Organization of an anti-epidemic regime in dressing rooms and treatment rooms.
1. General provisions.
Responsibility for organizing and carrying out a set of measures to comply with the sanitary and anti-epidemic regime and prevent intra-hospital infections in departments (clinics) rests with senior nurses.
In accordance with the current regulatory documents of the Ministry of Health of Russia, in order to prevent occupational diseases (including nosocomial infections) and occupational injuries, each employee is given instructions on safe techniques and work methods, which is divided into: introductory (upon hiring), initial at work place and periodic (repeated).
Instruction of medical personnel in the workplace and communication of the provisions of these methodological recommendations is carried out under signature, upon hiring and subsequently once a year. The briefing must be recorded in a special journal.
In accordance with orders of the Ministry of Health of Russia dated 29.09.89, No. 000 and dated 14.03.96 No. 90, all persons hired to work in healthcare facilities are required to undergo medical examinations, laboratory and functional examinations.
2. Standard of equipment for the treatment room.
Nurse's desk - 1 piece
Chair – 1 piece
Chair for the patient (screw) – 1 piece
Table for IV injections – 1 piece
Medical couch – 1 piece
Medical cabinet for medicines, solutions, instruments - 1-2 pcs.
Medical instruments: hemostatic clamp - 4, forceps - 2, anatomical tweezers - 2, surgical scissors - 2, mouth retractor - 1, tongue holder - 1.
Instrument tables for storing sterile bix, packs with sterile balls, sterile tweezers and other instruments. (conditionally sterile table).
For storing alcohol, packaged medicines, disposable syringes, scissors, adhesive plaster, and other items that cannot be sterilized. (not a sterile table).
Table (bedside table) for storing disinfectants and preparing their working solutions.
Containers for sending blood tubes to the laboratory.
A bedside table for storing detergents and disinfectants, rags, chemical indicators, test controls. Etc. -1 –2 pcs.
Sink
Household refrigerator – 1 piece
Air sterilizer - 1 piece
Stands for intravenous drip infusions - 4-6 pcs.
Test tube racks – 2 pcs.
- containers for disinfection (1 piece each) (all containers must be marked, equipped with lids, sinks and used strictly for their intended purpose) for:
Disposable syringes
Rubber gloves
Used blood transfusion systems and blood substitutes
Used balls
- measuring containers for disinfectants and detergents - 2 pcs.
- container with disinfectant solution for tweezers
Kidney-shaped trays - 4 pcs.
Turn on the bactericidal lamp for 60 minutes.
After completing the 60-minute exposure, put on another clean gown, a second pair of rubber gloves, and rinse off the disinfectant solution with a sterile rag and clean tap water.
Complete the cleaning by disinfecting the floors with a disinfectant solution with the addition of detergents (exposure 60 minutes), followed by washing them with clean water and repeated ultraviolet irradiation of the room for 60 minutes.
Disinfect all cleaning equipment in a disinfectant solution for 1 hour, then rinse and dry.
At the end of the general cleaning, the nurse makes a note about its implementation in the “general cleaning” journal.
Labeled cleaning equipment for general cleaning and routine cleaning is stored separately.
9. Rules for the operation and operation of bactericidal lamps.
9.1. The bactericidal irradiator is equipped at a height that is easily accessible for its treatment (about 2 meters), so that the flow of rays is directed into a clean area.
9.2. Germicidal lamps that have served their guaranteed service life (in accordance with the passport from 3 to 5 thousand hours of operation) must be replaced with new ones. To do this, they must keep track of the operating time of each of them. As the lamps operate, it is necessary, after 1/3 of the nominal service life of the lamps has expired (for example, 1 thousand hours out of 3 thousand), to increase the initially set duration of irradiation by 1.2 times. (at a rate of 1 hour - by 12 minutes) and after 2/3 of the period - by 1.3 times (by 18 minutes). Accounting for the operating time of irradiators and changes in the duration of irradiation must be entered into the “log of registration and control of the operation of bactericidal irradiators”
9.3. Weekly (during general cleaning), the irradiator lamp is wiped from all sides from dust and fatty deposits with a sterile gauze cloth (the presence of dust reduces the effectiveness of air disinfection by 50%). To do this, you need to: unfold the napkin lengthwise, moisten it with 70% alcohol, throw one end of the napkin over the other side of the lamp, encircling it into a ring. Then hold both ends of the napkin with one hand and wipe the lamp lengthwise.
9.4. The lamp fittings are wiped with one of the disinfectants with the addition of 0.5% detergent, and then with clean distilled water.
10. Features of the anti-epidemic regime when performing injections.
IV, IM, subcutaneous injections can be performed in the treatment room and in the wards if necessary.
Before starting work, the requirements of clauses 5.1 and 5.2 are met.
Sterile rubber gloves are put on your hands.
Prepare 5 cotton balls moistened with 70% alcohol or other skin antiseptic.
Hands with gloves are treated with the first ball.
The syringe is assembled and the needle is capped.
The second ball treats the ampoule with the drug.
The ampoule is opened.
The medicine is drawn into the syringe and the needle is closed with a cap.
A pad (roller) with oilcloth is placed under the elbow.
An elastic tourniquet is applied to the shoulder (but not to the bare area) at a distance of 10 cm from the injection site.
The third ball is used to wipe the skin of the patient's elbow over an area of at least 15x15 cm.
The fourth ball is used to wipe gloved hands again.
Venipuncture is performed.
The fifth ball presses the venipuncture site.
The used syringe is filled through a needle with a disinfectant solution, after which, without removing the needle, it is placed in a special marked container for disinfection.
Wipe the pillow, tourniquet and oilcloth with a rag soaked in a disinfectant solution.
Used balls are disinfected in a separate container, after which they are transferred to disposable yellow plastic bags, sealed and removed from the department for disposal.
10.1 To disinfect disposable syringes and balls, disinfectants supplied to health care facilities are used in accordance with the instructions.
After disinfection, disposable syringes are handed over to the senior medical officer. sister for subsequent processing, for disposal.
10.2 Disinfection of disposable systems for transfusion of solutions and blood, plastic containers for donor blood.
Before disinfection, a nurse, wearing gloves, cuts the system hoses in half with scissors into 15-20 cm fragments, plastic blood containers are also cut in half and immersed in a disinfectant solution. After exposure, they are placed in a yellow plastic bag for disposal.
10.3. Collection of sharp instruments (needles, feathers) after disinfection, are collected in a hard, puncture-proof sealed package.
10.3. Rubber gloves are removed and disinfected by soaking in a disinfectant solution. After which they are disposed of.
10.4. At the end of the procedures, routine cleaning and ultraviolet irradiation of the office are carried out, clause 8.1.
10.5. Injections at the patient's bedside.
Injections in the ward are given only to patients on bed rest.
The treatment room is equipped with a sterile tray in which the following is placed:
A disposable syringe filled with medicine, with a cap on the needle, 5 balls moistened with an antiseptic or alcohol.
The tray is covered on top with another sterile tray or sterile napkin.
An injection is performed at the patient's bedside, following the rules outlined above.
Used syringes and balls are placed in a tray and must be disinfected in the treatment room.
Reuse of the tray is allowed only after pre-sterilization treatment and sterilization.
11.Use of bottles with infusion solutions.
Before use, a bottle of a sterile drug used for several patients is marked with the date and time of opening. Use the bottle within 24 hours. When using a dropper bottle for one patient, the date and time are not set.
Disinfect the cap and stopper of the bottle with 70% alcohol or an antiseptic solution.
Draw the medicine into the syringe.
Between uses, close the bottle cap with a dry, sterile gauze ball; Before each repeated use of the drug, disinfect the stopper by wiping with 70% alcohol (antiseptic).
The remainder of the drug after the expiration date can be used for external use.
12. Documentation on the organization and control of compliance with the sanitary and anti-epidemic regime in the department.
- Each department maintains the following documentation on sanitary and anti-epidemic work:
Plan – schedule for medical examinations and laboratory tests.
Medical sanitary records for all employees.
Logbook for recording the results of monitoring the operation of air sterilizers.
Logbook for recording the quality of pre-sterilization treatment of medical devices.
Logbook for monitoring the operation of bactericidal irradiators.
Journal of general cleaning.
List of department employees subject to vaccination against viral hepatitis B.
Journal of nosocomial infections among patients and employees.
Logbook for recording emergency situations in the staff department.
Documentation
Logbook for registering the bactericidal installation and recording the operation of bactericidal lamps
1. Characteristics of bactericidal installations and lamps.
2. Accounting for the operation of bactericidal lamps.
No. bacter. | current cleaning | spring-cleaning | number of hours of work |
||||||
Schedule
carrying out general cleaning of the treatment room
(name of division)
Magazine
taking into account the quality of pre-sterilization treatment
Magazine
Registering cases of nosocomial infections
in patients of the department
(name of department)
Magazine
registration of cases of intra-hospital infection among department staff
(name of department)
Purpose of a clean dressing room
The clean dressing room is intended for carrying out dressings after clean operations and for outpatient treatment of a number of diseases and injuries. The following interventions are performed in the dressing room.
- 1. Surgical treatment of shallow soft tissue wounds, introduction of antibiotics into the tissue surrounding the wound, suturing.
- 2. Reduction of simple dislocations after anesthesia.
- 3. Treatment of limited I-II degree burns without signs of suppuration: toileting the burn surface, applying a bandage.
- 4. Catheterization or puncture of the bladder for acute urinary retention.
- 5. Reduction of the head or dissection of the pinching ring in case of paraphimosis.
In addition, in case of severe injuries and acute surgical diseases with a critical condition of patients, they are provided with emergency care in the dressing room.
- 1. Removal from terminal conditions: restoration of airway patency, external cardiac massage, artificial respiration, intravenous jet administration of plasma substitutes.
- 2. Temporarily stopping external bleeding using a tourniquet, applying a ligature or clamp to a bleeding vessel visible in the wound, tightly tamponade the wound with gauze napkins and suturing the skin wound over tampons.
- 3. Anti-shock measures for severe traumatic shock: novocaine blockades, transport immobilization for fractures of the bones of the limbs, pelvis, spine; jet infusion of plasma substitutes intravenously, especially before the upcoming long-term transportation.
- 4. Application of a sealing bandage for open pneumothorax; puncture or drainage of the pleural cavity for tension pneumothorax; alcohol-novocaine intercostal or paravertebral blockade for multiple rib fractures.
- 5. Catheterization of the bladder in case of damage, spinal cord injury; puncture of the bladder in case of rupture of the urethra and overflow of the bladder.
Equipment and facilities for a clean dressing room
The dressing room is equipped in a room with an area of at least 15 m2 with natural illumination of 1:4. The requirements for covering the ceiling, walls and floor of the dressing room are the same as in the operating room. The same applies to cleaning the dressing room. For hand washing, two sinks with hot and cold water mixer taps are installed in it. Equipment and fittings for dressing room may vary depending on local conditions, the predominance of a particular surgical pathology. Below is a sample list.
- 1. Dressing table - 1
- 2. Table for sterile materials and instruments - 1
- 3. Small tool table - 1
- 4. Gynecological chair - 1
- 5. Table for medicines and cutting instruments - 1
- 6. Screw chair - 2
- 7. Stands for bixes - 2
- 8. Enameled basins for hand treatment - 2
- 9. Pelvis supports - 2
- 10. Tool cabinet - 1
- 11. Cabinet for medicines - 1
- 12. Stand for hand operations - 1
- 13. Shadowless lamp with emergency lighting - 1
- 14. Germicidal lamp - 1
- 15. Bixes (sterilization boxes) of different sizes - 4
- 16. Stand with bottle holder for intravenous infusions - 1
- 17. Electric boiler (sterilizer) - 1
- 18. Quadrangular basin with lid - 1
- 19. Sphygmomanometer - 1
- 20. Hemostatic tourniquets - 2
- 21. Mouth retractor, tongue holder - 1 each
- 22. Breathing tube (air duct) - 1
- 23. Forceps in a jar with disinfectant solution - 1
- 23.Scissors for cutting bandages - 1
- 24. Disposable intravenous infusion systems, sterile - 4
- 25. Hair clipper and razor - 1 each
- 26.Set of transport tires - 1
- 27. Foot bath
- 29. Hand bath - 1
- 30.Hanger - 1
- 31.Plastic aprons - 3
- 32.Bucket for collecting dirty material - 1
- 33. A set of surgical instruments corresponding to the volume of operations and surgical work in the dressing room.
The medicine cabinet contains external agents and solutions for intravenous or subcutaneous administration on different shelves. P A sample list of products for external use is as follows:
- 1. Iodonate - 300 ml
- 2. Alcohol iodine solution 5% - 300 ml
- 3. Ethyl alcohol - 200 ml
- 4. Ether or gasoline - 200 ml
- 5. Hydrogen peroxide - 300 ml
- 6. Furacilin 1:5000 - 500 ml
- 7. Syntomycin emulsion - 200 g
- 8. Sterile Vaseline oil - 50 g
- 9. Ammonia (10% ammonia solution) - 500 ml
- 10.Degmicide - 1500 ml
- 11.Triple solution - 3000 ml
The following drugs are used as intravenous and injection agents:
- 1. Glucose 40% solution in ampoules - 1 box
- 2. Poliglyukin in bottles - 5 bottles
- 3. Sodium chloride 0.85% solution - 1000 ml
- 4. Calcium chloride 10% solution in ampoules - 1 box
- 5. Novocaine 0.25% solution - 400 ml
- 6. Novocaine 0.5% solution - 800 ml
- 7. Novocaine 2% solution in ampoules - 2 boxes
- 8. Hydrocortisone in bottles - 4 bottles
- 9. Adrenaline 0.1% in ampoules - 1 box
- 10.Mezaton 1% in ampoules - 1 box
- 11.Diphenhydramine 1% in ampoules - 1 box
- 12.Caffeine 10% in ampoules - 1 box
- 13.Tetanus toxoid in ampoules - 1 box
- 14. Antitetanus serum in ampoules - 1 box
- 15. Various antibiotics in bottles - 30 bottles
In-hospital laboratory control over the quality of cleaning, including in dressing rooms, is carried out by an assistant epidemiologist according to a special schedule. In addition, bacterial tests are taken to test for sterility and cultures to test for air sterility.
The results of the control are heard at the council of senior nurses.
Control over the sanitary and epidemiological regime in the dressing room, as well as the work on training nurses, is carried out by the head nurses of the hospital and specialists from the epidemiological department of the hospital.
Organization of an anti-epidemic regime in dressing rooms and treatment rooms.
1. General provisions.
Responsibility for organizing and carrying out a set of measures to comply with the sanitary and anti-epidemic regime and prevent intra-hospital infections in departments (clinics) rests with senior nurses.
In accordance with the current regulatory documents of the Ministry of Health of Russia, in order to prevent occupational diseases (including nosocomial infections) and occupational injuries, each employee is given instructions on safe techniques and work methods, which is divided into: introductory (upon hiring), initial at work place and periodic (repeated).
Instruction of medical personnel in the workplace and communication of the provisions of these methodological recommendations is carried out under signature, upon hiring and subsequently once a year. The briefing must be recorded in a special journal.
In accordance with orders of the Ministry of Health of Russia dated 29.09.89, No. 000 and dated 14.03.96 No. 90, all persons hired to work in healthcare facilities are required to undergo medical examinations, laboratory and functional examinations.
2. Standard of equipment for the treatment room.
Nurse's desk - 1 piece
Chair – 1 piece
Chair for the patient (screw) – 1 piece
Table for IV injections – 1 piece
Medical couch – 1 piece
Medical cabinet for medicines, solutions, instruments - 1-2 pcs.
Medical instruments: hemostatic clamp - 4, forceps - 2, anatomical tweezers - 2, surgical scissors - 2, mouth retractor - 1, tongue holder - 1.
Instrument tables for storing sterile bix, packs with sterile balls, sterile tweezers and other instruments. (conditionally sterile table).
For storing alcohol, packaged medicines, disposable syringes, scissors, adhesive plaster, and other items that cannot be sterilized. (not a sterile table).
Table (bedside table) for storing disinfectants and preparing their working solutions.
Containers for sending blood tubes to the laboratory.
A bedside table for storing detergents and disinfectants, rags, chemical indicators, test controls. Etc. -1 –2 pcs.
Sink
Household refrigerator – 1 piece
Air sterilizer - 1 piece
Stands for intravenous drip infusions - 4-6 pcs.
Test tube racks – 2 pcs.
- containers for disinfection (1 piece each) (all containers must be marked, equipped with lids, sinks and used strictly for their intended purpose) for:
Disposable syringes
Rubber gloves
Used blood transfusion systems and blood substitutes
Used balls
- measuring containers for disinfectants and detergents - 2 pcs.
- container with disinfectant solution for tweezers
Kidney-shaped trays - 4 pcs.
Turn on the bactericidal lamp for 60 minutes.
After completing the 60-minute exposure, put on another clean gown, a second pair of rubber gloves, and rinse off the disinfectant solution with a sterile rag and clean tap water.
Complete the cleaning by disinfecting the floors with a disinfectant solution with the addition of detergents (exposure 60 minutes), followed by washing them with clean water and repeated ultraviolet irradiation of the room for 60 minutes.
Disinfect all cleaning equipment in a disinfectant solution for 1 hour, then rinse and dry.
At the end of the general cleaning, the nurse makes a note about its implementation in the “general cleaning” journal.
Labeled cleaning equipment for general cleaning and routine cleaning is stored separately.
9. Rules for the operation and operation of bactericidal lamps.
9.1. The bactericidal irradiator is equipped at a height that is easily accessible for its treatment (about 2 meters), so that the flow of rays is directed into a clean area.
9.2. Germicidal lamps that have served their guaranteed service life (in accordance with the passport from 3 to 5 thousand hours of operation) must be replaced with new ones. To do this, they must keep track of the operating time of each of them. As the lamps operate, it is necessary, after 1/3 of the nominal service life of the lamps has expired (for example, 1 thousand hours out of 3 thousand), to increase the initially set duration of irradiation by 1.2 times. (at a rate of 1 hour - by 12 minutes) and after 2/3 of the period - by 1.3 times (by 18 minutes). Accounting for the operating time of irradiators and changes in the duration of irradiation must be entered into the “log of registration and control of the operation of bactericidal irradiators”
9.3. Weekly (during general cleaning), the irradiator lamp is wiped from all sides from dust and fatty deposits with a sterile gauze cloth (the presence of dust reduces the effectiveness of air disinfection by 50%). To do this, you need to: unfold the napkin lengthwise, moisten it with 70% alcohol, throw one end of the napkin over the other side of the lamp, encircling it into a ring. Then hold both ends of the napkin with one hand and wipe the lamp lengthwise.
9.4. The lamp fittings are wiped with one of the disinfectants with the addition of 0.5% detergent, and then with clean distilled water.
10. Features of the anti-epidemic regime when performing injections.
IV, IM, subcutaneous injections can be performed in the treatment room and in the wards if necessary.
Before starting work, the requirements of clauses 5.1 and 5.2 are met.
Sterile rubber gloves are put on your hands.
Prepare 5 cotton balls moistened with 70% alcohol or other skin antiseptic.
Hands with gloves are treated with the first ball.
The syringe is assembled and the needle is capped.
The second ball treats the ampoule with the drug.
The ampoule is opened.
Journal of nosocomial infections among patients and employees.
Logbook for recording emergency situations in the staff department.
Documentation
Logbook for registering the bactericidal installation and recording the operation of bactericidal lamps
1. Characteristics of bactericidal installations and lamps.
2. Accounting for the operation of bactericidal lamps.
No. bacter. | current cleaning | spring-cleaning | number of hours of work |
||||||
Schedule
carrying out general cleaning of the treatment room
(name of division)
Magazine
taking into account the quality of pre-sterilization treatment
Magazine
Registering cases of nosocomial infections
in patients of the department
(name of department)
Magazine
registration of cases of intra-hospital infection among department staff
(name of department)
Let's see how it happens carrying out dressings according to approved standards.
The first stage is preparatory
- The dressing room is prepared for work: wet cleaning and bactericidal irradiation are performed.
- Before starting dressing changes in the office, the nurse carries out dressings according to approved standards.
- The nurse puts on sterile work clothes. Hands are treated with a sterile swab or cotton ball moistened with a skin antiseptic.
- The sterile container is treated twice with a napkin with a disinfectant solution and opened.
- The dressing table is disinfected and covered with a sterile sheet (disposable or made of bix). A disinfected oilcloth or plastic film is placed on top of the sheet.
Directly performing dressings
- We cut the old bandage with scissors, the ends of which are directed in the direction that is safest for the patient and the nurse. We dump the waste material into a container with a disinfectant solution. Leave the napkin on the skin.
- We take out the first clip from the individual packaging. Using a cotton ball with an antiseptic solution, we clean the area of skin where the dressing is performed.
- We remove the napkin left from the old bandage from the skin and dump it into the disinfectant solution. We also immerse the first tweezers in a container with a disinfectant solution for used instruments.
- We take out the second tweezers, take a sterile ball with it, moisten it in antiseptic and treat the wound.
- If you need to remove the stitches, take out the third tweezers, scissors and remove the stitches.
- Using the second and third tweezers, apply an aseptic dressing to the wound surface.
- We fix the bandage with a bandage or cleol.
- We immerse used materials and tools in containers with a disinfectant solution, close them with lids and maintain exposure.
- After each dressing, wipe the surface of the oilcloth with a rag soaked in a disinfectant solution.
- After disinfection, we collect the used dressing material in special yellow plastic bags (class B waste). Once filled, bags should be sealed and removed from the compartment for disposal.
- Every 2 hours, the dressing room should be subjected to routine wet cleaning using a disinfectant, ventilation and bactericidal irradiation. In this case, the sterile sheet should be replaced on the dressing table.
Should be shared carrying out dressings for clean and purulent wounds. For this purpose, so-called clean and purulent dressings are distinguished. If this is not possible, clean dressings are carried out first. After each dressing of patients with signs of suppuration or with purulent wounds, the sheet on the dressing table is replaced. therefore, it is better to use disposable underwear.
The nurse should carry out carrying out dressings according to the schedule approved by the head of the department. The schedule is posted in a visible place - on the office door or near it.
Peculiarities of organizing the work of nurses in surgical departments.
The surgical department requires more attentive and thorough patient care, especially in the postoperative period. The nurse must monitor as closely as possible and have patience with patients throughout the day and night; The slightest changes in blood pressure, pulse, appearance can lead to permanent consequences.
The nurse's work schedule is rotating, every three days. The surgical department is staffed by operating rooms and shift nurses who report to the head of the department, operating unit or the head of the medical institution.
The surgical department nurse borrows:
The operating room nurse, together with the surgical team, prepares the operating room, the necessary instruments, dressings, and suture material. During the operation, provides the surgical staff with instruments. She also does everything necessary to ensure the infection safety of staff and patients, and monitors compliance with all aseptic rules. The absence of postoperative complications in patients depends on the quality of work of the operating room nurse.
The shift nurse keeps logs of reception and transfer of duty, various medical documentation (logs of quartzing, dressings, general cleaning, disinfection treatment and other similar ones).
A nurse's working day begins long before patients get up. Then he turns on the lights in the wards, greets the patients, and distributes thermometers. After measuring the temperature, collects thermometers, records the readings in the medical history, and gives injections according to the prescription log. In a department with seriously ill patients, a nurse treats the patients’ eyes, mouth, nose, helps them wash, and combs their hair. Sends tests to the laboratory. After distributing medications, he reminds patients about the necessary tests and informs them when and where they will take place. Her responsibilities include preparing for X-ray and ultrasound examinations, and she also warns about hunger before upcoming examinations. According to the doctor's indications, he gives enemas, compresses, and bandages. Gives seriously ill patients a comfortable position in bed and ventilates the room. The nurse on duty helps distribute food, feeds seriously ill patients if necessary, and monitors diet for all patients. When returning to duty, the nurse reports on the condition of the patients, all incidents during the shift, prepares a sterile table with instruments, and prepares dishes for analysis.
Rules for working in the dressing room.
Prevention of nosocomial infections consists of a set of measures aimed at breaking the chain of occurrence of the epidemiological process. One of the important sections of this complex is compliance with the sanitary-hygienic and anti-epidemic regime when carrying out various surgical procedures. Today the topic of our article is the organization of work in the dressing room. We will talk about the work of dressing rooms using the example of the State Clinical Hospital named after. S.P. Botkin.
Organization of work in dressing rooms. In accordance with the requirements of current regulatory documents (SNiP 2.08.02-89), the department must have two dressing rooms (for clean and purulent dressings). However, many medical institutions have one dressing room. Therefore, it is especially important in the prevention of purulent-septic complications to strictly comply with the requirements of the sanitary-hygienic and anti-epidemic regime.
If there is only one dressing, patients with purulent wounds should be scheduled for the procedure at the end of the work shift. Here are the basic requirements that must be strictly observed when performing dressing changes in the department:
All dressings and instruments should be stored in bags for no more than 3 days or in packaging paper (kraft paper) for no more than 7 days. When opening the bix, the shelf life of the dressing material is no more than 6 hours. There should be a mark on the box indicating the time of opening;
To carry out dressings, prepare a sterile table, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the surface of the table. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all the objects on the table, and is tightly fastened with clamps to the bottom sheet. The sterile table is set for 6 hours. In cases where the instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before the manipulations. Dressings are carried out wearing a sterile mask and rubber gloves. All items from the sterile table are taken with forceps or long tweezers, which are also subject to sterilization. Forceps (tweezers) are stored in a container (jar, bottle, etc.) with 0.5% chloramine or 3% or 6% hydrogen peroxide. The chloramine solution is changed once a day. 6% hydrogen peroxide is changed after three days. Containers for storing forceps (tweezers) must be sterilized in a dry-heat oven every 6 hours;
Unused sterile material is set aside for re-sterilization;
After each dressing or manipulation, the couch (table for dressings) must be wiped with a rag moistened with a solution of approved disinfectants;
After each dressing (manipulation), the nurse must wash gloved hands with toilet soap (be sure to soap them twice), rinse with water and dry with an individual towel. Only after this procedure are the gloves removed and thrown into a container with a disinfectant solution;
Used dressings are collected in plastic bags or special marked buckets and, before disposal, are pre-disinfected for two hours with a disinfectant solution.
As a rule, in our hospital, in each dressing room there is a dry-heat cabinet, where nurses sterilize all metal instruments (trays, tweezers, jars, forceps, etc.). The operation of the dry-heat oven is monitored using chemical tests: hydroquinone or thiourea at 180°. The dry-heat oven operates twice a day, and the operating mode is noted in the journal “Accounting for the operation of the dry-heat oven.” Dressings and rubber products in bags are sterilized in a central autoclave and delivered to all departments by specially designated vehicles.
Twice a day - in the morning before starting work and in the evening after finishing work - routine cleaning is carried out, combined with disinfection. For disinfection, a 1% chloramine solution is used. Once a week, a mandatory general cleaning is carried out: the room is cleared of equipment, inventory, tools, medicines, etc. A complex of disinfectant and detergent is used as a disinfectant. The disinfectant solution is applied by irrigation or wiping to walls, windows, window sills, doors, tables and a bactericidal lamp is turned on for 60 minutes. Then all surfaces are washed with a clean rag moistened with tap water, disinfected furniture and equipment are brought in and the bactericidal lamp is turned on again for 30 minutes.
Cleaning equipment specially designated for work in the dressing room (buckets, rags) are marked and after cleaning they are disinfected in a disinfectant solution for an hour.
A journal “Accounting for general cleaning” is kept in each office.
Features of the nurse in the preoperative period.
Preoperative period -- this is the time from the moment the decision to operate is made until the patient is taken to the operating room. The main goal of this period is to minimize possible complications during and after surgery.
Main tasks in preparation for surgery:
· clarify the diagnosis, indications for surgery and timing of its implementation;
· identify the functional state of the main organs and systems (concomitant diseases);
· correct as much as possible the identified violations of vital organs and systems;
· carry out preparation: psychological, somatic, special (according to indications), immediately before the operation and deliver the patient to the operating room.
The preoperative period consists of two stages: diagnostic and preoperative preparation.
Preoperative preparation.
Types of preoperative preparation.
There are three types of preoperative preparation: psychological, somatic, special.
· Psychological preparation. The main goal of this preparation is to calm the patient and instill in him confidence in the successful outcome of the operation. An important point is a conversation with the patient and relatives before the operation in order to create a trusting relationship between the patient, loved ones and medical staff. The moral and psychological climate in the department plays a big role. In a gentle manner, in a calm voice, the doctor and nurse must convince the patient of the need for surgery and obtain his consent. Beliefs of this nature are especially important when a patient refuses surgery due to insufficient information about the state of his health. For example, with penetrating wounds of the abdomen, chest, acute appendicitis, perforated stomach ulcer, when delay in surgery can result in death.
If the patient is unconscious, relatives must give consent to the operation, and in their absence, the issue is decided by a council consisting of two or more doctors.
To conduct psychological preparation, you can use medications (sedatives, tranquilizers), especially in emotionally labile patients.
· Somatic preparation. The main goal of this training is to correct dysfunctions of organs and systems that have arisen as a result of the underlying or concomitant disease, and to create a reserve of the functional capabilities of these organs and systems.
Correction of identified disorders is carried out using various treatment methods, taking into account the nature of the disease.
So, when a patient is admitted to a hospital in a state of traumatic shock, anti-shock therapy is carried out (pain is eliminated, blood volume is restored); for hypertension, antihypertensive drugs are prescribed, etc.
During somatic preparation, special attention is paid to the prevention of endogenous infection. It is necessary to find out whether the patient has chronic inflammatory diseases (carious teeth, chronic tonsillitis, pustular skin diseases, etc.), and carry out sanitation of the organs of chronic infection, and, if necessary, treatment with antibiotics.
· Special training is determined by the nature of the disease, the localization of the pathological process and the special properties of the organ on which the operation is performed, for example, the upcoming operation on the large intestine requires special preparation of the patient: a slag-free diet, taking laxatives, prescribing broad-spectrum antibiotics, cleansing enemas to clean rinsing water.
For various surgical diseases, preoperative preparation has its own characteristics, which are discussed in the course of private surgery.
Diagnostic preparation.
Tasks of the diagnostic stage- establishing an accurate diagnosis of the underlying disease and determining the condition of the main organs and systems of the body.
Making an accurate surgical diagnosis- the key to a successful outcome of surgical treatment. It is an accurate diagnosis indicating the stage, extent of the process and its features that allows you to choose the optimal type and extent of surgical intervention.
However, first of all, an accurate diagnosis is necessary in order to resolve the issue of the urgency of the operation and the degree of need for a surgical treatment method.
Nursing process in postoperative patients.
The postoperative period is the time from the moment of surgery until recovery or transfer of the patient to disability. During this period, the patient is in a certain state, which is caused by the previous disease, surgical intervention to eliminate it, and narcotic drugs used during the operation.
In general, the patient's postoperative condition should be considered as a “postoperative illness” - a transition period from a stressful state to recovery. Stress is caused by surgery and anesthesia, and the way out of it depends on the initial state (the underlying disease and preoperative preparation), the results of the operation and the patient’s adaptive defense mechanisms.
The success of the operation depends on the nurse. Preparing the room and bed . After extensive operations, the patient is placed in the intensive care unit for 2-4 days. Then, depending on his condition, he is transferred to the postoperative or general ward. In these wards it is necessary to strictly observe the SER: ventilation, quartz treatment, wet cleaning. A functional bed for each patient is covered with clean linen, a clean towel and a sippy cup with water are prepared. Before laying down a postoperative patient, the bed must be warmed with heating pads. Delivery of the patient from the operating room . The patient is transferred from the operating table to a gurney or functional bed and, observing precautions, transported to the intensive care or postoperative ward. When delivering a patient on a gurney, the latter is placed with its head end at a right angle to the lower end of the bed. The three of us, on command, simultaneously lift the patient and transfer him to the bed. Another way.6: the foot end of the gurney is placed at the head end of the bed at a right angle and the patient is transferred to the bed. Cover with a blanket on top. Position of the patient on the bed determined by the type of operation. Supine position- most common after anesthesia. For the first two hours, the patient lies without a pillow, with his head turned to the side. This situation prevents the development of cerebral hypoxia and aspiration of the respiratory tract with vomit and mucus. Side position- facilitates the work of the heart, improves gastrointestinal function, and prevents vomiting. Allowed after stabilization of the patient's condition. Fowler position (semi-seated)) - the head end is raised, the legs are bent at the knees and hip joints at an angle of 120-130°. Helps restore intestinal function, facilitates the functioning of the heart and lungs. Used after surgery on the gastrointestinal tract. Prone position- used after surgery on the spine or brain. Trandelenburg position- the head end is lowered, the foot end is raised by 30-45°. It is used for acute anemia, shock, and also on the operating table (surgery on the pelvic organs). For operations on the lower extremities, they are placed on Belair tires. Monitoring the patient . The nurse observes the patient’s appearance: facial expression (suffering, calm, cheerful); skin color (pallor, hyperemia, cyanosis) and their temperature when palpated. The nurse is required to record basic functional indicators: pulse, respiration, blood pressure, temperature, amount of fluid administered and excreted (with urine, sweat, from the pleural or abdominal cavity); passage of gases, stools. She immediately reports any changes in the patient’s condition to the doctor. The nurse cares for the patient’s mouth and skin, performs hygiene procedures, feeds the patient, and carries out all the doctor’s orders.
Dressing room is a specially equipped room for dressing dressings, examining wounds and carrying out a number of procedures in the process of treating wounds. Injections, transfusions and minor operations can also be performed in the dressing room.
Dressing rooms in neurosurgical, gynecological, urological and burn departments have equipment appropriate to their profile.
The first dressing rooms appeared in the Moscow Hospital and St. Petersburg Marine Hospital, built by decree of Peter I. The division of dressings into clean and purulent was carried out by N.I. Pirogov.
Depending on the profile of the department, the following are performed in a clean dressing room: novocaine blockades, diagnostic and therapeutic punctures of the chest and abdominal cavity. They also provide blood transfusions and infusions of certain medications. Small operations are often performed in clean dressing rooms. Application of skeletal traction, removal of skin and subcutaneous tissue tumors, primary treatment of small wounds of patients admitted by ambulance.
Organization of the work of a purulent dressing room and features of care for patients with purulent pathology.
For patients with purulent wounds, a separate ward section is allocated, or separate wards in a separate wing of the department, as far as possible from the operating unit. For these wards there is a separate purulent dressing room, and all patients are served by separate personnel. If there is one dressing room, patients with purulent wounds are bandaged after “clean” dressings with careful further treatment of the room and equipment with disinfectant solutions.
In purulent dressing rooms, purulent wounds are treated, puncture and opening of ulcers, and other manipulations with a patient with a purulent infection (including blood transfusion). It is unacceptable to call purulent dressings dirty, since when treating purulent patients it is necessary to adhere to strict asepsis so that there is no additional contamination of the purulent wound by the microbes of the second patient. Such a secondary infection can cause severe complications (suppuration, sepsis, etc.). Personnel working in the dressing room, where both clean and purulent dressings are performed, must be especially careful and attentive so as not to confuse the instruments used when dressing clean and purulent patients. In a dressing room, overloaded with equipment and furniture, where there are many people every day, it is much more difficult to maintain cleanliness and order. During dressing changes, the dressing nurse supervises the work of the dressing room and requires strict adherence to all rules of asepsis.
A strict order of dressings is established: first, clean ones (for example, after plastic surgery), and lastly, conditionally clean ones.
Disposal of dressings contaminated with purulent secretions (cotton wool, lignin, gauze) is carried out by burning.
Dressing room- a specially equipped room for performing dressings and minor surgical procedures (suture removal, laparocentesis, therapeutic and diagnostic punctures, etc.). P. is deployed in hospitals and outpatient medical institutions, in surgical departments and offices (surgical, traumatological, urological). There are P. for so-called clean dressings and separate P. for patients with purulent-inflammatory diseases and complications. In departments with 100 beds, 2 dressing rooms with two tables in each should be organized.
The area of the dressing area is determined based on 1 table 22 m 2 and for dressing rooms for 2 tables - 30 m 2. The room for P. is equipped taking into account the need for wet cleaning. The ceiling is painted with oil paint in gray-green or gray-blue. The walls are lined with ceramic tiles of the same color to a height of at least 1.7-2 m from the floor, but better to the ceiling. The floor is covered with ceramic tiles or wide sheets of durable linoleum, the joints between which should be well coated with a special putty that does not allow water to pass through. The dressing room should have 2 separate basins for washing hands and for washing instruments with appropriate markings and hot and cold water mixer taps. The design of the heating system should not make wet cleaning difficult. The most convenient heaters are in the form of pipes located horizontally above each other at a distance of 25-30 cm from the wall, or solid panels. The optimal air temperature for P. is about 22°. P. windows are oriented to the north, northeast or northwest. For better natural light, the ratio of window (or window) area to floor area should be at least 1:4.
For artificial lighting, lamps with a total power of at least 500 are mounted on the ceiling. W by 50 m 2 rooms that can be wet cleaned. Additionally, a shadowless lamp is installed above the dressing table, creating an illumination of at least 130 OK. P. is equipped with air conditioning or supply and exhaust ventilation with a predominance of air flow, providing double air exchange per 1 h. It is also recommended to have mobile recirculation air purifiers (VOPR-0,
9 and VOPR-1.5 m), which are capable of 15 min work to reduce the dust content of the air and the number of microbes in it by 7-10 times. To disinfect the air, bactericidal irradiators are installed: ceiling-mounted (OBP-300, OBP-350) and wall-mounted (OBN-150, OBN-200). The lamps are placed at a distance of 2.5 m one from the other. In the presence of people, you can turn on only shielded lamps, but no more than 6-8 h. Preferably every 2-3 h work P. take a 10-minute break and turn on the bactericidal lamps. In purulent P., you should additionally have a bactericidal lighthouse-type irradiator or a mobile irradiator.
Special furniture is installed in the dressing room: a dressing table, a large table for sterile material and instruments, a small mobile table for sterile instruments, a small table with a glass panel for antiseptic solutions, a medical cabinet for instruments, a cabinet for dressing material and linen, a ladder stand, a hanger - stand. Enameled basins and buckets with lids for used dressings are also required. An operating table of any model can be used as a dressing table (see.
Medical equipment ). Before each dressing, the dressing table is covered with a clean sheet. A large instrumental and material sterile table is prepared daily at the beginning of the working day after preliminary cleaning of P. Only the dressing nurse opens it. All objects are taken from the table with sterile long tweezers or forceps. Tools, dressings, vessels with antiseptic solutions must have their strictly defined places on tables and in cabinets, shelves in cabinets should be marked. The set of instruments and their number depend on the profile of the department or office in which the dressing room is deployed.Medical staff, working in the dressing room, must strictly follow the rules asepsis , change your robe, cap, and mask daily. In clean P., first of all, manipulations are performed that require strict asepsis (blockades, punctures, laparocentesis, etc.), then patients who were operated on the day before are bandaged. Secondly, the remaining clean dressings are performed and the sutures are removed.
In purulent P., first of all, patients with healing purulent wounds are bandaged, then with significant purulent discharge, and lastly patients with fecal
Dressings play an important role in the treatment of wounds. For this reason, it is necessary to strictly follow the rules for dressing wounds. There are general rules, and there are specific ones, depending on the type of damage.
General information about dressings
Dressing is a therapeutic procedure that is indispensable in the treatment of wounds. Its main tasks:
- inspection of the wound surface;
- treatment of the damaged area and the skin around it;
- cleaning the wound;
- drug therapy;
- replacing an old dressing by applying a new one.
This is the general algorithm for the dressing procedure. It can be performed by a nurse in the dressing room in the presence of the attending physician. The latter may take responsibility for applying the bandage in particularly severe cases.
The frequency of wound dressing depends primarily on the extent of the damage and the healing process, as well as on the type of dressing itself:
- clean postoperative wounds are bandaged 1 week after surgery to remove the sutures;
- superficial injuries that heal under the scab are also rarely bandaged;
- purulent wounds are bandaged every 2-3 days if they do not show signs of getting wet;
- dry ulcers are also bandaged once every 2-3 days;
- wet-drying dressings, which are heavily saturated with purulent discharge, are changed every day;
- dressings that are soaked with the contents of the intestines or bladder are changed 2 to 3 times a day.
In the hospital, patients with clean wounds are first treated and only after them - with purulent ones.
General rules for applying a bandage
The specialist performing this manipulation must follow the general rules.
The main ones are:
- Do not touch the wound. Under no circumstances should you touch the wound surface with your hands.
- Disinfection. Before starting treatment, the nurse should wash and disinfect the patient’s hands and skin.
- Sterility. This applies primarily to dressings and instruments.
- Position. It is very important for an even application of the bandage that the affected part of the body is in the correct position.
- Direction of bandaging. It is correct to perform this procedure from bottom to top and from left to right. You need to unwind the bandage with your right hand, and hold the bandage with your left hand, while straightening the bandage. If a limb is bandaged, you need to start the procedure in the direction from the edge of the wound to the center.
- Correct selection of material. It is important that the bandage matches the size of the wound. So, its diameter should be slightly larger than the diameter of the damaged area.
- Fixation. In order for the dressing to be firmly fixed, you need to bandage from the narrowest part to the widest. There is no need to make the bandage tighter than necessary.
It is important that the bandage is not too loose so that it falls off. At the same time, it should not be very tight, so as not to disrupt local blood circulation. To do this, soft pads are applied in places of compression.
Algorithm for dressing a clean wound
A wound in which there are no signs of infection is called clean: there is no pus or any pathological processes in it, it is granulated, there is no local increase in temperature, redness of the surrounding skin, etc. The main task of the doctor is to prevent infection in the future.
Indications for dressing a clean postoperative wound are the following situations:
- if after surgery a tampon or drainage was left in it and 1 to 3 days passed;
- the time has come to remove the stitches;
- if the bandage gets wet with blood or ichor.
To treat a clean wound, you need to prepare the following sterile equipment:
- 2 trays, one of which is intended for the use of dressings;
- dressing material: plaster, bandage, cleol;
- tweezers;
- medical mask and gloves;
- antiseptics for treating the hands of a nurse and the patient’s skin;
- clean cloth;
- saline solution for disinfecting used dressings and surfaces.
The dressing process is carried out in 3 stages: preparatory, main and final.
Stages of the procedure
The first stage is preparatory. The doctor performs the following manipulations:
- Disinfects hands: washes them with soap and then treats them with antiseptic. Wears gloves and a mask.
- Prepares the dressing table. To do this, the table is covered with a clean sheet, because the procedure is performed with the patient lying down.
After this, the next stage begins - the main one. In this case, the doctor or nurse performs the following manipulations (all dressing material is held with tweezers, not fingers!):
- Removes the old bandage. Tweezers are used for this.
- Inspects the wound. In this case, not only the visual inspection method is used, but also the palpation method to assess the condition of the skin of the suture.
- Treats the skin around the wound. To do this, the nurse soaks a napkin in an antiseptic. In this case, the direction of the tweezers is from the edges of the wound to the periphery.
- Performs seam processing. An antiseptic napkin is also used for this. This procedure is performed with blotting movements.
- Apply a dry, clean cloth to the wound. After this, secure it with a bandage, plaster or cleol.
Finally, the last step is to completely disinfect used instruments, dressing materials and work surfaces.
Algorithm for bandaging a purulent wound
If the wound becomes infected, purulent discharge appears. In addition, the patient's body temperature rises, and painful pulsating sensations appear in the wound. Indications for dressing are the following situations:
- the bandage becomes saturated with purulent contents;
- it's time for another dressing;
- the bandage has moved.
To carry out the procedure, it is necessary to prepare the following sterile instruments:
- Trays. You will need 2 of them, one of which is intended for used tools and material. In addition, a table for tools is needed.
- Dressing. In particular, cleol, plaster, bandage.
- Tools for dressing: tweezers, scissors, probe, syringe, clamps, rubber drains (flat). You will also need medical gloves, an oilcloth apron and a mask.
- Antiseptic solution. It is needed to treat the doctor’s hands and the patient’s skin.
- Hydrogen peroxide solution.
- Disinfection solution. It is needed for final surface treatment.
- Clean cloth.
The procedure is performed by a doctor. As with the treatment of clean wounds, it also takes place in 3 stages.
Stages of dressing infected wounds
The preparatory stage is the same as when working with clean wounds: the doctor washes and treats his hands with an antiseptic, puts on a mask, gloves and an apron. The apron is additionally treated with a disinfectant solution. Then they are additionally washed with soap and treated with an antiseptic and the hands that are already wearing gloves.
After this, the main stage of the procedure begins, that is, treatment and dressing of the wound. The doctor performs the following manipulations (while all the dressing material is held with tweezers, not fingers!):
- Removes the old bandage. This should be done using tweezers.
- Treats the wound. To do this, you need a napkin soaked in a solution of hydrogen peroxide.
- Dries the seam. To do this, use a clean, dry cloth. The movements are of a wet nature.
- Treats seams and skin. To do this, use napkins moistened with an antiseptic solution. They treat the seam and the skin around it.
- Identifies the site of suppuration. To do this, the doctor palpates around the suture.
- Removes stitches. In the area of suppuration, the doctor removes no more than 1-2 stitches and widens the wound with a clamp.
- Cleans the wound. To do this, use a cloth moistened with hydrogen peroxide, or a syringe with a blunt needle.
- Dries the wound. To do this, the doctor takes a dry napkin.
- Treats the skin around the wound. To do this, use a napkin with an antiseptic solution.
- Inject sodium chloride solution into the wound. It can be administered in two ways: using drainage or turunda.
- Apply a napkin soaked in an antiseptic solution to the wound.
- Secures the napkin. A bandage is used for this.
After this, the doctor completely disinfects all work surfaces and instruments.
FEATURES OF ORGANIZING THE NURSING PROCESS IN SURGERY.
1. DEFINITION OF THE NURSING PROCESS.
NURSING PROCESS is a method of organizing and providing qualified nursing care to a patient.
2. STAGES OF THE NURSING PROCESS
A joint venture is a series of actions leading to a specific result and including 5 main stages.
FIRST STAGE – EXAMINATION OF THE PATIENT
SEQUENCING:
1) collecting anamnesis: general information about the patient, history of the problem, risk factors; psychological data; sociological data (from medical history);
2) physical examination: blood pressure, heart rate, body temperature; Height Weight; identification of vision, hearing, memory, sleep, and motor impairments; examination of the skin and mucous membranes; examination of systems (musculoskeletal, respiratory, cardiovascular system, digestive, urinary);
3) laboratory and instrumental studies: as directed by the doctor.
The foundation of nursing assessment is the doctrine of the basic vital needs of a person.
NEEDS according to A. Maslow:
Physiological: eat, drink, breathe, excrete, maintain temperature (homeostasis)
Protection needs - to be healthy, clean, sleep, rest, move, dress, undress, avoid danger
Needs for belonging and love – communicate, play, study, work
Respect needs - to be a competent specialist, to achieve success, to be approved
Maslow later identified 3 more groups of needs:
Cognitive - explore, know, be able to, understand
Aesthetic – in beauty, harmony, order
The need to help others.
It is important to remember that the needs of each subsequent level become relevant only after the previous ones are satisfied!!
SECOND STAGE – IDENTIFYING THE PATIENT'S PROBLEMS AND FORMULATING A NURSING DIAGNOSIS.
CLASSIFICATION OF PROBLEMS:
PHYSIOLOGICAL – pain, suffocation, cough, sweating, palpitations, nausea, lack of appetite, etc.
PSYCHOLOGICAL – fear, depression, anxiety, fear, anxiety, despair, etc. Reflect the disharmony of someone who finds themselves in an unusual situation (shame when giving an enema, etc.).
SOCIAL – job loss, divorce, change in social status.
SPIRITUAL – loss of meaning in life, alone with illness, no friend.
PATIENT PROBLEMS are divided into EXISTING AND POTENTIAL.
EXISTING PROBLEMS are those that concern the patient at the moment. For example, fear of surgery, inability to independently move around the department and take care of oneself.
POTENTIAL PROBLEMS are those that may arise over time. In surgical patients, this is a violation of the mental state (the body’s reaction to premedication), pain, changes in the state of the body (T, blood pressure, blood sugar, intestinal dysfunction) with concomitant diseases. As a rule, a patient may have several problems at once. In such cases, it is necessary to find out which of them are primary and require emergency intervention (increased blood pressure, pain, stress), and which intermediate ones are not life-threatening (forced position after surgery, lack of self-care).
The next task of the second stage is the formulation of the NURSING DIAGNOSIS.
NURSING DIAGNOSIS is a patient's health condition determined by a nursing assessment and requiring intervention by the nurse. In fact, these are problems that the nurse can prevent or resolve. Nursing diagnosis differs from medical diagnosis and is aimed at identifying the body's reactions to the disease. The diagnosis may change as the body's reactions change. The nursing diagnosis is formulated in PES format, where P is a problem..., E-...associated with..., S-...confirmed... (signs of a problem)
THIRD STAGE – PLANNING NURSING CARE. The nurse must formulate goals of care and develop a plan of action to achieve the goals.
Goals must be realistic and within the nurse's control!!
There are two types of goals:
SHORT TERM must be completed in a short period of time, usually 1-2 weeks. They are placed, as a rule, in the acute phase of the disease/
LONG-TERM are achieved over a longer period of time (more than 2 weeks). They are usually aimed at preventing relapses of diseases, complications, their prevention, rehabilitation and social adaptation, and acquiring knowledge about health.
FOURTH STAGE – IMPLEMENTATION OF NURSING INTERVENTIONS.
INDEPENDENT nursing intervention involves actions carried out by the nurse on his own initiative.
DEPENDENT nursing interventions are performed based on written orders and under the supervision of a physician.
INTERDEPENDENT nursing intervention involves the joint activities of the nurse with the doctor and other specialists (nutritionist, exercise therapy instructor).
Leading up to the fourth stage of the nursing process, the nurse implements two strategic directions:
Observation and control of the patient’s response to doctor’s prescriptions
Observe and control the patient's response to nursing actions. Both are recorded in the nursing record.
FIFTH STAGE – ASSESSMENT OF THE EFFECTIVENESS OF THE NURSING PROCESS
Its PURPOSE is to assess the patient's response, results and summarize. Assessment of the effectiveness and quality of care should be carried out by the senior and chief sister constantly and by the sister herself as self-monitoring at the end and beginning of each shift. If the goal is not achieved, then it is necessary to identify the reasons, deadlines for implementation, and make adjustments.
ORGANIZATION OF WORK IN THE SURGICAL DEPARTMENT.
The surgical hospital includes several main functional units: admissions department, operating unit, surgical departments (urological, vascular surgery, neurosurgery, burns, etc.), dressing rooms, procedural departments.
SURGICAL DEPARTMENT: designed to accommodate patients during their surgical treatment. It consists of hospital wards, the office of the head of the department and doctors of the nursing station, treatment room, dressing rooms, sanitary facilities, utility rooms (cystoscopy room, plaster room, etc.).
One of the main tasks of the department is to ensure the prevention of nosocomial infections (HAIs), therefore all surgical patients are divided into “purulent, septic” (GSI), “clean, aseptic” and traumatological. The flows of these patients must be separated.
The wards contain special functional beds and a minimum number of pieces of furniture (bedside table, chair for each patient, there is an alarm system for calling medical staff), which is easy to clean and disinfect.
The optimal number of beds in the wards is up to 4, and for burn patients and GSI – 2. The filling of the wards for burn patients is “simultaneous”. Beds must be accessible from all sides. The optimal air temperature in the rooms is 20-25*.
Cleaning of the department 3 times a day, incl. 1 time with disinfectants, in burn and medical examination wards - 3 times with disinfectants. After cleaning – air disinfection. When performing work in the wards for patients with GSI, personnel must wear gloves and protective equipment that is specially marked and has distinctive markings.
Change of bed linen once every 7 days and when soiled, collection of linen in waterproof containers, storage in a special room of the department for a maximum of 12 hours. Bedding (mattress, blanket, pillow) is subject to decontamination after discharge, transfer to another department or death of the patient, or contamination with biomaterial. Mattresses and pillows placed in tightly sewn hygienic covers can be disinfected by wiping or spraying the covers with a solution of a chemical disinfectant.
Treating the bed and bedside table with a disinfectant - after the patient is discharged, transferred to another department, before the patient’s admission.
General cleaning once every 7 days, in burn wards - and after the immediate discharge of patients, when repurposing wards.
ORGANIZATION OF THE WORK OF A NURSE IN THE SURGICAL DEPARTMENT.
The work of a nurse is based on knowledge and compliance with the requirements of regulatory documentation regulating compliance with sanitary and epidemiological regulations, organization of work and the correct implementation of all manipulations within the competence of the nurse.
MAIN RESPONSIBILITIES OF A NURSE
The duties of a nurse include the following:
Strictly comply with internal labor regulations;
Carry out the procedures prescribed by the doctor accurately and in a timely manner;
Ensure the issuance, receipt, storage, control of expiration dates, consumption of medications, property necessary for work;
Timely complete the syndromic kits for providing medical care in emergency conditions;
Ensure the implementation of measures aimed at preventing nosocomial infections
Maintain medical documentation in accordance with established forms (logs of reception and delivery of duties, medical prescriptions, medication records, registration of admitted and discharged patients, temperature sheets, etc.);
Constantly improve your qualifications and professional level.
ORGANIZATION OF WORK IN THE DRESSING ROOM.
DRESSING ROOM - a specially equipped room in a surgical hospital or outpatient facility for the production of dressings and minor surgical interventions.
In surgical hospitals, as a rule, clean and purulent dressing rooms are created; in the presence of one dressing, dressings of purulent patients are carried out after clean. The dressing room equipment consists of dressing tables, cabinets with instruments and medications, a table with sterile material on which the most commonly used instruments and prepared sterile dressings are located. At the dressing tables there are basins on stands for used dressing material. In addition, the dressing room should have stands for blood transfusions and solutions, portable devices for giving oxygen and anesthesia. WORK PROCEDURE IN THE DRESSING ROOM
During dressing changes, entry to outsiders is prohibited;
The medical staff in the dressing room wears a gown, a waterproof apron (it is disinfected after each dressing), gloves, a mask, and a cap. Change of overalls - daily and when soiled. Changing gloves - after each dressing;
Medical instruments are disinfected using a virucidal regimen;
In dressing rooms intended for emergency care, a sterile table is available around the clock (the nurse is responsible for preparing sterile material and instruments!);
Once a day, the sterile material on the table is changed, even if the table has not been used;
For routine work, a sterile table is prepared to begin dressing changes each morning;
It is necessary to ensure the rapid removal of used dressings, which are collected in sealed containers and subsequently incinerated;
Purulent dressing room linen must have a special marking, because its use in a clean dressing room is unacceptable.
Dressing room cleaning (preliminary, current, final, general) and bacteriological control are carried out in the same way as in the operating room (see below).
ORGANIZATION OF WORK OF THE OPERATING BLOCK
An operating unit is a complex of specially equipped premises for performing operations and carrying out activities that support them. The operating unit should be located in a separate room or on a separate floor of a multi-story surgical building. It has separate operating rooms for performing clean and purulent operations. In addition to the operating rooms, the operating block provides the following specially equipped rooms: preoperative room, sterilization room, blood transfusion room, anesthesia room, material room, plaster room, director's office, staff rooms, sanitary checkpoint.
The organization of the operation of the operating unit and the rules of behavior in it are strictly regulated. The fundamental principle in the operation of the operating unit is strict adherence to the rules of asepsis. There should be no unnecessary furniture and equipment in the operating room, the volume of movements and walking is reduced to a minimum, conversations are limited, and there should be no unnecessary people in the operating room. Persons with acute respiratory diseases and purulent-inflammatory processes are not allowed to be in the operating room. Entrance to the operating room for personnel is through a sanitary inspection room, which is divided into 2 zones; personnel (if necessary) take a shower, put on a surgical suit, shoe covers, cap, mask and go to the preoperative room, where they wash and perform surgical hand antisepsis. Members of the surgical team wear a waterproof apron. Staff wear a sterile gown and gloves in the operating room. Change of clothing and personal protective equipment - after each operation. Change masks and gloves - every 3 hours with repeated surgical hand antiseptics.. If gloves are damaged - the same. All members of the operating team wear special clothing, which differs in color from the clothing accepted in other departments of the hospital
The patient is delivered on a gurney in the operating room through the airlock. The gurney is disinfected after each patient. All instruments and devices brought into the operating unit must be disinfected.
In the operating room, when carrying out planned operations, first of all, clean operations are performed (on the thyroid gland, blood vessels, joints, for hernias) and only then operations associated with possible microbial contamination (cholecystectomy, gastric resection) are performed. After performing urgent (emergency) medical intervention on a patient with suppurative processes in the general(!) operating room and general dressing room, the following must be carried out: cleaning; final disinfection; disinfection of the air environment in accordance with the requirements of these Sanitary Rules.
There are some additional requirements for the procedure for working in a purulent operating room. Surgical instruments, dressings and linen are stored separately and under no circumstances are used for aseptic operations. The combination of work of personnel (nurses, orderlies) in a clean and purulent operating room is excluded. Used dressing material is burned.
FUNCTIONAL ZONES. To ensure sterility, special functional areas are allocated in the operating unit.
GENERAL SECURITY AREA: here are the offices of the head, head nurse, rooms for storing and sorting linen and instruments.
A RESTRICTED ZONE, or technical zone, combines production premises to ensure the operation of the operating unit. There are equipment for air conditioning, vacuum installations, installations for supplying the operating room with oxygen, a battery substation for emergency lighting, and a darkroom for developing X-ray films. Material - a room for storing supplies of instruments, suture material and medicines.
A HIGH SECURITY ZONE includes such premises as a sanitary inspection room, storage rooms for surgical instruments and devices, anesthesia equipment and medications, a blood transfusion room, rooms for the duty team, and a senior operating nurse.
THE STERILE MODE AREA combines the operating room, preoperative room and sterilization room.
CLEANING OF THE OPERATING UNIT is always carried out using a wet method. There are the following types of operating room cleaning:
Preliminary is carried out in the morning before starting work; all horizontal surfaces (floors, tables and window sills) are wiped with a damp cloth to collect dust that has settled overnight, and bactericidal ultraviolet lamps are turned on to disinfect the air;
The current one is carried out during the operation; the nurse collects all accidentally fallen balls and napkins from the floor, wipes away any blood or other liquid that has fallen on the floor;
Intermediate is done between operations; all material used during the operation is removed, the floor is wiped with a damp cloth;
The final one is carried out at the end of the operating day.
General surgery is carried out according to plan on a day free from surgery, once a week.
Surgical department of the hospital deployed with 40 beds.
In the department, patients with pathology from the gastrointestinal tract, trauma with damage to the internal organs of the abdominal cavity and patients with purulent-septic diseases are treated.
Currently, the department is located on the 2nd floor of a 3-story building. The department includes: 14 rooms, of which 5 have 2 beds, the rest have 4, each equipped with a shower and toilet, a treatment room, a dressing room, 2 manipulation rooms, a sanitary room, a nurse’s station, a head nurse’s office, and at the other end of the corridor , there is a staff room and a cafeteria.
The department carries out the following functions:
- - provision of diagnostic, therapeutic and preventive care to patients with cancer;
- - providing advisory assistance to doctors of other departments of a medical organization in resolving issues of diagnosis and provision of medical care to patients with cancer;
- - development and implementation of measures to improve the quality of treatment and preventive work of the department;
- - participation in the process of improving the professional qualifications of personnel on the issues of diagnosis and provision of medical care to patients with cancer;
- - introduction into clinical practice of modern methods of diagnosis, treatment and rehabilitation of patients with cancer;
- - carrying out examination of temporary disability;
- - holding conferences on the analysis of the causes of deaths in the treatment of patients with cancer in conjunction with the pathology department;
- - implementation of sanitary-hygienic and anti-epidemic measures to ensure the safety of patients and staff, prevent the spread of nosocomial infection;
- - maintaining accounting and reporting documentation, submitting reports on its activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.
Dressing room of the surgical department- this is my workplace. For ease of cleaning, the floor is covered with ceramic granite tiles, the walls are tiled, the ceiling and doors are painted with light-colored oil paint. There is a centralized supply of cold and hot water, heating, electricity and ventilation. Artificial lighting is provided by a fluorescent lamp located above the dressing table and lighting fixtures. The electrical wiring is hidden and there is a ground loop. Two sinks are installed for washing hands and washing tools. The cabinet doors and doors are covered with plastic.
Dressing room equipment: table for instruments and dressings - 1 pc. Ultralight - for storing sterile instruments 1 pc., Dry-heat cabinet for sterilizing instruments 1 pc., Germicidal lamp - 1 pc.; tripod; Hemostatic tourniquets - 2 pcs.; Chairs and stools - 3 pcs.; Bench stands - 2 pcs.; operating table / gynecological chair - 1 pc.; tool cabinet - 1 pc.; cabinet for storing medicines - 1 pc.; desktop - 1 pc.; table for medical documentation - 1 pc.; tongs for collecting contaminated dressings - 2 pcs.; containers for disinfection solutions - 8 pcs.; buckets for waste class A and B: dry white bag; medical yellow bag - 2 pcs.; mobile reflector lamp - 1 pc.; aprons made of oilcloth and plastic - 4 pcs.; glasses - as a means of eye protection - 4 pcs.; disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance; disposable sterile linen - in abundance; ready-made sterile material - in abundance; containers for preparing working solutions of disinfectants, measuring containers for diluting disinfectants, brushes, brushes for processing instruments, a bedside table for storing detergents and disinfectants. Anti-shock and anti-AIDS first aid kits with instructions for their use, also, next to the office there is a sanitary room for a dressing room, where cleaning equipment for routine and general cleaning is located - 2 buckets for washing floors and walls, containers for treating furnishings and surfaces -2 pcs., mops for washing floors and walls - 2 pcs. and containers for diluting disinfectants.
Dressing room instruments: maskites; Volkmann spoons; disposable sets for pleural puncture; suture material, anatomical, surgical and claw tweezers - 8 pcs each; hemostatic clamps - 8 pcs.; abdominal scalpels - 3 pcs.; pointed scalpels - 2 pcs.; pointed scissors - 2 pcs.; pointed eye scissors - 1 pc.; blunt scissors, curved along the plane, - 2 pcs.; plate hooks - 1 pair; general surgical needle holders - 2 pcs.; different surgical needles - 10 pcs.; forceps - 2 pcs.; long tweezers - 2 pcs.; button and grooved probe - 1 pc.; kidney-shaped trays; different cuvettes - 5 pcs. Sterile disposable dressing trays with ready-made dressing material are also available.
REQUIREMENTS FOR THE PLACEMENT OF EQUIPMENT IN THE DRAGING ROOMS.
The dressing room is divided into two zones: clean and conditionally clean.
In the clean area: a table with sterile instruments, a dry-heat cabinet, a cabinet for medicines and instruments are placed.
In the conditionally clean area: the rest of the equipment, a nurse’s work table, an operating and dressing table, a table with disinfectants, a sink, etc. are placed.
RESPONSIBILITY.
The dressing room nurse is responsible for:
- 1. lack of sanitary and hygienic conditions in the dressing room.
- 2. safety of instruments, suture material, equipment.
- 3. violation of asepsis rules.
- 4. failure and delay of dressings due to one’s own fault.
- 5. lack of knowledge about the progress of dressings.
My job responsibilities:
In the dressing room, postoperative wounds are dressed and monitored, minor operations and punctures are performed. And:
- 1. The procedures prescribed by the attending physician and authorized to be performed by nursing staff are performed.
- 2. Seriously ill patients are escorted to the ward after the procedures.
- 3. Instruments and dressings are prepared for sterilization.
- 4. Systematic sanitary and hygienic control of the dressing room is carried out.
- 5. Systematic replenishment, accounting, storage and consumption of medicines, dressings, instruments and linen are ensured.
- 6. Junior medical personnel in the dressing room are instructed and their work is supervised.
- 7. Regulatory medical documentation is maintained in accordance with the nomenclature of cases.
- 8. Collection, disinfection and disposal of medical waste is carried out.
- 9. Measures are taken to comply with the sanitary and hygienic regime in the premises, the rules of asepsis and antiseptics, the conditions for sterilizing instruments, to prevent post-infectious complications, hepatitis, and HIV infection. 10. Immediately inform your immediate supervisor about any accident that occurs at work, about signs of an occupational disease, as well as about a situation that poses a threat to the life and health of people. If necessary, perform the functions of an operating nurse when performing simple surgical interventions performed in the dressing room.
The volume of work performed.
My working day begins with an inspection of the dressing room. I, as a dressing room nurse, check whether the staff on duty used the dressing room at night. In case of emergency intervention or unscheduled dressing, used and contaminated dressing material is placed in buckets with lids (yellow bag - class “B” waste), used instruments are soaked in a disinfectant solution.
I check whether wet cleaning has been carried out using disinfectants, pick up sterile instruments from the central care center, arrange containers with materials, and install the medications received the day before from the pharmacy.
I receive a list of all dressings for the day and set their order. First of all, I bandage patients with a smooth postoperative course (removal of sutures), then with granulating wounds. Having made sure that the dressing room is ready, I begin to treat my hands.
After cleaning my hands, I begin to put on a sterile gown. Opening the lid of the box, I check the appearance of the indicator. Taking the robe, I carefully unfold it, holding the edges of the collar with my left hand at arm's length so that it does not touch surrounding objects and clothing, and I put the robe on my outstretched right arm. With this hand I take the collar by the left edge and put it on my left hand, stretching it forward and up. The assistant ties the ribbons on the robe from the back. Next, I tie the ribbons on the sleeves, as well as the belt, taking it by the loose ends, without touching the robe and hands. After this I put on sterile gloves.
When I put on a sterile gown and gloves, I begin preparing the sterile table. A sterile table is prepared, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the surface of the table. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all the objects on the table, and is tightly fastened with clamps to the bottom sheet. The sterile table is set for 6 hours. In cases where the instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before the manipulations.
Dressings are carried out in a mask, cap and sterile gloves, which are changed for each patient. All items from the sterile table are taken with forceps or long tweezers, which are also subject to disinfection and sterilization.
Analysis of work for the reporting period.
Participation in the work of the surgical (dressing) room of the surgical department
Much surgical work is carried out in surgical rooms of clinics, outpatient clinics and dispensaries. It consists mainly of dressings and partly in small operations performed on the go (minor surgery). It is advisable that the outpatient room be isolated from the surgical department and served by special, at least non-surgical, personnel, since most of the work in the surgical office is purulent.
Three rooms are required for the surgical office. In the first room, patients are examined without damage to the integument and, if necessary, the patient undresses; the second room is a dressing room, where a patient with open injuries is bandaged and examined, and the third is an operating room.
The arrangement of the operating room and dressing room is simpler than in the corresponding rooms of the surgical department. There are sinks for hand washing in the dressing room and operating room; in the dressing room they put boilers for instruments; It is advisable to sterilize the material in a special, fourth room (sterilization room, also known as material) or outside the surgical room of the outpatient clinic.
In well-organized clinics, as well as in clinics of medical and sanitary units of enterprises, there is a trauma center or office in which emergency care for injuries is provided. Its design and equipment provide the ability to make a dressing, perform primary surgical treatment of the wound for minor injuries and apply a splint or plaster bandage.
In a small outpatient clinic, it is often necessary to carry out all the work in one room. At the same time, in one part of the room there is a table for the person conducting the reception, for the necessary entries in outpatient cards and writing out prescriptions, a table with dressings, instruments and medicines. In another part of the room there is a table for examining patients and stools for seated patients. Buckets and basins for dirty dressings are placed near them.
In a rural environment, at local medical centers, outpatient appointments, including surgical patients, are often carried out by a paramedic, and therefore he must know well the structure of the outpatient surgical room. The closer the outpatient surgery room gets to the dressing room, the better. The paramedic must not only know the structure of the dressing room, but also be able to properly organize it, providing all the necessary equipment.
We will indicate the necessary equipment: a table for bandaging patients, a table for instruments and dressings, 2-3 stools for sitting patients, a stool for the person conducting the reception, a washbasin with hot water, a bucket or basin for removing bandages, a vessel with boiled brushes for washing hands , soap plate. In addition, you need: a bottle with a disinfectant solution (for example, a solution of 1: 1000 sublimate), a box with sterile material, a tray with clean instruments, trays for dirty instruments, jars and bottles with ointments and disinfectant liquids. Necessary medications: iodine tincture, hydrogen peroxide, 2% soda solution, rivanol, sterile petroleum jelly, ointments (zinc, bismuth). Instruments are sterilized in the surgical office of the outpatient clinic or in the next room. All equipment must be easy to clean.
The organization and distribution of work depends on how many people take part in the work. If a nurse helps a paramedic, he examines patients and gives prescriptions; The sister bandages and bandages the sick, and the nanny monitors cleanliness and order and unbandages the sick. If a paramedic sees only a nanny, then the latter needs to be taught not only how to unbandage, but also how to apply simple bandages.
For fast and good work, it is necessary to properly establish the correct order of arrival of patients and fight the formation of queues. This works best if a certain number of patients are assigned to each hour, especially those who come for repeated dressings. Outpatient cards should be kept in order so that they do not get lost and do not have to be found. A well-organized reception of patients and order in the cards greatly facilitate the work.
After reviewing the outpatient card, the paramedic examines the patient. The nanny should put the patient to bed and help him undress. After interviewing and examining the patient, he is prescribed treatment and a paramedic or nurse makes a dressing.
Dressings should be organized according to the type of instrumental ones, and the necessary instruments (10-15 tweezers, 3-4 scissors, 1-2 probes, 1 scalpel, 1-2 hemostatic clamps, 2-3 spatulas) should be boiled in advance and lie in the tray. As they become dirty, the nanny should wash them over the sink and put them back in the boiler. With this organization of work, it is possible to quickly and correctly make many dressings during an appointment.
The paramedic must give advice to the patient on how he should behave, make notes on the outpatient card (diagnosis, course of the disease, treatment) and on the sick leave certificate, if the patient is insured, and provide the necessary certificates.
Dressing room equipment:
- 1) Table for instruments and dressings - 1 pc.;
- 2) Distiller - 1 pc.;
- 3) Germicidal lamp - 1 pc.;
- 4) Stands for long-term infusions - 2 pcs.;
- 5) Refrigerator for storing medicines, etc. - 1 pc.;
- 6) Hemostatic tourniquets - 2 pcs.;
- 7) Chairs or stools - 3 pcs.;
- 8) Bench stands - 2 pcs.;
- 9) Operating table / gynecological chair - 1 pc.;
- 10) Tool cabinet - 1 pc.;
- 11) Cabinet for storing medicines - 1 pc.;
- 12) Desk - 1 pc.;
- 13) Table for medical documentation - 1 pc.;
- 14) Nippers for collecting contaminated dressings - 2 pcs.;
- 15) Containers for disinfection solutions - at least 4 pcs.;
- 16) Garbage buckets: dry white bag; medical yellow bag - 2 pcs. ;
- 17) Mobile reflector lamp - 1 pc.;
- 18) Aprons made of oilcloth or plastic - 4 pcs.;
- 19) Glasses - as a means of eye protection - 4 pcs.;
- 20) Disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance;
- 21) Disposable sterile linen - in abundance;
- 22) Ready-made sterile material - in abundance;
- 23) Containers for preparing working solutions of disinfectants, measuring containers for diluting disinfectants, a water thermometer, anti-allergenic disinfectants - alaminol, brushes, ruffs - for processing instruments.
Dressing room instruments:
- - Trays;
- - Tweezers;
- - Clamps;
- - Maskit;
- - Needle holders;
- - Volkmann spoons;
- - Probes;
- - Scissors for removing sutures;
- - Scalpels;
- - Fenestrated tweezers;
- - Regular scissors;
- - Disposable sets for pleural puncture;
- - Suture material.
The structure and staffing of surgical rooms and departments depend on the structure of the clinic, the number of calls per shift (depending on this, there are 5 categories of clinics - from 400 to 1200 calls or more), its functions and tasks, in particular on the patient population. According to the norm, the population's need for outpatient services is 12.9 visits per year per city resident and 8.2 per village resident, including 1.4 visits to surgical offices (departments).
The surgical office of a district clinic consists of two, less often one or three rooms. In one room, the surgeon receives, registers and examines patients; the second, connected to the first, is used as a dressing room. If the office is one-room, the doctor’s table and the couch for examining the patient are in one half of the room, and the dressing table is in the second, and they are separated by a screen.
If the office or department consists of three rooms, the middle one is equipped as a doctor’s office, where he receives patients, the other two, located on both sides, are equipped with a dressing room and an operating room, or (less often) two dressing rooms - a clean one and a purulent one.
In large clinics (city, regional, etc.), the surgical department has four or more rooms: a doctor’s office, two dressing rooms (clean and purulent), an operating room, a preoperative room, and sometimes also a sterilization room. This is already an surgical dressing block.
In the surgical room, which is combined with a dressing room, the distribution of patients with clean and purulent wounds and processes is achieved by establishing a priority in work: patients with clean wounds are bandaged and operated on first, and those with purulent processes second. If there are two dressing rooms (without an operating room), surgical treatment of fresh wounds, dressing of clean wounds, as well as operations on planned patients are performed in a clean room.
In those surgical departments that also have an operating room, planned operations and surgical treatment of fresh wounds are carried out in the operating room. The premises of the surgical office and department, in particular their dressing rooms and operating rooms, in their design features and interiors must comply with all the sanitary and hygienic requirements for similar premises in a surgical hospital.