u00een ciclul complet de sterilizare desorb\u0163ia la sf\u00e2r\u015fitul programului, timpul de desorb\u0163ie necesar pentru echipamente dup\u0103 extragerea din aparat este mare:<\/p>\n

– 16 s\u0103pt\u0103m\u00e2ni pentru materiale fabricate din poliamide,<\/p>\n

– 6 s\u0103pt\u0103m\u00e2ni pentru materiale fabricate din polielietilen\u0103, teflon, latex, silicon, acetatul de etilenvinil, poliuretan, polipropilen, PVC plastifiat.<\/p>\n

4.5.7. Spa\u0163iile \u00een care se efectueaz\u0103 sterilizarea cu oxid de etilen\u0103<\/p>\n

Sterilizarea cu oxid de etilen\u0103 se va realiza \u00een spa\u0163ii ventilate, destinate numai pentru aceast\u0103 activitate.<\/p>\n

Concentra\u0163ia \u00een aer a oxidului de etilen\u0103 trebuie controlat\u0103 prin:<\/p>\n

– instala\u0163ii fixe tip detector<\/p>\n

– periodic prin serviciul tehnic al spitalului cu ajutorul unor aparate mobile de dozare a gazului (tip Draeger) echipate cu tuburi cu reactivi specifici.<\/p>\n

4.5.8. \u00centre\u0163inere (Mentenan\u0163\u0103)<\/p>\n

Personal tehnic calificat va efectua periodic verificarea \u015fi \u00eentre\u0163inerea aparatului.<\/p>\n

Sterilizatoarele necontrolate pot avea pierderi de gaz \u015fi pot antrena riscuri toxice pentru personal \u015fi risc de explozie.<\/p>\n

Art. 4. . – STERILIZAREA LA STERILIZATOARE CU ABUR \u015eI FORMALDEHID\u0102 LA TEMPERATURI JOASE \u015eI PRESIUNE SUBATMOSFERIC\u0102<\/p>\n

4.7.1. Sterilizatorul cu abur \u015fi formaldehid\u0103 la temperaturi joase \u015fi presiune subatmosferic\u0103 este utilizat \u00een sta\u0163ia central\u0103 de sterilizare a unit\u0103\u0163ilor sanitare pentru sterilizarea obiectelor, echipamentelor sensibile la c\u0103ldur\u0103, care pot fi deteriorate la temperaturile realizate \u00een sterilizatoare cu abur conven\u0163ional. Agentul de sterilizare este formaldehid\u0103, utilizat\u0103 \u00een procesul care are loc la presiune subatmosferic\u0103.<\/p>\n

4.7.2. Sterilizarea cu abur \u015fi formaldehid\u0103 la temperaturi joase \u015fi presiune subatmosferic\u0103 se va efectua numai \u00een sta\u0163ia central\u0103 de sterilizare, special echipat\u0103 \u015fi deservit\u0103 de personal calificat, instruit \u015fi acreditat s\u0103 lucreze cu astfel de aparate.<\/p>\n

4.7.3. Sterilizarea cu abur \u015fi formaldehid\u0103 la temperaturi joase \u015fi presiune subatmosferic\u0103 nu trebuie niciodat\u0103 utilizat\u0103 pentru sterilizarea materialului medico-chirurgical \u00een urgen\u0163\u0103.<\/p>\n

4.7.4. Toxicitatea formaldehidei<\/p>\n

Formaldehid\u0103 este un gaz incolor, cu miros caracteristic. Este u\u015for solubil\u0103 \u00een ap\u0103 p\u00e2n\u0103 la aproximativ 38%, la temperatura camerei. Apa \u015fi gazul pot fi separate prin \u00eenc\u0103lzirea solu\u0163iei.<\/p>\n

Este toxic\u0103.<\/p>\n

Anumite persoane sunt predispuse la alergii cauzate de formaldehid\u0103, chiar la concentra\u0163ii foarte sc\u0103zute \u015fi de aceea este necesar\u0103 o grij\u0103 deosebit\u0103 la manipulare.<\/p>\n

Este toxic\u0103 prin inhalare, \u00eenghi\u0163ire \u015fi contact cu pielea. Doza letal\u0103 este la ingestia a 10-20 ml formaldehid\u0103.<\/p>\n

Este considerat\u0103 ca un poten\u0163ial agent mutagen, cancerigen, teratogen. Este alergizant\u0103. Limita de expunere pentru o scurt\u0103 perioad\u0103 de timp TLV-STEL pentru 15 min. este de 0,3 ppm.<\/p>\n

Formaldehid\u0103 gaz \u00eentr-un anumit amestec cu aerul este exploziv\u0103.<\/p>\n

4.7.5. Sterilizarea<\/p>\n

4.7.5.1. Ciclul complet de sterilizare cuprinde urm\u0103toarele faze: testul de vacuumare, \u00eendep\u0103rtarea aerului cu umidificarea obiectelor, sterilizare (expunere la formaldehid\u0103), purjarea aburului, purjarea aerului, aerare.<\/p>\n

Parametrii programelor automate de sterilizare sunt:<\/p>\n

a) temperatura de 73 \u00b0C, presiune subatmosferic\u0103, timp de sterilizare 10 minute. Durata procesului 3-5 ore.<\/p>\n

b) temperatura de 80 \u00b0C, presiune subatmosferic\u0103, timp de sterilizare 10 minute.<\/p>\n

c) temperatura de 65 \u00b0C, presiune subatmosferic\u0103, timp de sterilizare 30 minute.<\/p>\n

Se admit \u015fi al\u0163i parametrii ai programelor automate de sterilizare pe care \u00eei recomand\u0103 produc\u0103torul aparatului: ex. temperatura de 60 \u00b0C, timp de sterilizare 60 minute, temperatura de 75 \u00b0C, timp de sterilizare 10 minute etc.<\/p>\n

Se recomand\u0103 a se citi cu aten\u0163ie instruc\u0163iunile de utilizare \u015fi cartea tehnic\u0103 a aparatului pentru a folosi temperatura (presiunea) \u015fi timpul de sterilizare recomandat de produc\u0103tor pentru materialele de sterilizat \u00eempachetate.<\/p>\n

4.7.5.2. Formaldehida este stocat\u0103 \u00een stare lichid\u0103 \u00een doze de sticl\u0103 dimensionate pentru un singur ciclu de sterilizare. Din m\u0103suri de securitate este important\u0103 achizi\u0163ionarea \u015fi utilizarea de formaldehid\u0103 \u00eembuteliat\u0103 direct de c\u0103tre produc\u0103tor.<\/p>\n

4.7.5.3. Verificarea eficien\u0163ei steriliz\u0103rii:<\/p>\n

Vor fi citite \u015fi interpretate diagramele \u00eenregistrate ale ciclului complet de sterilizare: se cite\u015fte temperatura, presiunea, presiunea negativ\u0103 (vidul) \u015fi durata.<\/p>\n

Indicatorii fizico-chimici, martori ai trecerii prin procesul de sterilizare, special fabrica\u0163i pentru sterilizarea cu formaldehid\u0103.<\/p>\n

Pentru fiecare ciclu se folosesc teste biologice (bacteriologice) cu spori de Bacillus stearothermophyllus.<\/p>\n

4.7.6. Nota\u0163i \u00een caietul de sterilizare: num\u0103rul \u015farjei \u015fi con\u0163inutul pachetelor, data \u015fi ora de debut \u015fi sf\u00e2r\u015fit a ciclului, temperatura la care s-a efectuat sterilizarea, rezultatele indicatorilor fizico-chimici \u015fi biologici, numele \u015fi semn\u0103tura persoanei responsabilizate cu sterilizarea, observa\u0163ii, data la care s-a efectuat \u00eentre\u0163inerea \u015fi verificarea aparatului.<\/p>\n

Data steriliz\u0103rii va fi notat\u0103 pe fiecare ambalaj.<\/p>\n

4.7.7. Spa\u0163iile \u00een care se efectueaz\u0103 sterilizarea cu formaldehid\u0103<\/p>\n

Sterilizarea cu formaldehid\u0103 se va realiza \u00een spa\u0163ii ventilate, destinate numai pentru aceast\u0103 activitate.<\/p>\n

Concentra\u0163ia \u00een aer a formaldehidei trebuie controlat\u0103 periodic prin serviciul tehnic al spitalului.<\/p>\n

4.7.8. \u00centre\u0163inere (Mentenan\u0163\u0103)<\/p>\n

Personal tehnic calificat va efectua periodic verificarea \u015fi \u00eentre\u0163inerea aparatului.<\/p>\n

Sterilizatoarele necontrolate pot avea pierderi de gaz \u015fi pot antrena riscuri toxice pentru personal \u015fi risc de explozie.<\/p>\n

4.8. CONDI\u0162II DE MEN\u0162INERE A STERILIT\u0102\u0162II MATERIALULUI STERILIZAT<\/p>\n

4.8.1. Instrumentar\/material textil\/obiecte din cauciuc (sonde, etc.)\/recipiente ambalate \u00een pungi h\u00e2rtie plastic sau h\u00e2rtie special\u0103.<\/p>\n

Co\u015furile\/navetele metalice cu pungile h\u00e2rtie plastic sau pachetele ambalate \u00een h\u00e2rtie special\u0103 sterilizate se depoziteaz\u0103 ca atare \u00een dulapurile pentru material steril.<\/p>\n

Nu se vor scoate pungile h\u00e2rtie plastic sau pachetele ambalate \u00een h\u00e2rtie special\u0103 cu material sterilizat din co\u015furi\/navete dec\u00e2t \u00een momentul utiliz\u0103rii lor.<\/p>\n

Orice manipulare \u00een plus a pungilor h\u00e2rtie plastic sau pachetelor ambalate \u00een h\u00e2rtie special\u0103 cu material sterilizat creeaz\u0103 condi\u0163ii de contaminare chiar dac\u0103 punga\/h\u00e2rtia r\u0103m\u00e2ne \u00een aparen\u0163\u0103 intact\u0103.<\/p>\n

Pungile h\u00e2rtie plastic sau pachete ambalate \u00een h\u00e2rtie special\u0103 cu material sterilizat care prezint\u0103 solu\u0163ii de continuitate (dezlipite, rupte, \u00een\u0163epate) sunt nesterile \u015fi ca atare materialul va fi reambalat \u015fi resterilizat.<\/p>\n

4.8.2. Material textil, obiecte din cauciuc (m\u0103nu\u015fi, sonde, etc.)\/recipiente ambalate \u00een cutii metalice perforate sau casolete cu colier.<\/p>\n

Con\u0163inutul cutiilor metalice perforate sau casoletelor cu colier poate suferi o contaminare din momentul scoaterii lor din sterilizatorul cu abur sub presiune, pentru c\u0103 ele nu sunt perfect etan\u015fe.<\/p>\n

Orice deformare a cutiei\/casoletei creeaz\u0103 condi\u0163ii de contaminare a con\u0163inutului prin neetan\u015feitate.<\/p>\n

Pentru diminuarea riscului de contaminare a materialului steril, acesta va fi manipulat c\u00e2t mai pu\u0163in \u015fi stocat \u00een dulapuri special destinate depozit\u0103rii materialului steril, \u00eentre\u0163inute \u00een perfect\u0103 stare de cur\u0103\u0163enie.<\/p>\n

4.8.3. Responsabili:<\/p>\n

Asistenta medical\u0103 responsabil\u0103 cu preg\u0103tirea instrumentarului, sticl\u0103riei, etc. \u00een vederea steriliz\u0103rii.<\/p>\n

Asistenta medical\u0103 responsabil\u0103 cu sterilizarea, instruit\u0103 \u015fi acreditat\u0103 pentru realizarea steriliz\u0103rii la pupinel, sterilizatorul cu abur sub presiune, sterilizatorul cu oxid de etilena, sterilizatorul cu abur \u015fi formaldehid\u0103 la temperaturi joase \u015fi presiune subatmosferic\u0103.<\/p>\n

Art. 5. – \u00ceNTRE\u0162INEREA MATERIALULUI DE ENDOSCOPIE. STERILIZARE CU PRODUSE CHIMICE<\/p>\n

5.1. Sterilizare cu produse chimice realizeaz\u0103 distrugerea tuturor microorganismelor pentru a evita transmiterea unei infec\u0163ii la pacien\u0163ii care beneficiaz\u0103 de endoscopie.<\/p>\n

5.2. Metode de sterilizare recomandate:<\/p>\n

Autoclavare (un timp scurt, la temperaturi ridicate) pentru anumite endoscoape rigide pentru care produc\u0103torul recomand\u0103 metoda.<\/p>\n

Sterilizarea cu oxid de etilen este aplicabil\u0103 teoretic, dar intervalul de timp necesar pentru evaporarea urmelor, \u00eel face inutilizabil \u00een practic\u0103, acolo unde nu exist\u0103 dec\u00e2t un endoscop.<\/p>\n

Sterilizarea cu produse chimice este metoda utilizat\u0103 frecvent \u00een practic\u0103 pentru sterilizarea endoscoapelor (artroscoapelor, cistoscoapelor, bronhoscoapelor, gastroscoapelor, etc).<\/p>\n

5.3. Etape \u00een \u00eentre\u0163inerea materialului de endoscopie \u015fi sterilizare cu produse chimice<\/p>\n

5.3.1. Cur\u0103\u0163are (decontaminare\/pre-dezinfectie)<\/p>\n

Imediat dup\u0103 folosire se \u015fterge aparatul cu o compres\u0103 pentru \u00eendep\u0103rtarea materiei organice (fecale, resturi de mucozit\u0103\u0163i, s\u00e2nge, \u0163esut, alte fluide ale organismului). Se trece la cur\u0103\u0163area meticuloas\u0103 a endoscopului \u015fi accesoriilor acestuia cu produse neabrazive etichetate ca „dezinfectant pentru instrumentar” aviza\u0163i de c\u0103tre Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei (este recomandabil de a nu se utiliza \u00een aceast\u0103 etap\u0103 un produs ce con\u0163ine aldehide), detergen\u0163i, detergen\u0163i enzimatici, detergen\u0163i-dezinfectan\u0163i sau produse de cur\u0103\u0163are-decontaminare pentru instrumente (gama pe care produc\u0103torul endoscopului le recomand\u0103, compatibile cu materialul din care sunt fabricate). Concentra\u0163ia de lucru a produsului utilizat \u00een aceast\u0103 etap\u0103 trebuie s\u0103 acopere spectrul de ac\u0163iune virulicid (inactivarea VHB \u015fi HIV).<\/p>\n

Se introduc p\u0103r\u0163ile imersibile ale endoscopului \u00een solu\u0163ia de cur\u0103\u0163are av\u00e2nd grij\u0103 ca solu\u0163ia s\u0103 umple toate cavit\u0103\u0163ile, canalele aparatului.<\/p>\n

Toate canalele accesibile trebuie irigate prin pomparea secven\u0163ional\u0103 a solu\u0163iei \u015fi periate pentru \u00eendep\u0103rtarea resturilor de materie organic\u0103.<\/p>\n

Inser\u0163ia tubului trebuie sp\u0103lat\u0103 cu solu\u0163ia de detergent \u015fi cl\u0103tit\u0103.<\/p>\n

Solu\u0163ia decontaminant\u0103 se arunc\u0103 dup\u0103 utilizare (\u00een cazul utiliz\u0103rii de detergen\u0163i, detergen\u0163i enzimatici, detergen\u0163i-dezinfectan\u0163i sau produse de cur\u0103\u0163are-decontaminare pentru instrumente). Periile folosite la cur\u0103\u0163area canalelor endoscopului trebuie cur\u0103\u0163ate \u015fi sterilizate sau dezinfectate nivel \u00eenalt cel pu\u0163in zilnic. Pot fi folosite perii de unic\u0103 utilizare.<\/p>\n

\u00cen timpul manipul\u0103rii trebuie observate eventualele defec\u0163iuni ale echipamentului \u015fi efectuat testul de etan\u015feitate.<\/p>\n

P\u0103r\u0163ile neimersibile ale endoscopului (p\u0103r\u0163ile exterioare, proximale \u015fi distale, articula\u0163iile, p\u0103r\u0163ile optice, etc.) se cur\u0103\u0163\u0103 cu o solu\u0163ie de cur\u0103\u0163are prin \u015ftergere umed\u0103 riguroas\u0103, \u015fi apoi se \u015fterg cu alcool isopropilic sau etilic 70%.<\/p>\n

Este de preferat sa fie utiliza\u0163i produse cu propriet\u0103\u0163i detergente etichetate ca dezinfectan\u0163i pentru instrumentar \u015fi aviza\u0163i de c\u0103tre Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei.<\/p>\n

5.3.2. Cl\u0103tire riguroas\u0103 cu ap\u0103 potabil\u0103 (exterior \u015fi interior).<\/p>\n

Toate p\u0103r\u0163ile imersibile ale endoscopului trebuie cl\u0103tite cu ap\u0103.<\/p>\n

5.3.3. Dezinfec\u0163ie<\/p>\n

Atunci c\u00e2nd opera\u0163iunea din etapa de cur\u0103\u0163are\/decontaminare (predezinfec\u0163ie) se face manual ea este urmat\u0103 \u00een mod obligatoriu de etapa de dezinfec\u0163ie.<\/p>\n

Se introduc p\u0103r\u0163ile imersibile ale endoscopului \u00eentr-un dezinfectant autorizat de c\u0103tre Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei (gama de dezinfectante pe care produc\u0103torul endoscopului le recomand\u0103, compatibile cu materialul din care sunt fabricate). Concentra\u0163ia solu\u0163iei de lucru (determinat\u0103 prin testul cantitativ al suspensiei) a dezinfectantului pentru instrumentar trebuie s\u0103 asigure distrugerea mycobacteriilor (obligatoriu tulpina de Mycobacterium Terrae – tulpina standardizat\u0103 la nivel european pentru evaluarea ac\u0163iunii tuberculocide). Se alege un dezinfectant capabil s\u0103 distrug\u0103 biofilmul care se constituie pe canale. Se cur\u0103\u0163\u0103 p\u0103r\u0163ile exterioare, proximale \u015fi distale (articula\u0163iile, p\u0103r\u0163ile optice, etc.). Se cl\u0103tesc riguros canalele interne prin circularea de mai multe ori a solu\u0163iei de dezinfectant prin fiecare canal.<\/p>\n

5.3.4. Cl\u0103tire. Toate p\u0103r\u0163ile imersibile ale endoscopului trebuie cl\u0103tite cu ap\u0103.<\/p>\n

NOT\u0102:<\/p>\n

a) Opera\u0163iunea de cur\u0103\u0163are-(decontaminare), cl\u0103tire, dezinfec\u0163ie, cl\u0103tire poate fi f\u0103cut\u0103 manual cu seringa sau cu instala\u0163ii speciale cu ajutorul c\u0103rora s\u0103 se realizeze cur\u0103\u0163area tuturor canalelor \u015fi cavit\u0103\u0163ilor, proces descris la punctele 5.3.1, 5.3.2, 5.3.3 \u015fi 5.3.4.<\/p>\n

b) \u00cen spitalele unde se realizeaz\u0103 un num\u0103r mare de investiga\u0163ii endoscopice, se pot folosi ma\u015fini automate cu program de dezinfec\u0163ie pentru cur\u0103\u0163area \u015fi dezinfec\u0163ia endoscoapelor flexibile avizate de Ministerul S\u0103n\u0103t\u0103\u0163ii\/Ministerul S\u0103n\u0103t\u0103\u0163ii \u015fi Familiei.<\/p>\n

Utilizarea ma\u015finilor automate pentru cur\u0103\u0163area \u015fi dezinfec\u0163ia endoscoapelor flexibile au avantajul c\u0103 reduc riscul de expunere a personalului ce efectueaz\u0103 aceast\u0103 opera\u0163iune la contaminarea cu agen\u0163i patogeni transmisibili \u015fi substan\u0163ele chimice toxice, iar timpul de contact cu dezinfectantul poate fi standardizat.<\/p>\n

5.3.5. Sterilizare cu un produs chimic.<\/p>\n

5.3.5.1. Endoscoapele flexibile care vin \u00een contact cu mucoasele sunt clasificate drept echipamente semicritice \u015fi necesit\u0103 STERILIZARE sau cel pu\u0163in DEZINFEC\u0162IE DE NIVEL \u00ceNALT \u00eentre utiliz\u0103ri. Se realizeaz\u0103, dup\u0103 parcurgerea \u00een mod obligatoriu a procedurilor de la pct. 2.4.1, 2.4.2, 2.4.3. Pentru a ob\u0163ine o dezinfectie de nivel \u00eenalt toate suprafe\u0163ele interne, externe, cavit\u0103\u0163ile, canalele trebuie s\u0103 vin\u0103 \u00een contact cu dezinfectantul (care au \u00een compozi\u0163ie glutaraldehid\u0103 2% sau peroxid de hidrogen stabilizat 6% sau acid peracetic).<\/p>\n

Endoscoapele flexibile care p\u0103trund \u00een cavit\u0103\u0163i sterile ale organismului sunt clasificate drept echipamente critice \u015fi necesit\u0103 STERILIZARE \u00eentre utiliz\u0103ri.<\/p>\n

5.3.5.2. Sterilizarea chimic\u0103 se realizeaz\u0103 dup\u0103 un timp de contact al substan\u0163ei chimice cu substratul de tratat de c\u00e2teva ore (\u00een func\u0163ie de recomandarea produc\u0103torului).<\/p>\n

Se aleg produse chimice sterilizante care au \u00een compozi\u0163ie glutaraldehid\u0103 2% sau peroxid de hidrogen stabilizat 6% sau acid peracetic.<\/p>\n

Solu\u0163ia de produs chimic sterilizant se pune \u00een cuve\/recipiente cu capac.<\/p>\n

Se introduc p\u0103r\u0163ile imersibile ale endoscopului \u00eentr-o solu\u0163ie de produs chimic sterilizant \u00een concentra\u0163ia recomandat\u0103 de produc\u0103tor, av\u00e2nd grij\u0103 ca solu\u0163ia sterilizant\u0103 s\u0103 acopere \u015fi s\u0103 umple toate cavit\u0103\u0163ile, canalele aparatului astfel \u00eenc\u00e2t s\u0103 fie eliminate bulele de aer.<\/p>\n

Pentru sterilizare, se las\u0103 p\u0103r\u0163ile imersibile ale endoscopului complet imersate pentru o perioad\u0103 de timp \u015fi la temperatura recomandat\u0103 de produc\u0103tor.<\/p>\n

Dup\u0103 scurgerea timpului de sterilizare manevrarea p\u0103r\u0163ilor endoscopului (mai ales pentru artroscop, cistoscop, celioscop, bronhoscop) se efectueaz\u0103 utiliz\u00e2nd tehnici aseptice, care comport\u0103: ap\u0103 steril\u0103, m\u0103nu\u015fi sterile, saci sterili, c\u00e2mpuri sau comprese sterile pentru \u015ftergere.<\/p>\n

5.3.6. Cl\u0103tire cu ap\u0103 steril\u0103 (ap\u0103 distilat\u0103 steril\u0103)<\/p>\n

Pentru a preveni efectele toxice generate de urmele de substan\u0163e chimice din solu\u0163iile sterilizante, echipamentul trebuie cl\u0103tit.<\/p>\n

\u00cen situa\u0163ia \u00een care \u00een spa\u0163iile unde se proceseaz\u0103 endoscoapele nu exist\u0103 posibilitatea aduc\u0163iunii apei sterile prin conducte direct de la sta\u0163ia de preparare a apei sterile, se pot folosi sticle cu ap\u0103 steril\u0103 (ap\u0103 distilat\u0103 steril\u0103) cuplate cu un tub. At\u00e2t sticla de ap\u0103 c\u00e2t \u015fi tubulatura trebuie sterilizate zilnic.<\/p>\n

Se procedeaz\u0103 la o cl\u0103tire abundent\u0103 cu ap\u0103 steril\u0103 (sub jet de ap\u0103 sau prin agitare) de trei ori la r\u00e2nd utiliz\u00e2nd de fiecare dat\u0103 tran\u015fe proaspete de ap\u0103 steril\u0103 \u00een cantitate suficient\u0103 av\u00e2nd grij\u0103 s\u0103 asigur\u0103m imersia complet\u0103 a dispozitivului.<\/p>\n

Apa steril\u0103 trebuie s\u0103 circule prin toate canalele.<\/p>\n

Fiecare cl\u0103tire trebuie s\u0103 dureze minimum 1 minut sau \u00een func\u0163ie de timpul recomandat de produc\u0103torul endoscopului precum \u015fi de produc\u0103torul dezinfectantului.<\/p>\n

Dup\u0103 fiecare cl\u0103tire apa se arunc\u0103 \u015fi nu va mai fi refolosit\u0103 sau utilizat\u0103 \u00een alte scopuri deoarece apa de cl\u0103tire poate con\u0163ine urme din substan\u0163a activ\u0103 a sterilizantului.<\/p>\n

5.3.7. Uscare<\/p>\n

Inser\u0163ia tubului \u015fi canalele trebuie bine uscate utiliz\u00e2nd trecerea unui jet de alcool etilic sau izopropilic 70% urmat\u0103 de aer comprimat.<\/p>\n

5.3.8. Se verific\u0103 etan\u015feitatea endoscopului dup\u0103 fiecare ciclu de procesare.<\/p>\n

5.3.9. Manipularea dup\u0103 sterilizare \u015fi stocarea.<\/p>\n

Endoscoapele sterilizate pot fi folosite imediat sau vor fi stocate \u00een locuri uscate, \u00een cutii metalice sterilizate sau dezinfectate nivel \u00eenalt, astfel \u00eenc\u00e2t s\u0103 nu permit\u0103 recontaminarea sau deteriorarea lor.<\/p>\n

5.4. Sterilizate prin autoclavare<\/p>\n

Anumite accesorii ale endoscopului (ace de scleroterapie, sondele pentru electrocauterizare, perii pentru citologie, forceps pentru biopsie sau excizii) trebuie cur\u0103\u0163ate (decontaminate) \u00een baia cu ultrasunete, dezinfectate \u015fi sterilizate prin autoclavare, \u00eenainte de utilizare. Cur\u0103\u0163area lor trebuie s\u0103 duc\u0103 la \u00eendep\u0103rtarea resturilor organice; \u00een caz contrar sterilizarea prin autoclavare este ineficient\u0103.<\/p>\n

5.5. Reguli generale:<\/p>\n

Dup\u0103 sterilizarea chimic\u0103 nu se admite cl\u0103tirea cu ap\u0103 potabil\u0103, deoarece aceasta poate con\u0163ine microorganisme, inclusiv Pseudomonas spp. \u015fi Mycobacterium spp. care se pot multiplica \u00een canalele, cavit\u0103\u0163ile endoscopului.<\/p>\n

\u00cen serviciile\/cabinetele de endoscopie trebuie s\u0103 existe un registru de eviden\u0163\u0103 a procedurilor \u00een care se noteaz\u0103: numele pacientului, num\u0103rul foii de observa\u0163ie, procedura efectuat\u0103, numele persoanei care a efectuat endoscopia, num\u0103rul de \u00eenregistrare a endoscopului sau seria.<\/p>\n

Nu vor fi utilizate endoscoapele cu defec\u0163iuni sau a c\u0103ror construc\u0163ie nu permite procesarea lor.<\/p>\n

Spa\u0163iile unde se efectueaz\u0103 endoscopia \u015fi procesarea endoscoapelor trebuie amenajate \u00een a\u015fa fel \u00eenc\u00e2t s\u0103 se asigure protec\u0163ia mediului, personalului medical \u015fi pacien\u0163ilor.<\/p>\n

Personalul trebuie s\u0103 poarte echipament de protec\u0163ie (m\u0103nu\u015fi, ochelari, masc\u0103 de protec\u0163ie sau protectoare faciale) pentru prevenirea expunerii la microorganismele patogene (HIV, HVB, VHC, M. tuberculosis, herpes simplex, patogeni enterici) sau la produsele chimice toxice.<\/p>\n

Personalul care lucreaz\u0103 \u00een serviciile de endoscopie trebuie s\u0103 cunoasc\u0103 \u015fi s\u0103 respecte precau\u0163iile universale.<\/p>\n

Personalul care lucreaz\u0103 \u00een serviciile de endoscopie va fi vaccinat antihepatit\u0103 B. Personalul care lucreaz\u0103 \u00een serviciile de bronhoscopie va fi periodic testat PPD.<\/p>\n

5.6. Material:<\/p>\n

Criterii de alegere a dezinfectantelor \u015fi produselor chimice sterilizante<\/p>\n

a) Ac\u0163iune antimicrobian\u0103: dezinfectantele trebuie s\u0103 aib\u0103 o ac\u0163iune:<\/p>\n

– bactericid\u0103 pe germeni Gram-pozitivi, Gram-negativi<\/p>\n

– tuberculocid\u0103 (testul cantitativ al suspensiei pe Mycobacterium terrae)<\/p>\n

– fungicid\u0103: levuri, ciuperci filamentoase<\/p>\n

– virulicid\u0103: distrugerea sau inactivarea virusului hepatitei B \u015fi C, HIV, Enterovirusuri, Adenovirusuri<\/p>\n

– sporicid\u0103: Bacillus, Clostridium<\/p>\n

Se aleg produse chimice sterilizante care au \u00een compozi\u0163ie glutaraldehid\u0103 2% sau peroxid de hidrogen stabilizat 6% sau acid peracetic.<\/p>\n

b) Compatibilitate<\/p>\n

\u00cen alegerea dezinfectan\u0163ilor \u015fi a produselor chimice cu ac\u0163iune sterilizant\u0103 trebuie s\u0103 se \u0163in\u0103 seama de compatibilitatea acestora cu materialele din care sunt confec\u0163ionate endoscoapele. Se respect\u0103 recomandarea produc\u0103torului echipamentului.<\/p>\n

Responsabili: Asistenta medical\u0103 responsabil\u0103 cu endoscopia sub supravegherea medicului care efectueaz\u0103 endoscopia.<\/p>\n

5.7. Materiale \u015fi produse:<\/p>\n

– m\u0103nu\u015fi de protec\u0163ie nesterile<\/p>\n

– m\u0103nu\u015fi de protec\u0163ie sterile (manevre aseptice)<\/p>\n

– saci sterili, cutii metalice sterile<\/p>\n

– c\u00e2mpuri sau comprese sterile pentru \u015ftergere<\/p>\n

– sering\u0103 sau pomp\u0103<\/p>\n

– cuve cu capac (3)<\/p>\n

– testator de etan\u015feitate<\/p>\n

– ap\u0103 steril\u0103<\/p>\n

– detergent, detergent enzimatic, detergent dezinfectant, produs pentru cur\u0103\u0163are \u015fi decontaminare, dezinfectant de uz spitalicesc cu propriet\u0103\u0163i de cur\u0103\u0163are<\/p>\n

– dezinfectant de uz spitalicesc<\/p>\n

– produs chimic sterilizant<\/p>\n

5.8. Evaluare:<\/p>\n

\u00cen cazul apari\u0163iei unei infec\u0163ii la un bolnav, unde se suspecteaz\u0103 la origine examenul endoscopie este necesar a se anun\u0163a serviciul de endoscopie pentru demararea anchetei clinico-epidemiologice.<\/p>\n

5.9. Parametrii care trebuie respecta\u0163i pentru garantarea eficacit\u0103\u0163ii procedurii de dezinfec\u0163ie \u015fi sterilizare:<\/p>\n

– Cur\u0103\u0163are eficient\u0103 a echipamentului.<\/p>\n

– Respectarea timpilor de imersie \u00een solu\u0163ia de dezinfectant \u015fi \u00een produsul chimic sterilizant.<\/p>\n

– Respectarea concentra\u0163iilor recomandate de c\u0103tre produc\u0103tor.<\/p>\n

– Efectuarea dezinfec\u0163iei \u015fi sterilizarea \u00een cuve cu capac.<\/p>\n

– Cur\u0103\u0163area \u015fi dezinfec\u0163ia cuvelor la fiecare re\u00eennoire a solu\u0163iilor.<\/p>\n

Roms7\ufffdt”\u0010e\u0002\ufffd\u0007\ufffd\u0005\ufffd\u0007no-proof:no’> Sunt instrumente care vin \u00een contact cu mucoasele, cu excep\u0163ia mucoasei periodontale, sau cu solu\u0163ii de continuitate ale pielii.<\/p>\n

 <\/p>\n

\u00a0\u00a0\u00a0<\/b> Exemple:<\/p>\n

\u00a0\u00a0\u00a0a)<\/b> endoscoape flexibile, laringoscoape, tuburi endotraheale, echipament de anestezie \u015fi respira\u0163ie asistat\u0103.<\/p>\n

– Necesit\u0103 STERILIZARE, sau cel pu\u0163in DEZINFEC\u0162IE DE NIVEL \u00ceNALT, \u00eentre utiliz\u0103ri<\/p>\n

\u00a0\u00a0\u00a0b)<\/b> termometre orale sau rectale \u015fi<\/p>\n

\u00a0\u00a0\u00a0c)<\/b> suprafe\u0163e netede, dure (c\u0103zi de hidroterapie).<\/p>\n

– Necesit\u0103 DEZINFEC\u0162IE DE NIVEL INTERMEDIAR \u00eentre utiliz\u0103ri<\/p>\n

\u00a0\u00a0\u00a02.3.8.3.<\/b> Instrumente non-critice:<\/p>\n

\u00a0\u00a0\u00a0<\/b> Sunt instrumente care vin \u00een contact doar cu pielea intact\u0103.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Exemple:<\/p>\n

– stetoscoape, suprafa\u0163a meselor, pavimente, plo\u015fti, mobilier, etc.<\/p>\n

– Necesit\u0103 DEZINFEC\u0162IA DE NIVEL INTERMEDIAR p\u00e2n\u0103 la SC\u0102ZUT, \u00eentre utiliz\u0103ri.<\/p>\n

 <\/p>\n

\u00a0\u00a0\u00a02.3.9.<\/b> EVALUAREA RISCURILOR PENTRU PACIEN\u0162I\/PERSONAL, DATORATE ECHIPAMENTULUI \u015eI MEDIULUI.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Echipamentele, obiectele, pot fi implicate \u00een transmiterea agen\u0163ilor patogeni din mediul de spital la pacien\u0163i, put\u00e2nd favoriza apari\u0163ia infec\u0163iilor nosocomiale. Echipamentele \u015fi obiectele din mediul de spital sunt clasificate pe patru nivele de risc, \u00een func\u0163ie de tipul de contact cu pacientul (\u00een unele cazuri cu personalul); acest mod de abordare faciliteaz\u0103 alegerea tipului adecvat de procesare, \u00een func\u0163ie de diversele aplica\u0163ii ale echipamentelor.<\/p>\n

\u00a0\u00a0\u00a02.3.9.1.<\/b> Risc minim<\/p>\n

– Obiecte la distan\u0163\u0103 de persoane (pacient, personal): pere\u0163i, pardoseli, tavane, chiuvete, canale de scurgere.<\/p>\n

– Obiecte \u00een imediata apropiere a pacientului: arm\u0103tura paturilor, dul\u0103pioare, etc.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Nivel necesar de decontaminare: cur\u0103\u0163are, uscare.<\/p>\n

\u00a0\u00a0\u00a02.3.9.2.<\/b> Risc sc\u0103zut<\/p>\n

– Obiecte \u00een contact cu suprafa\u0163a pielii intacte: stetoscop, man\u015feta tensiometrului, tac\u00e2muri, vesel\u0103, telefoane mobile, ligheane \u015fi alte obiecte sanitare.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Nivel de decontaminare: cur\u0103\u0163are, uscare.<\/p>\n

\u00a0\u00a0\u00a02.3.9.3.<\/b> Risc mediu<\/p>\n

– Obiecte \u00een contact cu mucoasele: termometre, echipament de asistare respiratorie, gastroscoape, bronhoscoape;<\/p>\n

– Obiecte contaminate cu microorganisme virulente: plo\u015fti, bazinete, etc.;<\/p>\n

– Obiecte folosite la pacien\u0163i cu grad \u00eenalt de receptivitate.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Nivel de decontaminare: dezinfec\u0163ie de nivel \u00eenalt, sterilizare chimic\u0103<\/p>\n

\u00a0\u00a0\u00a02.3.9.4.<\/b> Risc \u00eenalt<\/p>\n

– Obiecte \u00een contact cu solu\u0163ii de continuitate ale pielii sau cu mucoasele: pansamente<\/p>\n

\u00a0\u00a0\u00a0<\/b> Obiecte care se introduc \u00een locuri normal sterile ale organismului: ace, instrumente chirurgicale, implante, catetere urinare.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Nivel de decontaminare: sterilizare<\/p>\n

 <\/p>\n

\u00a0\u00a0\u00a02.3.10.<\/b> REGULI GENERALE \u00ceN ALEGEREA PROCEDURILOR DE DEZINFEC\u0162IE \u015eI STERILIZARE<\/p>\n

\u00a0\u00a0\u00a0<\/b> \u00cen general, instrumentele care penetreaz\u0103 \u0163esuturile normal sterile, inclusiv sistemul vascular (instrumente critice), precum \u015fi instrumentele prin care curge s\u00e2nge, trebuie sterilizate \u00eenainte de utilizare.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Instrumentele reutilizabile, sau alte obiecte care vin \u00een contact cu mucoasele intacte trebuie s\u0103 fie sterilizate sau dezinfectate prin dezinfec\u0163ie de „nivel \u00eenalt” \u00eenainte de reutilizare.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Instrumentele medicale care necesit\u0103 sterilizare sau dezinfec\u0163ie trebuie s\u0103 fie cur\u0103\u0163ate (pre-dezinfec\u0163ie) cu aten\u0163ie, pentru a reduce gradul de \u00eenc\u0103rc\u0103tur\u0103 cu materie organic\u0103, \u00eenainte de a fi supuse dezinfec\u0163iei cu substan\u0163e germicide. Trebuie respectate at\u00e2t instruc\u0163iunile produc\u0103torilor de substan\u0163e germicide, c\u00e2t \u015fi ale celor care produc instrumentele medicale.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Este important\u0103 starea de cur\u0103\u0163enie a pere\u0163ilor, pardoselilor sau altor suprafe\u0163e din mediu. Cur\u0103\u0163enia \u015fi \u00eendep\u0103rtarea murd\u0103riei trebuie s\u0103 fie o activitate de rutin\u0103. O aten\u0163ie deosebit\u0103 trebuie s\u0103 se acorde suprafe\u0163elor de lucru: suprafe\u0163ele pe care se preg\u0103tesc tratamentele injectabile, separate de cele pentru depozitarea probelor bilogice prelevate pentru laborator, trebuie s\u0103 fie curate \u015fi dezinfectate, pentru evitarea transmiterii germenilor ce recunosc drept cale de transmitere s\u00e2ngele (virusurile hepatitice B \u015fi C, HIV, etc.).<\/p>\n

\u00a0\u00a0\u00a0<\/b> Dezinfectantele care sunt aprobate ca „dezinfectante de spital” \u015fi care sunt tuberculicide sau virulicide, folosite \u00een concentra\u0163ia de utilizare \u015fi timpul de contact recomandat, sunt recomandate pentru decontaminarea petelor con\u0163in\u00e2nd s\u00e2nge sau alte fluide ale organismului care con\u0163in sau nu s\u00e2nge, dup\u0103 cum urmeaz\u0103:<\/p>\n

– \u00een zonele \u00een care pacien\u0163ii primesc \u00eengrijiri medicale, pe suprafe\u0163ele vizibil contaminate cu s\u00e2nge \u015fi\/sau alte fluide biologice, se toarn\u0103 dezinfectantul adecvat pentru a \u00eenmuia \u015fi distruge eventualii agen\u0163i patogeni, se las\u0103 un timp de contact, apoi se cur\u0103\u0163\u0103 \u015fi se dezinfectez\u0103 chimic;<\/p>\n

– suprafe\u0163ele din laborator, contaminate cu culturi microbiene sau cu alte substan\u0163e care pot con\u0163ine concentra\u0163ii ridicate de agen\u0163i infec\u0163io\u015fi, trebuie inactivate cu substan\u0163e germicide lichide (decontaminate), \u00eenainte de cur\u0103\u0163are; dup\u0103 \u00eendep\u0103rtarea materialului organic, dezinfec\u0163ia se face cu solu\u0163ii proaspete de germicide chimice.<\/p>\n

\u00a0\u00a0\u00a0<\/b> \u00cen toate situa\u0163iile \u00een care se realizeaz\u0103 procedurile de cur\u0103\u0163enie \u015fi de decontaminare este obligatoriu portul m\u0103nu\u015filor.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Pentru dezinfec\u0163ia obiectelor sau instrumentelor critice, care penetreaz\u0103 \u0163esuturile sau sistemul vascular, sau semi-critice, care vin \u00een contact cu mucoasele, sau cu solu\u0163ii de continuitate ale pielii, nu se utilizeaz\u0103 substan\u0163e germicide pe baz\u0103 de s\u0103ruri cuaternare de amoniu, sau alte dezinfectante „de nivel sc\u0103zut”.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Pentru cur\u0103\u0163area suprafe\u0163elor din mediu, sau a obiectelor \u015fi instrumentelor non-critice, nu se utilizeaz\u0103 glutaraldehida sau alte dezinfectante „de nivel \u00eenalt”.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Este necesar s\u0103 se foloseasc\u0103 \u00eentotdeauna concentra\u0163iile corecte de utilizare ale dezinfectantului \u015fi s\u0103 se respecte timpul de contact recomandat. Uneori, dezinfectantele \u00een concentra\u0163ii mari nu inactiveaz\u0103 microorganismele \u015fi pot fi toxice pentru cel care le utilizeaz\u0103, sau pot deteriora obiectul care trebuie dezinfectat.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Endoscoapele \u015fi alte instrumente semi-critice trebuie cur\u0103\u0163ate, dezinfectate, sterilizate ca \u015fi c\u00e2nd pacien\u0163ii pentru care au fost folosite ar fi infecta\u0163i cu M. tuberculosis, HIV sau virusuri heparitice. (PRECAU\u0162IUNILE UNIVERSALE)<\/p>\n

\u00a0\u00a0\u00a0<\/b> Nu se utilizeaz\u0103 dezinfectan\u0163ii fenolici pentru igienizarea incubatoarelor \u00een sec\u0163iile de nou-n\u0103scu\u0163i \u00een prezen\u0163a acestora; c\u00e2nd sunt utiliza\u0163i la cur\u0103\u0163enia \u015fi dezinfec\u0163ia terminal\u0103 \u00een sec\u0163iile de nou-n\u0103scu\u0163i este necesar ca toate suprafe\u0163ele s\u0103 fie bine cl\u0103tite cu ap\u0103 \u015fi apoi uscate.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Este obligatorie utilizarea echipamentului de protec\u0163ie \u015fi respectarea recomand\u0103rilor privind siguran\u0163a manipul\u0103rii.
\n\u00a0\u00a0\u00a02.3.11.<\/b> Metode de aplicare a dezinfectantelor chimice \u00een func\u0163ie de suportul tratat<\/p>\n

\u00a0\u00a0\u00a0<\/b> Vezi „Ghidul privind cur\u0103\u0163enia, dezinfec\u0163ia \u015fi sterilizarea \u00een unit\u0103\u0163ile de asisten\u0163\u0103 medical\u0103”, elaborat de Institutul de S\u0103n\u0103tate Public\u0103 Bucure\u015fti<\/p>\n

\n\n\n\n
\u250c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2510
\n\u2502\u00a0\u00a0\u00a0\u00a0Suportul\u00a0de\u00a0tratat\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Tipul\u00a0de\u00a0dezinfectant\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Observa\u0163ii\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015fi\u00a0Metoda\u00a0de\u00a0aplicare\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a01\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a03\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502SUPRAFE\u0162E\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Folosirea\u00a0dezinfectantelor\u00a0pentru\u00a0suprafe\u0163e,\u00a0cu\u00a0respectarea\u00a0concentra\u0163iilor\u00a0de\u2502
\n\u2502utilizare\u00a0\u015fi\u00a0timpului\u00a0de\u00a0contact\u00a0conform\u00a0recomand\u0103rilor\u00a0produc\u0103torului\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Pavimente\u00a0(mozaic,\u00a0ciment,\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502linoleum,\u00a0lemn,\u00a0etc.)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Pere\u0163i\u00a0(faian\u0163\u0103,\u00a0tapet\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Se\u00a0va\u00a0insista\u00a0asupra\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502lavabil,\u00a0uleia\u0163i,\u00a0etc.),\u00a0\u00a0\u00a0\u2502Pulverizare*)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502cur\u0103\u0163eniei\u00a0\u015fi\u00a0dezinfec\u0163iei\u00a0\u00a0\u2502
\n\u2502u\u015fi,\u00a0ferestre\u00a0(toc\u0103rie)\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502p\u0103r\u0163ilor\u00a0superioare\u00a0ale\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502pervazurilor\u00a0\u015fi\u00a0a\u00a0altor\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502suprafe\u0163e\u00a0orizontale,\u00a0precum\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015fi\u00a0ale\u00a0col\u0163urilor.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Mobilier,\u00a0inclusiv\u00a0paturi\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Cur\u0103\u0163enie\u00a0riguroas\u0103\u00a0\u015fi\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u015fi\u00a0noptiere\u00a0(din\u00a0lemn,\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Stropire\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ia\u00a0suprafe\u0163elor\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502metal,\u00a0plastic)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Pulverizare*)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502orizontale\u00a0(partea\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502superioar\u0103\u00a0a\u00a0dulapurilor,\u00a0a\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502rafturilor,\u00a0etc.)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Mese\u00a0de\u00a0opera\u0163ie,\u00a0mese\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Cur\u0103\u0163enie\u00a0riguroas\u0103\u00a0\u015fi\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502instrumentar,\u00a0suprafe\u0163e\u00a0\u00a0\u00a0\u00a0\u2502Stropire\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ia\u00a0suprafe\u0163elor\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502pentru\u00a0preg\u0103tirea\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Pulverizare*)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502orizontale.\u00a0Decontaminare\u00a0\u00a0\u00a0\u2502
\n\u2502tratamentului,\u00a0suprafe\u0163e\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00eenainte\u00a0de\u00a0cur\u0103\u0163are,\u00a0acolo\u00a0\u00a0\u2502
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\n\u2502temporar\u0103\u00a0a\u00a0produselor\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Mese\u00a0de\u00a0lucru\u00a0\u00een\u00a0laborator\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Decontaminare,\u00a0cur\u0103\u0163enie\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502OBIECTE\u00a0SANITARE,\u00a0RECIPIENTE\u00a0DE\u00a0COLECTARE,\u00a0MATERIALE\u00a0DE\u00a0CUR\u0102\u0162ENIE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502utilizare\u00a0\u015fi\u00a0timpului\u00a0de\u00a0contact\u00a0conform\u00a0recomand\u0103rilor\u00a0produc\u0103torului\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502B\u0103i,\u00a0b\u0103i\u0163e\u00a0pentru\u00a0copii,\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Plo\u015fti,\u00a0oli\u0163e,\u00a0urinare,\u00a0\u00a0\u00a0\u00a0\u2502Imersie,\u00a0dup\u0103\u00a0golire\u00a0\u2502Dup\u0103\u00a0dezinfec\u0163ie\u00a0se\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Grupuri\u00a0sanitare\u00a0(WC,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502bazine,\u00a0scaune\u00a0WC,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502vidoare),\u00a0gr\u0103tare\u00a0din\u00a0lemn\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502sau\u00a0plastic\u00a0pentru\u00a0b\u0103i\u00a0\u015fi\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Sifoane\u00a0de\u00a0pardoseal\u0103,\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Aplicarea\u00a0unei\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502G\u0103le\u0163i\u00a0pentru\u00a0cur\u0103\u0163enie,\u00a0\u00a0\u00a0\u2502Sp\u0103lare,\u00a0dezinfec\u0163ie\u00a0\u2502Se\u00a0p\u0103streaz\u0103\u00a0uscate\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502ustensile\u00a0pentru\u00a0cur\u0103\u0163enie\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502(perii,\u00a0mop,\u00a0Teu,\u00a0lavete,\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Recipiente\u00a0pentru\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Sp\u0103lare,\u00a0dezinfec\u0163ie\u00a0\u2502Se\u00a0p\u0103streaz\u0103\u00a0uscate\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502colectarea\u00a0de\u015feurilor,\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502LENJERIE\u00a0\u015eI\u00a0ECHIPAMENT\u00a0DE\u00a0PROTEC\u0162IE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502utilizare\u00a0\u015fi\u00a0timpului\u00a0de\u00a0contact\u00a0conform\u00a0recomand\u0103rilor\u00a0produc\u0103torului\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Lenjerie\u00a0contaminat\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00cenmuiere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Se\u00a0pot\u00a0folosi\u00a0ma\u015fini\u00a0de\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502(murd\u0103rit\u0103\u00a0cu\u00a0excrete,\u00a0\u00a0\u00a0\u00a0\u00a0\u25024\u00a0litri\u00a0solu\u0163ie\u00a0la\u00a0\u00a0\u00a0\u2502sp\u0103lat\u00a0automate\u00a0cu\u00a0program\u00a0\u00a0\u2502
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\n\u2502Alte\u00a0categorii\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Sp\u0103lare\u00a0la\u00a0ma\u015fini\u00a0automate\u00a0\u00a0\u2502
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\n\u2502Echipament\u00a0de\u00a0protec\u0163ie\u00a0\u015fi\u00a0\u2502\u00cenmuiere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Se\u00a0dezinfecteaz\u0103\u00a0numai\u00a0cel\u00a0\u00a0\u2502
\n\u2502de\u00a0lucru\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502contaminat\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502\u015eor\u0163uri\u00a0impermeabile\u00a0din\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502cauciuc\u00a0\u015fi\u00a0plastic\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502ZONE\u00a0DE\u00a0PREPARARE\u00a0\u015eI\u00a0DISTRIBUIRE\u00a0ALIMENTE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Folosirea\u00a0dezinfectantelor\u00a0recomandate\u00a0pentru\u00a0uz\u00a0\u00een\u00a0buc\u0103t\u0103rii,\u00a0oficii\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502alimentare,\u00a0dezinfec\u0163ia\u00a0veselei\u00a0recipientelor,\u00a0tac\u00e2murilor,\u00a0ustensilelor,\u00a0cu\u00a0\u00a0\u2502
\n\u2502respectarea\u00a0concentra\u0163iilor\u00a0de\u00a0utilizare\u00a0\u015fi\u00a0timpului\u00a0de\u00a0contact,\u00a0conform\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502recomand\u0103rilor\u00a0produc\u0103torului\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Vesel\u0103\u00a0din\u00a0sticl\u0103,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Imersie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Cl\u0103tire\u00a0insistent\u0103\u00a0dup\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502por\u0163elan,\u00a0tac\u00e2muri\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Suprafe\u0163e\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Pulverizare*)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Ustensile\u00a0\u015fi\u00a0vase\u00a0de\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Sp\u0103lare\u00a0cu\u00a0solu\u0163ii\u00a0de\u2502\u00cen\u00a0epidemii,\u00a0utilizarea\u00a0de\u00a0\u00a0\u2502
\n\u2502buc\u0103t\u0103rie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502detergent\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfectante\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502INSTRUMENTE,\u00a0ECHIPAMENTE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Folosirea\u00a0dezinfectantelor\u00a0pentru\u00a0instrumentar,\u00a0cu\u00a0respectarea\u00a0concentra\u0163iilor\u2502
\n\u2502de\u00a0utilizare\u00a0\u015fi\u00a0timpului\u00a0de\u00a0contact,\u00a0conform\u00a0recomand\u0103rilor\u00a0produc\u0103torului\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Termometre\u00a0(orale,\u00a0rectale)\u2502Submersie\u00a0dup\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Solu\u0163ii\u00a0dezinfectante\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502sp\u0103lare\u00a0\u015fi\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502proaspete.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502A\u00a0nu\u00a0se\u00a0amesteca\u00a0\u00een\u00a0timpul\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502proces\u0103rii\u00a0termometrele\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502orale\u00a0cu\u00a0cele\u00a0rectale\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Incubatoare,\u00a0izolete,\u00a0m\u0103\u015fti\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Nu\u00a0se\u00a0recomand\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502de\u00a0oxigen\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfectan\u0163ii\u00a0fenolici\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Instrumente,\u00a0echipamente\u00a0\u00a0\u00a0\u2502Imersie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Predezinfec\u0163ie,\u00a0cur\u0103\u0163are,\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ie,\u00a0cl\u0103tire,\u00a0uscare\u2502
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\n\u2502CAZARMAMENT\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Folosirea\u00a0dezinfectantelor\u00a0pe\u00a0baz\u0103\u00a0de\u00a0aldehid\u0103\u00a0formic\u0103\u00a0sau\u00a0alte\u00a0dezinfectante\u00a0\u2502
\n\u2502special\u00a0destinate\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502DOAR\u00a0PENTRU\u00a0OBIECTELE\u00a0CARE\u00a0PROVIN\u00a0DE\u00a0LA\u00a0BOLNAVII\u00a0CONTAGIO\u015eI\u00a0(BK),\u00a0\u00ceN\u00a0SPA\u0162II\u00a0\u00a0\u00a0\u2502
\n\u2502SPECIAL\u00a0AMENAJATE\u00a0\u015eI\u00a0\u00ceN\u00a0ABSEN\u0162A\u00a0ALTOR\u00a0MIJLOACE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Pulverizare*)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00cen\u00a0spa\u0163ii\u00a0etan\u015feizate.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502Saltele,\u00a0huse\u00a0pentru\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502saltele,\u00a0perne,\u00a0paturi,\u00a0\u00a0\u00a0\u00a0\u2502Vaporizare\u00a0aldehid\u0103\u00a0\u00a0\u2502Camer\u0103\u00a0special\u0103\u00a0de\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502halate\u00a0din\u00a0molton,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502formic\u0103\u00a010-15g%\/m3<\/sup>\u00a0\u00a0\u00a0\u2502formolizare\u00a0(descamer\u0103)\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00eembr\u0103c\u0103minte\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Expunere\u00a012-24\u00a0ore\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\n\u2502cauciuc\u00a0sau\u00a0lemn\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502detergent\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfectant,\u00a0produse\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502chimice\u00a0de\u00a0cur\u0103\u0163are\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502decontaminare,\u00a0apoi\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Juc\u0103rii\u00a0din\u00a0material\u00a0textil\u2502Pulverizare*)\u00a0cu\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502solu\u0163ii\u00a0dezinfectante\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Vase\u00a0de\u00a0flori\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Sp\u0103lare\u00a0cu\u00a0solu\u0163ii\u00a0de\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502detergent\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfectant,\u00a0produse\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502chimice\u00a0de\u00a0cur\u0103\u0163are\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502decontaminare,\u00a0apoi\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Telefoane\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u015etergere\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Ambulan\u0163e,\u00a0mijloace\u00a0auto\u00a0\u00a0\u00a0\u2502Pulverizare*\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2514\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2534\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2518<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

*) \u00cen cazul \u00een care dezinfectantul se aplic\u0103 prin pulverizare se va utiliza cantitatea certificat\u0103 de c\u0103tre produc\u0103tor de a fi utilizat\u0103 pentru un metru p\u0103trat la timpii recomanda\u0163i
\n\u00a0\u00a0\u00a02.3.12.<\/b> SITUA\u0162II CARE NECESIT\u0102 DEZINFEC\u0162IE COMPLEMENTAR\u0102 \u015eI\/SAU TERMINAL\u0102<\/p>\n

\u2022 Dezinfec\u0163ia terminal\u0103 este obligatoriu de efectuat \u00een:<\/p>\n

– sec\u0163ii de spitalizare a cazurilor de boli contagioase cu declarare nominal\u0103,<\/p>\n

– situa\u0163ia evolu\u0163iei unor focare de infec\u0163ii nosocomiale,<\/p>\n

– situa\u0163ii de risc epidemiologic (eviden\u0163ierea cu ajutorul laboratorului a circula\u0163iei microorganismelor multirezistente, „germeni de spital”, prezen\u0163i la personalul medico-sanitar\/asista\u0163i\/mediu)<\/p>\n

– sec\u0163ii cu risc \u00eenalt: sec\u0163ii unde sunt asista\u0163i pacien\u0163i imunodeprima\u0163i, ar\u015fi, neonatologie, prematuri, sec\u0163ii unde se practic\u0103 grefe (de m\u0103duv\u0103, cardiace, renale), sec\u0163ii de oncologie \u015fi onco-hematologie<\/p>\n

– bloc operator, bloc de na\u015fteri<\/p>\n

– sec\u0163ii de reanimare, terapie intensiv\u0103<\/p>\n

– alte: servicii de urgen\u0163\u0103, ambulan\u0163\u0103, locul unde se triaz\u0103 lenjeria<\/p>\n

– orice alt\u0103 situa\u0163ie de risc epidemiologic identificat\u0103<\/p>\n

\u2022 Microorganisme care pot genera un risc de infec\u0163ie:<\/p>\n

\u00a0\u00a0\u00a0<\/b> Aspergillus spp. – \u00een sec\u0163iile cu pacien\u0163i cu risc \u00eenalt (aplazie medular\u0103, imuno-depresie, etc.)<\/p>\n

\u00a0\u00a0\u00a0<\/b> Candida spp.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Salmonella (typhi, paratyphi)<\/p>\n

\u00a0\u00a0\u00a0<\/b> Streptococcus grup A<\/p>\n

\u00a0\u00a0\u00a0<\/b> Infec\u0163ii cu germeni multirezisten\u0163i: Pseudomonas aeruginosa, Pseudomonas cepacia<\/p>\n

\u00a0\u00a0\u00a0<\/b> Klebsiella sau alte enterobacteriaceae secretoare de (beta)-lactamaz\u0103<\/p>\n

\u00a0\u00a0\u00a0<\/b> Staphylococcus aureus (rezistent la meticilin\u0103)<\/p>\n

\u00a0\u00a0\u00a0<\/b> Staphylococcus epidermidis<\/p>\n

\u2022 \u00cen dezinfec\u0163ia terminal\u0103 (eliminatori de BK) pot fi utilizate dezinfectante pe baz\u0103 de aldehid\u0103 formic\u0103; este de preferat utilizarea altor produse dezinfectante pe care le recomand\u0103 ca atare produc\u0103torul.<\/p>\n

\u2022 Metode folosite \u00een dezinfec\u0163ia cu aldehid\u0103 formic\u0103, atunci c\u00e2nd aceasta se impune stringent<\/p>\n

\u00a0\u00a0\u00a0a)<\/b> pulverizare<\/p>\n

\u00a0\u00a0\u00a0b)<\/b> vaporizare<\/p>\n

\u00a0\u00a0\u00a0a)<\/b> Dezinfec\u0163ia prin pulverizare este o metod\u0103 comod\u0103 \u015fi u\u015for de aplicat, dar mai pu\u0163in eficient\u0103. Pentru a realiza o pulverizare corespunz\u0103toare, cu acoperirea complet\u0103 \u015fi uniform\u0103 a suprafe\u0163elor, trebuie respectate urm\u0103toarele:<\/p>\n

– etan\u015feizarea \u00eenc\u0103perilor;<\/p>\n

– \u00eenc\u0103lzirea \u00eenc\u0103perilor la temperatura de 22-30\u00b0C;<\/p>\n

– umiditate relativ\u0103 80% – 90%;<\/p>\n

– utilizarea aparaturii de pulverizare conform recomand\u0103rilor produc\u0103torului, cu respectarea parametrilor: presiune, deschiderea duzelor, distan\u0163a fa\u0163\u0103 de suprafa\u0163a de dezinfectat;<\/p>\n

– concentra\u0163ia de lucru: solu\u0163ie 2 – 5%; solu\u0163ia 2% se ob\u0163ine din aldehid\u0103 formic\u0103 40% = 50 ml aldehid\u0103 formic\u0103 + 950 ml ap\u0103, sau din 29% aldehid\u0103 formic\u0103 = 69 ml aldehid\u0103 formic\u0103 + 951 ml ap\u0103. Solu\u0163ia 5% se ob\u0163ine din aldehid\u0103 formic\u0103 40% = 125 ml aldehid\u0103 formic\u0103 + 875 ml ap\u0103, sau din 29% aldehid\u0103 formic\u0103 = 172 ml aldehid\u0103 formic\u0103 + 828 ml ap\u0103.<\/p>\n

– cantitatea de solu\u0163ie se calculeaz\u0103 \u00een func\u0163ie de suprafa\u0163\u0103, apreciind ca necesari 40 – 60 ml\/m2<\/sup>.<\/p>\n

– timpul de contact 6-24 ore.<\/p>\n

\u00a0\u00a0\u00a0b)<\/b> Dezinfec\u0163ia prin vaporizare<\/p>\n

\u00a0\u00a0\u00a0<\/b> Pentru vaporizarea aldehidei formice se folosesc aparate speciale, cu respectarea strict\u0103 a instruc\u0163iunilor de utilizare. Pentru evitarea riscurilor este interzis\u0103 folosirea aparaturii defecte sau improvizate.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Efectuarea vaporiz\u0103rilor implic\u0103 urm\u0103toarele:<\/p>\n

– stabilirea cubajului \u00eenc\u0103perii de dezinfectat<\/p>\n

– etan\u015feizarea u\u015filor \u015fi ferestrelor<\/p>\n

– acoperirea prizelor, protejarea sau \u00eendep\u0103rtarea aparaturii electronice<\/p>\n

– a\u015fezarea saltelelor \u015fi pernelor suspendat sau oblic, evitarea supra\u00eenc\u0103rc\u0103rii cu materiale<\/p>\n

– preg\u0103tirea aparaturii pentru vaporizare conform recomand\u0103rilor produc\u0103torului. Aparatul este amplasat \u00een exterior, \u0163eava de ie\u015fire a vaporilor se introduce prin orificiul cheii. Aparatul se men\u0163ine \u00een func\u0163iune p\u00e2n\u0103 c\u00e2nd se evapor\u0103 cantitatea de aldehid\u0103 formic\u0103 corespunz\u0103toare. Se retrage \u0163eava, se astup\u0103 orificiul \u015fi \u00eenc\u0103perea r\u0103m\u00e2ne \u00eencuiat\u0103 \u015fi supravegheat\u0103 timp de 6 – 24 ore.<\/p>\n

– Se instituie toate m\u0103surile de precau\u0163ie pentru evitarea riscului de incendiu \u015fi a intoxica\u0163iilor<\/p>\n

– \u00cenc\u0103perile trebuie s\u0103 fie \u00eenc\u0103lzite (\u00een perioadele reci), temperatura indicat\u0103 20-30\u00b0C<\/p>\n

– Dup\u0103 trecerea timpului necesar de ac\u0163iune se deschid ferestrele \u015fi u\u015file \u015fi se las\u0103 s\u0103 se aeriseasc\u0103 2-4 ore, dup\u0103 neutralizarea vaporilor restan\u0163i.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Pentru neutralizarea vaporilor restan\u0163i de aldehid\u0103 formic\u0103 se utilizeaz\u0103 o cantitate de amoniac egal\u0103 cu jum\u0103tate din cantitatea de aldehid\u0103 formic\u0103 utilizat\u0103 \u015fi un timp de expunere de 3 ore.<\/p>\n

– Opera\u0163iunile de dezinfec\u0163ie se efectueaz\u0103 numai de personal instruit, supravegheat.<\/p>\n

– Concentra\u0163ia de aldehid\u0103 formic\u0103: 3-10 g\/m3<\/sup>, umiditate relativ\u0103 80%.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Cantitatea de aldehid\u0103 formic\u0103 necesar\u0103 se calculeaz\u0103 astfel:<\/p>\n

\n\n\n\n
\u00a0\u00a0\u00a0X\u00a0=\u00a0a\u00a0x\u00a0100\/b,\u00a0unde\u00a0a\u00a0=\u00a0concentra\u0163ia\u00a0\u00een\u00a0grame\u00a0aldehid\u0103\u00a0formic\u0103\/m3<\/sup>\u00a0aer
\nb\u00a0=\u00a0concentra\u0163ia\u00a0\u00een\u00a0grame\u00a0aldehid\u0103\u00a0formic\u0103\u00a0\u00een\u00a0formolul
\ncomercial
\nX\u00a0=\u00a0cantitatea\u00a0de\u00a0aldehid\u0103\u00a0formic\u0103\u00a0\u00een\u00a0ml.
\nExemplu:\u00a0pentru\u00a0a\u00a0realiza\u00a0o\u00a0concentra\u0163ie\u00a0de\u00a05\u00a0g\/m3<\/sup>,\u00a0din\u00a0aldehid\u0103\u00a0formic\u0103\u00a037%,
\nformula\u00a0este:
\nX\u00a0=\u00a05\u00a0x\u00a0100\/37\u00a0=\u00a013,51\u00a0ml\u00a0formol\/m3<\/sup><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

\u00a0\u00a0\u00a0<\/b> Pentru a calcula cantitatea necesar\u0103 pentru dezinfec\u0163ia unei \u00eenc\u0103peri, valoarea X se \u00eenmul\u0163e\u015fte cu num\u0103rul de m3<\/sup> corespunz\u0103tori \u00eenc\u0103perii. Aprecierea necesarului de concentra\u0163ie \u00een aldehid\u0103 formic\u0103 se face \u00een func\u0163ie de num\u0103rul \u015fi volumul obiectelor care absorb vapori de formol din \u00eenc\u0103pere.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Cantitatea de aldehid\u0103 formic\u0103 se amestec\u0103 cu ap\u0103 \u00een propor\u0163ie de 1:4, dup\u0103 care se introduce \u00een aparatul de formolizare, proced\u00e2nd \u00een continuare conform indica\u0163iilor de utilizare ale produc\u0103torului.<\/p>\n

\u00a0\u00a0\u00a0<\/b> Dezinfec\u0163ia prin vaporizare se efectueaz\u0103, pentru cazarmament, efecte, \u00een camere speciale de formolizare (descamere).<\/p>\n

\u00a0\u00a0\u00a0<\/b> \u00cen aceste camere se efectueaz\u0103 dezinfec\u0163ia saltelelor (cu excep\u0163ia celor din latex expandat), pernelor, pledurilor, halatelor din molton, etc. cu o concentra\u0163ie de 8 – 15 g\/m3<\/sup> aldehid\u0103 formic\u0103.<\/p>\n

 <\/p>\n

\u00a0\u00a0\u00a02.3.13<\/b> Dezinfectante – Exemple<\/p>\n

\n\n\n\n
\u250c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2510
\n\u2502Clasa\u00a0chimic\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Utilizare\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Activitate\u2502Avantaje\u00a0\u00a0\u00a0\u00a0\u2502Dezavantaje\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Compu\u015fi\u00a0care\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Dezinfec\u0163ia\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Bactericid\u2502Spectru\u00a0larg\u2502Inactivate\u00a0\u00a0\u00a0\u2502
\n\u2502elibereaz\u0103\u00a0clor:\u00a0\u00a0\u00a0\u00a0\u00a0\u2502suprafe\u0163elor\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Virulicid\u00a0\u2502Ieftine\u00a0\u00a0\u00a0\u00a0\u00a0\u2502de\u00a0materia\u00a0\u00a0\u00a0\u2502
\n\u2502Dicloroizocianuratul\u00a0\u2502dup\u0103\u00a0cur\u0103\u0163are\u00a0\u00a0\u00a0\u00a0\u00a0\u2502(HIV,\u00a0HBV,\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502organic\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502de\u00a0sodiu\u00a0(NaDCC)\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Vesel\u0103,\u00a0biberoane\u00a0\u2502HCV)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Solu\u0163ii\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Hipoclori\u0163ii\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Obiecte\u00a0sanitare\u00a0\u00a0\u2502Fungicid\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502instabile\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Cloramine\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Apa\u00a0de\u00a0la\u00a0flori\u00a0\u00a0\u00a0\u2502Sporicid\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Corozive\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Iritante\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502Compu\u015fi\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00cen\u00a0asociere\u00a0pt.\u00a0\u00a0\u00a0\u2502Bactericid\u2502Slab\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Spectru\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502cuaternari\u00a0de\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502dezinfec\u0163ia\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Fungicid\u00a0\u00a0\u2502iritante\u00a0\u00a0\u00a0\u00a0\u2502variabil\u00a0de\u00a0\u00a0\u2502
\n\u2502amoniu:\u00a0clorura\u00a0de\u00a0\u00a0\u00a0\u2502suprafe\u0163elor\u00a0\u015fi\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Ieftine\u00a0\u00a0\u00a0\u00a0\u00a0\u2502la\u00a0un\u00a0produs\u00a0\u2502
\n\u2502benzalkonium\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502obiectelor\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502la\u00a0altul\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502Clorura\u00a0de\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502(sinergie\u00a0cu\u00a0alte\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Inhibate\u00a0de\u00a0\u00a0\u2502
\n\u2502didecildimetilamoniu,\u2502clase\u00a0chimice)\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502materia\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502cetrimide\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502organic\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Se\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502contamineaz\u0103\u00a0\u2502
\n\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502u\u015for\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
\n\u251c\u2500\u252c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u253c\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2524
\n\u2502\u00a0\u2502Aldehid\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Dezinfec\u0163ie\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Bactericid\u2502Spectru\u00a0larg\u2502Precipit\u0103\u00a0\u00a0\u00a0\u00a0\u2502
\n\u2502A\u2502formic\u0103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502suprafe\u0163e\u00a0obiecte,\u2502Fungicid\u00a0\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502proteinele\u00a0\u00a0\u00a0\u2502
\n\u2502l\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502instrumente\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Virulicid\u00a0\u2502\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Inhibate\u00a0de\u00a0\u00a0\u2502
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\n\u2502Fenolii:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Dezinfec\u0163ia\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502Bactericid\u2502Nu\u00a0e\u00a0coroziv\u2502Miros\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2502
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\u00a0Norma tehnica din 06\/03\/2003 Publicat in Monitorul Oficial, Partea I nr. 194bis din 26\/03\/2003\u00a0privind efectuarea steriliz\u0103rii \u015fi p\u0103strarea sterilit\u0103\u0163ii dispozitivelor\u00a0materialelor sanitare \u00a0 \u00a0Art. 1. – INTRODUCERE Sterilizarea este opera\u0163iunea prin … Citeste mai departe …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[9,19],"tags":[20],"class_list":["post-54","post","type-post","status-publish","format-standard","hentry","category-norme","category-sterilizarea","tag-sterilizarea-2"],"_links":{"self":[{"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/posts\/54","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/comments?post=54"}],"version-history":[{"count":3,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/posts\/54\/revisions"}],"predecessor-version":[{"id":77,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/posts\/54\/revisions\/77"}],"wp:attachment":[{"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/media?parent=54"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/categories?post=54"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medfam.ro\/medlex\/wp-json\/wp\/v2\/tags?post=54"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}