DE102011105843A1 - Methods for cleaning, disinfecting, sterilizing, cooling and maintenance of transfer instruments, medical instruments and tools, such as hairdressers, involves bringing cold water for cleaning of outer pipe system - Google Patents

Abstract

The method involves bringing the cold water for the cleaning of an outer pipe system. The cold water is pushed through the outer pipe system and nozzles (9) by using compressed air. The water and air mixture strikes a to-be-cleaned object by specially arranged nozzles. The water, which is suitable for internal cleaning, is brought into an internal pipe system. The water is pressurized using the compressed air and is pushed through a transmission channel (10) and a spray channel (11). The outer and inner supply pipes (1,4) are heated for cleaning and disinfection. An independent claim is included for an apparatus for cleaning, disinfecting, sterilizing, cooling and maintenance of transfer instruments, medical instruments and tools, such as hairdressers with a sterilization chamber.

Description

• Process for cleaning, disinfecting, sterilizing and caring for transfer instruments and other objects with cavities.
• Device in which this procedure is used for the cleaning, disinfection and care of transmission instruments as a validated method.
• Device in which this procedure is used for the cleaning, disinfection, sterilization and care of transmission instruments as a validated method.
• Device in which this method is used as a validated method for the preparation of dental / medical instruments.

Introduction:

Transmission instruments within the meaning of this application are turbines, handpieces and contra-angles as used in dental and medical practices. Of course, with the presented methods, other objects with and without cavities such as instruments can be cleaned and disinfected and / or sterilized. Whenever transfer instruments are written below, these items are meant as well.

Problem:

Legislation requires that validated and documented procedures be used to reprocess medical devices for patient reuse. In order to meet this requirement, it is important to use cleaning methods and disinfection methods and / or sterilization methods which are capable of achieving reliably reproducible cleaning results / disinfection results / sterilization results under well-defined conditions and defined parameters, which are sufficient to meet the legal requirements in be fully met. When reprocessing medical devices, the principles also apply: "mechanical reprocessing before manual reprocessing" and "physical methods before chemical methods".

Purpose of this application

Is it a preparatory process to provide suitable methods such as cleaning methods, disinfection methods, sterilization methods, care procedures ... to be used in the preparation of transfer instruments from all manufacturers, and by pre-set parameters that guarantee defined procedures, to be validated or validated treatment process, which can then be used in processing equipment for automated reprocessing. To fulfill the legal requirements, the essential parameters and the successful completion of the reprocessing process are documented in these machines.

In addition to fulfilling the legal requirements, the reprocessing process must proceed in such a way that the transfer instruments to be reprocessed are maximally protected. Another essential requirement of the reprocessing process is that the transfer instruments are processed in as short a time as possible and then available to the practitioner as soon as possible for further use. At the end of the reprocessing process, the transmission tools should not be hotter than "hand-warm".

An essential object of this application is to provide equipment in which this method (s) find application. It describes a device that cleans, disinfects and cares for and a device that can be additionally sterilized. The devices differ essentially in that in the device with which is not sterilized, the treatment process is shortened by the time required for sterilization processing step. The arrangement of the individual preparation steps may change. If, in a specific embodiment, the sterilization is not provided in principle, then the necessary components can be omitted in this device. Included in the application are also combination devices in which the preparation of transmission instruments and other medical, dental, veterinary instruments in a device is made. A preferred embodiment of such a treatment device additionally uses ultrasound for cleaning, in which case the described cleaning process is expanded by the component ultrasonic cleaning in the described treatment process.

State of the art:

The QuattroCare devices from KaVo, Assistina from W & H, spray cans ... are not automatic procedures, they can only perform subtasks during reprocessing. The ICare NSK device is cleaned, disinfected and oiled only on a chemical basis. Sterilization is not possible with this device. The process chemicals used can damage the transmission instruments.

In the treatment with the Quattrocare and the ICare, it can happen that blood and blood components in the cleaning of one Be transferred to another transmission instrument, thus turning a formerly semicritical instrument into a critical instrument. This "cross-contamination" is excluded in our method since each transfer instrument is processed in a separate chamber.

The "dishwasher" thermodisinfector uses process chemicals such as cleaner and neutralizing liquid. With the thermodisinfector, the transmission instrument can not be maintained, sterilization is not possible.

The DAC from Sirona is the only device that complies with the law in a processing machine. However, in comparison to the method presented here, the DAC has some disadvantages: 1. The DAC is a sterilizer, which means that every transmission instrument is sterilized although the legislator only needs to be disinfected for "semi-critical" contaminated transmission instruments. 2. After preparation with the DAC, only the first transfer instrument can be used immediately as a sterile instrument, the other transfer instruments become non-sterile and must be sealed and then re-sterilized. 3. longer process duration, 4. cooling takes place in the cooler ambient air, no active cooling, 5. after preparation, the transmission instruments on the surface are oily, 6. the oiling is considered unreliable, 7. no process control, 8. lower cleaning performance, 9 Rinse Shadow

Our solution:

In the following description, the process steps for the exterior / interior cleaning and exterior / interior disinfection and sterilization will be described separately and then summarized to a treatment process. The individual steps can also run, at least partially, at the same time. Process steps can be omitted in the various devices in which this treatment is carried out: An example of this is that, preferably in a special device, after the cleaning, disinfection, care (oiling) and possibly cooling the process is terminated, without that additionally sterilized. This is useful, among other things, since in all dental practices already a sterilizer is available, with which then the transmission instruments, if necessary after welding, can be sterilized.

In the devices using these methods, it is possible that the sterilized transfer instruments can be kept sterile by sterilizing each transfer instrument in a separately sealable chamber which is sealed so tight that no re-contamination can occur. This is particularly advantageous in surgical practices, since predominantly the same type of transmission instrument is used here. In this way, the sterility status can be maintained without having to be welded.

In order to turn these process sections, which have been described first, into a "validated" treatment process, optimized parameters are defined, under the conditions of which reliably reproducible cleaning and disinfection results are achieved. The processes used then act as a unit during the treatment process: Explanation: During the cleaning, cold water is used. The residual water is then used in the disinfection. In the disinfection turn lines are heated, in which then water is evaporated. The heated pipes are then reused so that the steam generated during sterilization is not condensed when it is distributed and the temperature in the sterilization chamber can be kept ... The generated steam not only disinfects but also cleans the cleaning process at the same time acts in the described process then together with the disinfection as a unit. During the subsequent sterilization, the treatment chamber, which was already heated to a great extent during the disinfection, is further heated. The functional components used in disinfection continue to be used in sterilization. In this way, the various processes will result in a reprocessing process of the applicable process parameters such as the frequency of the individual applications, the duration of the applications, the temperatures and pressures used ... a validatable treatment process with guaranteed treatment results. This also explains why the defined times, temperatures and pressures can vary widely due to the different uses of these methods in different devices. However, the goal is always the same: the result is a reprocessing process with validatable results that is suitable for reprocessing medical devices so that they meet all hygiene requirements and that these medical devices can then be used on the patient. When describing the individual devices, a validatable reprocessing process is presented.

The following descriptions differentiate between an outer supply line and an inner supply line: This means that in the processes (cleaning, disinfection, sterilization) with which the outer surface is treated, the process media are conducted to the transmission instrument via the outer supply line and at Processes in which the interior of the Transmission instruments is treated, the process media are supplied via the inner supply line. In devices in which, for example, instruments are also processed which are not connected by means of a coupling with the device, this inner supply line, for example, go through an insert through which then process media are selectively brought to these objects.

The individual process steps:

A. Cleaning:

1. Exterior cleaning with cold water:

By opening a valve water is spent in the supply line of the exterior cleaning. Subsequently, by means of compressed air, the water is forced through the supply line and connected nozzles / openings under high pressure, so that the water is pressed as a water / air mixture at high pressure on the outer surface of the transmission instruments. The number and arrangement of the nozzles and outlet openings in the disinfection chamber (sterilization chamber) can be adapted to the shape of the transfer instrument, so that rinse shadows can be maximally avoided. A particularly difficult area on the transmission instrument is, for example, the area between the coupling and the transmission instrument.

Check valves in the water supply line and the compressed air supply line can prevent the air from being blown back into the water supply line and vice versa.

2. interior cleaning:

The internal cleaning is carried out according to the same principle: Again, water is introduced into the supply line to the spray channels and the transmission channel, which is then pressed at high pressure by means of compressed air through these cavities.

Steps 1 and 2 are carried out until the desired cleaning success is achieved. The step 1 can run simultaneously with the step 2 or else separated. At balanced pressures, water and compressed air can also be used at the same time. Further cleaning takes place during disinfection: This is described there.

B: Disinfection and further cleaning

3. General:

For disinfection, first the entire disinfection chamber, the transfer instrument and the water supply lines (inside and outside) with nozzles and / or outlet openings and the coupling ... are heated. After the cleaning phase there is water, which is evaporated by heating (water vapor). Already now a first thermal disinfection takes place. Preferably, a temperature of approximately 100 degrees Celsius is used, since this can be achieved without particular pressure increase at 1 bar atmospheric pressure.

4. External disinfection:

The supply line for external cleaning is strongly heated: In this supply line there are nozzles and / or outlet openings in the disinfection chamber, through which the external disinfection and cleaning takes place. Preferably, this supply line is laid in a metal block which is heated by means of a heating cartridge. At 250 watts, for example, this heating cartridge reaches an outside temperature of 350 degrees Celsius and more, so that the adjacent supply line is also heated to a very high temperature. Now by briefly opening a valve water is spent in this supply line, which evaporates immediately due to the high temperatures. An optional non-return valve prevents steam from bouncing back into the water supply line. In this generation of steam, there is a very rapid and strong volume expansion, which leads to an increase in pressure in the line, which in turn has the consequence that the resulting vapor is pressed at high pressure through the nozzle / outlet openings in the disinfection chamber. As a result, the transmission instrument is additionally heated and thermally disinfected and at the same time, as in a steam jet device, pressure-cleaned. With optimum combination of the components heating the supply line, the amount of water supplied and the number and size of the nozzles / outlet openings, this process can be repeated as often as desired, so that a continuous steam and / or saturated steam flow is formed. For example, the process can be optimized by clocking the water supply. A particularly preferred embodiment provides that additional compressed air is added to increase the pressure in the supply line. Thereby, a further improvement of the cleaning performance can be achieved. However, it must be noted that the temperature does not drop too far due to the compressed air. This can be achieved by heating the compressed air before it is introduced, or by increasing the temperature of the supply line. Even when increasing the pressure with compressed air, a check valve can prevent the steam from striking back into the compressed air line.

5. indoor disinfection;

The internal disinfection also takes place in different ways.

As already described, residual water is evaporated after the cleaning phase in the transfer instrument and in the water supply line. This creates a water vapor environment which disinfects in connection with the heating of the instrument.

Another internal disinfection of the instrument takes place in that the transmission instrument is heated from the outside. This is done, for example, by heating the disinfection chamber, by irradiating the instrument with radiant heat, by heating the supply line and coupling by means of a suitable heater such as heating cartridge, heating coils, heating plates, induction, radiators, ...

Furthermore, as in the case of external disinfection, water is introduced into the supply line in the heated supply line to the transmission channel and to the spray channels. The water evaporates very quickly and the volume expansion in the generation of steam "shoots" a jet of steam through the instrument and disinfects and cleans the inside. By optimizing the parameters used, a continuous vapor stream can be created. For example, by clocking the water supply can create a pulsating vapor stream, which can cause an even better cleaning and counteracts the formation of an air cushion. As with external disinfection, additional compressed air can be used to optimize the effect.

6. Sterilization:

Sterilization: By installing an overpressure valve in a pourable water reservoir, steam can be generated by heating this water reservoir. By opening the pressure valve, high pressure, high temperature steam can then be generated, which is then introduced through the instrument and externally to the instrument. It is possible to use a pressure valve that automatically opens at a certain pressure. The advantage is that by controlling the pressure and the temperature used can be controlled. These temperatures can be 134 degrees Celsius or more, depending on the pressure valve and heater used. Another possibility of temperature control is via the factor "time". This means that the valve opens after a certain time. In principle, this type of vapor generation can also take place in the inner supply line and / or outer supply line. In a preferred embodiment, a separate volume of water is created, which is filled during cleaning, for example, and then sealed. This water volume is located in a "pressure chamber" which is preferably connected to the inner and / or the outer feed line. Already in the disinfection phase, this volume of water is preferably heated with the same heating system that is also used for disinfection. This results in time advantages. In the preparation process, the generated steam is then forced through the inner supply line (supply line into the instrument) and / or through the outer supply line (supply line to the instrument) as soon as the appropriate valves have been opened. In the device for sterilization, the disinfection chamber is redesigned to the pressure chamber. With an additional built-in pressure valve, which is preferably mounted in the outlet of the "sterilization chamber", the chamber pressure and thus the temperature in the chamber can be controlled. Other safety devices such as pressure-tight cover, signals, pressure gauge ... may be required.

In a most preferred embodiment, each sterilization chamber receives its own closable lid. This lid is opened after sterilization only when the transfer instrument used or reinserted on the patient. In this way, the sterility status can be obtained. This is an advantage because it can prevent packaging and re-sterilization. This is possible, inter alia, because an external cooling system is used in which the cooling medium does not come into contact with the sterile transfer instrument.

Maintenance:

Oiling: Oiling only lubricates the gearbox. This is achieved by making a technical separation of the transmission channel and the spray channels. This is preferably done in a component to which the coupling is attached. The oil channel is then deliberately introduced into the transmission channel supply line. It has proven to be advantageous if this junction is positioned as far away from the spray channel. During oiling, oil is then forced into the oil line or the oil flows into the oil line by opening a valve. Then compressed air is forced into the line to the spray channels and into the gear channel. The compressed air takes the oil in the oil line and maintains the transmission instrument. A return of the oil in the spray channels is prevented by the fact that the compressed air is applied to both channels. This process can be repeated as often as you like for optimization. In a particularly preferred embodiment, compressed air is first pressed through the transmission channel and the spray channels. As long as the compressed air is pressed through, a valve in the oil line is opened and the oil is pressed together with the compressed air through the transmission channel (see water jet effect). After oiling, the valve in the oil line is closed and the oil is briefly blown with compressed air. This type of oiling has another big advantage: When the oil is drawn out of the oil line by the compressed air, a negative pressure arises in the oil reservoir which can be measured. Thus it can be ensured in the sense of a process control whether the oil has also flowed through the transmission channel. A flow meter in the oil line can do the same job.

In this process, the oiling can be done to each process section. A particularly effective oiling takes place in that the oil is introduced into the optimally preheated transmission channel, so that it expands during heating and so passes into otherwise difficult to reach areas.

In the treatment process, after oiling, the instrument can be briefly evaporated again from the outside, so that thereafter no oil remains on the transmission instrument.

Cooling:

Cooling: Cooling is achieved by passing a closed cooling line, through which cooling liquid flows, outside the disinfection chamber or through the disinfection chamber / sterilization chamber. This prevents coolant from coming in contact with and contaminating the disinfected / sterile transfer instruments. The cooling line is preferably laid in the wall of the disinfection / sterilization chamber. In another preferred embodiment, the cooling line extends below the chamber. The process time is significantly reduced by this active cooling.

Chemical cleaning and disinfection:

For reasons of process safety, it may be necessary for the process to be extended: In the case of particularly stubborn soiling, the addition of a cleaning agent and / or, in the case of a special germ load, the addition of a disinfectant may, in addition, bring advantages. The use of certain chemical substances may require that at least one other chemical be used for neutralization. The application is preferably carried out, as in the oiling, by the opener of a valve. Preferably, by means of compressed air, the chemical is then pressed selectively through the outer feed line and / or through the inner feed line. As in the case of oiling, a device of a pressure sensor and / or a flow meter can be used for process control. This additional method may be particularly advantageous in the preparation of instruments such as mirrors, tweezers, probes.

Advantages of the presented method:

The main advantages will be apparent from the explanations, from the description of the prior art and the figures and descriptions. Further advantages are: 1. The individual process steps can be repeated as often as desired. 2. low consumption of process media 3. Flexibility: The system can be optimized very well by adjusting the temperature, the amount of water supplied, the nozzle / exit points. The temperatures used are significantly higher than those of thermodisinfector 4. Disinfection does not require a separate pressure chamber for the generation of steam. 5. Cost-effective, 6. fast. 7. safe 8. High time advantage, as not only a steam generator must be activated, shorter disinfection time 9. very high cleaning performance. 10. No process chemicals required.

Examples of devices that use these methods in a processing machine as a validated method.

1. Device for cleaning. Disinfection, care and cooling of transmission instruments:

In this device, the external cleaning, internal cleaning, internal disinfection, external disinfection, care and cooling is carried out according to the described method. Processes with pre-set parameters result in a validatable process that delivers consistent cleaning and disinfecting results. User recognition and automatic documentation, safety shutdown, indicator lights and signals are other important components of the device. Components that provide the media air, suitable water, if necessary, with water treatment, oil and other process media, valves, ... are optionally installed in this unit. A device for process monitoring which ensures that the used media have flowed, such as a Waag pressure sensor and / or flow meter are used to monitor process safety. These can be used optionally.

A dedicated facility ensures that a simple re-validation process can be used.

2. Device for cleaning, disinfection, sterilization, care and cooling of transmission instruments:

This device has all components like the device described above. In this device, the disinfection chamber is redesigned to the pressure chamber. For this purpose, a special lock, special materials and safety components are installed. Preferably in the course of the sterilization chamber, at least one pressure valve is installed ensures that a constant pressure prevails in the sterilization chamber. By heating a sealed water reservoir, steam is generated, which is accessed by opening a pressure valve to the transmission instrument and through it. Process control and process monitoring and programmed program sequences guarantee consistent process sequences, resulting in a validated process.

The installation of a chemical cleaning / disinfection unit is easily integrated into the described treatment process, since most cleaning agents and disinfectants have their optimum effect at temperatures of 40-50 degrees Celsius. These temperatures can be achieved very easily by temporarily interrupting the heating of the lines at the desired temperature and carrying out the chemical treatment as an intermediate step. In the subsequent steam treatment, the chemicals used are removed again.

The duration of the individual process steps and their arrangement are based on the specifications such as hygiene laws. Continuous heating via the built-in heating system gives the temperature and pressure.

3. Device for cleaning, disinfection / sterilization and cooling of instruments.

This device differs essentially from the first two devices described in that no means for oiling is required. However, the already described installation of a further cleaning and / or disinfecting device may be advantageous. In this device, the "inner supply line" is preferably coupled to an insert through which the process media are then distributed in a targeted manner in the disinfection chamber / sterilization chamber.

Description Fig. 1

About the supply line 1 is opened by opening the valve 2 through the check valve 3 Water spent in the outer - and in the inner → line system. About the supply line 4 is through the valve 5 and the check valve 6 Compressed air in the outer - and in the inner → line system spent. When cleaning with cold water is by opening the valve 7 , with the valve closed 8th , Water and compressed air pressed into the outer wiring. About the nozzles 9 the transmission instrument is cleaned from the outside with a water / compressed air spray. Through the valve 8th water and compressed air are forced into the inner wiring. These processes can take place at the same time or else preferably in succession. In doing so, water is released by opening the valve 1 pressed into the inner wiring, the valve 1 is then closed again and the compressed air valve 5 open, allowing the water / compressed air mixture by opening the valve 8th , when the valve is closed 7 through the transmission channel 10 and the spray channel 11 is pressed. The heating cartridges 12 both heat up the transmission instrument 17 , the outer wiring, the inner wiring, the coupling and the disinfection chamber. In this case, the residual water present after cleaning is evaporated, there is a first thermal disinfection. In the further disinfection water is through the valves 2 . 3 and 7 pressed into the outer wiring. This is through the heating cartridges 12 already heated. The water is vaporized, in this generation of steam there is a volume expansion and thus the pressure increases and the resulting vapor is through the nozzles 9 From the outside spent on the transmission instrument, which is cleaned and thermally disinfected. To support the effect, - optionally - compressed air can be pressed into the outer cable routing. In the case of internal disinfection and further interior cleaning, water is passed through the valves in the manner already described 2 and 3 with the valve open 8th and - optionally - closed valve 7 in the spray channel 10 and the transmission channel 11 pressed. Since the inner wiring is heated, this water is evaporated, it comes to the volume expansion described and the steam is forced through the transmission instrument, while it cleans and disinfects. To support the effect, compressed air can additionally be compressed into the inner cable routing. In the care (oiling) care oil in the oil channel 13 Spent by the valve 14 is opened. (In the oil line 13 can the oil - optionally - with pressure in the oil line 13 , if necessary portioned, are pressed). Via the compressed air line 4 through the valve 5 and the check valve 6 is compressed air through the valve 8th when the valve is closed 7 through the spray channel 11 and the transmission channel 10 through the transmission instrument 16 pressed. It is important that the oil channel 13 as close to the entrance of the transmission channel opens into the clutch and previously a clear separation between the transmission channel and the spray channels in the form of an intermediate barrier 15 took place. The oil valve 14 is closed in front of the compressed air valve, so that the oil in the gearbox channel will be blown. The cooling line 16 is arranged externally, so that the cooling medium through the cooling line 16 does not come into direct contact with the transmission instrument. (is indicated by long arrows.) In this 1 the pressure increase and thus the temperature increase is not shown. This representation we see in the 2

Description of Fig. 2: Representation of the pressure increase and thus at the same time the temperature increase: generation of steam

Through the valve 1 gets water in the pipe 2 through the check valve 3 in the pressure chamber 4 spent. The valve 5 is - optionally - open for ventilation. The heating system 7 heats the water in the water volume 4 , the valves 1 and 5 are closed. As soon as the thermal expansion, a defined pressure has built up (when the valve 5 a pressure valve is like a steam pressure pot), or after a certain time, the valve 5 opened and the generated steam flows through the distributor 6 defines the outer and / or the inner supply line. The heater, which is shown here as a heating element, of course, can also be a surface heating, an inductively acting heater, a hot plate, a radiation source such as an infrared radiator, ... or another heating system. Although also a heater in the water volume 8th conceivable, is the described heater 7 given the preference because it also the valve 5 and the distribution 6 to be heated. This can prevent the outflowing steam from cooling or condensing prematurely. It has proved to be particularly advantageous if the individual functional components such as the water supply line, the valve seat for the valve 1 and the check valve 3 and the pressure chamber 4 and the valve seat 5 with the steam supply lines and the distributor 6 be milled out of a metal block.

Description Fig. 3: Provision of the media.

By way of example, for the distribution of other media, the media water and compressed air are mixed or distributed in the outer and the inner piping system in this representation.

About the supply line 1 is through the valve 2 through the check valve 3 Water is brought into the system, then by opening the valve 4 exclusively in the outer pipe system 5 arrives when the valve 10 closed is. When the valve 4 closed, and the valve 10 is open, the water enters the inner pipe system via the pipe section 9 ,

About the line 6 is compressed air through the valve 7 and the check valve 8th placed in the distributor. When the valve 4 is open and the valve 10 is closed, then the compressed air in the outer pipe system 5 pressed, with the valve closed 4 and open valve 10 The compressed air is printed in the inner pipe system.

The other options inevitably arise. When the valves 4 and 10 are opened, then the medium passes simultaneously into the outer and the inner line. For the distribution, the pressures used play an important role. The check valves prevent a medium from being able to strike back into the supply line of the other medium under unequal pressure conditions.

Fig. 4 Explanation: Functional components: Device for cleaning, disinfection Care of transmission instruments.

Cross section through a disinfection chamber and functional components:
In this embodiment, the heating cartridges 2 and the cooling 3 and the outer lead 8th in a metal block 1 incorporated or milled from a metal block out. The transmission instrument 7 is about the clutch 6 connected to the inner pipe system so. The nozzles 9 are with the outer supply line 8th connected. When cleaning the outside water is in the outer supply line 8th spent. This water is then used with compressed air through the nozzles 9 to the transmission instrument 7 pressed. During external disinfection, the heating cartridge heats up 2 the outer supply line. As a result, the residual water that is in it after the cleaning phase, evaporated. At the same time, the transmission instrument 7 , the inner supply line, the coupling and the disinfecting trough are heated. In that way in the outer supply line 8th Water is introduced, which then evaporates immediately, becomes the transmission instrument 7 from the outside via the nozzles 9 disinfected and cleaned. Compressed air can increase this cleaning effect. After processing, a cooling medium flows through the cooling line 3 , This can be, for example, drinking water. About the drain 5 the pressure compensation in the disinfection chamber is regulated and the used media can drain off. The lid 10 closes the disinfection chamber during processing. Each transfer instrument is conditioned in a separate chamber, thereby preventing cross-infection (transmission of germs and / or blood and / or blood components from one transfer instrument to another transfer instrument being processed in the same chamber). The distribution of the media in the outer and the inner supply line takes place in a distribution block with the metal blocks 1 is connected. In separate valve blocks, the distribution of the media takes place air and water and oil. For this purpose, for example, valves are arranged as in 3 described. Not shown are: The documentation center with the essential parameters such as the successful execution of the reprocessing program, date, time, if necessary users are documented. Safety switches and signals are also not shown. An operator display with the required software and hardware for controlling a defined program sequence with the associated control switches are also not shown. Thermologger 11 serve the process monitoring. At the drain 5 is a flow meter 12 attached, which is checked in the sense of process monitoring whether the media have actually flowed. A device as a safety cut-out in the event of faults and the connected fault detector 13 are on the lid 10 attached.

• 1. Das kontaminierte Übertragungsinstrument wird an die Kupplung angedockt.
• 2. Das Gerät wird eingeschaltet, Benutzererkennung (fakultativ): Der Benutzer meldet sich im Gerät an. Das Gerät ist an ein Wassersystem angeschlossen das geeignetes Wasser zur Verfügung stellt, und an ein Druckluftsystem.
• 3. Der Deckel wird geschlossen, die Programmtaste für die Aufbereitung wird betätigt
• 4. Außenreinigung: Durch betätigen der in 3 beschriebenen Ventile wird Wasser in die äußere Zuleitung gedrückt. Dauer 0,5 Sekunden
• 5. Das „Wasserventil” wird geschlossen und das „Druckluftventil” geöffnet. Das Wasser wird durch die äußere Zuleitung und durch die Düsen zusammen mit der Druckluft gegen das Übertragungsinstrument gedrückt. Dauer 1 Sekunde Die Verfahrensschritte 4 und 5 werden 10 mal wiederholt. ... .Gesamtdauer 15 Sekunden-
• 6. Innenreinigung: Das Wasserventil wird geöffnet, das Ventil für die innere Zuleitung wird geöffnet, bei geschlossenem Ventil für die äußere Zuleitung: Dadurch gelangt Wasser in die innere Zuleitung: Dauer 0,5 Sekunden.
• 7. Das Wasserventil wird geschlossen und das Druckluftventil wird geöffnet: Das Ventil für die äußere Zuleitung ist geschlossen. Das Wasser wird zusammen mit der Druckluft durch das Übertragungsinstrument (Spraykanäle und Getriebekanal) gedrückt. Dauer 1 Sekunde, Die Verfahrensschritte 6 und 7 werden 10 mal wiederholt. ... .Gesamtdauer 15 Sekunden-
• 8. Die Heizpatronen werden eingeschaltet. Diese bleiben für die nächsten 6 Minuten eingeschaltet. (An dieser Stelle könnte beispielsweise eine zusätzliche chemische Desinfektion sinnvoll sein: Da dieser chemische Aufbereitungsprozess standartmäßig nickt vorgesehen ist, wird er „in Klammer” beschrieben: Die Heizpatronen werden vorübergehend ausgeschaltet, sobald die Temperatur erreicht ist, bei der das Desinfektionsmittel sein Wirkungsoptimum hat. Dann wird das Desinfektionsmittel in die äußere und innere Zuleitung verbracht und mit Druckluft an das Übertragungsinstrument verbracht. Nach der vorgeschriebenen Einwirkzeit wird die Heizung wieder eingeschaltet und der Prozess geht weiter. Da es zwischenzeitlich zu einer gewissen Abkühlung des Systems gekommen ist, wird die Heizperiode etwas verlängert. Wichtig ist, dass das Desinfektionsmittel bei der späteren im Prozess bereits enthaltenen Dampfreinigung sauber entfernt wird.)
• 9. Das Übertragungsinstrument, die Desinfektionskammer, die äußere und die innere Zuleitung, die Kupplung ... werden erhitzt.
• 10. Das Restwasser das sich noch in der Desinfektionskammer, im Übertragungsinstrument und in den Leitungen befindet, wird verdampft. Ausbildung eines Wasserdampfmilieus. Dampfgeneration im Instrument selbst. Dauer 3 Minuten.
• 11. Das Wasserventil und das innere Zuleitungsventil werden geöffnet. Die andreren Ventile sind geschlossen: Dauer 0,2 Sekunden: Das Wasser verdampft, Dampf entsteht, Volumenausdehnung und Druckerhöhung, der Dampf wird durch das Übertragungsinstrument hindurch gedrückt. Desinfektion und Reinigung.
• 12. Das Wasserventil und das äußere Zuleitungsventil werden geöffnet. Die andreren Ventile sind geschlossen. Dauer 0,2 Sekunden: Das Wasser verdampft, Dampf entsteht, Volumenausdehnung und Druckerhöhung, der Dampf wird durch die Düsen in der Desinfektionskammer an das Übertragungsinstrument gedrückt: Reinigung und Desinfektion Die Prozessschritte 11 und 12 werden 3 Minuten lang im Wechsel durchgeführt. Zur Effektsteigerung kann Druckluft zugeführt werden: Die dadurch verursachte Abkühlung wird durch eine höhere Heizleistung der Heizpatronen oder eine gesonderte Leitungsführung ausgeglichen. Dadurch, dass diese Prozessschritte so schnell hintereinander durchgeführt werden, entsteht ein pulsierender Dampffluss. Dieser wirkt der Ausbildung eines Luftpolsters im Übertragungsinstrument entgegen. Über Thermologger wird kontrolliert ob die definierte Temperatur an jeder Stelle in der Desinfektionskammer in der gesamten Sterilisationsphase erreicht wurde. Datenabgleich mit Solltemperatur.
• 13. Kühlung beginnt. durch öffnen eines Ventils in der Kühlleitung. Dadurch wird Trinkwasser durch die Kühlleitung gedrückt und über den Hauswasserabfluss direkt entsorgt. Das Kühlwasser hat keinen Kontakt zu dem Übertragungsinstrument. Dauer 1 Minute
• 14. Die Ölung wird parallel zur Kühlung durchgeführt: alle Ventile sind geschlossen: Das Ölventil und das Druckluftventil wird geöffnet und Öl wird mit Druckluft in die Ölleitung gedrückt. Dauer: 1 Sekunde:
• 15. Das Ölventil wird geschlossen, das Druckluftventil bleibt noch für eine Sekunde geöffnet, die Druckluft verbläst das Öl im Getriebekanal. Die Schritte 14 und 15 werden wiederholt. Da der Getriebekanal noch heiß ist, kommt es auch hier zu einer Druckerhöhung.
• 16 Dokumentation: Der fehlerfreie Ablaufdes validierten Aufbereitungsprozesses wird dokumentiert. Kontrolle ob die Prozessmedien geflossen sind.
• 17. Mindestens ein Signal zeigt an, dass der Aufbereitungsvorgang erfolgreich abgeschlossen wurde.
• 18. Das handwarme Übertragungsinstrument kann als gereinigt, desinfiziert und gepflegt zur Sterilisation oder zur Wiederverwendung am Patienten entnommen werden.

The device description of the cleaning disinfection and care machine is the 4 and the descriptions of the methods used:
The validated reprocessing process is shown below. The time fees are only indicative.

• 1. The contaminated transmission instrument is docked to the coupling.
• 2. The device is switched on, user recognition (optional): The user logs in to the device. The unit is connected to a water system that provides suitable water and to a compressed air system.
• 3. The lid is closed, the program key for processing is activated
• 4. Outside cleaning: By pressing the in 3 described water is pressed into the outer supply line. Duration 0.5 seconds
• 5. The "water valve" is closed and the "compressed air valve" is opened. The water is forced through the outer inlet and through the nozzles together with the compressed air against the transmission instrument. Duration 1 second The process steps 4 and 5 are repeated 10 times. ... total duration 15 seconds
• 6. Internal cleaning: The water valve is opened, the valve for the inner supply line is opened, with the valve closed for the outer supply line: this causes water to enter the inner supply line: duration 0.5 seconds.
• 7. The water valve is closed and the compressed air valve is opened: the valve for the external supply line is closed. The water is pressed together with the compressed air through the transmission instrument (spray channels and gearbox channel). Duration 1 second, process steps 6 and 7 are repeated 10 times. ... total duration 15 seconds
• 8. The heating cartridges are switched on. These remain on for the next 6 minutes. (At this point, for example, an additional chemical disinfection could be useful: Since this chemical treatment process is provided by default nods, it is described "in parenthesis": The heating cartridges are temporarily switched off when the temperature is reached at which the disinfectant has its optimum effect. The disinfectant is then transferred to the outer and inner supply lines and sent to the transmission instrument with compressed air.After the prescribed exposure time, the heating is switched back on and the process continues.There has been a certain cooling of the system in the meantime, the heating period is somewhat It is important that the disinfectant is cleanly removed in the later steam cleaning process already included in the process.)
• 9. The transfer instrument, the disinfection chamber, the outer and the inner supply line, the coupling ... are heated.
• 10. The remaining water that is still in the disinfection chamber, in the transmission instrument and in the pipes, is evaporated. Formation of a water vapor milieu. Steam generation in the instrument itself. Duration 3 minutes.
• 11. The water valve and the inner supply valve are opened. The other valves are closed: duration 0.2 seconds: The water evaporates, steam is generated, volumetric expansion and pressure increase, the steam is forced through the transmission instrument. Disinfection and cleaning.
• 12. The water valve and the external supply valve are opened. The other valves are closed. Duration 0.2 seconds: The water evaporates, steam is generated, volume expansion and pressure increase, the steam is pressed through the nozzles in the disinfection chamber to the transmission instrument: Cleaning and disinfection The process steps 11 and 12 are carried out alternately for 3 minutes. To increase the effect of compressed air can be supplied: The cooling caused thereby is compensated by a higher heating capacity of the heating cartridges or a separate wiring. The fact that these process steps are carried out so quickly in succession, creates a pulsating vapor flow. This counteracts the formation of an air cushion in the transmission instrument. Thermologger controls whether the defined temperature has been reached at any point in the disinfection chamber during the entire sterilization phase. Data comparison with setpoint temperature.
• 13. Cooling begins. by opening a valve in the cooling line. As a result, drinking water is forced through the cooling line and disposed of directly via the domestic water drain. The cooling water has no contact with the transmission instrument. Duration 1 minute
• 14. The oiling is carried out parallel to the cooling: all valves are closed: The oil valve and the compressed air valve are opened and oil is forced into the oil line with compressed air. Duration: 1 second:
• 15. The oil valve is closed, the compressed air valve remains open for a second, the compressed air fills the oil in the gearbox. Steps 14 and 15 are repeated. Since the gearbox is still hot, there is also an increase in pressure here.
• 16 Documentation: The error-free expiry of the validated reprocessing process is documented. Check if the process media flowed.
• 17. At least one signal indicates that the conditioning process has been completed successfully.
• 18. The hand-warm transfer instrument can be removed as cleaned, disinfected and maintained for sterilization or reuse on the patient.

The device for cleaning, disinfection, sterilization and care of transmission instruments: With this device, the disinfection chamber becomes the pressure chamber. This is closed and locked with a tight and secure sealable lid. Steam is formed by the described steam generation system or another steam generator, which is then introduced into the disinfection chamber via the inner and / or outer feed line and through the transmission instrument and / or to the transmission instrument. Via a pressure valve, which is preferably mounted in the outlet of the sterilization chamber, the temperature and the pressure in the chamber are controlled.

The process: The cleaning and disinfection is carried out exactly as described in the device for cleaning, disinfection and care. These are the described process steps 1-12. Steam is generated by means of the heating cartridges or another heater. This happens parallel to the disinfection. After disinfection care and sterilization take place:
Sterilization continues from process step 13:
After disinfection, the transmission instrument is maintained as described. The care can also be done at a different time.

It continues with process step 14:
By opening a pressure valve, the generated vapor is forced through the inner and outer feed lines into the sterilization chamber. To increase the pressure in the chamber is located in the outlet of the chamber, a pressure valve which opens only when the pressure in the chamber has exceeded a defined height. The generated steam has a temperature of, for example, 150 degrees Celsius, so that in the chamber a temperature of 134 degrees Celsius is reached very quickly. This temperature is maintained for a period of at least 3 minutes. By changing the time setting, this duration can also be significantly longer if, for example, sterilization is also used to inactivate prions. (Then the sterilization time is at least 10 minutes.).

• 15. Danach erfolgt die Kühlung wie beschrieben
• 16. Dokumentation und Datenabgleich ob die Prozessmedien geflossen sind
• 17. Mindestens ein Signal zeigt an, dass der Sterilisationsvorgang erfolgreich abgeschlossen ist
• 18. Das Übertragungsinstrument kann zum Verpacken oder zur Wiederverwendung am Patienten entnommen werden.

Thermologger controls whether the defined temperature has been reached at any point in the sterilization chamber during the entire sterilization phase. Data comparison with setpoint temperature.

• 15. Thereafter, the cooling is done as described
• 16. Documentation and data comparison as to whether the process media flowed
• 17. At least one signal indicates that the sterilization process has been completed successfully
• 18. The transfer instrument can be removed for packaging or reuse on the patient.

Claims (22)

Claim 1 method for cleaning, disinfection, sterilization, care and cooling of transmission instruments and other objects such as medical instruments and work equipment (including those of craft professions such as hairdressers) and description of important functional components characterized in that the transmission instruments or other objects with cavities by means of a clutch be coupled in a disinfection / sterilization chamber or objects are moved without cavities in or close to a flushable insert. In this disinfection chamber / sterilization chamber nozzles and / or other openings mounted in a defined arrangement which are connected to an "outer" line system through which the media used for external cleaning and external disinfection, are introduced to the objects to be reprocessed. In the device for the preparation of transmission instruments, there is also an "internal" pipe system through which the media for interior cleaning, indoor disinfection and care are introduced. In the processing of transmission instruments, this inner line system is connected to both the transmission channel and the spray channels. In addition, there is a separate line which opens into the transmission channel or in the supply line to the transmission channel through which the oil is spent for care (oiling) of the transmission instrument. The device for reprocessing instruments also has an "inner cable routing". This is connected to at least one flushable with a medium insert with nozzles / openings. The two piping systems, outer and inner piping, are preferably separated by valves. Check valves in the supply lines of the media used prevent the media from being blown back into the supply lines. The process sequences can be carried out separately or simultaneously at the outer / inner cleaning and / or outer / inner disinfection: The "care" (oiling) step can take place after the cleaning and / or after the disinfection and / or after the sterilization. The individual process steps are, goal-oriented, repeated several times. The method is characterized in that 1. spent for external cleaning cold water in the outer pipe system, which is then forced with compressed air through the outer pipe system and the nozzles / openings so that the water / air mixture then on the specially arranged nozzles so on impinges on the object to be cleaned, that this is cleaned specifically. 2. For internal cleaning, suitable water is brought into the inner pipe system, this water is then pressed with compressed air through the gear channel and through the spray channels or the insert. 3. For chemical cleaning and / or disinfection, the outer and inner supply lines are heated to a temperature of approx. 45 degrees Celsius (at this temperature, the agents used have their optimum effect). Thereafter, using the compressed air, in the manner described, the cleaning / disinfecting agent and / or neutralizing agent spent in the outer and / or inner supply line. After the required exposure time, either continue with step 4, or there is a renewed intermediate cleaning according to the method shown in steps 1 and 2. As a result, the disinfectant is removed from the objects again. In one embodiment, which is preferably used in the instrument processing, a chemical cleaning and / or chemical disinfection before cleaning with cold water, which is then carried out. In this embodiment, id R can be dispensed with the use of the neutralizing agent usually used, since the chemical treatment agents are removed in the subsequent treatment process. In order to prevent the blood and blood components are fixed during heating, in a preferred embodiment, the heating of the chemicals dispensed with or performed only under well-defined conditions. 4. for further disinfection, the transmission instruments, the coupling, the disinfection chamber, the outer pipe system and the inner pipe system, the inserts and objects are further heated by means of a heating system. As a result, residual water remaining after cleaning with cold water, which is in the transfer instrument, in the outer and inner piping system and in the disinfection chamber, in use and the objects ... is evaporated (water vapor). The outer and the inner piping system are particularly heated by the heater, since the heater is preferably in their immediate vicinity or even in the piping itself. 5. for further external disinfection water is spent in the outer pipe system, this evaporates in the strongly heated outer pipe system. In this generation of steam, there is an increase in pressure, the resulting vapor is forced through the nozzles / openings against the transmission instrument, to increase the pressure compressed air is additionally pressed into the outer pipe system. In addition to the disinfecting effect, the water vapor also cleans the transmission instrument from the outside, cleaning and disinfectant residues are also removed. 6. For internal disinfection and in addition to further internal cleaning water is spent in the heated inner pipe system. This water evaporates, in the generation of vapor there is a volume expansion and thus an increase in pressure and the generated steam is forced through the transmission channel and the spray channels of the transmission instrument, or inserts. Here, too, the pressure is increased by additionally pressing compressed air into the inner pipe system. The transfer instrument is further cleaned inside and freed from detergent and / or disinfectant residues. 7. During care (oiling), a valve in the oil line is opened for a defined time so that a defined amount of conditioning oil can flow into / through the oil channel. After that, the oil valve is closed and the oil is pressed with the compressed air through the spray channels and the gearbox. The oil is blown with compressed air. A preferred embodiment has between the valve which is opened to spend oil in the oil passage, and the access to the transmission passage a connection channel with a defined cross-section to the compressed air channel. The connection branches off as close as possible to the valve in the oil channel. This ensures that the compressed air entrains the oil. 8. for sterilization is, preferably, created via valves a closed water reservoir in a pressure chamber. When filling this water reservoir this is vented by opening valves. Thereafter, the valves are closed and the water reservoir is heated. When heated it comes in addition to the increase in temperature to a pressure increase. During heating, the inner and outer piping system is also heated to distribute the steam. Once in the reservoir of the desired pressure and thus the desired temperature is reached, the resulting vapor is spent in the outer and / or the inner conduit system and in the sterilization chamber for cleaning and / or sterilization by the targeted opening of at least one pressure valve , To increase the pressure and thus increase the temperature of the saturated steam environment in the sterilization chamber, the sterilization chamber is designed as a closable pressure chamber and installed at least one pressure valve which then opens when the defined temperature or the set pressure in the sterilization chamber is exceeded. Further measuring and control technology can be used in addition to the fine adjustment. To maintain the sterility status of the sterilized transfer instruments each disinfection / sterilization chamber receives - preferably - its own pressure-tight sealable lid. 9. For cooling, a separate cooling line is passed through the disinfection chamber / sterilization chamber or past it, in this cooling line flows the cooling medium. 10. For drying, the sterilization chamber is reheated for a defined time. By temporarily opening the valve in the sterilization chamber, the pressure generated thereby can escape together with the moisture. During the subsequent cooling, a vacuum environment is created which can be used to check for leaks. This can ensure that the sterility status has been obtained. Claim 2 as claim 1 characterized in that the described method is also used without sterilization after cleaning, care and disinfection. Claim 3 as claim 1 characterized in that the described method is used without additional compressed air to increase the pressure during evaporation of the water in the previously heated outer and / or inner piping system. Claim 4 as claim 1 characterized in that the described method is also used without chemical cleaning and / or chemical disinfection. Claim 5 as claim 1 as claim 9, characterized in that Individual process steps are omitted and this still creates a uniform treatment process that provides validated and validatable treatment results, so that the thus processed medical devices / work equipment may be used in the patient. Claim 6 as claim 1 characterized in that the described cleaning method is used together with another disinfection method and / or Ölungsverfahren and / or cooling method. Claim 7 as claim 1 characterized in that the described disinfection method is also used with another cleaning method and / or Ölungsverfahren and / or cooling method. Claim 8 as claim 1 characterized in that the described separate cooling method is also used with another disinfection method and / or Ölungsverfahren and / or cleaning method. Claim 9 as claim 1 characterized in that the care method described is also used with a different disinfection method and / or cooling method and / or cleaning method. Apparatus for cleaning, disinfecting and maintaining transmission instruments with the components: disinfection chambers, inner and outer wiring, distributor system for separating the inner and outer pipe system, valves for providing the process media, suitable heating system for heating the disinfection chamber, the transmission instrument, the inner and the external supply line, software and hardware for programming the defined process flows, device for temperature control and comparison with defined nominal values, device for checking whether the process media flowed (process control), documentation center, signals and safety precautions, connections for compressed air, suitable water, chemicals and oil, housing, characterized in that with this device the following validated and validatable treatment process proceeds reliably reproducible: After closing the lid and the triggering of the preparation ungsprozesses the external cleaning, characterized in that process water is spent in the outer supply line is then pressed with compressed air from the outside to the transmission instrument. Subsequent interior cleaning, characterized in that process water is spent in the inner supply line, which is then pressed with compressed air through the transmission instrument. Subsequent general disinfection characterized in that the disinfection chamber, the transmission instrument, the coupling and the inner and the outer supply line to be heated, wherein the residual water, that is after the cleaning phase him this system is evaporated. Thereafter, external cleaning and external disinfection, characterized in that in the hot outer supply process water is introduced, which evaporates there and cleaned as a vapor through nozzles, which are mounted in the disinfection chamber, the transmission instrument from the outside and disinfected and that is pressed to increase the pressure of compressed air in this supply line , The subsequent internal cleaning and internal disinfection is characterized in that process water is spent in the heated inner supply line, which evaporates there and the resulting vapor is pressed through the transmission instrument and the transmission instrument is cleaned and disinfected from the inside and that is pressed to increase the pressure of compressed air in this supply line. Preferably, then oiling, in which oil is pressed using compressed air selectively through the transmission channel, then the transmission instrument is again briefly evaporated from the outside and cooled by means of a separate cooling system and dried. The successfully expired validated process flow is automatically documented together with other data. Thermologgers monitor that the defined temperature is applied at each point in the disinfection chamber over the defined period, a process monitoring system checks whether the process media flowed. The end of the reprocessing process is indicated by signals, a fault notifier is used to indicate if the reprocessing process has not taken place in the defined way. Claim 11 as claim 10, characterized in that the individual process steps take place in a different order and that, nevertheless, a uniform processing process results, which supplies validated and validatable processing results, so that the medical products processed in this way may be used on the patient. Claim 12 as claim 10, characterized in that individual process steps are omitted and that nevertheless a uniform treatment process is created, which provides validated and validatable treatment results, so that the thus processed medical devices may be used in the patient. Apparatus for cleaning, disinfecting, caring for and sterilizing transmission instruments with the components: sterilization chamber which can be closed pressure-tightly with a lid or sterilization chambers which can be closed with a lid for each sterilization chamber, further pressure valves in the sterilization chambers and the steam generation, inner and outer Ducting, steam generation system with steam being conducted into the inner and / or outer supply line, distribution system for separating the inner and outer piping, valves for providing the process media, suitable heating system for heating the sterilization chamber, the transmission instrument, the inner and outer supply lines, Software and hardware for programming the defined process sequences, device for temperature control and comparison with defined setpoint values, device for checking whether the process media flowed (process control role), document ntationszentrum, signals and safety precautions, connections for compressed air us suitable water and oil, housing, characterized in that with this device the following validated and validatable treatment process runs reliably reproducible: After closing the lid and the triggering of the treatment process, the external cleaning is characterized first characterized that process water is brought into the outer supply line which is then pressed with compressed air from outside to the transmission instrument. Thereafter, internal cleaning, characterized in that process water is spent in the inner supply line, which is then pressed with compressed air through the transmission instrument. Subsequently, general disinfection, characterized in that the sterilization chamber, the transmission instrument, the coupling and the inner and the outer feed are heated, wherein the residual water, which is after the cleaning phase this system, is evaporated. Thereafter, the external cleaning and external disinfection is characterized in that in the hot outer supply process water is introduced, which evaporates there and as steam through nozzles which are mounted in the disinfection chamber so that the transmission instrument is cleaned and disinfected from the outside and that to increase the pressure of compressed air this supply line is pressed. The subsequent internal cleaning and internal disinfection is characterized in that process water is spent in the heated inner supply line that evaporates there and the resulting vapor is pressed through the transmission instrument and the transmission instrument is cleaned and disinfected from the inside and that compressed air is pressed into this supply line to increase the pressure. Preferably thereafter, the oiling is carried out, in which oil is compressed by using compressed air targeted through the transmission channel. The oil is then blown again with compressed air. Preferably thereafter, the sterilization is carried out, in which steam is generated in the manner described, which then presses by opening a pressure valve through the inner and the outer supply line. The vapor further cleans the transfer instrument and heats the sterilization chamber to the defined temperature. The movement of the steam in the Chamber when flowing prevents air bubbles form. The pressure valve, which is preferably mounted in the outlet of the sterilization chamber, ensures constant pressure and temperature in the chamber, after which the transmission instrument is briefly evaporated again from the outside and dried and cooled by means of a separate cooling system. This successfully expired validated process flow is automatically documented together with other data. Thermologgers monitor that the defined temperature is applied at each point in the disinfection chamber over the defined period, a process monitoring system checks whether the process media flowed. The end of the reprocessing process is indicated by signals, a fault notifier is used to indicate if the reprocessing process has not taken place in the defined way. Claim 14 as claim 13, characterized in that the individual process steps take place in a different order and that, nevertheless, a uniform processing process results, which supplies validated and validatable processing results, so that the medical products processed in this way may be used on the patient. Claim 15 as claim 13, characterized in that individual process steps are omitted and that nevertheless a uniform treatment process is created, which provides validated and validatable treatment results, so that the thus processed medical devices may be used in the patient. Claim 16 Apparatus for cleaning and disinfecting instruments of objects (such as mirrors, tweezers, probes, etc. working means) with the components: disinfection chamber, internal and / or external wiring, distribution system for separating the inner and outer piping, valves for providing the Process media, suitable heating system for heating the disinfection chamber, the instruments, the inner and the outer supply line, all inserts, juice and hardware for programming the defined process sequences, device for temperature control and comparison with defined nominal values, device for checking whether the process media flowed ( Process control), documentation center, signals and safety precautions, connections for compressed air, chemicals and water, housing, ... characterized in that with this device the following validated and validatable treatment process proceeds reliably reproducible: First, the I Defined instruments are inserted into an insert with nozzles / openings or at least close to an insert which has been connected to the inner supply line. After closing the lid and triggering the treatment process, first a chemical cleaning and / or chemical disinfection takes place in that the chemicals are brought into the outer and / or inner supply line and with compressed air through the nozzles / openings in the chamber and in use the instruments are pressed. This is followed by a reaction time dependent on the chemicals used. Thereafter, the disinfection chamber is filled with water and there is a cleaning by means of ultrasound. After the ultrasonic cleaning, the water is drained off. The water used in the ultrasonic cleaning and the instruments and the disinfection chamber and the inserts are additionally sterilized with UV radiation. This is followed by a further cleaning which is characterized in that process water is spent in the outer supply line which is then pressed with compressed air from the outside to the transmission instrument. When cleaning over the insert (or inserts) process water is introduced into the inner supply line and then forced through the insert with compressed air. The subsequent general disinfection is characterized in that the disinfection chamber, the instruments and the inner and the outer supply line are heated, the residual water that is after the cleaning phase him this system, is evaporated. The subsequent external cleaning and external disinfection is characterized in that in the hot outer feed process water is introduced, which evaporates there and impinges as steam through nozzles which are mounted in the disinfection chamber on the object. The instruments are thereby further cleaned and disinfected from outside and compressed air is forced into this supply line to increase the pressure. Subsequent cleaning and disinfection by the insert (s) is characterized by the process water being delivered to the heated internal supply line which evaporates there and the resulting vapor is forced through the insert and the instruments pass through the nozzles and / or openings be cleaned and disinfected and that compressed air is pressed into this supply line to increase the pressure. Thereafter, the instruments are cooled by means of a separate cooling system. This successfully expired validated process flow is automatically documented together with other data. Thermologgers monitor that the defined temperature is applied at each point in the disinfection chamber over the defined period, a process monitoring system checks whether the process media flowed. The end of the reprocessing process is indicated by signals, a fault detector is used display if the rendering process did not run as defined. Claim 17 as claim 16, characterized in that the individual process steps take place in a different order and that, nevertheless, a uniform processing process results, which supplies validated and validatable processing results, so that the medical products processed in this way may be used on the patient. Claim 18 as claim 16, characterized in that individual process steps are omitted and that nevertheless a uniform treatment process is created, which provides validated and validatable treatment results, so that the thus processed medical devices may be used in the patient. Claim 19 Device for cleaning, disinfection, care and sterilization of instruments with the components: sterilization chambers, at least one pressure-tight lid, further pressure valves in the sterilization chambers and the steam generation, inner and outer lines, steam generation system with the steam pressed into the inner and / or outer supply line is, distribution system for the separation of the inner and the outer piping system, valves for providing the process media, suitable heating system for heating the sterilization chamber, the instrument, the inner and the outer supply line, all inserts, software and hardware for programming the defined process flows, means for Temperature control and comparison with defined setpoints, means to check whether the process media flowed (process control), documentation center, signals and safety precautions, connections for compressed air, chemicals and suitable water and Oil, housing, characterized, The following validated and validatable preparation process is reliably reproducible with this device: Initially, the instruments are deployed in an insert or at least near an insert connected to the inner lead. After closing the lid and triggering the treatment process, first a chemical cleaning and / or chemical disinfection takes place in that the chemicals are brought into the outer and / or inner supply line and with compressed air through the nozzles / openings in the chamber and in use the instruments are pressed. This is followed by a reaction time dependent on the chemicals used. Thereafter, the disinfection chamber is filled with water and there is a cleaning by means of ultrasound. After the ultrasonic cleaning, the water is drained off. In addition, the water used in the ultrasonic cleaning and the instruments and the disinfection chamber and the inserts are additionally sterilized with UV radiation. This is followed by a further external cleaning is characterized in that process water is spent in the outer supply line which is then pressed with compressed air from the outside to the transmission instrument. When cleaning over the insert (or inserts) process water is introduced into the inner supply line and then forced through the insert with compressed air. The subsequent general disinfection is characterized in that the disinfection chamber, the instruments and the inner and the outer supply line are heated, the residual water that is after the cleaning phase him this system, is evaporated. The subsequent external cleaning and external disinfection is characterized in that process water is introduced into the hot outer supply line, which evaporates there and as. Steam through nozzles, which are mounted in the disinfection chamber, the instruments are thereby further cleaned and disinfected from the outside and that is pressed to increase the pressure of compressed air in this supply line. Subsequent cleaning and disinfection by the insert (s) is characterized by the process water being introduced into the heated inner supply line, evaporating there, and the resulting vapor being forced through the insert and passing the instruments through nozzles and / or openings be cleaned and disinfected and that compressed air is pressed into this supply line to increase the pressure. Thereafter, the sterilization, in which steam is generated in the manner described, which is then by opening a pressure valve in the inner and the outer lead, simultaneously or offset in time, is pressed, thereby the sterilization chamber is heated to the defined temperature. The movement of the vapor in the chamber when flowing prevents the formation of air bubbles, the pressure valve, which is preferably mounted in the outlet of the sterilization chamber, ensures a constant pressure and temperature in the chamber, then the instruments are dried in the manner described and means a separate cooling system cooled. This successfully expired validated process flow is automatically documented together with other data. Thermologgers monitor that the defined temperature is applied at each point in the disinfection chamber over the defined period, a process monitoring system checks whether the process media flowed. The end of the reprocessing process is indicated by signals, a fault notifier is used to indicate if the reprocessing process has not taken place in the defined way. Claim 20 As claimed in claim 19, characterized in that the individual process steps take place in a different order and that nevertheless a uniform treatment process is created, which supplies validated and validatable treatment results, so that the medical products thus processed may be used on the patient. Claim 21 as claim 19, characterized in that individual process steps are omitted and that nevertheless a uniform treatment process is created, which provides validated and validatable treatment results, so that the thus processed medical devices may be used in the patient. Claim 22 combination devices characterized in that The validated reprocessing processes described in this application are used so that both instruments and medical / dental / veterinary instruments are processed in one device in such a way that they can be used as medical devices for reuse on the patient according to the applicable hygiene laws.

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