Requirements for the disinfection, destruction and disposal of single-use injection syringes
Guidelines
MU 3.1.2313-08

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1 area of use

1.1. These guidelines (MU) are intended for all medical and preventive institutions (HCIs), organizations, enterprises, regardless of departmental affiliation and ownership, using single-use injection syringes in sterile factory packaging; engaged in the collection, transportation, disinfection, destruction and disposal of syringes, design and operation of installations for the processing of single-use injection syringes made of plastics; as well as for institutions that supervise the provision of medical care, immunoprophylaxis, compliance with the sanitary and anti-epidemic regime in medical facilities.
1.2. The guidelines set out the requirements aimed at organizing the work of a medical institution for the collection, storage, disinfection, destruction and disposal of single-use injection syringes, reducing the risk of infection of medical personnel in the performance of their duties, compliance with the basic safety rules when handling used injection syringes single use, as well as the procedure for emergency situations.
1.3. The requirements of the guidelines are aimed at protecting the health of medical personnel, personnel of organizations involved in the collection, transportation, disinfection, destruction and disposal of used single-use injection syringes, as well as ensuring protection environment when carrying out medical and diagnostic manipulations in medical institutions.

3. General provisions

3.1. In order to prevent the spread of human infectious diseases and exclude the possibility of infection of medical personnel, it is necessary to carry out preventive measures provided for by sanitary rules in a timely manner and in full, including disinfection, destruction and disposal of single-use injection syringes.
3.2. Single-use injection syringes made of plastics used in medical institutions for injections (manipulations), after treatment and diagnostic procedures, are classified as medical waste potentially dangerous in relation to the spread of infectious diseases, and are medical waste of classes B and C.
3.3. Measures for the disinfection, destruction and disposal of single-use injection syringes must be carried out in accordance with the requirements of sanitary rules and other regulatory legal acts Russian Federation in all medical institutions, regardless of their profile.
3.4. Monitoring compliance with the measures for disinfection, destruction and disposal of single-use injection syringes, the quality of their disinfection is included in the production control program (plan) of the medical facility.

4. Requirements for the collection and disinfection of single-use injection syringes

4.1. Single-use injection syringes are medical devices that provide injection and diagnostic and treatment procedures. After use, syringes are hazardous (class B) or extremely hazardous (class C) healthcare facility waste due to contamination with infected or potentially infectious body fluids.
4.2. Single-use injection syringes are not subject to reuse for injections.
4.3. Collection, disinfection, temporary storage, transportation, destruction and disposal of used single-use injection syringes are carried out in accordance with the "Rules for the collection, storage and disposal of waste from medical institutions" (SanPiN 2.1.7.728-99).
4.4. For the disinfection of single-use injection syringes, chemical and physical methods are recommended.
4.4.1. Chemical disinfection method.
4.4.1.1. For disinfection of used single-use injection syringes chemical method a disinfectant solution is preliminarily prepared, which is poured into two special labeled containers with lids: “Container for disinfecting needles” and “Container for disinfecting syringes”. A needle remover can be used as a “Needle Decontamination Tank” when filled with a disinfectant solution. The needle remover is a hard, non-penetrating, disposable plastic container that has a lid with a specially shaped opening, suitable for removing needles from syringes of different diameters. "Container for disinfection of syringes" must be equipped with a perforated tray and oppression.
4.4.1.2. After injection (manipulation) medical worker, without covering the needle with a cap, it performs separate disinfection of the used needle and syringe by a chemical disinfection method, for which it draws a disinfectant solution from the "Container for disinfecting syringes" into the syringe using a piston. Then the medical worker disconnects the needle from the syringe in one of the following ways, depending on the availability of special devices in the medical institution:
removing the needle with a needle remover;
cutting off the needle with a needle cutter with an integrated puncture-proof container for needles;
needle destruction using a needle destructor - a device for burning needles by exposure to high temperature.
4.4.1.3. After disconnecting the needle, the body of the syringe with the plunger is placed in a container with a disinfectant solution, marked "for disinfecting syringes", and the required exposure time is maintained according to the instructions for use of the disinfectant used. Then, a disinfectant solution is released from the syringe body using a piston, after which the disinfected pistons and syringe bodies are placed in a bag fixed on a trolley rack or a single-use container with color marking corresponding to the class medical waste B or C. The container (bag, container) after filling by ¾ of the volume is packed, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a room for temporary storage of medical waste until the end of the working shift for the purpose of subsequent transportation to place of destruction or disposal.
When the needle remover is filled ¾ of the volume with needles and the required disinfection exposure time is observed, the solution is carefully drained, the container is closed with a lid, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a room for temporary storage of medical waste until the end of the working shift from for the purpose of subsequent transportation to the place of neutralization or disposal.
4.4.1.4. If there are no devices for removing, cutting off or destroying needles (needle removers, needle cutters, needle destructors) in the medical institution, the needle should be separated from the syringe only after the syringe with the needle has been decontaminated. Disinfection is carried out by taking the disinfectant solution through the needle into the syringe and immersing the syringe with the needle into the "Capacity for disinfecting syringes" with the disinfectant solution for the required exposure time.
After the end of the disinfection exposure time, the needle is separated from the syringe with tweezers and placed in a solid package (non-piercing sealed single-use container) in accordance with the requirements of SanPiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions".
A disinfectant solution is released from the syringes using a piston, then they are placed in a bag fixed on a trolley rack, or a single-use container with a color marking corresponding to the class of medical waste B or C. The container (bag, container) after filling by ¾ of the volume is packed, placed in a mini-container with a color marking corresponding to the class of medical waste and stored in a room for temporary storage of medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.
4.4.1.5. For disinfection of single-use injection syringes, disinfectants are used that have a certificate of state registration, a certificate of conformity and guidelines (instructions) for their use. The concentration of the disinfectant and the exposure time are determined in accordance with the guidelines (instructions) for its use, taking into account the regimen that is effective against pathogens of infectious diseases that the healthcare institution is focused on, and the regimens recommended for disinfecting medical devices for viral infections.
The disinfectant solution in the containers is changed at the end of the shift. The frequency of changing the solution in containers can be determined in accordance with the guidelines (instructions) for the use of a disinfectant.
The name, concentration, purpose and date of preparation should be indicated on the container for storing the disinfectant solution (for ready-to-use products approved for repeated use, indicate the start date of use).
4.4.2. Physical methods of disinfection.
4.4.2.1. The method of disinfection of single-use injection syringes with saturated water vapor in steam sterilizers (autoclaves) is used in accordance with " Guidelines on Disinfection, Pre-Sterilization Cleaning and Sterilization of Medical Devices” dated December 30, 1998 No. MU-287-113 and “Instructions for the Collection, Storage and Delivery of Single-Use Medical Device Scrap”, approved by the USSR Ministry of Health on September 24, 1989.
When using this method of disinfection, the bodies and pistons of syringes are placed in a special vapor-permeable single-use bag that is resistant to high temperatures and is intended for sterilizing medical devices. This bag is fixed on a rack-trolley inside a single-use bag designed for collecting waste with color and text marking corresponding to hazard class B and C, or put on a single-use container (container with a lid) with color and text marking corresponding to waste class B and C .
After filling the bag by ¾ of its volume, it is sealed and delivered in a container (container) with a closed lid or in a bag designed to collect medical waste of the appropriate color marking, using a trolley rack to the place of disinfection.
After delivery to the place of disinfection, a vapor-permeable bag with syringes without needles is removed from a container (container) or an outer bag intended for collection, transportation and temporary storage of class B and C waste, placed in an autoclave and kept at a temperature of 121 C for 30 minutes.
Needle removers (tanks of needle cutters) with removed (cut off) non-disinfected needles, after filling them by ¾ of the volume, are closed with a lid and delivered using a trolley rack to the place of disinfection.
Needle removers (tanks of needle cutters) with needles are placed in an autoclave, having previously opened the covers of the needle removers (needle cutters) so that steam can penetrate into the container.
After the disinfection cycle, the needle removers (needle cutters) are tightly closed with lids (sealed). Syringes without needles, located in a vapor-permeable bag, are packed in a single-use outer bag designed to collect waste with color and text marking corresponding to hazard class B and C, sealed and delivered via a trolley rack to a temporary waste storage room (into a mini-container) until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.
4.4.2.2. Method for disinfection of injection syringes for single use in the UOMO-01/150 (UOMO-02/90) installation by exposure to electromagnetic radiation ultra-high frequency and wet steam at a temperature of 100 С for 60 minutes are used in accordance with the guidelines "Use of electromagnetic radiation of ultra-high frequency for the disinfection of infected medical waste", approved by the Federal State Health Institution "Federal Center for Hygiene and Epidemiology" of Rospotrebnadzor dated 06.05.06 No. 02.007. 06.
When using this method of disinfection, after the needle is separated, the bodies and pistons of the syringes are placed in a single-use bag, fixed on a single-use container (container) or a trolley rack and intended for collecting waste with color and text marking corresponding to hazard class B and C. After filling the bag by ¾ of its volume, it is sealed and delivered by means of a trolley rack directly to the place of disinfection.
Syringes in single-use bags are placed in a special polypropylene tank, which is attached to the UOMO-01/150 (UOMO-02/90) unit, with a polypropylene bag previously inserted into it. 2 liters of a special sensitizing solution are added to the polypropylene bag.
Needle removers (tanks of needle cutters) with removed (cut off) non-disinfected needles, after filling them by ¾ of the volume, are closed with lids and delivered by means of a trolley rack to the place of disinfection.
Needle removers (capacities of needle cutters) with removed (cut off) non-disinfected needles are placed in the center of the tank above packages with disposable syringes without needles. Before placing the needle removers (canisters of needle cutters) with needles into the tank, a sensitizing solution is added to them so that the needles are completely immersed in the solution.
After the disinfection cycle, disposable syringes, needle removers (needle cutter containers) located in a polypropylene bag are packed in a single-use outer bag designed to collect waste with color and text markings corresponding to hazard class B and C, which is then sealed and delivered by means of a trolley rack to the premises for temporary storage of waste (in a mini-container) until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.
4.4.3. Medical workers who disinfect single-use injection syringes draw up a final act of disinfection for the entire batch of used syringes accumulated over a certain period and prepared for delivery to specialized organizations that have licenses to work (handle) with hazardous (medical) waste (Appendix 1 ).
4.4.4. The quality control of disinfection of injection syringes for single use is carried out in accordance with the production control plan of the medical facility.
4.5. Without preliminary decontamination in a medical facility, collection, temporary storage and transportation of medical waste generated during injections is allowed, if all the necessary epidemiological safety requirements are met in the process of their collection, temporary storage, transportation to the place of neutralization with the obligatory use of thermal methods of destruction (burning).
In this case, syringes with needles immediately after their use are placed in disposable sealed non-piercing containers with color and text markings corresponding to waste class B and C, registered and authorized for use in the prescribed manner. The design of containers for collecting waste should ensure their sealing and the impossibility of opening them during transportation. After filling the containers by ¾ of their volume, they are sealed, placed for temporary storage in a specially designated room for the storage of medical waste, and then transported for the purpose of subsequent destruction by thermal methods (burning) by specialized vehicles of an organization (firm) that has a license to work (handle) with hazardous (medical) waste.
4.6. The method of collecting medical waste generated during immunization without preliminary disinfection specified in paragraph 4.5 can be used when vaccinating children and educational institutions, during the work of mobile vaccination teams. In this case, disposable sealed containers with color and text marking corresponding to waste class B and C are sealed at the end of the working day or after filling them to ¾ of the volume, placed in a mini-container with a tight-fitting lid, specially designed for transporting hazardous medical waste. A mini-container with waste generated after immunization in children's and educational institutions, during the work of mobile vaccination teams, is transported to the healthcare facility by vehicles specially allocated for this purpose of this institution for subsequent destruction by thermal methods together with other healthcare facility waste. After transportation, the mini-container(s) are subjected to washing and disinfection.
4.7. Single-use packaging for waste collection (bags, containers, sealed containers for collecting needles and syringes) used in medical facilities must meet the medical and technical requirements for these products and have a registration certificate authorizing its use in medical practice in accordance with SanPiN 2.1 .7.728-99.

5. Requirements for temporary storage and transportation of used single-use injection syringes

5.1. Temporary storage (accumulation) of needles, pistons and cylinders of syringes collected in the departments of a medical institution, packed in a single sealed container, is carried out in mini-containers of the appropriate color marking, placed in a room specially designated for this purpose or in an open area, using labeled according to the hazard class of inter-vessel containers. Open storage and contact of personnel with epidemiologically hazardous waste is not allowed.
5.2. Premises for temporary storage of waste should be equipped with exhaust ventilation and a sink for washing hands with hot and cold water. The interior lining of these rooms should exclude desorption and withstand repeated wet cleaning with the use of disinfectants.
5.3. If there are no conditions in the health facility for the use of decentralized methods of destruction of epidemiologically hazardous waste permitted in the established manner, the health facility concludes an agreement for the export of used single-use injection syringes with a specialized organization licensed to handle epidemiologically hazardous medical waste (collection, transportation , placement, destruction, disposal). Small HCFs may enter into waste disposal contracts with larger HCFs that have provisions for the collection and temporary storage of additional waste.
5.4. An agreement between a healthcare facility and a specialized organization for the removal of used single-use injection syringes must include a schedule for the removal of waste.
5.5. Transportation of reusable containers with used single-use injection syringes by specialized organizations is allowed only in closed bodies of special vehicles intended for the transportation of class B and C medical waste, with its subsequent daily disinfection. In case of emergencies, if an open (without sealed packaging) waste is found inside containers or vehicles, transport is disinfected immediately.
Special vehicles must have a sanitary passport. The use of this special vehicle for other purposes is not allowed.

6. Requirements for recycling (disposal) and destruction of used single-use injection syringes

6.1. Only disinfected single-use injection syringes are subject to secondary processing (disposal). During the recycling (disposal) of single-use injection syringes, thermal methods should be used to guarantee the complete epidemiological safety of the resulting secondary raw materials.
It is forbidden to manufacture medical devices, goods for children, products that come into contact with food products from the obtained secondary raw materials.
6.2. For the destruction of medical waste of hazard class B and C, including single-use injection syringes, thermal methods are recommended.
6.2.1. The priority is the method of high-temperature thermal destruction (burning) of medical waste in pyrolysis furnaces, which involves the afterburning of the resulting combustion products at a temperature of 1200-1300 С, which ensures the complete decomposition of dioxins.
The advantages of the method are its environmental and epidemiological safety, a significant reduction (by 5-10 times) in the volume and mass of waste being destroyed. The method is universal - any waste can be loaded into the plant without any preliminary sorting.
6.2.2. It is permissible to use combined technologies for the destruction of medical waste based on a combination of mechanical grinding of medical waste and thermal (chemical) methods of disinfection in special installations of domestic and foreign production, registered and permitted for use on the territory of the Russian Federation.
The disadvantages of these developed technologies is their non-universality - it is not recommended to destroy bioorganic and pathological-anatomical waste in these installations, medical waste requires additional sorting. The knives used in the installations do not withstand large objects and must be replaced periodically. During operation, additional consumption of disinfectants, forced ventilation equipment at their installation sites is required. At the same time, continuous loading of medical waste is not ensured, low productivity is noted, and the mass of waste does not decrease.
6.3. If there are no organizations in the locality involved in the collection, destruction or disposal of used single-use injection syringes, as well as specialized facilities designed for the destruction of medical waste in healthcare facilities, it is preferable to disinfect used single-use injection syringes (class B and C waste) in a specially designated for these purposes, a steam sterilizer (autoclave) at a temperature of 132 С (20 min) in order to subject them to destruction (change appearance and loss of consumer properties). After the disinfection, waste from health facilities can be taken out and buried at landfills for solid waste. household waste(MSW).

7. Requirements for organizations involved in transportation, disinfection, placement, recycling (disposal) and destruction of used single-use injection syringes

7.1. Transportation of medical waste (used single-use injection syringes) from medical institutions (organizations), disinfection, placement, recycling (utilization) and destruction are carried out by specialized organizations licensed to handle epidemiologically hazardous medical waste.
7.2. Specialized organizations Those carrying out this activity must have their own vehicles intended for the transportation of epidemiologically hazardous medical waste (classes B and C). Special vehicles must have a sanitary passport. Vehicles are disinfected daily.
7.3. The final stage of the activities of specialized organizations for the handling of used single-use injection syringes is their destruction (burning) or recycling (utilization) at specialized facilities owned by these organizations, or export under contracts with other enterprises and organizations specializing in destruction (burning) or recycling (disposal) of used single-use injection syringes.
7.4. All employees of specialized organizations are required to:
undergo special training on the rules for handling epidemiologically hazardous medical waste;
observe safety precautions when working with medical waste, the requirements for the operation of installations for the destruction (incineration) or recycling (disposal) of used single-use injection syringes;
use personal protective equipment;
be immunized against viral hepatitis B.
7.5. Specialized organizations licensed to deal with epidemiologically hazardous medical waste must be provided with the necessary technological equipment, consumables and disinfectants in sufficient quantities.

8. Requirements for the observance of safety precautions by the staff of health facilities during the collection, disinfection, temporary storage and transportation of single-use injection syringes

8.1. Medical workers who collect, decontaminate, temporarily store and transport used single-use injection syringes must have special training in safety precautions during these works, be able to apply special equipment and disinfectants in accordance with the functional responsibilities approved by the head of the healthcare facility. Personnel must be immunized against hepatitis B and have an appropriate entry in the medical book.
8.2. Persons under the age of 18 and who have not undergone preliminary training are not allowed to work related to the collection, disinfection, temporary storage and transportation of used single-use injection syringes.
8.3. Training of personnel on the rules for the safe handling of used single-use injection syringes is carried out by specialists responsible for organizing waste management in each health facility.
8.4. The specialist (deputy chief physician for technical issues, epidemiologist, chief nurse) responsible for organizing the management of medical waste is appointed by order of the head of the healthcare institution after passing a specialized training cycle.
8.5. Medical workers collecting, disinfecting, storing, transporting medical waste are strictly prohibited from:
pour the collected single-use injection syringes from one container to another;
place containers for collecting single-use injection syringes near electric heaters (both in places of formation and in temporary storage rooms);
tamp the waste of single-use injection syringes with your hands;
to collect waste of single-use injection syringes without gloves and overalls.
8.6. The head of the healthcare facility is responsible for training staff in the safe handling of medical waste.
8.7. In the event that an employee is injured when handling used syringes, emergency preventive measures must be taken in accordance with the current instructive and methodological documents. All such cases are recorded in the injury reports indicating the date, time, place, nature of the injury, they describe in detail the situation, the use of personal protective equipment, compliance with safety regulations, indicate the persons who were at the site of the injury, as well as the applied skin treatment method, mucous membranes (Appendix 2).
8.8. At the workplace of personnel involved in the collection and transportation of waste, there should be a first aid kit (5% alcohol tincture of iodine, 70 ° alcohol, potassium permanganate and water for dissolution, sterile wipes, bandages, plaster and bactericidal plaster) .
8.9. Employees involved in the collection and transport of medical waste must pass pre-employment and periodic medical examinations in accordance with applicable regulations.
8.10. Personnel engaged in disinfection, collection and transportation of waste should be provided with overalls (gown, cap, shoes) and personal protective equipment (respirators, rubber gloves, sealed goggles, waterproof aprons, which are used in accordance with the instructions).
8.11. In the event of an accident during the use, disinfection, collection and transportation of single-use injection syringes, the following actions are necessary:
the medical worker immediately informs the head of the organization;
if the injection material gets on the mucous membranes of the eyes, they are washed with plenty of water;
in case of contact with the injection material, the skin is wiped twice with 70 ° m of ethyl alcohol, and in case of damage to the skin, the wound is washed with water, treated with tincture of iodine and medical observation of the victim is established;
contaminated surfaces and medical clothing are treated with disinfectant solutions;
upon completion of the actions to eliminate the accident, the responsible person draws up an act in which he reflects the place, time, causes of the accident, measures to eliminate it;
the act is approved by the head of the organization.

9. References

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REQUIREMENTS FOR DISINFECTING, DESTRUCTION AND DISPOSAL OF SINGLE-USE INJECTION SYRINGES - GUIDELINES - M... Relevant in 2018

4. Requirements for the collection and disinfection of single-use injection syringes

When using this method of disinfection, after the needle is separated, the bodies and pistons of the syringes are placed in a single-use bag, fixed on a single-use container (container) or a trolley rack and intended for collecting waste with color and text marking corresponding to hazard class B and C. After filling the bag to 3/4 of its volume, it is sealed and delivered by means of a trolley rack directly to the place of disinfection.

3.1. Prevention of infectious diseases

Guidelines MU 3.1.2313-08

"Requirements for decontamination, destruction and disposal
single use injection syringes

Date of introduction: from the moment of approval

2.12. Instructions for the collection, storage and delivery of scrap medical products for single use (approved by the Ministry of Health of the USSR on March 24, 1989).

3. General provisions

3.2. Single-use injection syringes made of plastics used in medical institutions for injections (manipulations), after treatment and diagnostic procedures, are classified as medical waste potentially dangerous in relation to the spread of infectious diseases, and are medical waste of classes B and C.

3.3. Measures for the disinfection, destruction and disposal of single-use injection syringes should be carried out in accordance with the requirements of sanitary rules and other regulatory legal acts of the Russian Federation in all medical institutions, regardless of their profile.

3.4. Monitoring compliance with the measures for disinfection, destruction and disposal of single-use injection syringes, the quality of their disinfection is included in the production control program (plan) of the medical facility.

4. Requirements for the collection and disinfection of single-use injection syringes

4.2. Single-use injection syringes are not subject to reuse for injections.

4.3. Collection, disinfection, temporary storage, transportation, destruction and disposal of used single-use injection syringes are carried out in accordance with the "Rules for the collection, storage and disposal of waste from medical institutions" (SanPiN 2.1.7.728-99).

4.4. For the disinfection of single-use injection syringes, chemical and physical methods are recommended.

4.4.1. Chemical method of disinfection.

4.4.1.1. For the disinfection of used single-use injection syringes by the chemical method, a disinfectant solution is preliminarily prepared, which is poured into two special labeled containers with lids: "Container for disinfecting needles" and "Container for disinfecting syringes". A needle remover can be used as a "Needle Decontamination Tank" when filled with a disinfectant solution. The needle remover is a hard, non-penetrating, disposable plastic container that has a lid with a specially shaped opening, suitable for removing needles from syringes of different diameters. The "Syringe Decontamination Tank" must be equipped with a perforated tray and yoke.

4.4.1.2. After the injection (manipulation), the medical worker, without covering the needle with a cap, performs separate disinfection of the used needle and syringe by a chemical disinfection method, for which he draws a disinfectant solution from the "Container for disinfecting syringes" into the syringe using a piston. Then the medical worker disconnects the needle from the syringe in one of the following ways, depending on the availability of special devices in the medical institution:

Removing the needle with a needle remover;

Cutting off the needle with a needle cutter with an integrated puncture-proof container for needles;

Destruction of the needle using a needle destructor - a device for burning needles by exposure to high temperature.

4.4.1.3. After disconnecting the needle, the body of the syringe with the plunger is placed in a container with a disinfectant solution, marked "for disinfecting syringes", and the required exposure time is maintained according to the instructions for use of the disinfectant used. Then, a disinfectant solution is released from the syringe body using a piston, after which the disinfected pistons and syringe bodies are placed in a bag fixed on a trolley rack or a single-use container with a color marking corresponding to the class of medical waste B or C. Capacity (bag, container) after filling to 3/4 of the volume, they are packaged, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a temporary storage room for medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

When the needle remover is filled 3/4 of the volume with needles and the required disinfection exposure time is observed, the solution is carefully drained, the container is closed with a lid, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a room for temporary storage of medical waste until the end of the working time. shifts for the purpose of subsequent transportation to the place of neutralization or disposal.

4.4.1.4. If there are no devices for removing, cutting off or destroying needles (needle removers, needle cutters, needle destructors) in the medical institution, the needle should be separated from the syringe only after the syringe with the needle has been decontaminated. Disinfection is carried out by taking the disinfectant solution through the needle into the syringe and immersing the syringe with the needle into the "Containers for disinfecting syringes" with the disinfectant solution for the required exposure time.

After the end of the disinfection exposure time, the needle is separated from the syringe with tweezers and placed in a solid package (non-piercing sealed single-use container) in accordance with the requirements of SanPiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions".

A disinfectant solution is released from the syringes using a piston, then they are placed in a bag fixed on a trolley rack, or a single-use container with a color marking corresponding to the class of medical waste B or C. The container (bag, container) after filling 3/4 of the volume packed, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a temporary storage room for medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

4.4.1.5. For disinfection of single-use injection syringes, disinfectants are used that have a certificate of state registration, a certificate of conformity and guidelines (instructions) for their use. The concentration of the disinfectant and the exposure time are determined in accordance with the guidelines (instructions) for its use, taking into account the regimen that is effective against pathogens of infectious diseases that the healthcare institution is focused on, and the regimens recommended for disinfecting medical devices for viral infections.

The disinfectant solution in the containers is changed at the end of the shift. The frequency of changing the solution in containers can be determined in accordance with the guidelines (instructions) for the use of a disinfectant.

The name, concentration, purpose and date of preparation should be indicated on the container for storing the disinfectant solution (for ready-to-use products approved for repeated use, indicate the start date of use).

4.4.2. Physical methods of disinfection.

4.4.2.1. The method of disinfection of single-use injection syringes with saturated water vapor in steam sterilizers (autoclaves) is used in accordance with the "Methodological guidelines for disinfection, pre-sterilization cleaning and sterilization of medical devices" dated 12/30/1998 No. MU-287-113 and "Instructions for the collection, storage and delivery of scrap medical devices for single use", approved by the Ministry of Health of the USSR on September 24, 1989.

When using this method of disinfection, the bodies and pistons of syringes are placed in a special vapor-permeable single-use bag that is resistant to high temperatures and is intended for sterilizing medical devices. This bag is fixed on a rack-trolley inside a single-use bag designed for collecting waste with color and text marking corresponding to hazard class B and C, or put on a single-use container (container with a lid) with color and text marking corresponding to waste class B and C .

After filling the bag to 3/4 of its volume, it is sealed and delivered in a container (container) with a closed lid or in a bag designed to collect medical waste of the appropriate color marking, using a trolley rack to the place of disinfection.

After delivery to the place of disinfection, a vapor-permeable bag with syringes without needles is removed from a container (container) or an outer bag intended for collection, transportation and temporary storage of class B and C waste, placed in an autoclave and kept at a temperature of 121 ° C for 30 minutes.

Needle removers (canisters of needle cutters) with removed (cut off) non-disinfected needles after they are filled by 3/4 of the volume are closed with a lid and delivered using a trolley rack to the place of disinfection.

Needle removers (tanks of needle cutters) with needles are placed in an autoclave, having previously opened the covers of the needle removers (needle cutters) so that steam can penetrate into the container.

After the disinfection cycle, the needle removers (needle cutters) are tightly closed with lids (sealed). Syringes without needles, located in a vapor-permeable bag, are packed in a single-use outer bag designed to collect waste with color and text marking corresponding to hazard class B and C, sealed and delivered via a trolley rack to a temporary waste storage room (into a mini-container) until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

4.4.2.2. The method of disinfection of single-use injection syringes in the UOMO-01/150 (UOMO-02/90) installation by exposure to microwave electromagnetic radiation and wet steam at a temperature of 100 ° C for 60 minutes is used in accordance with the methodological recommendations "Use of microwave electromagnetic radiation for the disinfection of infected medical waste", approved by the Federal State Health Institution "Federal Center for Hygiene and Epidemiology" of Rospotrebnadzor dated 06.05.06 No. 02.007-06.

Syringes in single-use bags are placed in a special polypropylene tank, which is attached to the UOMO-01/150 (UOMO-02/90) unit, with a polypropylene bag previously inserted into it. 2 liters of a special sensitizing solution are added to the polypropylene bag.

Needle removers (tanks of needle cutters) with removed (cut off) non-disinfected needles after they are filled by 3/4 of the volume are closed with lids and delivered by means of a trolley rack to the place of disinfection.

Needle removers (capacities of needle cutters) with removed (cut off) non-disinfected needles are placed in the center of the tank above packages with disposable syringes without needles. Before placing the needle removers (canisters of needle cutters) with needles into the tank, a sensitizing solution is added to them so that the needles are completely immersed in the solution.

After the disinfection cycle, disposable syringes, needle removers (needle cutter containers) located in a polypropylene bag are packed in a single-use outer bag designed to collect waste with color and text markings corresponding to hazard class B and C, which is then sealed and delivered by means of a trolley rack to the premises for temporary storage of waste (in a mini-container) until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

4.4.3. Medical workers disinfecting single-use injection syringes draw up a final act of disinfection for the entire batch of used syringes accumulated over a certain period and prepared for delivery to specialized organizations that have licenses to work (handle) with hazardous (medical) waste (app.) .

4.4.4. The quality control of disinfection of injection syringes for single use is carried out in accordance with the production control plan of the medical facility.

5. Requirements for temporary storage and transportation of used single-use injection syringes

5.2. Premises for temporary storage of waste should be equipped with exhaust ventilation and a sink for washing hands with hot and cold water supply. The interior lining of these rooms should exclude desorption and withstand repeated wet cleaning with the use of disinfectants.

5.3. If there are no conditions in the health facility for the use of decentralized methods of destruction of epidemiologically hazardous waste permitted in the established manner, the health facility concludes an agreement for the export of used single-use injection syringes with a specialized organization licensed to handle epidemiologically hazardous medical waste (collection, transportation , placement, destruction, disposal). Small HCFs may enter into waste disposal contracts with larger HCFs that have provisions for the collection and temporary storage of additional waste.

5.4. An agreement between a healthcare facility and a specialized organization for the removal of used single-use injection syringes must include a schedule for the removal of waste.

5.5. Transportation of reusable containers with used single-use injection syringes by specialized organizations is allowed only in closed bodies of special vehicles intended for the transportation of class B and C medical waste, with its subsequent daily disinfection. In case of emergencies, if an open (without sealed packaging) waste is found inside containers or vehicles, transport is disinfected immediately.

Special vehicles must have a sanitary passport. The use of this special vehicle for other purposes is not allowed.

6. Requirements for recycling (disposal) and destruction of used single-use injection syringes

It is forbidden to manufacture medical devices, goods for children, products that come into contact with food products from the obtained secondary raw materials.

6.2. For the destruction of medical waste of hazard class B and C, incl. single-use injection syringes, thermal methods are recommended.

6.2.1. The priority is the method of high-temperature thermal destruction (burning) of medical waste in pyrolysis furnaces, which involves the afterburning of the resulting combustion products at a temperature of 1200 - 1300 ° C, which ensures the complete decomposition of dioxins.

The advantages of the method are its environmental and epidemiological safety, a significant reduction (by 5 - 10 times) in the volume and mass of waste being destroyed. The method is universal - any waste can be loaded into the plant without any preliminary sorting.

6.2.2. It is permissible to use combined technologies for the destruction of medical waste based on a combination of mechanical grinding of medical waste and thermal (chemical) methods of disinfection in special installations of domestic and foreign production, registered and permitted for use on the territory of the Russian Federation.

The disadvantages of these developed technologies is their non-universality - it is not recommended to destroy bioorganic and pathological-anatomical waste in these installations, medical waste requires additional sorting. The knives used in the installations do not withstand large objects and must be replaced periodically. During operation, additional consumption of disinfectants, forced ventilation equipment at their installation sites is required. At the same time, continuous loading of medical waste is not ensured, low productivity is noted, and the mass of waste does not decrease.

6.3. If there are no organizations in the locality involved in the collection, destruction or disposal of used single-use injection syringes, as well as specialized facilities designed for the destruction of medical waste in healthcare facilities, it is preferable to disinfect used single-use injection syringes (class B and C waste) in a specially designated for these purposes, a steam sterilizer (autoclave) at a temperature of 132 ° C (20 min) in order to subject them to destruction (change in appearance and loss of consumer properties). After the disinfection, waste from health facilities can be taken out and buried at landfills for municipal solid waste (MSW).

7. Requirements for organizations involved in transportation, disinfection, placement, recycling (disposal) and destruction of used single-use injection syringes

7.2. Specialized organizations carrying out this activity must have their own vehicles intended for the transportation of epidemiologically hazardous medical waste (classes B and C). Special vehicles must have a sanitary passport. Vehicles are disinfected daily.

7.3. The final stage of the activities of specialized organizations for the handling of used single-use injection syringes is their destruction (burning) or recycling (utilization) at specialized facilities owned by these organizations, or export under contracts with other enterprises and organizations specializing in destruction (burning) or recycling (disposal) of used single-use injection syringes.

7.4. All employees of specialized organizations are required to:

Undergo special training on the rules for handling epidemiologically hazardous medical waste;

Observe safety precautions when working with medical waste, the requirements for the operation of installations for the destruction (incineration) or recycling (disposal) of used single-use injection syringes;

Use personal protective equipment;

Be immunized against viral hepatitis B.

7.5. Specialized organizations licensed to deal with epidemiologically hazardous medical waste must be provided with the necessary technological equipment, consumables and disinfectants in sufficient quantities.

8. Requirements for the observance of safety precautions by the staff of health facilities during the collection, disinfection, temporary storage and transportation of single-use injection syringes

8.1. Medical workers who collect, decontaminate, temporarily store and transport used single-use injection syringes must have special safety training during these works, be able to use special equipment and disinfectants in accordance with the functional duties approved by the head of the healthcare institution. Personnel must be immunized against hepatitis B and have an appropriate entry in the medical book.

8.2. Persons under the age of 18 and who have not undergone preliminary training are not allowed to work related to the collection, disinfection, temporary storage and transportation of used single-use injection syringes.

8.3. Training of personnel on the rules for the safe handling of used single-use injection syringes is carried out by specialists responsible for organizing waste management in each health facility.

8.4. The specialist (deputy chief physician for technical issues, epidemiologist, chief nurse) responsible for organizing the management of medical waste is appointed by order of the head of the healthcare institution after passing a specialized training cycle.

8.5. Medical workers collecting, disinfecting, storing, transporting medical waste are strictly prohibited from:

Pour the collected single-use injection syringes from one container to another;

Place containers for collecting single-use injection syringes near electric heaters (both in places of formation and in temporary storage rooms);

Tamp the waste of single-use injection syringes with your hands;

Collect waste from single-use injection syringes without gloves and overalls.

8.6. The head of the healthcare facility is responsible for training staff in the safe handling of medical waste.

8.7. In the event that an employee is injured when handling used syringes, emergency preventive measures must be taken in accordance with the current instructive and methodological documents. All such cases are recorded in the injury reports indicating the date, time, place, nature of the injury, they describe in detail the situation, the use of personal protective equipment, compliance with safety regulations, indicate the persons who were at the site of the injury, as well as the applied skin treatment method, mucous membranes (app.).

8.8. At the workplace of personnel involved in the collection and transportation of waste, there should be a first aid kit (5% alcohol tincture of iodine, 70 ° alcohol, potassium permanganate and water for dissolution, sterile wipes, bandages, plaster and bactericidal plaster) .

8.9. Employees involved in the collection and transportation of medical waste must undergo preliminary medical examinations upon admission to work and periodic medical examinations in accordance with applicable regulations.

8.10. Personnel engaged in disinfection, collection and transportation of waste should be provided with overalls (gown, cap, shoes) and personal protective equipment (respirators, rubber gloves, sealed goggles, waterproof aprons, which are used in accordance with the instructions).

8.11. In the event of an accident during the use, disinfection, collection and transportation of single-use injection syringes, the following actions are necessary:

The medical worker immediately informs the head of the organization;

If the injection material gets on the mucous membranes of the eyes, they are washed with plenty of water;

If the injection material gets into the skin, wipe the skin twice with 70 ° m of ethyl alcohol, and in case of damage to the skin, the wound is washed with water, treated with tincture of iodine and medical observation of the victim is established;

Contaminated surfaces and medical clothing are treated with disinfectant solutions;

Upon completion of the actions to eliminate the accident, the responsible person draws up an act in which he reflects the place, time, causes of the accident, measures to eliminate it;

The act is approved by the head of the organization.

9. References

1. Order of the Ministry of Health of the USSR dated July 31, 1978 No. 720 "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection."

2. Order of the Ministry of Health of the USSR of 03.09.91 No. 254 "On the development of disinfection in the country" with amendments and additions (letter of the Ministry of Health of the Russian Federation 23-02/733 and GKSEN of 29.07.92 No. 01-20 / 104-11).

3. Order of the Ministry of Health of the Russian Federation dated November 26, 1997 No. 345 "On improving measures for the prevention of nosocomial infections in obstetric hospitals".

4. Order of the Ministry of Health of Russia dated November 10, 2002 No. 344 "On the state registration of disinfectants, disinsection and deratization agents for use in everyday life, in medical institutions and at other facilities to ensure the safety and health of people."

After use, syringes are hazardous (class B) or extremely hazardous (class C) healthcare facility waste due to contamination with infected or potentially infectious body fluids.

Single-use injection syringes are not subject to reuse for injections.

For the disinfection of single-use injection syringes, chemical and physical methods are recommended.

Chemical method of disinfection.

To disinfect used single-use injection syringes by the chemical method, a disinfectant solution is preliminarily prepared, which is poured into two special labeled containers with lids: “Container for disinfecting needles” and “Container for disinfecting syringes”. As a “Tank for disinfecting needles”, a needle remover can be used when it is filled with a disinfectant solution (Fig. 4).

Fig. 4 Needle removers for disinfection and disposal of needles.

"Container for disinfection of syringes" must be equipped with a perforated tray and oppression (Fig. 5)

Fig.5. Capacity for disinfection of syringes

After the injection, the medical worker, without covering the needle with a cap, performs separate disinfection of the used needle and syringe by a chemical disinfection method, for which he draws a disinfectant solution from the "Syringe disinfection tank" into the syringe using a piston. Then the medical worker disconnects the needle from the syringe in one of the ways :

Removing the needle with a needle remover;

Cutting off the needle with a needle cutter with an integrated puncture-proof container for needles;

Destruction of the needle using a needle destructor - a device for burning needles by exposure to high temperature (Fig. 6)

Rice. 6. Destructor of needles.

After disconnecting the needle, the body of the syringe with the plunger is placed in a container with a disinfectant solution, marked "for disinfecting syringes", and the required exposure time is maintained according to the instructions for use of the disinfectant used. Then, a disinfectant solution is released from the syringe body using a piston, after which the disinfected pistons and syringe bodies are placed in a bag fixed on a trolley rack or a single-use container with a color marking corresponding to the class of medical waste B or C. The container (bag, container) after ¾ fills are packed, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a temporary storage room for medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

When filling the needle remover with needles by ¾ of the volume and observing the necessary disinfection exposure time, the solution is carefully drained, the container is closed with a lid, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a room for temporary storage of medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

In the absence of devices for removing, cutting off or destroying needles in the medical facility, the separation of the needle from the syringe should be carried out only after the syringe with the needle has been decontaminated. Disinfection is carried out by taking the disinfectant solution through the needle inside the syringe and immersing the syringe with the needle into the “Container for disinfecting syringes” with the disinfectant solution for the required exposure time.

After the end of the disinfection exposure time, the needle is separated from the syringe with tweezers and placed in a solid package in accordance with the requirements of SP 2.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions".

A disinfectant solution is released from the syringes using a piston, after which the disinfected pistons and syringe bodies are placed in a bag fixed on a trolley rack or a single-use container with a color marking corresponding to the class of medical waste B or C. The container (bag, container) after filling on ¾ of the volume is packed, placed in a mini-container with a color marking corresponding to the class of medical waste, and stored in a temporary storage room for medical waste until the end of the working shift for the purpose of subsequent transportation to the place of destruction or disposal.

The disinfectant solution in the containers is changed at the end of the shift.

Physical method of disinfection.

At physical method disinfection of single-use injection syringes use saturated water vapor in autoclaves or microwave electromagnetic radiation and wet steam.

After filling the bag by ¾ of its volume, it is sealed and delivered to containers (containers) with a closed lid or to a bag designed to collect medical waste of the appropriate color marking, using a trolley rack to the place of disinfection. Then the package is placed in an autoclave and kept at 121°C for 30 minutes.

Fig.7 Installation UOMO-01/150 for disinfection of disposable products by electromagnetic radiation.

When using electromagnetic radiation of ultrahigh frequency and wet steam at a temperature of 100 ° for 60 minutes, the UOMO-01/150 installations are used (Fig. 7).

Without preliminary decontamination in a medical facility, collection, temporary storage and transportation of medical waste generated during injections is allowed, if all the necessary epidemiological safety requirements are met in the process of their collection, temporary storage, transportation to the place of neutralization with the obligatory use of thermal methods of destruction (burning) ( Fig. 8). This method is used to collect and destroy medical waste generated during immunization during vaccination in children's and educational institutions during the work of mobile vaccination teams.

Rice. 8 Solid domestic waste incinerator.

All premises, equipment, medical and other inventory must be kept clean. Wet cleaning of premises (treatment of floors, furniture, equipment, window sills, doors) should be carried out at least 2 times a day, using detergents and disinfectants that are approved for use in the prescribed manner. The administration of the LPO organizes preliminary and periodic (at least once a year) briefing of the personnel cleaning the premises on the issues of the sanitary and hygienic regime and cleaning technology.

Storage of detergents and disinfectants should be carried out in the container (packaging) of the manufacturer, provided with a label, on racks, in specially designed places.

It is necessary to have separate containers with working solutions of disinfectants used to treat various objects:

For disinfection, for pre-sterilization cleaning and for sterilization of medical devices, as well as for their preliminary cleaning (when using products with fixing properties);

For disinfection of surfaces in rooms, furniture, devices, instruments and equipment;

For decontamination of cleaning material, for decontamination of class B and C waste (in the absence of decontamination facilities).

Containers with working solutions of disinfectants should be equipped with tight-fitting lids, have clear inscriptions or labels indicating the agent, its concentration, purpose, date of preparation, expiration date of the solution.

When working with disinfectants, all precautions, including the use of personal protective equipment, specified in the instructions for use, must be observed.

Cleaning equipment (trolleys, mops, containers, rags, mops) must be clearly marked or color-coded, taking into account the functional purpose of the premises and types of cleaning work, and stored in a dedicated room. The color coding scheme is placed in the inventory storage area. Washing machines for washing, rags are installed in the places where the cleaning trolleys are assembled.

Window glass washing should be carried out as needed, but at least 2 times a year.

spring-cleaning rooms of ward departments and other functional rooms and offices should be carried out according to the schedule at least once a month, with the processing of walls, floors, equipment, inventory, lamps.

Storage of cleaning equipment must be carried out in a specially allocated room or closet outside the premises of the offices.

In order to reduce air contamination to a safe level, the following technologies are used:

Impact ultraviolet radiation using open and combined bactericidal irradiators used in the absence of people, and closed irradiators, including recirculators that allow air disinfection in the presence of people, the required number of irradiators for each room is determined by calculation in accordance with applicable standards;

Exposure to aerosols of disinfectants in the absence of people using special spray equipment (aerosol generators) during final disinfection and during general cleaning;

The use of bacterial filters, including electrostatic precipitators.

For cleaning (except for class A premises), it is allowed to involve professional cleaning (cleaning) companies operating in around the clock for which it is necessary to provide separate rooms. Cleaning company personnel must comply with these rules when cleaning in OOMD.

This article will focus on the SAFE USE of needles from syringe pens and syringes, as well as lancets and infusion set cannulas - at home, at work and while traveling. The following will also be useful to read for those who are forced to give injections for other diseases (allergies, arthritis, hepatitis, HIV, osteoporosis, blood clotting disorders, psoriasis, etc.) or for their pets.

How to dispose of used sharps, which are in abundance in the daily life of a person with diabetes?

The easiest way is to throw it in the trash and forget it. BUT: when throwing away, it is important to make sure that no one can get hurt with needles (at risk - your loved ones, children, employees of waste disposal companies, a housekeeper, janitors) - this is dangerous not only with cuts or injuries, but also with infection, in if the user has diseases such as viral hepatitis B, C or HIV.

To avoid accidental cuts/damage, needles and other sharp objects must be placed in special CONTAINERS after use - they are made of puncture-resistant plastic with a tight-fitting lid. In some countries, these containers are available from pharmacies, medical supply stores, or online. In the absence of such containers, you can use a suitable container from detergent or other household chemicals made of durable plastic. Label the container stating that it contains sharps. Always place the container in the middle of the trash bag.

Safe disposal of used needles/syringes/lancets/cannulas is essential everywhere - at home, at work, at school, while traveling and in other public places such as hotels, parks and restaurants.

Never leave needles and other sharps (outside the sharps disposal container) in the open or in public trash cans, and never flush them down the toilet!

And in conclusion - 8 simple rules for preventing injuries from sharp objects:

Do not throw used needles in the trash.

Keep sharps containers out of the reach of children.

Do not throw used sharp objects down the toilet.

Do not use glass or plastic bottles, cardboard boxes and cans for the manufacture of containers.

No need to "fill to the very brim" the container - when it is two-thirds full, it's time to throw it away.

Do not wait. Place your sharps in a container immediately after use.

Do not bend or break the needle.

Do not use other people's needles;