There should be a nail-brush for each solution used. The brushes should be clean and sterilized by boiling or by placing in the steam sterilizer.
After sterilizing the hands, the operator, the assistants, and nurses should touch nothing which is not sterile. If they are obliged to do so, the hands should be again washed.
Rubber gloves, such as are used in general surgery, are very useful in the operations of gynecology. They may be worn to protect the patient in case the operator or the assistants are not certain of the sterility of their hands, or to protect the operator when working upon a septic patient. Rubber gloves should be sterilized in the steam sterilizer.
Sterilization of Dressings, Towels, etc.—The operating-cloths, aprons, sheets, towels, dressings, gauze pads, etc. are most conveniently sterilized by steam heat. The temperature should be at least 100° C. (212° F.). The dressings and bandages should not be too tightly packed, so that all parts may be exposed to the same temperature.
Several kinds of steam sterilizers have been introduced. The most easily obtained is the Arnold sterilizer. An apparatus like the Sprague sterilizer, in which the steam is superheated, is preferable, but, as it is not portable, it is adapted only for hospital use.
The dressings should be maintained at the elevated temperature for an hour or more. Although this method secures very good sterilization, yet there are certain spores which resist such elevated temperature even after a two hours’ exposure. The method of fractional or discontinuous sterilisation has therefore been introduced. Two or three successive sterilizations are practised at intervals of twenty-four hours. Spores which at first escape destruction will have developed into vegetative forms in the intervals, and are destroyed by the final sterilizations.
At the Gynecean Hospital all dressings are sterilized for three consecutive days for two hours each day. The dressings, towels, etc., after sterilization, should be preserved in sterile glass jars or other sterile receptacle.
Sterilization of Instruments.—Instruments, drainage-tubes, catheters, and any rubber appliance may be sterilized by boiling in water for fifteen to thirty minutes. A dilute solution (1 per cent.) of carbonate of soda is preferable, as the instruments are not so easily rusted, and this solution, when boiling, has greater germicidal qualities than plain water.
Very convenient instrument-sterilizers are made, in which the instruments are contained in a tray that may be lifted out and placed in the receptacle for containing the instruments during the operation. This receptacle or pan should itself be sterilized, and should contain sterile water, or preferably the sterile solution of bicarbonate of soda, in sufficient quantity to cover the instruments.
It is very convenient to keep on hand a saturated solution of carbonate of soda, sterilized by boiling, a small quantity of which may be added to the water in the instrument-tray. Rusting of instruments is diminished by this means.