(BCB) – white or slightly yellowish powder with faint odor chlorine Contains up to 30% active chlorine. It can be stored at home for years without reducing its activity. Unlike bleach, chloramine does not destroy fabrics and paints.

For use in the form of a solution of 0.2% -10% concentration for disinfection of brushes, tableware, etc.

Preparation of the solution

To prepare chloramine solutions you need the following quantities drug:

Precautions when working with chloramine

When working with chloramine and especially its activated solutions, it is necessary to protect the respiratory system with a RU-60 respirator. The work is performed in a robe, rubber gloves, and an apron. Guidelines were developed at the All-Union Scientific Research Institute of Disinfection and Sterilization. Instructions for the use of chloramine for disinfection purposes dated December 24, 1947 from the date of approval of the data methodological instructions be considered invalid.

General information

Chloramines include a number of organic compounds that have a common chemical formula RSO 2 NH 2 (R - means radical), in which one or both hydrogen atoms located at nitrogen are replaced by chlorine. A distinction is made between chloramine B, if the starting product is benzene, and chloramine T, if toluene is used for this.

Domestic chloramine used for disinfection purposes is called chloramine B, belongs to the group of monochloramines and has the formula: C 6 H 5 SO 2 N(Na)C1*3H 2 . It represents sodium salt benzene sulfonic acid chloramide, has the form of a white fine-crystalline powder. Typically contains 26% active chlorine, maintaining this amount of chlorine for a long time at proper storage.

Chloramine B is highly soluble in water at room temperature. Its solutions do not spoil or discolor fabrics.

Chloramine has high activity against gram-negative and gram-positive microorganisms, starting from 0.2%. Since active chlorine binds to organic substances, then the concentration of solutions in practical conditions is increased to 0.5-1-2-3-5%. Hot solutions of chloramine have a higher disinfecting effect.

The bactericidal and virucidal properties of chloramine solutions are increased by the addition of ammonium compounds (ammonia, ammonium sulfate or ammonium chloride), which act as an activator. Activated chloramine solutions quickly lose active chlorine, so they are used immediately after preparation.

Chloramine is stored in a dark glass container with a well-fitted stopper or, even better, with a ground-in stopper, in a wooden container or in a tin container coated on the inside with asphalt varnish, as well as in polyethylene bags. When storing chloramine, avoid direct exposure to light and moisture.

Chloramine and solutions prepared from it are checked from time to time for the content of active chlorine in them; This establishes the loss of active chlorine and the correct preparation and storage of solutions.

Find something else interesting:

Chloramine- white powder with the smell of chlorine, has high activity against bacteria and viruses.

Preparation of bleach solutions.

Bleach- white powder with pungent odor Chlorine, poorly soluble in water, causes corrosion of metals. Currently used extremely rarely. Preparation of a 10% bleach solution (per 10 liters):

1. Put on a respirator and rubber gloves.

2. Take 1 kg of dry preparation, dilute with a small amount of water to a pasty consistency.

3. Add water to a volume of 10 liters (stirring constantly).

4. Leave the prepared 10% bleach for 24 hours (so that the active chlorine completely goes into solution).

5. After 24 hours, pour the clarified solution (without shaking) into a dark glass bottle or enamel pan.

6. On the label indicate: the date of preparation of the solution; concentration; position, full name of the person who prepared the solution.

Preparation of working solutions of bleach.

Preparation of working hypochlorite solutions.

(from 5% stock solution)

Calcium hypochlorite- (DSGK - dibasic salt of calcium hypochlorite) Powder white with the smell of chlorine, active chlorine content 34-39%, is corrosive, destroys fabrics. Possesses wide range antimicrobial action.

Due to their high antimicrobial activity, chlorine-containing agents are widely used in health care facilities; but for for many years During the operation of these products, the formation of intrahospital strains of microorganisms that are immune to the effects of chlorine-active disinfectants occurred. In addition, chlorine has a toxic effect on humans, causes corrosion of metals, destroys fabrics, loses properties during storage; the disadvantage is the complexity of the technology for preparing working solutions. Currently, the scope of application of these substances is the disinfection of room surfaces, sanitary equipment, and dishes from the patient’s secretions. Most perfect form chloraxants that help reduce toxic effect per person, we use disinfectant medium ib 4 generation (Deochlor tablets, DP 2, etc.)

Sanitary and anti-epidemic regime of hospitals.

(Extracts from the order of the USSR Ministry of Health dated March 23, 1976, No. 288)

Ø Organization and implementation of a set of sanitary and hygienic measures are aimed at preventing and combating nosocomial infections caused by various pathogenic and opportunistic microorganisms (staphylococci, Klebsiella, Pseudomonas aeruginosa, Proteus, etc.)

Sanitary and hygienic regime in reception department.

Ø If you suspect infectious disease, incoming patients are isolated and transferred to the appropriate infectious diseases hospitals.

Ø For this purpose, patients are examined skin, pharynx, measure temperature. Spatulas and thermometers are disinfected.

Ø The patient is examined on a couch covered with oilcloth; After each patient, the oilcloth is wiped with a rag soaked in a disinfectant solution.

Ø If a patient is detected with a suspected infectious disease, the furniture and objects that the patient came into contact with, as well as the room where he was, are subjected to disinfection.

Ø When examining a patient in the emergency department, it is necessary to pay attention to the presence of lice. If pediculosis is detected, the patient, premises and objects with which the patient has been in contact are subject to special disinfestation treatment. Each patient who has been diagnosed with lice is reported to the sanitary and epidemiological station at the patient’s place of residence; make a corresponding note in the medical history.

Ø The patient in the emergency department undergoes complete sanitary treatment, takes a shower or bath (as directed by the doctor), and cuts his nails.

Ø Sanitation is carried out in a special room, in which the access system must be observed, excluding counter flows of patients.

Ø After each use, washcloths for washing patients, baths, hair clippers, combs, razors and razors, scissors, tweezers, enema tips, spittoons, bedpans and urinals are disinfected.

Ø The patient’s clothes and shoes are placed in an individual bag. The bag is stored on racks in a specially designated room.

Ø Wearing medical personnel Caps that completely cover your hair are a must.

Ø The reception area is cleaned at least 2 times a day wet method with the use of disinfectants. The cleaning equipment of the reception department is marked, not used for other purposes, and disinfected after cleaning.

(Approved by the head of the Main sanitary and epidemiological Department of the USSR Ministry of Health V.E. Bucket 21.10.75 No. 1359-75)

General information

Chloramines include a number of organic compounds having the general chemical formula RS02NH2 (R means radical), in which one or both hydrogen atoms located at nitrogen are replaced by chlorine.

A distinction is made between chloramine B, if the starting product is benzene, and chloramine T, if toluene is used for this.

Domestic chloramine used for disinfection purposes is called chloramine B * belongs to the group of monochloramines and has the formula: C6H5S02N(Na)Cl-3H20.

It is a sodium salt of chloramine benzene sulfonic acid and has the appearance of a white fine-crystalline powder (sometimes yellowish). Typically contains 26% active chlorine, retaining this amount of chlorine for a long time if properly stored (loss of active chlorine during the year does not exceed 0.1%).

Chloramine B is highly soluble in water at room temperature. Its solutions retain active chlorine for 15 days and can be prepared for future use. They do not spoil or discolor fabrics.

Chloramine has high activity against gram-negative and gram-positive microorganisms, starting from 0.2%. Since active chlorine binds with organic substances, the concentration of solutions under practical conditions is increased to 0.5-1-2-3-5%. Hot solutions of chloramine (50-60°C) have a higher disinfecting effect.

The bactericidal and virucidal properties of chloramine solutions are increased by the addition of ammonium compounds (ammonia, ammonium sulfate or ammonium chloride), which act as activators.

Activated chloramine solutions quickly lose active chlorine, so they are used immediately after preparation.

Chloramine is stored in a dark glass container with a well-fitted stopper or, even better, with a ground-in stopper, in a wooden container or in a tin container coated on the inside with asphalt varnish, as well as in polyethylene bags.

When storing chloramine, do not allow it to be directly exposed to light and moisture.

Chloramine and solutions prepared from it are checked from time to time for the content of active chlorine in them; This establishes the loss of active chlorine and the correct preparation and storage of solutions.

Preparation of chloramine solutions

Working solutions of chloramine are prepared by stirring it until completely dissolved in water, preferably heated to 50-60°C.

To prepare chloramine solutions, the following quantities of the drug are required:

Concentration	Amount of chloramine (g) per
working solution, %	1 liter of solution	10 l of solution
0,2	2	20
0,5	5	50
1,0	10	100
2,0	20	. 200
3,0	30	300
5,0	50	500
10,0	100	1000 (1 kg)

Activated solutions of chloramine are prepared by first diluting a weighed amount of chloramine in cold or hot (50-60°C) water until completely dissolved, followed by adding an activator (ammonium chloride, sulfate, nitrate) in an amount equal to the amount of active chlorine in the solution, and 8 times less ammonia is added.

Activated chloramine solutions are used immediately after preparation.

To prepare 1 or 10 liters of activated solution you need:

Working solution concentration	Concentration of active chlorine in% in the working solution	Amount of activator (g) per
		1l solution		10 l of solution
		Ammonium salts (1:1)	Ammonia	Ammonium salts (1:1)	Ammonia
0,5	0,13	1,3	0,162	13,0	1,62
1,0	0,26	2,6	0,324	26,0	3,24
2,5	0,65	6,5	0,812	65,0	8,12

Application of chloramine solutions

Solutions of chloramine in various concentrations are used for disinfection of intestinal and droplet infections of bacterial and viral etiology, tuberculosis, and fungal diseases.

For these infections, chloramine solutions are used to wipe or irrigate surfaces and soak objects to be disinfected, and also, in some cases, to fill secretions.

Disinfection regimes for various objects for the listed infections are presented in Table. 1-5.

Modes for disinfecting objects with chloramine in intestinal and droplet infections bacterial etiology

Table 2

Regimes for disinfecting objects with chloramine in foci of microsporia, trichophytosis and favus

Table 3

Modes for disinfecting objects in outbreaks with chloramine viral hepatitis and enteroviral infections

Precautions when working with chloramine

When working with chloramine, and especially its activated solutions, it is necessary to protect the respiratory system with a RU-60 respirator.

The work is performed in a robe, rubber gloves, and an apron.

The instructions for the use of chloramine for disinfection purposes dated December 24, 1947 shall be considered invalid from the moment of approval of these guidelines.

Regimes for disinfecting objects with activated chloramine solutions in foci of tuberculosis

Note. According to instructions for current and final disinfection for tuberculosis No. 744-68, the use of non-activated chloramine solutions in areas of tuberculosis is not recommended.

Table 5. Modes for disinfecting objects with activated chloramine solutions at anthrax

Note. To disinfect surfaces during anthrax, 10-20% solutions of bleach are recommended.

Preparation of a 10% bleach solution and

working solutions (0.5%, 1%, 3%)

Target: Prepare a 10% clarified bleach solution (stock solution).

Indications: disinfection.

Equipment:

1. Gown (long surgical).

2. Rubber apron.

3. Respirator or 4-layer gauze mask.

5. Medical cap.

6. Rubber gloves.

7. Measuring container.

8. Enameled container with a lid.

9. A dark glass bottle with a ground stopper.

10. Wooden spatula.

11. Label.

12. Warm water - 10 liters.

13. Gauze napkin or sieve.

14. Dry bleach 1kg.

15. Ventilated room.

Sequence of actions:

1. Put on a second robe, rubber apron, rubber gloves, respirator or mask.

2. Take 1 kg of dry bleach.

3. Pour it carefully into an enamel container and chop it with a wooden spatula.

4. First add 2-3 liters of water, stirring constantly with a wooden spatula until a uniform suspension is formed, and then add water to the 10 liter mark.

5. Close the enamel container with a lid and leave for 24 hours (during the first 4 hours of settling, it is necessary to stir the mixture at least 3 times so that the active chlorine completely goes into solution).

6. After 24 hours, pour the resulting solution, without shaking, through 4 layers of gauze (bandage) into a dark glass bottle marked “10% bleach solution.”

7. Close with a stopper.

8. Put on the label: - the date of preparation of the solution;

His concentration;

Your position and surname.

9. Remove protective clothing.

10. Wash your hands.

11. Lubricate your hands with cream.

Note:

The 10% solution is stored in a dark, cool place;

Use within 5-7 days.

Preparation of working solutions of bleach

from a stock solution of 10% bleach

Example: Take 1 liter of 10% bleach solution and add 9 liters of water - you get a 1% bleach solution.

Application of bleach solutions:

10% - disinfection of secretions and rinsing waters, for the preparation of all working solutions.

0,5% - for processing dishes and various surfaces.

1% - for treating floors, surfaces, vessels, toilets, bathtubs, etc.

3% - 5% - for disinfection of disposable systems and syringes with their subsequent destruction, debris, purulent dressings.

Preparation of working solutions of chloramine (0.5%, 1%, 3%, 5%)

Before use, working solutions are prepared from dry chloramine, diluting the powder with water in the required concentrations. Water is added to the powder to the desired volume (up to 1 l, 1.5 l, etc.)

Working solutions can be used for 15 days if stored correctly (dark, dry, cool and well-ventilated area).

Preparation of working solutions of chloramine

A chloramine solution is prepared immediately before use (as chloramine dissolves quickly in water).

For example: prepare a 1% chloramine solution – 1 liter.

1 liter – 1% 1000 ml – 10.0 g chloramine = 990 ml water

100 ml – 1.0 g. St.

1000 ml – 10.0 g. st.

To prepare a 1% chloramine solution, 1 liter, you need 10.0 g of chloramine and 990 ml of water.

Thus, it is possible to calculate the preparation various solutions chloramine. For example: 2% chloramine solution – 1 liter: - 20 g of chloramine + 980 ml of water; 3% chloramine solution – 1 liter: - 30 g of chloramine + 970 ml of water.

V. ADDITIONAL INFORMATION.

Precautions when working with disinfectants

1. Preparation and storage of disinfectant solutions is carried out in separate, dark and well-ventilated rooms, inaccessible to patients and children.

2. Personnel preparing chlorine-containing solutions wear special clothing: gown, cap, goggles, respirator, gloves, rubber apron, boots.

3. Bleach powder is stored in plastic bags, tightly tied, since chlorine loses its bactericidal properties when exposed to sunlight.

4. Disinfectant solutions stored in labeled containers with tight-fitting lids, indicating the name of the solution, its concentration, date of preparation and signature of the nurse.

5. When preparing a disinfectant solution, the powder is added to water, and not vice versa, in order to avoid strong evaporation and burns.

6. If a chlorine-containing disinfectant solution gets on your skin or mucous membranes, you should immediately rinse them thoroughly. cold water(flow-through).

PROFESSIOGRAM No. 2

PRE-STERILIZATION TREATMENT OF USED MEDICAL INSTRUMENTS ACCORDING TO 408 ORDER

I. RATIONALE.

Used medical instruments dressing is processed according to a 408 order in order to prevent the occurrence nosocomial infection– viral hepatitis, AIDS, etc.

II. EQUIPMENT.

5 containers marked: " cold water", "washing off water", "disinfectant solution", "washing solution", "distilled water";

10% bleach solution, 5% bleach solution, 3% chloramine solution (30.0 chloramine + 970 ml water), 2% sodium bicarbonate solution (20.0 soda + 980 ml water), washing solution - 1 l - 1 % hydrogen peroxide + 5.0 detergent(or 20 ml 33% perhydrol + 980 ml water + 5.0 detergent), distilled water;

Water thermometer, electric stove, cotton balls, gauze wipes, brushes, mandrels, pipettes, brushes.

Control samples:

Benzidine test : ( 5-6 benzidine crystals + 3% hydrogen peroxide + 50% solution acetic acid– in equal parts);

Amidopyrine test: (5% alcohol solution amidopyrine + 3% hydrogen peroxide solution + 30% acetic acid solution in equal parts).

Azopyram test:(1.0-1.5% solution of aniline hydrochloride in 95% ethyl alcohol. Before use, mix azopyram and 3% hydrogen peroxide in equal quantities).

Phenolphthalein test: 1% phenophthalein solution.

III. PREPARATION: The nurse is dressed in uniform and wearing gloves.

IV. ALGORITHM.

Stage I – flushing:

Medical instruments are washed with cold water over a container for flush water until visible particles are removed: blood, pus, mucus;

The flush water is filled with a 10% bleach solution 1:1 for 1 hour, after which it is drained into the sewer;

Cotton balls and gauze pads are soaked in a 5% bleach solution for 1 hour and then thrown away.

Stage II – disinfection:

Metal and glass instruments are disinfected in a 3% chloramine solution for 1 hour, rubber and plastic products are disinfected by boiling in a 2% sodium bicarbonate solution for 15 minutes.

After disinfection, the instruments are washed under running water until the disinfectant solution is removed.

Stage III – destruction and release of protein:

Place the instruments in the washing solution until completely immersed, heat them to 50 o C and keep the medical instruments in it for 15 minutes. Then let the solution cool, put on two pairs of gloves and wash in this solution.

Wash medical instruments using brushes, pipe cleaners, mandrels (6 to 10 times each).

After this, the medical instruments are washed under running water until removed. cleaning solution(within 10 minutes).

Stage IV – conducting control samples:

Samples for occult blood:

- Benzidine test– through a syringe barrel, needle, etc. Using a pipette, drop the solution. If the color changes to green, the test is considered positive (there is blood left on the medical instruments);

- Amidopyrine test: if the color changes to blue, the test is positive);

- Azopyram test- at positive test a pink color appears. If the test for occult blood is positive, the medical instruments are processed again starting from stage 1;

- Phenolphthalein test– if the color changes to pink, the test is considered positive (that is, the presence of detergent) – which means you should rinse again under cold water.

This step is not carried out for rubber products.

Stage V – removal of salts

All medical instruments are washed in distilled water to remove salts.

Stage VI - drying

Disassembled metal instruments and glass instruments are laid out on grids and dried in a dry-heat oven at a temperature of 80-85 o C until the moisture disappears.

Rubber and plastic products are laid out disassembled on a napkin and dried at room temperature.

Stage VI – sterilization